CORONAVIR-US

Dr Anthony Fauci: A calm spot in the centre of the Covid-19 storm

By J Brooks Spector 1 April 2020
Caption
Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health Dr. Anthony Fauci, joined by United States President Donald J. Trump and members of the Coronavirus Task Force, makes remarks on the Coronavirus crisis in the Brady Press Briefing Room of the White House in Washington, DC, USA, 21 March 2020. EPA-EFE/Stefani Reynolds / POOL

For decades, Dr Anthony S Fauci has been a key figure in the intersection of US medical research and politics. This time, he is trying to manoeuvre an errant president into sensible positions in the face of the Covid-19 pandemic. He appears to be winning, even if he has become an enemy of the president’s base.

Some 60 years ago, when this writer was still a junior high school student near Washington, DC, my uncle, Louis “Buddy” Diamond, took me to his laboratory at the National Institutes of Health (NIH) to give me an introduction into what real science was about, and what real scientists did. At that time, I harboured the idea of becoming one.

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Consequently, I accompanied him to his lab on a quiet Saturday. There he carefully removed a cryogenically frozen glass container from within a large insulated vacuum chamber. The tube was filled with a carefully controlled “line”, or pure strain, of Entamoeba histolytica, otherwise known as that nasty little one-celled creature that causes dysentery, a disease that kills many, and  that incapacitates even more, all around the globe.

He carefully took a bit of the liquid from the container, once it had warmed up sufficiently in the ambient air, and then placed it on a microscope slide and allowed me to look at it through the instrument. Watching the tiny creatures on the slide, almost made me feel like Antonie Philips van Leeuwenhoek discovering those microscopic animals with his first, primitive microscope four hundred years ago. Then, my uncle stained the creatures with a special dye and placed the slide back onto the microscope’s table. Looking through the eyepiece again, there they were, but with all of the internal structures of those tiny but malevolent creatures on display. 

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I didn’t realise it at the time, but my uncle was actually an internationally renowned expert on a number of the parasites that cause untold suffering around the world. In fact, he was one of the many stars in NIH’s research constellation. NIH is a government laboratory complex spread across a large campus in suburban Washington, DC, that, unlike commercial or industrial labs, or even many in universities these days, has been dedicated to giving researchers the time and space to explore their scientific passions, without overwhelming pressure to deliver the next new vaccine or miracle drug as fast as they can run on an unrelenting hamster wheel. 

Instead, it has often given its scientists the chance to chase intriguing questions through a chain of research that can span years. In my uncle’s case, teasing out the secrets of the lethal parasite had taken up much of his energies over the space of several decades, until he finally retired in the mid-1990s. Throughout those years, researchers frequently came to work with him from Latin America, from Africa, from India, and East Asia. They built a global network of people fascinated by many of the same questions, and all eager to make use of his techniques and the pure strains of those poisonous little microscopic critters he had cultivated. 

Dr Anthony S Fauci was, of course, one more of those extremely bright, intensely curious young scientists who had been brought into NIH’s world by older researchers who eagerly scouted out the best talent. Fauci had grown up in Brooklyn, the son of a pharmacist. (He delivered prescriptions for his family pharmacy while a student.) He attended one of the most academically rigorous Catholic high schools in New York City where he excelled both in the classroom and on the sports field, before going to Holy Cross University for his Bachelor’s degree, and then to Cornell University’s medical school. In an oral history project he participated in back in 1989, he described his trajectory as a young doctor heading into the research lane. As he explained: 

“The reasons I went into immunology and research, in general, were due to an unusual situation. I left Cornell and went into my internship and residency in 1966. That was at the exponential phase of the Vietnam War, and every single physician went into military service. I can remember very clearly when we were gathered in the auditorium at Cornell early in our fourth year of medical school. 

“Unlike today, we had only two women in the class and 79 men. The recruiter from the Armed Forces came there and said, ’Believe it or not, when you graduate from medical school at the end of the year, except for the two women, everyone in this room is going to be either in the Army, the Air Force, the Navy or the Public Health Service. So, you’re going to have to take your choice. Sign up and give your preferences.’

“I had heard about the NIH and the opportunity there. At the time, the NIH was just blossoming, and everyone who had any role in academic medicine spent some time at the NIH. So I put down Public Health Service as my first choice, and then the Navy. Essentially, I came down to the NIH because I didn’t have any choice. I was very lucky because I knew that it was a phenomenal scientific opportunity.

“When I was trying to decide what laboratory to go to, some of my advisers at Cornell suggested very strongly that I pursue the field of immunology, since I had developed an interest in immunology in medical school. I had done some projects during the summer and had worked for a period with Dr Marvin Schlesinger, who was the chief of gastroenterology division of the Department of Medicine. I also had worked with [Dr] Graham Jeffries and [Dr] Walter Rubin. 

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“The project I did as a student turned out to be a successful project. I was lucky, since that doesn’t usually happen when you have a student project. Because of this research, I applied for the National Institute of Allergy and Infectious Diseases. It so happened that Dr Schlesinger knew Dr Sheldon Wolff at the NIH, and I came down to the NIH for an interview. 

“I was interviewed by Dr Wolff, and I immediately fell in love with the man. He was just my kind of person— intellectually and personally. I was accepted by Dr Wolff right off. At the end of my residency, I came down to the NIH to work in the National Institute of Allergy and Infectious Diseases with Dr Wolff….”

Fauci then talked about how his actual research path had come about. He said, “When I came down to what was the Laboratory of Clinical Investigation, of which Dr Wolff was the laboratory chief as well as being the clinical director of the National Institute of Allergy and Infectious Diseases, I wanted to work on cellular immunology. But, interestingly enough, as popular as cellular immunology is now, there really were not very many cellular immunologists at the time, and certainly not in the Laboratory of Clinical Investigation. I went to work with Dr John Johnson, who now practices rheumatology in Nashville, Tennessee. John was an immuno-chemist at the time, but he allowed me to work on problems in cellular immunology. I had to go around to different groups in different laboratories to learn the fundamentals of cellular immunology under the auspices of the Laboratory of Clinical Investigation. It was a great experience and a testimony to the flexibility of people like Dr Wolff and Dr Johnson, who allowed me to work in that field even though it wasn’t their field of expertise. 

“Dr Wolff was mainly working on the pathogenesis of fever. I told him I didn’t want to work on that, although it was a very interesting topic. I wanted to learn some basic cellular immunology with the ultimate aim of going into what has been my theme for the past 21 years – human immunobiology and the regulation of the human immune system. I was then, and still am, extremely interested in clinical medicine, and I have been successful in being able to mix and meld together the very fundamental, basic concepts of immunology with clinical medicine.” 

Yes, and it would eventually become clear that, along with all his many scientific interests, he also had a rather deft hand as a politically and bureaucratically savvy scientist. Along the way, he turned down a number of offers to head up the entire NIH structure, preferring to stay in charge of his own laboratory instead. Good choice, it seems now.

In recent months, Fauci, the head of NIH’s National Institute of Allergy and Infectious Diseases, just as he has been for three decades, has become the steadying hand — albeit one ready to carefully pour cold water on some of the wilder statements by the president — at the White House’s briefings by the Covid-19 team. Fauci is, after all, a man who has successfully worked with six very different presidents, Ronald Reagan, George HW Bush, Bill Clinton, George W Bush, Barack Obama, and now Donald Trump, on highly public medical and scientific issues that have had broad international repercussions, including HIV/AIDS, Sars, H1N1, Mers, and now Covid-19. 

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At a time when millions are quite literally fearful of death from yet another new and terrible disease, Fauci’s bureaucratic nous (along with his wide circle of national and international connections) have made him a natural at the business of giving his nation the straight scoop, no matter how difficult the news is. This has been true especially when a certain apex politician has been all too willing to dissemble with happy-talk-tall-tales about an imminent vaccination coming onstream; to punt miracle drugs used on other diseases; to explain that the spring weather will make the virus magically disappear; or to push the notion that Covid-19 was somehow going to be easy to beat, given the country’s medical technology and systems.

In a more recent, second oral history recording, discussing his role in dealing with HIV, Fauci recalled, “As you know, I was one of the first people to get involved in HIV back in 1981, and he [Massachusetts Senator Ted Kennedy] was among – if not among, then the first politician who immediately took a very keen interest. Of course, he had obviously, historically, a great interest in health, particularly health for disenfranchised people. 

“When the first cases came up, I remember getting calls from his staff, wanting a bit of a briefing, first with them, and then with him. So, probably the first time that I met him was down at his office in the early years, before I became the director of the institute, and it was centered around the issue of HIV/AIDS. HIV was not yet discovered. We didn’t even call it AIDS at the time.

“It was the very beginning. I was very excited about the fact that he was interested in it. Of course, I had, very early on, made a decision in my own career to divert away from what I was doing, with just classic immunology and infectious diseases, and begin to start studying this group of people, who were literally measured in handfuls early on. The first case reports from Morbidity and Mortality Weekly Report in June of 1981 were of five cases of Pneumocystis carinii pneumonia, in individuals in Los Angeles. Then a month later, the second Morbidity and Mortality Weekly Report was of about 20-plus patients, who had not only Pneumocystis pneumonia, but also Kaposi’s sarcoma, from three cities, Los Angeles, San Francisco, and New York.”

Fauci went on to explain that the newly identified disease was first picked up in the US as a new health threat. 

“Absolutely. It definitely was picked up here. So that’s the reason why there was that confusion in the beginning: is this a strange disease of gay men? Then, as it evolved, literally week after week after week, you’d get the unfolding and the evolution of the epidemiology, which made it clear that it wasn’t restricted just to gay men, that it was a sexually transmitted disease, that it was blood-borne, because injection drug users and recipients of blood and blood products were getting it. 

“Then the first cases of mothers who were injection drug users, who were giving it to their kids. Then the Haitian situation, which was a big red herring, and which was probably a roundabout way of Africa to Haiti, or gay men who went to Haiti for pleasure-type weekends, and were infected. We still don’t know whether the gay men from New York infected the Haitians, or the Haitians were the first ones to give it to them when they came back from Africa. It’s unclear.”

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In time, Fauci became one of the prime movers, behind the scenes mostly, in pushing the George W Bush administration into establishing the President’s Emergency Plan For AIDS Relief (Pepfar) programme to deal with HIV/AIDS, something that has become increasingly important for South Africa, especially after the Mbeki administration’s barriers to antiretroviral drug treatments were finally dislodged. 

Although his name is now inextricably linked to AIDS and Covid-19, Fauci has also made important scientific observations that contributed to the understanding of the regulation of the human immune response, and he has been widely recognised for delineating the mechanisms whereby immunosuppressive agents adapt to that response. 

He developed therapies for formerly fatal diseases such as polyarteritis nodosa, granulomatosis with polyangiitis, and lymphomatoid granulomatosis. In a 1985 Stanford University Arthritis Center Survey of the American Rheumatism Association, its membership ranked Fauci’s work on the treatment of polyarteritis nodosa and granulomatosis with polyangiitis as one of the most important advances in patient management in rheumatology over the previous 20 years. His scientific papers continue to be widely cited in professional literature in journal articles.

Naturally, his very public presence has not gone without criticism from fanatics. By virtue of his participation in the White House task force on Covid-19, his frequent appearances on various television channels and in print interviews, his careful but thorough corrections of the president in the midst of the White House’s Covid-19 media conferences, as well when he covered his face with his hand at the moment of a particularly egregious presidential miscue seen by the world, Fauci has increasingly come under withering criticism from the far right and Donald Trump’s base. 

The New York Times reported the other day, “At a White House briefing on the coronavirus on March 20, President Trump called the State Department the ‘Deep State Department.’ Behind him, Dr Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, dropped his head and rubbed his forehead. Some thought Dr Fauci was slighting the president, leading to a vitriolic online reaction. On Twitter and Facebook, a post that falsely claimed he was part of a secret cabal who opposed Mr. Trump was soon shared thousands of times, reaching roughly 1.5 million people.

“A week later, Dr Fauci – the administration’s most outspoken advocate of emergency measures to fight the coronavirus outbreak – has become the target of an online conspiracy theory that he is mobilizing to undermine the president. That fanciful claim has spread across social media, fanned by a right-wing chorus of Mr. Trump’s supporters, even as Dr Fauci has won a public following for his willingness to contradict the president and correct falsehoods and overly rosy pronouncements about containing the virus.

“An analysis by The New York Times found over 70 accounts on Twitter that have promoted the hashtag #FauciFraud, with some tweeting as frequently as 795 times a day. The anti-Fauci sentiment is being reinforced by posts from Tom Fitton, the president of Judicial Watch, a conservative group; Bill Mitchell, host of the far-right online talk show YourVoice America; and other outspoken Trump supporters such as Shiva Ayyadurai, who has falsely claimed to be the inventor of email.

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“Many of the anti-Fauci posts, some of which pointed to a seven-year-old email that Dr Fauci had sent praising Hillary Clinton when she was Secretary of State, have been retweeted thousands of times. On YouTube, conspiracy-theory videos about Dr Fauci have racked up hundreds of thousands of views in the past week. In private Facebook groups, posts disparaging him have also been shared hundreds of times and liked by thousands of people, according to the Times analysis. One anti-Fauci tweet on Tuesday said, ‘Sorry liberals but we don’t trust Dr Anthony Fauci.’

“The torrent of falsehoods aimed at discrediting Dr Fauci is another example of the hyperpartisan information flow that has driven a wedge into the way Americans think. For the past few years, far-right supporters of President Trump have regularly vilified those whom they see as opposing him. Even so, the campaign against Dr Fauci stands out because he is one of the world’s leading infectious disease experts and a member of Mr Trump’s virus task force, and it is unfolding as the government battles a pathogen that is rapidly spreading in the United States.”

Still, Fauci seems to have taken the criticism in stride, together with an understanding of the curious way one has to move this current White House. As he said in a widely quoted interview in Science magazine recently, “When you’re dealing with the White House, sometimes you have to say things one, two, three, four times, and then it happens. So, I’m going to keep pushing.” 

And criticism has not dampened him from appearing on television on the internet. Last week he joined a 30-minute Instagram Live discussion about the coronavirus hosted by the National Basketball Association star Stephen Curry. Reiterating the message he has consistently been giving, with a miniature basketball hoop behind him, he said, “This is serious business. We are not overreacting.”

Not giving in to pseudo-science or misleading happy talk, Fauci was instrumental in reversing the president’s inclinations to end the standing national stay-at-home recommendations so that millions could go to Easter church services, now that the worst was, preemptively, over. By the time last weekend was over, the president had finally accepted and seemingly embraced the dire calculations that without proper precautions, somewhere seriously north of a million people might die, and that even with those precautionary measures in place, there might still be one hundred to two hundred thousand fatalities by the time the disease was brought under control. 

The New York Times noted, “‘There seems to be a concerted effort on the part of Trump supporters to spread misinformation about the virus aggressively,’ said Carl Bergstrom, a professor of biology at the University of Washington who has studied misinformation. Adding that Dr Fauci is bearing the brunt of the attacks, Mr Bergstrom said: ‘There is this sense that experts are untrustworthy, and have agendas that aren’t aligned with the people. It’s very concerning because the experts in this are being discounted out of hand.’ But in the face of such attacks, Dr Fauci’s steadfastness in promoting a full acceptance of the medical and public health implications of Covid-19 may prove to be one of his most important services to the nation in a career of distinguished service that stretches back into the 1960s. DM 

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Dr Anthony Fauci’s most important awards and honours:

Fauci has also been a visiting professor at many medical centres, and has received 30 honorary doctorate degrees from universities in the United States and abroad.

A short list of selected publications includes:

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