IRA FLATOW: This is Science Friday. I’m Ira Flatow.

I first crossed paths with Dr. Anthony Fauci back in the early 1980s, when I was covering the first mysterious hints of an HIV/AIDS outbreak. Little did I know then that he and I would be spending the next 40 years in conversation. We’ve been through a lot of diseases together, and I’ve lost count of the number of times he’s appeared on this program since 1994, explaining AIDS, Ebola, yellow fever, Zika, flu, allergies, and lots, lots more.

And you know what? Fauci never says no to an interview, even over the past years as he has taken on an outsized role as a public face of medicine in this country. Fearlessly speaking truth to power at the Trump White House or in congressional testimony, he has a reputation as a tireless public servant, working long hours and navigating those weekend talk shows. So when he announced that he’d be stepping down from his role as the director of the National Institute of Allergy and Infectious Diseases, I was a bit surprised. I thought they’d find him one day slumped over his desk.

Here to talk about his career and what lies ahead is Dr. Anthony Fauci, outgoing director of the NIAID at the NIH, in Bethesda, recipient of the Presidential Medal of Freedom, chief medical advisor to President Biden. Welcome back to Science Friday.

ANTHONY FAUCI: Thank you, Ira. It’s really great to be back with you again.

IRA FLATOW: So nice to have you. I don’t know where to begin. I want to have a wide-ranging talk about your career as a researcher and a public figure. And I think I need to begin with the present, and have you tell us about your experiences with the pandemic. Can you recall a time when fighting a disease devolved into such a polarizing political battle?

ANTHONY FAUCI: No. The answer is a resounding no, Ira. It is certainly never even anything close to this. But it’s also so disconcerting because we have two things that are unique. We have a pandemic, the likes of which we have not experienced on this planet since the iconic influenza pandemic of 1918, simultaneously with a degree of divisiveness in this country in which political ideologies, misinformation, disinformation, conspiracy theories, have all conflated together to make what you would hope have been a unified, concerted pulling together effort to fight this pandemic.

Instead, we have such differences in approaches that are not just honest differences of opinion, but that are manifested by attacks, attacks on science, conceptually, verbal and sometimes physical attacks on public health officials. It is most extraordinary and most disturbing, Ira, because I think it not only inhibits what we would hope had been a better response to this deadly outbreak, but I think it’s linked into what we’re seeing in the country, which is really an affront and an attack on our democratic institutions and our democratic process.

That’s one of the more scary aspects of it. One is a public health issue, but one of them is a manifestation of how profound differences and divisiveness can impact important efforts like fighting a pandemic.

IRA FLATOW: Speaking of attacks, you became one of these people who was attacked and your credibility questioned. How did you handle that, and how do you handle that?

ANTHONY FAUCI: Well, the only way I could handle that is what I’m doing, Ira, is to focus like a laser beam on what my job and what my purpose is. Which it has been ever since I became a physician more than 60 years ago, ever since I’ve come to the NIH 54 years ago, and ever since I’ve become the director of the NIAID, which is 38 years ago, is to focus on what your purpose and job is. And mine is to do whatever I can, within the realm of science, evidence, data, and public health, to preserve and protect the health and the safety of the American public.

And if you get distracted by all the barbs and the arrows and all of the disinformation and conspiracy theories, that distracts you from what you should be doing. So as much as I don’t pay attention to the praise– I mean, it’s nice that people like what I’m doing, and there are a lot of people who do– you don’t want to get taken up by that. But you also don’t want to get taken up by the barbs and the arrows and the discouraging remarks.

IRA FLATOW: That’s really interesting that you say that. Because for those of us who’ve known you for 40 years, and suddenly you become this public figure, you’re seen almost every day on the biggest public stage in the world, you’ve become a household name– as you say, loved by many, hated by some– how do you handle that transition emotionally and mentally from one side to the other?

ANTHONY FAUCI: Again, Ira, it’s a question of compartmentalization. If you get too deeply immersed in the adulation and the praise, that’s unrealistic and that’s distracting. If you get too deeply immersed in the other aspects of it, that is also distracting. So I don’t want it to interfere with my job.

But what it has done– and I’ve got to be perfectly honest with you– it has very much disrupted my life, in the sense that my job stays steady and I keep doing what I’m doing– and I’m doing what I did the first time you interviewed me decades ago, working 16 hours a day, all the weekends and stuff, because I like it. I’m an unapologetic workaholic, and I really love what I do.

But when you get the venom introduced into it, it impacts, for example– it’s not comfortable having to go around with armed federal agents around you all the time. That’s not a good model for encouraging people to go into public health. I don’t like the idea that my wife and my three daughters get harassed and threatened all the time. But I’m not alone. I’m a very visible person, so you know about it. But there are many public health officials who are also being threatened and harassed because they stick up for good public health principles.

That should never happen in a country like ours, but it is.

IRA FLATOW: And where do you draw your strength from? I know your background shows you to be a pretty tough guy. In high school, you captained the school’s basketball team, despite just standing only 5 foot, 7 inches. But do you have a background that keeps you working and keeps your drive going?

ANTHONY FAUCI: Yeah. I mean, I think it’s just we are the sum total of our experiences and our background, Ira. You’re right. I grew up in a tough neighborhood in Brooklyn. I had great parents, who kept me on the right track of education and doing things for public service. That has been a part of my family tradition, from my father and my mother and my schooling. You know, Jesuit training in high school and college, about making sure that honesty and integrity is absolutely critical to everything you do. And don’t back down under any circumstances from that.

The other important thing is the relationships you develop. I’ve been very, very fortunate. I have a wife who is just most extraordinary. She’s brilliant intellectually. She is the anchor in my life, in the sense that she has a bit of a different personality than I. She takes things very calmly, in a very measured way. She’s very analytic. And whenever I need a reality check, I have one at home every day when I go home. And that’s really important.

IRA FLATOW: I recall during the early days of HIV/AIDS that you and other researchers were also getting criticized for the way federal research and funding were being handled. Now, if you compare the political and social pushback during the beginning of the HIV pandemic with the COVID pandemic, how similar are they? Or compare and contrast them, if you will, as they say in school.

ANTHONY FAUCI: So the comparison is, a unit 1, the differences are units of 1,000.

IRA FLATOW: Really?

ANTHONY FAUCI: So let me explain. The idea that the activists who pushed back and picked me out because I was a visible figure– one of the few people who was out there talking about HIV in the ’80s– there were not a lot of us there, and I was a federal employee, so I became the face of the federal government. The activists had some very valid concerns. And the authorities were not paying attention to them.

So they acted in a very theatrical, iconoclastic, and disruptive way to gain attention. They used exaggerated language, like you’re killing us, you’re a murderer, that kind of thing– hang you in effigy. But they were doing it for the purpose of getting our attention. And in some respects, that was a good thing because they got my attention. And when I started listening to what they were saying, they were making perfect sense. They had really important considerations that needed to be looked at and taken seriously– including them in the discussions of the scientific agenda, the clinical trial design, the rigidity of the regulatory process.

And I sat down with them and we talked about it. And we went from, gradually, their being adversarial to being cooperative to being colleagues, to now many of them are literally my closest friends. They were right all along. They were disruptive, but they made a point that was a valid point.

What you’re seeing now is attacks and slings and arrows that are based on misinformation, disinformation, and very strong political considerations. The differences are profound between the pushback in the HIV days and the pushback now.

IRA FLATOW: Speaking of pushback, when you look back on how COVID was handled from the very beginning, are there mistakes that were made that if we had to do it again– and we might have to– that you and the administration and society should do differently?

ANTHONY FAUCI: Yeah. Well, there’s some things that really worked, Ira, and some things that didn’t. So the thing that was the clear success story of all of this was the scientific approach. Namely, the fact that we had invested for decades on basic and fundamental and clinical science, in platform technology for vaccines, in structure-based immunogen design, in delineating the replication cycle of viruses in order to pinpoint vulnerable targets. That investment paid off to save millions of lives by getting us a vaccine in 11 months.

That was beyond anyone’s wildest expectations that we’d be able to do that. And it was a combination of investment in science and investment and implementation.

What didn’t go so well was what we thought was a good public health response. When you had a moving target like a virus the likes of which we had never seen before, the information that rolled out early on was not correct information. We didn’t fully appreciate how efficient it was in spreading. We didn’t get the right early information from China. We didn’t think or know that it would be aerosol spread. We approached it as a syndromic disease, where you knew who was sick by their symptoms, when in fact you had 50% to 60% of the transmissions were of people who had no symptoms at all. That was a total game changer.

So certainly, had we known all of those things early on, we could have done much, much better. But we didn’t. Sometimes we responded quickly enough and sometimes we didn’t. So there was no perfection in this from a public health standpoint, that’s for sure. Let’s hope we learn the lessons of what has happened for the future preparedness and response, particularly the idea of getting data in real time so that we could move as quickly as our moving target was moving.

IRA FLATOW: This is Science Friday, from WNYC Studios. We’re talking with Dr. Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases.

Let’s talk about some of the things that you’re most proud of in your research career at NIH, as the head of your division or even before then. What do you get up in the morning, think about and smile about your achievements?

ANTHONY FAUCI: Well, Ira, since I’ve been doing this so long and I’ve worn, I believe, three different types of hats– so when I think of the things I feel good about, one is as a scientist, when I came to the NIH very early on, well before HIV, when certainly nobody outside of inner group of scientists in that field even had any idea who I was, I had the luck and the privilege of working in a field of auto-inflammatory and autoimmune diseases, and developed highly effective therapies for inflammatory diseases of the vessels, called vasculitis. They’re rare. They’re unusual. But it was a major advance in people who had almost a 95% mortality rate, had a 93% remission rate. So that was as a scientist.

Then, when HIV came along, I– and I still do that to this day– have a laboratory that is delineating the pathogenic mechanisms of HIV. We weren’t alone in that. There were many, many very competent investigators in the field. But I believe our lab played a major role in understanding HIV pathogenesis. So that’s the scientific hat.

Then the hat as director of the National Institute of Allergy and Infectious Diseases, where one of the things I did right off was develop an AIDS program, and put an enormous amount of resources into understanding HIV, but, importantly, partnering with pharmaceutical companies to develop the multiple combination drugs that we have now that have resulted, literally, in transforming the lives of persons with HIV, to make them lead almost a normal life span. That I feel very good about because that’s a program that I started from scratch, again, with the help from a lot of very talented people. But I was the one that started that program.

Then, being in the position I was in, I had the opportunity to advise seven presidents. And among those experiences, the one that stands out was the fact that President George W. Bush– who did something that was extraordinary and for which he deserves great credit– tasked me to put together, as one of the principal architects of the President’s Emergency Plan for AIDS Relief, that provides treatment, care, and prevention for HIV for people in the developing world, particularly Southern Africa. I did that in 2002. The program was accepted in 2003. And thus far, it’s been responsible for saving 18 to 20 million lives throughout the world.

So again, other people will judge. But when you say, when I wake up in the morning and say, what have I done with the almost 60 years that I’ve been doing this, those are the three things that I think about.

IRA FLATOW: We’re going to take a short break. And when we come back, more conversation with Dr. Anthony Fauci. Stay with us.

This is Science Friday. I’m Ira Flatow. We’re talking with Dr. Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases.

I spoke with Dr. William Haseltine about the potential bad diseases lurking out there, ready to pounce. Do we have a plan– and not only a plan, but do we have the money, the resources– for dealing with the next one?

ANTHONY FAUCI: Well, the answer is, right now, no. And that’s unfortunate. We have a plan. There’s a pandemic preparedness plan that was put together, involving an all-of-government response that came out a while ago from OSTP, the Office of Science and Technology Policy. The total of that, from the standpoint of resources, the amount that would be needed, was tens and tens and tens of billions of dollars. We must say, to be perfectly fair, that the Congress has given an enormous amount of money for us to respond to the current outbreak.

However, that funding has now dried up. And that’s a real problem. Because if we want to continue to respond to the ongoing outbreak and be prepared for the inevitability– even though we don’t know when it will occur– of the next outbreak, we are going to need a continual consistent investment in resources. And for a variety of reasons, we don’t have that right now.

IRA FLATOW: If you had advice for the next head of the division who will be taking your place, what advice would you give that person?

ANTHONY FAUCI: Well, I don’t like to use the word advice. It’s somewhat, almost, presumption. I would explain to that person that you have to stick with the science, the evidence, and the data, and do whatever you can to get the best of the best involved in the field for which you are responsible– and NIAID is responsible for infectious diseases, immunity, immune system diseases, and allergy– and just go for it. Put everything you can into it, support the field, and work with the best scientists that you possibly can. And don’t be put aback or get involved in politics. Because as I think some very wise people have said, when you mix politics with science, you get politics. So keep science a pure discipline.

IRA FLATOW: Speaking of science, what is it about science that you think is most misunderstood or misconstrued by the public during a public health emergency?

ANTHONY FAUCI: Great question, Ira. I’m glad you asked that because that’s the source, I think, of a lot of the anti-science feeling, is a lack of an appreciation of what we in the field of science know– that science is an iterative, self-correcting process. You get data and information. If you are dealing with an evolving process that changes, like a virus that all of a sudden mutates and develops multiple waves of variance, what you say at point A may be relevant to point A. But if you follow the science and the changing aspect of the outbreak, what is true at point A evolves into point B, C and D. And what you may say at point D is different than what you said at point A because the data and the evidence have evolved. That’s what confuses people. They think it’s a static process, when science is a dynamic process to keep up with the evolving data.

And that’s why scientists kept saying, well, you flip-flop, you change your mind. No– you follow the data.

IRA FLATOW: Now, do you think it’s possible to change people’s minds? I’ve never found that people who’ve made up their mind and don’t want to listen to the facts or the data, they’re not going to change their mind.

ANTHONY FAUCI: Well, I think it is likely that not all of them will change their mind, but I really think it’s important, Ira, to continue to try and educate, and don’t give up. Because if you give up, you’ve really given into something that is antithetical to what we stand for. We’ve got to continue to try and get people to understand the importance of data, evidence, and science.

IRA FLATOW: You said, when you announced that you were going to be stepping down, that this was not the end of your career. What’s next? Have you got a book in progress? Where will we see you next?

ANTHONY FAUCI: I can only say for sure, Ira, that you will see me. I don’t know exactly the venue in which you will. Because according to the government ethical considerations for a person at my level in government, unless you want to recuse yourself from everything you do for the months that you’re stepping down– I don’t want to have to pull away from my responsibilities– so I can’t engage in any negotiations for positions outside of government until I actually step down. So I don’t know what I’m going to be doing.

What I would like to do is to use my multi, multi-decade experience to be able to advise and perhaps motivate and inspire young people to either get in science or, for people in science, to get them to really feel the same passion and the same motivation that I have felt in science. Whether I do that writing a book or lecturing or writing essays or advising people, I don’t know that yet.

But I decided to step down, Ira, at this point because I felt, while I still have some years of energy and passion and motivation, and thank goodness, good health, I want to be able to do that for a period of time. You’ve known me a long– and for those who don’t– I’m going to be 82 years old at the end of December. And it isn’t like I have 30 years to do something. So I want to step down at a time while I still can do it.

IRA FLATOW: Well, Tony, I want to thank you for your decades of public service. And I hope this won’t be the last time we talk.

ANTHONY FAUCI: I hope not, Ira. I’ll always look forward to chatting with you. We’ve had some great conversations over the years. Hopefully, we’ll continue to do that.

IRA FLATOW: Thank you. And good luck to you.

ANTHONY FAUCI: Thank you.

IRA FLATOW: Dr. Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases.

Copyright © 2022 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/.