The famous doctor’s new memoir reveals that his foibles were on full display well before Covid.
The famous doctor’s new memoir reveals that his foibles were on full display well before Covid.
On Call: A Doctor’s Journey in Public Service, by Anthony Fauci (Viking, 480 pp., $36.00)
Dr. Anthony Fauci, the former director of the National Institutes of Health subagency that deals with infectious diseases, has been a prominent inside-the-Beltway celebrity since he began publicly opining about HIV 40 years ago. He became a national celebrity, even a target of a Saturday Night Live skit, because of his awkward Covid press conferences with President Trump. As with most prominent political figures today, the public has highly divided opinions about him. As is usually the case, he is neither a demon nor a persuasive candidate for sainthood.
This autobiography is a train wreck of a book. Friends — indeed good friends — reviewed an early draft and persuaded him to bring in a “collaborator” to fix it. By his own admission, his editors at Viking edited the book heavily as well. What remains is still insufferably vain — the book lovingly records a seemingly endless torrent of compliments from celebrities, colleagues, and employees. It is also factually sloppy — for example, Boston Latin is not a Jesuit school but America’s oldest public school, and former HHS secretary Louis Sullivan is not dead, but alive and kicking at 90.
Many of Fauci’s anecdotes are unintentionally revealing about his character. For instance, he provided medical treatment to the greatest public-health leader of the era, Surgeon General C. Everett Koop. Referring to that relationship is fine, but it was tacky and unethical to disclose the details of Dr. Koop’s medical issues and their privileged conversations. In fact, it is arguable that his disclosures violated federal health-privacy laws. I also cringed when I read that, after a valued gay employee came out as gay, Fauci put his arm on the man’s shoulder and said, “Jim, you are totally clueless. I have known you were gay from the moment I met you ten years ago in the NIAID conference room.”
Fauci came to the National Institute of Allergy and Infectious Diseases (NIAID) in 1968 immediately after completing his medical education and conducted research on polyarteritis nodosa and Wegener’s granulomatosis. In 1981, shortly after the first reports of what we now call AIDS, his research focus shifted to the disease. He became the agency head in 1984 just as the AIDS epidemic was creating enormous medical and political turmoil.
Fauci blundered badly in his first year as head of NIAID and spent the rest of his career trying to avoid responsibility for those mistakes. In 1984 he declared that a National Cancer Institute researcher, Dr. Robert Gallo, had discovered the retrovirus now called HIV, and he persuaded Secretary Margaret Heckler to announce that this discovery meant that there would be a vaccine in 1986.
Fauci’s fantasy about a quickly developed vaccine led to millions of Americans having false hopes; it made development of AIDS therapeutics seem less urgent; and it led to consistent congressional funding for a long string of failed AIDS vaccine trials sponsored by NIAID. I do not have an objection to the failed trials — I worked in the biotech industry for 15 years and know all too well that the best scientific theories often produce terrible clinical results. However, Fauci should have offered candid scientific assessments, not overhyped rhetoric, to Congress.
Self-serving fantasies were also the basis for Fauci’s persistent support for Gallo’s fraudulent scientific claims, even after tests eventually proved that Dr. Luc Montagnier of the Pasteur Institute discovered HIV — which is why the Nobel Prize Committee awarded the Nobel to Montagnier, not Gallo. The Pasteur Institute had sent a sample to Gallo that it believed contained the retrovirus they were both looking for; that sample was covered by a material-transfer agreement that reserved rights for any use derived from that sample. Gallo soon published his claim that he had found the retrovirus in an independent sample, and he filed patents on his “discovery.” For many years the Pasteur Institute and NIH fought a ground war over this issue.
By 1989, when I rejoined HHS as general counsel, Fauci knew that doubts were rising about Gallo’s story, and he insisted on a small, hush-hush meeting with the newly confirmed HHS Secretary, Dr. Louis Sullivan. Fauci wove a carefully crafted tale about how important the Gallo discovery was for the reputation of NIH, and that it was essential for HHS to rally around Gallo and to stonewall oversight by Representative John Dingell’s fearsome oversight committee.
Secretary Sullivan was visibly impressed by Fauci’s performance and seemed about to agree with him until I gave him “the Nixon warning” about how it was the cover-up, not the crime, that did Nixon in. I told him that if Gallo had done nothing wrong, there would be no harm in oversight, but if Gallo had committed fraud, stonewalling would inflict a heavy price on the leadership of HHS and NIH. Lou then refused to embrace Fauci’s proposed obstructionism, and Gallo stormed off. Not long afterward, a new technology called polymerase chain reaction showed that the material Gallo used in his experiments contained the Pasteur Institute material — whether accidentally or by fraud we will probably never know. Gallo, his lawyers, and his supporters have never articulated a plausible theory for unintentional contamination.
Gallo’s behavior became increasingly erratic, and for years he spent much of his official time spreading conspiracy theories and other slander about Montagnier and the Pasteur Institute. Nonetheless, Fauci’s defense of Gallo continued until at least 2013; at that late date, his office was still referring to Gallo as the “co-discoverer” of HIV. To the best of my knowledge, Fauci never apologized to Montagnier or supported financial restitution to the French.
I have always believed that part of the reason for this behavior was that senior NIH officials were embarrassed that their in-house research programs had never created breakthrough science for the treatment of patients; many officials, including Fauci, saw Gallo as their best shot at having a superstar. NIAID’s performance with its in-house research was even worse than the rest of NIH’s; at least the National Cancer Institute did have one team produce a minor contribution to the war against AIDS from its in-house research. Furthermore, not only did NIAID fail to come up with innovative science to help treat or prevent AIDS, it substantially failed with every other disease that became a focus of its research, including Ebola, Zika, avian flu, and anthrax.
Fauci’s biggest contributions came mostly from building bridges to the AIDS activist community and his relentless advocacy within the executive branch to support new initiatives. Most notably, he was the key figure driving President George W. Bush’s program to bring the newest AIDS treatments to Third World nations.
Sadly, however, Fauci is not content just to take credit for what he has actually done; he tries to claim credit for the accomplishments of others, most notably the decision by FDA Commissioner Frank Young to overrule his resistant employees and open up an accelerated “parallel track” for AIDS therapeutics. This significant reform, later expanded to other life-threatening treatments, originated with AIDS activists; the fact that Fauci once gave a speech endorsing the activists’ proposal does not entitle him to take credit for Commissioner Young’s achievement.
Fauci’s own descriptions of his efforts reveal his strengths of tenacity and compassion, but they also unintentionally reveal the downsides of his ego and competitiveness. The mission of the Agency for International Development (AID) is to provide services in economically and culturally challenged countries that cannot provide those services on their own. During the second Bush administration, the agency was run by Andrew Natsios, an experienced and capable executive who had spent a substantial amount of effort considering the hard issues involved in supplying good medical care to the targeted countries.
The public interest required Fauci to approach Natsios with his own ideas and to try to develop a joint proposal. If a joint proposal wasn’t possible, their work could be presented as options to the ultimate decision-makers. What happened, though, is that Fauci, the head of a subagency with little expertise in the area of international public health, didn’t bother to talk to the CDC or AID about his own plan, which he presented to President Bush; he did not know that the CDC had already agreed on behalf of HHS that AID would be the lead agency for this initiative. It is no wonder that the president “did not seem at all amused.”
Fauci’s closed-circle style also undermined his Covid efforts. Covid required difficult decisions involving a broad range of issues outside of Fauci’s expertise, and that lack of expertise combined with his slowness to change his guidance in the face of new information led to overly cautious state edicts. On Call tries to divert attention from these issues, mostly by focusing on his criticisms of his most extreme critics, and the two chapters on Covid are shorter than one might expect.
Fauci does make an effort to dismiss concerns about the origin of Covid, but he conveniently does not mention that he responded “I don’t recall” more than 100 times in response to congressional members’ questions about Covid; this performance before Congress kept bringing me back to the self-serving fictions he pushed while trying to stonewall the Dingell Committee in July 1989. He does seem to be able to recall, however, the bulk of his conversations with the rock star Bono.
On Call should serve as a reminder to Congress and future presidents about the dangers of civil servants turning their jobs into permanent power bases; a ten-year term limit for senior NIH officials would be appropriate. More important, On Call should keep reminding us about how poorly prepared we are for future pandemics.
Policy improvisation, bureaucratic rigidity, and censorship of discussion and dissent during the Covid pandemic undercut the effectiveness of our response; it also cost us lives and cost children vital educational experiences. It is time for the National Academy of Sciences or a similar organization to develop a fresh plan for legislation that would eliminate overlapping jurisdictions, create a public oversight board to increase accountability, and establish a fund to be used only for fast immediate responses during the beginning of pandemics.
On Call, for all its convenient fictions, should persuade us that the failures of our federal public-health agencies require strong action.