By James B. Meigs
July 16, 2024
Source: City Journal
Photo / Image Source: Unsplash,
At the 1996 meeting of the International AIDS Society in Vancouver, a group of researchers presented the results of a much-anticipated study.
The scientists had tested AZT, the first drug approved to fight human immunodeficiency virus (HIV), in combination with two newer anti-viral drugs. HIV is a particularly devious infection. When AZT or other antiviral medications were administered individually, the virus would soon find a way to evade them. But when the three drugs were prescribed together, something almost miraculous happened: the combination therapy suppressed HIV to undetectable levels, even in patients with advanced AIDS. And the virus did not bounce back.
Anthony Fauci was sitting in the audience that day. The Brooklyn-born doctor had joined the National Institutes of Health as a researcher in 1968 and began focusing on AIDS in 1981, soon after the baffling new disease emerged among gay men in New York and California. In 1984, when Fauci was named director of National Institute of Allergy and Infectious Diseases (NIAID, a division of NIH), he made developing effective HIV medications one of the agency’s top goals. It was “a long, tortuous, and incremental quest,” Fauci writes in his new memoir On Call: A Doctor’s Journey in Public Service. Twelve years later, “AIDS was no longer an inevitable death sentence,” he writes.
In retrospect, that would have been a fine time for Fauci to retire from his federal post. If he had chosen that moment to return to private practice or join a top medical school, he would be remembered today as one of the greatest public health leaders of the twentieth century.
The HIV therapies he championed brought the AIDS epidemic under control and saved tens of millions of lives around the world. But Fauci remained in his NIAID role for almost three more decades. During that time, he would have more successes, including fighting emerging threats like Ebola and Zika. But he would also build up more institutional power, presiding over vast research budgets and becoming increasingly isolated from divergent views or criticism.
Fauci finally retired at age 83 in January 2023, after five decades with the NIH. It must have seemed like a propitious time to write his memoirs and take a valedictory promenade. The media widely celebrated Fauci for his leadership during the Covid-19 pandemic. In On Call, he writes that his constant Covid press appearances—along with his well-publicized differences with President Donald Trump—had made him “an instant hero to the millions of Americans who saw me as a physician bravely standing up for science, truth, and rational decision-making.” In short, Fauci had become something like a secular saint, at least in liberal circles. His image would soon join those of George Washington, Thomas Edison, and Martin Luther King in the National Portrait Gallery. And collectible Fauci bobbleheads and figurines were available in fine gift shops everywhere.
Of course, conservatives still vilified Fauci as the architect of the Covid lockdowns. Some journalists and scientists kept probing the connections between his agency and dangerous gain-of-function research at the Wuhan Institute of Virology, where many believe the pandemic got its start. And Fauci’s Capitol Hill nemesis, Kentucky senator Rand Paul, promised to keep holding hearings investigating the missteps and alleged coverups of Fauci’s final years as a public health czar. But those inquiries seemed likely to fade away, along with the pandemic, allowing the former NIAID head to enjoy the sunlit uplands of retirement. Fauci had every reason to think his autobiography would be received with grateful praise. And that has mostly been the case. (“Fauci has earned his victory lap,” wrote the New York Times.)
More skeptical readers, like me, will notice that Fauci’s memoir skates over the darker aspects of his Covid legacy. During the 18 months since he left NIAID, a string of devastating public disclosures has made clear how Fauci and other top health officials misled the public, twisted scientific findings, evaded legitimate inquiries, and hid important evidence about the possible origin of Covid. Thanks to determined probing from lawmakers, FOIA requests from journalists and researchers, and studies by skeptical scientists, the critical view of Fauci’s Covid legacy has gained both heft and granular detail since he left the government and began work on this volume. Call it bad timing.
An autobiography that honestly grappled with the legitimate criticisms of his Covid leadership would have made for a fascinating read. But Fauci hasn’t written that book.
Instead, at times he seems to be subtly rewriting the past to put himself and his agency in the best light. At other points, he relies on dubious or discredited research to defend his policies and statements. Concerning some of the most serious allegations against him, Fauci chooses to say nothing.
Nonetheless, for a reader who knows the backstory, On Call takes the shape of an epic tragedy: How did the pioneering young Fauci, who fought so heroically against AIDS, turn into the imperious old Fauci, who used his power and influence to suppress scientific debate, discredit skeptical scientists, and implement restrictive policies for which there was little scientific justification? For students of public policy, the book raises a related question: How do we prevent brilliant and dedicated public servants like Fauci from turning into Machiavellian schemers?
Fauci’s life is the kind of all-American success story we love—at least until the final act. The son of Italian immigrants (his father owned a Bensonhurst pharmacy), young Anthony juggled sports and academics, excelling at both. But when his height peaked at 5’7”, the teenaged Fauci realized that brains rather than brawn would be his key to success. While On Call offers only quick sketches of his blazing path through college and medical school, his passion for both patients and scientific research shines through.
Fauci’s narrative comes alive when he begins seeing reports of a mysterious new disease that seemed to dismantle the human immune system—and that targeted gay men. Already a specialist in immunology at the NIH, Fauci decided to specialize in the confounding condition that would become known as AIDS. Here was a mystery—and a human tragedy—worthy of his talents. Once he became the director of NIAID, Fauci also revealed his genius for working the machinery of government. Today, the Reagan administration has an exaggerated reputation for “ignoring” AIDS, but Fauci describes how he convinced the executive branch and Congress to double NIAID’s budget for AIDS research in 1986. (He also writes warmly of his friendship with Reagan’s surgeon general, C. Everett Koop, who used to stop by the NIAID director’s office in the evenings to “learn everything he could” about HIV/AIDS.)
Fauci, who would ultimately serve under seven presidents, conveys a key lesson he learned about working with Congress and the White House: you cannot appear to be “motivated by self-interest,” he writes. It is “crucial to be truthful and consistent in providing information based purely on scientific evidence and best judgement, and nothing else.” (This is a lesson he had evidently forgotten by the time of Covid.) Fauci’s mastery of the political craft paid dividends. Over the course of his long tenure at NIAID, that agency’s budget would increase nearly twentyfold.
In a preview of the role he would play during the Covid pandemic four decades later, Fauci quickly became the most visible public official talking about the AIDS crisis. But rather than crediting the NIAID head with increasing government focus on the disease, gay activists blamed him for the lack of good treatments and the deaths of their friends. Playwright Larry Kramer, who founded both the Gay Men’s Health Crisis organization and the more confrontational ACT UP, berated him constantly. One Kramer article was titled, “I Call You Murderers, an Open Letter to an Incompetent Idiot, Dr. Anthony Fauci.”
Here’s where Fauci did something remarkable: rather than denouncing the activists or trying to freeze them out of the AIDS dialogue, he responded with a kind of radical empathy. Even as marchers carried signs saying “F– Fauci,” he tried to understand their panic and heartbreak. Regarding Kramer’s attacks, he writes, “If I had been in his position, I would have been just as angry.” Fauci began meeting with activist groups and invited Kramer to visit him at NIAID headquarters. (His AIDS leadership wasn’t flawless. As Manhattan Institute senior fellow John Tierney has pointed out, Fauci was an early proponent of the wildly exaggerated claim that HIV could be spread by “routine close contact.” This was an early example of the kind of “noble lie” Fauci would often utter during the Covid pandemic, hoping to nudge the public toward what he deemed proper behavior.)
By the late 1980s, a host of new AIDS drugs were in the testing pipeline but only available to the small number of patients in clinical trial programs. ACT UP and other activists wanted a “parallel track,” under which sick patients could have access to drugs not yet approved for general use by the Food and Drug Administration. This is not the way pharmaceutical science normally works. But after spending so much time with activists, Fauci came around to their view. Many patients had only months to live; there wasn’t much harm—and might be some good—in letting them try unproven meds. He announced his change of heart at a 1989 conference, blindsiding the George H. W. Bush administration and the FDA (over which he had no authority). But the president backed him, the FDA came around, and soon the parallel track was a standard protocol for AIDS and, eventually, other severe diseases. At a subsequent meeting, Larry Kramer stood up and bellowed, “Tony, I used to call you a murderer, but you are now my hero.”
Fauci writes that his “decision to open the doors to the activist community was one of the best administrative decisions I ever made.” What a contrast to his haughty and insular approach during the Covid pandemic. When Stanford public health professor and doctor Jay Bhattacharya, along with two colleagues, published the Great Barrington Declaration, which argued for a partial rollback of lockdowns, Fauci did not invite the dissident experts to his office or try to understand their views. Instead, he and National Institutes of Health director Francis Collins discussed the need for “a quick and devastating published takedown” of their ideas. Soon, the Biden administration was leaning on Google, Twitter, and other platforms to censor Bhattacharya’s statements. Fauci and his colleagues took the same grant-no-quarter stance toward lab-leak proponents, skeptics of blanket vaccine mandates, and other critics.
The Fauci of the AIDS era was willing to talk to—and learn from—his harshest opponents. By the time Covid arrived, Fauci had decided that his critics weren’t just wrong, but “dangerous.” When people criticized him, he famously told Face the Nation in 2021, “they’re really criticizing science, because I represent science.”
What explains this evolution? Power, for one thing. Even before 9/11, Vice President Dick Cheney and other officials in the George W. Bush administration were concerned about the risks of bioterrorism and natural pandemics. Then came the attacks, and, in the following weeks, the still mysterious spate of letters containing deadly anthrax spores mailed to public figures. The administration wanted a single, powerful agency to be tasked with researching potential bioterror threats. Cheney turned to Fauci and NIAID to lead this effort. “With the stroke of Cheney’s pen, all U.S. biodefence efforts, classified or unclassified, were placed under the aegis of Anthony Fauci,” Ashley Rindsberg wrote in 2022.
In NIAID’s view, research programs against bioterror weapons and those targeting naturally occurring diseases went hand in hand. Budgets for both types of projects skyrocketed. So did Fauci’s independence and authority. “Fauci now had a virtual carte blanche to not merely approve but design and run the kind of research projects he sought,” Rindsberg wrote, “and could do so with no oversight structure above him.”
Over the coming years, NIAID would grapple with a series of threatening new diseases—including SARS, swine flu, Ebola, and MERS. But none made the kind of mass breakout that would threaten U.S. society as a whole—until Covid. The approaching pandemic prompted Fauci’s first extended interactions with President Trump. (Trump began one meeting by telling the NIAID leader, “Anthony, you are a really famous guy.” Fauci’s bemused portrait of Trump rings true.) The Covid threat also pushed Fauci—once again—back into the public eye. “I became the de facto public face of the country’s battle with the disease,” he writes. This led to what he calls the “gross misperception . . . that I was in charge of most or even all of the federal government’s response to the coronavirus.”
Here begins Fauci’s rearguard action to protect his reputation. He wants readers to give him credit for wise decisions, such as laying the groundwork for the stunningly successful Operation Warp Speed vaccine program. But he simultaneously tries to deflect blame for the government’s controversial calls, including endless lockdowns and school closures, heavy-handed vaccine mandates, and more. “I had no power to mandate or control anything,” he insists. It’s true Fauci had no direct authority over the CDC or the FDA. But he was, for better or worse, the face of the government’s Covid policy. Cities, states, and other federal agencies followed his lead. Moreover, he had the ear of both pandemic presidents. (It’s worth remembering that Trump, despite his blustering statements, mostly followed the doctor’s advice.) At any point, Fauci could have helped moderate America’s immoderate Covid policies with just a few words.
Fauci instead vigorously defended those policies in his many public appearances, and he relitigates the debates in this book. Keeping schools closed made sense, he writes, because children “almost certainly played a role in community transmission.” (That claim is disputed, to say the least. One review of 40 research papers found “limited evidence of transmission in the school or childcare setting” and advised against school closures.) The Great Barrington Declaration “has since been widely discredited,” Fauci continues. (Again, debatable. Another large publication review found that the lockdowns had minimal benefits and, in one author’s words, constituted “the biggest policy mistake in modern times.”) The list of Fauci’s tendentious claims goes on.
On Call takes an especially slapdash approach to the question of Covid’s origin. For example, there is no mention of the famous February 1, 2020, phone conference in which Fauci, NIH head Francis Collins, and a group of top virologists discussed the coming storm. Some of the scientists on that call suspected the virus might have leaked from the Wuhan Institute. Nonetheless, a group of them agreed to co-write a scientific paper flatly asserting that no “type of laboratory-based scenario is plausible.” The virus must have jumped into the human population from some animal host, they claimed.
That paper, “The Proximal Origin of SARS-CoV-2,” was just one of many efforts to strongarm the public—and the scientific community—into dropping any questions about the Wuhan lab. The House Oversight Committee, led by James Comer of Kentucky, concluded last year that Fauci, Collins, and others “tended to act more akin to politicians than scientists.” That tendency worsened as the pandemic progressed.
When questions about the U.S. government’s relationship with the Wuhan lab first surfaced, Fauci and his colleagues waved them away. Today, he defends the sketchy studies funded by his agency, arguing that they didn’t technically involve “gain-of-function” research, in which a virus’s potentially dangerous features are enhanced. But that’s according to Fauci’s own, absurdly narrow definition of gain of function. Under the definition used by most virologists, the Wuhan research funded by NIAID unquestionably involved gain-of-function techniques.
Whether or not U.S.-backed research proves to have been linked to the later emergence of Covid-19, it was inherently risky. And it is entirely likely that Wuhan scientists, following the paths proposed by American researchers, kept tinkering with ever more dangerous viruses until one escaped the lab. Today, Fauci insists his agency’s funding of virus research was safe and above board. Yet he and his lieutenants spent years stonewalling investigations, misleading Congress, and evading Freedom of Information Act requests. On Call never explains why.
As for the lab-leak theory, Fauci blandly states, “as I have often stated publicly, we must keep an open mind to the origin of COVID.” He doesn’t mention his long campaign to label lab-leak proponents “conspiracy theorists” or apologize for the administration’s secretive efforts to suppress their voices on social media. Claims of open-mindedness aside, Fauci admits to leaning heavily toward the theory that Covid emerged “as a natural spillover from infected animals brought illegally into the [Wuhan] market.” To back up that claim he cites papers from “experienced evolutionary virologists throughout the world.” But the papers Fauci references have been strongly challenged—some would say debunked—by other leading scientists. Evidence for a natural source of Covid remains negligible. Fauci is, or once was, a disciplined enough scientist to know that. He insults readers by pretending otherwise.
Anthony Fauci, whose early career did so much to improve human health, leaves behind a tainted legacy. He and his colleagues abused their authority, overreached on lockdowns and vaccine policies, and dissembled about dangerous research that his agency funded. The populist backlash to these excesses is still building. The public’s growing distrust of medical experts—and new skepticism toward all vaccines—is a public-health timebomb.
It is tempting to attribute Fauci’s late-career lapses to some personal moral deficiency. I think that’s the wrong tack. Fauci’s ethical shortcomings weren’t personal so much as institutional; he had been given enormous authority while being almost completely insulated from political oversight. Even the president could not easily fire him. And his centralized control over massive research budgets meant that few scientists were willing to challenge his claims or policies.
Over the decades, Fauci came to see himself as infallible. He represented “science.” Instead of welcoming contrary views, as he did during the AIDS years, the older, more thin-skinned (and more institutionally entrenched) Fauci resented criticism and tried to silence dissent. If not for the persistent pushback from a few bold scientists, journalists, and lawmakers, he might have succeeded in shutting down crucial debates entirely. No federal official should have so much power, with so little accountability, for so long.
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