Dr. Fauci's Journey

 

Had the covid pandemic never occurred, Dr. Anthony Fauci’s career would still have been highly consequential, but I suspect many of us might never have heard of him. He might perhaps still have written a memoir, but most of us might never have read it. But the 2020 covid pandemic transformed him, in his own words, into “a political lightning rod—a figure who represents hope to so many and evil to some.” The result is that his already consequential career became even more so, and almost everyone has heard of him, and many more will - and should - read this memoir. 

Dr. Fauci was born on Christmas Eve 1940. His parents were first-generation Italian-Americans. His pharmacist father, of Sicilian descent, was a graduate of Columbia University. His mother, of Neapolitan descent, was a graduate off Hunter College. The Faucis lived in Bensonhurst and later in Dyer Heights. Anthony experienced the delights of growing up in a close-knit Italian family and attended Catholic school taught by Dominican sisters and then Regis High School in Manhattan, New York's "most academically elite Catholic high school, run by Jesuit priests," who "provided an atmosphere steeped in intellectual curiosity and academic excellence," where he studied Latin and Greek and played on the basketball team. rom Regis, he went on to the Jesuit-run Holy Cross College in Massachusetts, then "nationally known as one of the top premedical programs among Catholic colleges, or for that matter among any schools in the country." He entered Cornell Medical School in 1962 and calls medical school "one of the happiest, most fulfilling periods of my life." Fauci clearly feels good about his background and formative experiences and uses this memoir to highlight "code of service to others instilled in me by my parents, followed by the 'Men for Others' theme of Regis High School, strengthened by my experience with the Jesuits at Holy Cross," all of which "culminated with the extraordinary medical training at Cornell." After graduation, he went to the National Institute of Allergy and Infectious Diseases (NIAID), doing research and seeing patients in infectious diseases and clinical immunology. That set the stage in turn for an extraordinary career, which eventually earned him the Presidential Medal of Freedom from George W. Bush in 2008. After a year back in New York York as chief medical resident, he went to NIH as the head of his own laboratory "doing basic and clinical research on the interface between infectious diseases and the human immune response" - providential preparation for the eventual HIV/AIDS crisis, which is the overall preoccupation of the second part of the book.

Our obsession with the present might tempt a reader to skip from Fauci's formative experiences directly to his encounter with the covid pandemic which pushed him into such a position of prominence. But it would be a mistake to skip over his important earlier experiences - especially his experience in responding to HIV/AIDS (which also includes his account of meeting and marrying his wife). In the early years of the AIDS crisis, Fauci famously became a target of activists, who perceived that the federal government was failing them ACT-UP's Larry Kramer famously wrote “I call you murderers: An open letter to an incompetent idiot, Dr. Anthony Fauci.” Kramer's "rationale for the attack," Fauci acknowledges, was that he "had not demanded enough money for AIDS.” In fact, Fauci "had requested from Congress and the president the largest increase in resources given to an NIH institute since the famous ‘war on cancer’ in the 1970s.”

Yet, even while ready to defend much of his record, Fauci found the attacks a learning experience. When activists protested, Fauci made a crucial decision to meet with some of the demonstrators. “This was the first time in anyone’s memory that a government official had invited them to sit down and talk on equal terms and on government turf.” As a result, the activists “played an increasingly important role in shaping my thinking and policy in these areas.” This in turn led to an expansion of the availability of experimental treatments for AIDS beyond the traditional confines of clinical trials. "Word spread quickly that I was someone who cared about them and that I was willing to be an advocate for them in dealing with the faceless bureaucracy of the federal government."

Dr. Fauci's career continued, and he got to see HIV go from death sentence to manageable chronic disease (at least in the richer countries of the world). After the HIV/AIDS crisis came other challenges. By chance, he was in Manhattan on "the Day the World Changed" (September 11, 2001). The preoccupation with global terrorism, in turn, highlighted new challenges and dangers - among them, Ebola and Zika. Those stories are not uninteresting. But, by now, my guess is that most readers will be eager to move on to the climactic final episode of Fauci's pubic health career, which began famously in early 2020. 

Already in January, Fauci "had the sense that something large and frightening was on the horizon." Very soon, he "became the de facto public face of the country’s battle with the disease." This proved problematic when, for example, the advice one mask-wearing was changed. "People associate science with absolutes that are immutable, when in fact science is a process that continually uncovers new information." As a result, Fauci explains, "as new information evolves, the process of science allows for self-correction."

Although Fauci's focus is on the pandemic and how he and his colleagues responded to it, there is no way of avoiding focusing on Donald Trup's role. "I think," he writes, "Donald Trump thought that COVID would be temporary: a little time goes by, the outbreak is over, everyone goes back to work, and the election cycle can begin. He could not have imagined that the pandemic would go on for such a long time. I believe this explains why he repeatedly asked Deb, Bob, and me whether COVID resembled the flu. He desperately wanted the pandemic to disappear just as flu does at the end of the flu season." Gradually, Fauci came to understand, "that even though a contingent of bright and dedicated public servants filled the offices of the West Wing and the Executive Office Building, this was not the White House I had known since the Reagan administration."

Eventually, Fauci would become identified with the political opposition to Trump. "The problem, of course, was that while millions of Americans appreciated or admired me, a hard-core group saw me as a nay-saying bureaucrat who deliberately, even maliciously, was undermining President Trump. They loved and supported the president and regarded me as the enemy." Trump, meanwhile, increasingly tried "to wish away COVID with solutions that had no scientific basis." Moreover, being identified so widely with the opposition to Trump took a personal toll in the dangers and threats that he and his family faced.

Looking ahead, Dr. Fauci warns "new pandemics will certainly emerge in the future. This is why it is so critical to prepare for the unpredictable, or, as I have often said, expect the unexpected." More than some impending public health disaster, however, he worries "about the crisis of truth in my country and to some extent throughout the world, which has the potential to make these disasters so much worse. We are living in an era in which information that is patently untrue gets repeated enough times that it becomes part of our everyday dialogue and starts to sound true and in a time in which lies are normalized and people invent their own set of facts."

In other words, the divided, polarized society we have become, a development he got to observe more up close and personally than most of us.

“At times, I am deeply disturbed about the state of our society,” Fauci writes near the end of his book. “We have seen complete fabrications become some people’s accepted reality.” If this “crisis of truth” persists, the effects of future pandemics will be much worse.