Anthony Fauci: ‘We are living in the perfect storm’ | Free to read
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I hear Anthony Fauci before I see him. Out of view of our video call, he asks his tech assistant: “Have you wiped down the table?” The assistant, who has already sprayed down the 79-year-old’s chair, hurries to disinfect the desk. The top adviser on the White House’s coronavirus task force cannot afford to fall ill.
Of all the unenviable jobs in this pandemic, Dr Fauci may have the trickiest. He is a leading public health scientist in a world growing suspicious of expertise; an affable self-described humanist in a society where soundbites get more play than sound advice. After 36 years as director of the US National Institute of Allergy and Infectious Diseases, he is facing a challenge that eclipses even the epidemics he has previously battled — Aids and Sars.
Now, Fauci reports to his sixth president: Donald Trump. The president flouts his advice — refusing to wear a mask and holding rallies — and, Fauci tells me, hasn’t even met him for more than a month. Trump appears to me to be preoccupied with polls and economic data, rather than the soaring case counts in the country hardest hit by Covid-19 in terms of confirmed cases and deaths.
We meet this week as the situation is becoming even more dire. Overflowing hospitals in Houston are beginning to look like New York’s in April, while areas of states including Texas, California, Arizona and Florida are starting to shut back down.
“I don’t think it’s an exaggeration to say we have a serious ongoing problem, right now, as we speak,” Fauci says, in an accent tinged by his native Brooklyn. He warned Congress late last month that the number of new cases could rise to 100,000 a day. “What worries me is the slope of the curve,” he explains, using his fingers to draw a chart in the air. “It still looks like it’s exponential.”
Fauci arrived on screen by bouncing into his padded beige chair at his office in Bethesda, Maryland, wearing a blue shirt and tie. Energetic in spite of his advancing years, he still has more wrinkles and grey hairs than Brad Pitt, who played him on Saturday Night Live, a sign of his sudden popularity with Americans craving sober leadership.
He displays his turkey and provolone sandwich to the camera. “You destroyed my routine!” he jokes.
Fauci does not normally have lunch, lasting through his 17- or 18-hour workdays on breakfast alone, before returning home for dinner. Worried that this would be a lunchless Lunch, I prodded him by text message the day before. I am touched that he took the time to make his own chunky roll in the morning before work.
I have also made my own lunch, harvesting cup-loads of basil from my plot in a Brooklyn community garden, a welcome addition to my lockdown life. I used it to make pesto for my spaghetti, a brasher green than store-bought sauce.
Waving half the roll in one hand, Fauci tells me the problem is that many states started opening up before their cases got down to a baseline level where new cases could easily be tracked. “I think we have to realise that some states jumped ahead of themselves. Other states did it correctly,” he says. “But the citizenry didn’t listen to the guidelines and they decided they were going to stay in bars and go to congregations of crowds and celebrations.”
The country will not respond well to locking down again, he fears. He thinks health officials need to get the message across to young people in particular that they are not “in a vacuum”, where their disease affects only themselves.
The spreading distrust of experts makes everything harder. “That is a real problem. We can’t run away from it,” he says. Fauci may have developed a fan base that is snapping up Fauci T-shirts, mugs and bobblehead dolls — but he has also been disparaged and even received death threats from people who believe coronavirus is a con.
The US has always valued individual rights, he says, but warns that this could make it hard to tackle the pandemic, even when we have a vaccine. “Our forefathers . . . had the guts to come by boat from Europe and wherever else. That’s the general spirit: you don’t always trust authority,” he says. Now it has been taken to an “extreme”, with a movement against science and authority helping to form “the foundation for the anti-vaccine movement, that we don’t trust what the government is telling us. That is very, very problematic right now.”
Fauci last saw Trump in person at the White House on June 2 — and says he has not briefed the president for at least two months. He tells me this in a matter-of-fact tone, but I suspect that his indifference is feigned. While Trump holds potential superspreader events, Fauci meets with the task force run by the vice-president.
He says he is “sure” that his messages are passed along — but Trump is evidently not listening. On July 4, the president declared that 99 per cent of Covid-19 cases were “harmless”. Stephen Hahn, the US Food and Drug Administration commissioner, refused to tell CNN whether this was right or wrong. So I try Fauci: “Is Trump wrong?”
Anthony Fauci in Bethesda, Maryland
Homemade turkey and provolone sandwich
Hannah Kuchler in Brooklyn, New York
Wholewheat spaghetti with homemade pesto
Iced Earl Grey tea
He chuckles, deflecting by calling it the “famous question”. Fauci tries to account for it as an accidental error, rather than part of a pattern of the president playing down the pandemic. “I’m trying to figure out where the president got that number. What I think happened is that someone told him that the general mortality is about 1 per cent. And he interpreted, therefore, that 99 per cent is not a problem, when that’s obviously not the case,” he says.
In fact, Fauci believes some of the “extreme confusion” about the virus is because it affects people so differently, from the asymptomatic to patients on ventilators. “I have never seen a virus or any pathogen that has such a broad range of manifestations,” he says. “Even if it doesn’t kill you, even if it doesn’t put you in the hospital, it can make you seriously ill.”
Coughing at an inopportune moment, he jests: “That’s not Covid, that’s my sandwich.”
Fauci has a fine line to tread. In an interview with Science magazine in March, he said that when Trump makes a mistake, he prefers to get Trump’s advisers to correct him for next time. “I can’t jump in front of the microphone and push him down,” he said, a comment that he tells me caused a “tussle”.
At times, Trump has seemed to have lost patience with Fauci. In early May, the White House stopped him testifying in front of Congress — although he has presented himself to answer questions more recently. Now, it is reported that the White House is preventing him from appearing on TV.
“I have a reputation, as you probably have figured out, of speaking the truth at all times and not sugar-coating things. And that may be one of the reasons why I haven’t been on television very much lately,” he says.
Fauci can be blunt — but he clearly also tries to hold back, believing he will make a bigger difference to the course of the pandemic if he keeps his job.
I wonder when he does have a responsibility to jump in front of the microphone. Trump’s wild suggestion that injecting disinfectant could help to treat Covid-19 appears to have affected public health. A survey from the US Centers for Disease Control and Prevention found that about one in three have been using it unsafely to try to protect against Covid-19, including ingesting it or applying it on their skin. I ask Fauci: has he spoken out about why this is not wise?
“I wasn’t there when it happened,” he says, in what seems to me a poor excuse. “I think that Dr Birx was put in the uncomfortable position of sitting there when he said that.”
Deborah Birx, another senior doctor on the coronavirus task force, later explained the president’s comments by saying he was “still digesting” new information about the power of disinfectant when he spoke to the press.
Fauci studied classics alongside his pre-med degree. He is an accomplished scientist, having published more than 1,300 papers, but he is just as interested in how to lead and engage people with his message. Classics helped him understand “the human species”, he says.
His work during the Aids crisis won him the praise of both President Bushes. At first, Fauci was accused by activists of being a murderer because the government was dragging its heels in the hunt for treatments. But he became friends with some, including the late playwright Larry Kramer, as he brought them into the fold. He responded to their campaigning and created a programme to make unapproved drugs available to HIV and Aids patients, even as clinical trials continued.
In a presidential debate in 1988, the older Bush described Fauci as one of his heroes. I ask Fauci if he thinks Trump would do the same. He rocks back in his seat with a belly laugh.
“What a loaded question that is,” he says. But he quickly finds his answer — telling the truth but keeping the peace. “You know, it’s unpredictable what he’ll do,” he replies.
Fauci’s “day job” is leading the $6bn institute searching for a vaccine that could end the pandemic. I ask him for a realistic timeline for a vaccine. He says he believes that “barring any glitches, bumps in the road or potholes”, one could be ready by the end of the year. It is a timeline that other experts have called optimistic.
The US government’s Operation Warp Speed has partnered with several companies, including Johnson & Johnson, Moderna and Novavax, to help fund trials or manufacturing. This funding should accelerate the process — but it could also exacerbate international tensions over who gets a vaccine first. Should the US have first dibs because it is pouring in billions of dollars?
“It’s not that we have a lock on the market at all,” Fauci insists. “I’m in total favour of pushing for the success of multiple candidates . . . The world needs multiple successes, so that different companies can use their resources to produce vaccines to make it available throughout the world and not just for the rich countries.”
Protectionism was on the rise before the pandemic. We spoke the day before Trump wrote to the World Health Organization to officially start to withdraw from it, though the move was in the works. Fauci has worked with the WHO throughout his career and believes it is an “imperfect organisation” that has “made mistakes in the past” — but he will not criticise its actions during the Covid-19 era, and laments as “really unfortunate” the tension between the organisation and the US government.
Even at home, there are questions about whether a vaccine would be affordable to the more than 27m Americans without health insurance. Fauci is sure that everyone will have access — but the details have not been worked out.
“We are going to make sure we negotiate a reasonable price,” he says. Yet there is a yawning gap between what pharma companies see as reasonable and what patients feel able to afford. Last week, Gilead priced its Covid-19 drug remdesivir at $2,340 for a course of treatment in a developed country. Wall Street analysts were surprised that Gilead priced it so low — and activists were shocked that it was priced so high.
The rush to grant emergency authorisation to the antimalarial drug hydroxychloroquine as a treatment for the disease, despite significant side-effects, has some worried that a vaccine approval could be raced through. Hydroxychloroquine’s emergency authorisation has now been revoked.
Fauci says the process must be transparent in order to regain trust. He tells me the government is already starting community engagement to teach the importance of the vaccine. In particular, he is concerned about minority groups including Latinx, African-Americans and Native Americans, more vulnerable to Covid-19 but also more distrustful “because they’ve been mistreated by authority for a very long time”.
“We’ve got to do some serious reaching out. Because the one thing you don’t want is a vaccine that protects people who are not nearly as vulnerable as the ones you want to protect,” he says.
Fauci has finished his sandwich and declared it “not bad”. My pesto is creamy but I seemed to have served myself enough for two, so I have pushed the plate aside. I sip my iced tea and try to forget that I’m talking to a scientific luminary from my bedroom.
The doctor still goes to the office — and even admits to having had a private, mask-wearing haircut after week 12, so that he didn’t become the “shag rug guy” on TV — but there is little doubt that his life has changed even more than most of ours.
He admits he was not prepared for being played by Pitt, but he understands why Fauci-mania has taken off. “I believe, in fact I’m certain, that the country, in a very stressful time, needed a symbol of someone who tells the truth, which I do,” he explains.
Yet large swaths of the country do not want to hear the truth. Some regional and local public health officials have resigned after threats of violence from opponents who view themselves as freedom fighters, resisting rules about mask-wearing and social distancing.
Fauci turns sombre as he thinks of the impact on his loved ones, including his wife Christine Grady, a nurse and bioethicist who also works at the National Institutes of Health, and his three adult daughters. “I’ve gotten death threats. My family has been harassed, my wife and my children. That required my getting security protection for a while,” he says.
Will he retire when this is over? “I will retire when I perceive, or the people that are close to me perceive, that I’m not doing 100 per cent. Right now, I haven’t lost any of my energy,” he says.
As he heads off to an afternoon coronavirus task force briefing where he expects an “intense” discussion about state surges, he imparts a message that is far from sugar-coated. He wants me to know that this pandemic really is “the big one”. Covid-19 has the worst elements of previous epidemics combined. “You have a random virus jump species from an animal to a human that is spectacularly efficient in spreading from human to human, and has a high degree, relatively speaking, of morbidity and mortality,” he says. “We are living in the perfect storm right now.”
Hannah Kuchler is the FT’s US pharma and biotech correspondent
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