AIDS crisis shaped Anthony Fauci, disease expert at front lines of coronavirus pandemic

For decades, Dr. Anthony S. Fauci has been known as the hardest worker in Building 31 — the first scientist to arrive at the sprawling National Institutes of Health campus in Bethesda, Md., in the morning and the last to leave in the evening.

“He’s even found notes on his windshield left by co-workers that say things like, ‘Go home. You’re making me feel guilty,’� President George W. Bush said in 2008 when he awarded Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, the Presidential Medal of Freedom.

In the last month, the 79-year-old infectious disease expert’s schedule has gotten more grueling as he works on the government’s response to the COVID-19 pandemic: squeezing in three to five hours of sleep between supervising work on a potential vaccine, making hospital rounds, attending meetings of the coronavirus task force and speaking at White House news conferences. On Sunday, he predicted that the United States might eventually see 100,000 to 200,000 deaths from the pandemic.

“The thing I worry about is he looks tired,� said Victoria A. Harden, a medical historian and former director of the Office of NIH History. “He’s being run ragged.�

While the frank and straight-shooting New Yorker has won widespread acclaim for explaining complex medical information to the public calmly, without exaggeration or understatement, some fear that his willingness to contradict President Trump’s rosier messages may lead to his ultimately being fired or pushed aside.

Every time Trump approaches the White House lectern to brief the public on the COVID-19 pandemic without Fauci, online spectators and the Washington press corps speculate that he is being sidelined by the administration.

“It will not shock me if, at the end of this process, he is chewed up and spat out,� said Peter Staley, a longtime AIDS activist who has known Fauci for decades.

“At that point, we’re all screwed,� he added. “He’s got a special skill set that is perfectly matched for this crisis. He’s more experienced with epidemics than probably anybody on the planet.�

Appointed director of NIAID in 1984, under President Reagan, the veteran scientist and HIV/AIDS researcher has spearheaded the nation’s approach to preventing, diagnosing and treating epidemics for nearly four decades, advising six U.S. presidents.

As a clinician, Fauci made significant breakthroughs in understanding how HIV destroys the body’s immune system and helped develop strategies to bolster immune defenses. Later, he was a key architect of George W. Bush’s President’s Emergency Plan for AIDS Relief, a program that now operates in more than 50 countries and has saved millions of lives throughout the developing world.

His latest challenge involves confronting his worst nightmare — a respiratory illness that easily spreads from person to person and has a high degree of morbidity and mortality. It also means dealing with a mercurial president who has, at times, underplayed the seriousness of the virus and chafed against the advice of public health experts. Last week, Trump expressed a desire to end government shutdowns of businesses before Easter in an effort to kick-start the economy.

At the White House, Fauci has not shied away from veering from Trump’s message.

When Trump urged the public to relax and said the new coronavirus was “something that we have total control over,� Fauci was more somber. “Bottom line,� he said, “it’s going to get worse.�

When Trump touted the possibilities of an antimalarial drug in combating the virus, Fauci stepped in. “The answer is no,� he said when asked whether there was any evidence that the drug might work.

Asked last week how he had managed to avoid being fired, Fauci told Science magazine that Trump listened, even if they at times disagreed.

“He goes his own way,� he said. “He has his own style. But on substantive issues, he does listen to what I say.�

Asked why he didn’t speak out when Trump said things that were factually incorrect, Fauci said: “I can’t jump in front of the microphone and push him down.�

Still, as a civil servant who reports to the NIH director, Fauci has more leeway than presidential appointees.

“He’s not so easily gotten rid of,� said Harold E. Varmus, a Nobel Prize-winning scientist who was director of the NIH and Fauci’s boss in the 1990s.

Though Fauci could be excluded from coronavirus briefings or task force meetings at the president’s whim, experts say, he is not so likely to be fired or asked to resign.

“In any case, I don’t think we’re in that kind of danger,� Varmus said. “He’s been forward in gently correcting the president without inviting political retribution. He makes it clear that there’s a difference of opinion, and that’s good because the public needs to hear that.�

Amid the tension, Trump has praised Fauci as a “major professional star.� Even after Fauci gave a critical interview to Science magazine, Trump commended him at a White House briefing for doing a “great job.�

Some onlookers say the media is too quick to seize on division.

“In any evolving situation, if you look really carefully for some daylight between what any two people are saying at any moment in time, there’s going to be a little bit of daylight,� said Dr. Robert W. Amler, a former chief medical officer at the Centers for Disease Control and Prevention. “It’s part of the fog that you get in a newly unfolding situation.�

“Obviously, there’s a little bit of tension,� Varmus said. “But nobody wants to see him depart from the podium, because at this point, he’s the most reliable voice on the podium.�

The grandson of Sicilian immigrants, Fauci was born in 1940 in Brooklyn and grew up in an apartment above his father’s pharmacy, helping the family business by delivering prescriptions by bike.

Early on, he set his sights on being a physician.

At Regis High School, an exclusive Jesuit school, his teachers drilled students on moral foundations and the importance of communicating scientific principles clearly without going off on tangents.

Fauci went on to graduate first in his class at Cornell University Medical College.

“He has his basic priorities straight in life,� Harden said. “He understands, as a physician, that human lives are what it’s about.�

“He’s not the snooty Harvard professor,� Staley said. “Even though he’s talking very highly complex scientific issues, he’s got a knack for not talking down to people in a room. You’re talking to him, you realize he knows more than you, he’s brighter than you. But he puts you at ease. He starts pulling you up at that learning curve.�

In 1981, Fauci was a senior investigator with NIAID when he read reports about a mysterious immune disorder among gay men. At the time, he was one of the few researchers devoted solely to human infectious diseases. Most young scientists were taught told that the field was a dead end after the conquering of polio and tuberculosis.

Recognizing early on that the new illness could be a global disaster, Fauci assembled a small group of scientists to study the emerging disease and devoted his whole lab to AIDS research.

In 1984, Fauci was appointed director of NIAID and continued his laboratory and clinical research, in addition to his administrative duties. He also led efforts to convince Congress to dramatically increase funds for AIDS research, work that he has said made him feel like the Lone Ranger.

As AIDS claimed the lives of thousands of gay men in the 1980s, Fauci drew the ire of activists frustrated by the government’s slow response.

But early on, Fauci differed from other scientists by inviting the activists into his office. Every nine months or so, he invited the activists to wine-fueled dinner parties at his deputy’s house on Capitol Hill.

“We adored the guy from Day One,� Staley said. “He wasn’t afraid of us at all. We were pushy, no bullshit, willing to confront. The entire scientific establishment was scared to death of us. With him, there was just no homophobia.�

The activists were so smitten that they resolved to meet only with Fauci in groups of three or four.

Every time they drove together from New York to Washington, they would strategize on what information they would try to extract and what tactics they would use.

“After three hours of the Tony Fauci charm machine, with alcohol, we’d get back in the car a little swooning and quickly dissect and compare notes,� Staley said. “I think we stayed tough on him, but I’m not sure we could have done that if it was one-on-one.�

Tension came to a head in 1990, when the activists could not persuade the experts to give them a seat at the table for the scientific committees in the AIDS clinical trial groups.

After making little headway over a long dinner, the activists organized a massive demonstration outside Fauci’s office wearing Grim Reaper masks and hoisting coffins. More than 60 protesters were arrested. But within a few months, the activists had seats at the table.

As the epidemic spread, Fauci lost more patients than most doctors in the country, including his former deputy and close friend, James C. Hill, who walked into his office one day in the early 1990s and broke down, telling Fauci he had gotten a diagnosis of HIV.

Four years ago, the activists regrouped with Fauci over dinner.

“So Tony, you’re 75 — should we start looking for your successor?� they asked.

No, Fauci told them. He was still running every day and his post-run heart rate was better than when he was 50. He thought he had another 10 years in him. He really wanted to be there when they found a functional AIDS cure.

“He is here for this pandemic now because he wanted to finish the work we all started in the ’80s,� Staley said.