Fauci on the Politicization of Public Health

In this exclusive video interview, Jeremy Faust, MD, editor-in-chief of MedPage Today, talks to Anthony Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases (NIAID), about his new memoir, On Call: A Doctor’s Journey in Public Service.

In this video, Fauci discusses how public health has become politicized over the course of his career.

You can watch part 1 of the interview here.

The following is a transcript of their remarks:

Faust: You did something where you not only debated people who were pushing you to do more — you were debating your own side in a way, which was advocacy — but you also debated AIDS denialists, people who really had some far-out-there views.

Should we be debating people at that extreme who exist today in other areas? Or is it more like, no, those people are unreachable, let’s consolidate people who actually have a little bit clearer of a view of the world?

Fauci: I think debating them is not necessarily going to change their viewpoint. I mean, Peter Duesberg… no matter what you told Peter Duesberg, he was going to deny that HIV was the cause of AIDS. The reason that I debated him sometimes publicly on TV was because I wanted to let anyone who was listening to see how ill-founded his claims were when you look at data.

Unfortunately, his denialism resulted indirectly in the avoidable deaths of hundreds of thousands of South Africans when Thabo Mbeki and Manto Tshabalala-Msimang, his health minister, used the denialist theme to not subsidize the availability of antivirals for persons with HIV in South Africa.

So we should be debating them to point out the falseness of their claims; I don’t think we’re going to change their mind. I mean, I would be surprised if we would change their mind.

I think the point I made in the book — and it became clear when you went from one chapter to another — that the anti-vax movement has resulted in the avoidable hospitalization and deaths of a considerable number of people. And the interesting thing is that the analogy and the comparability of some of the denialists were scientists with very good credentials from Berkeley and Stanford.

You know, Peter Duesberg was from Berkeley, a PhD, National Academy of Sciences, and yet he was way, way off track on what he was saying. We see the same things with COVID when you have people from very established and highly ranked universities who have doctoral degrees, usually in an area that’s not the area that we’re talking about — you get economists and other people start talking about viral epidemiology and they’re a little bit out of their lane — but because of their degree and the institution they come from they often get believed, which is unfortunate and can lead to dire circumstances.

Faust: Why do you think that people, who ostensibly have the education and the background, get this wrong sometimes? People who [are] really way out and meandering in conspiracies or in misunderstandings of this virus, and I’m not going to name names, but people who ought to know better. What do you make of that?

Fauci: You know, it’s difficult to explain, Jeremy. I can’t get into their head, but what you see sometimes is that there’s a certain heady wine about having your name in the newspaper or getting on TV a lot. And you know when you say something outlandish, all of a sudden everybody’s clicking on that. The next thing you know, you’re being quoted as the person who stands for this.

And sometimes people say, “This feels good. I like having my name in the newspaper every week or being on whatever TV show you’re on.” And they say things that, you’re right, they should know better. You would imagine that they should know better. And yet they’re saying things that seem to be patently wrong by anybody’s imagination

Faust: Is the answer to that, especially with people who are highly visible and highly known, to bring them into your circle and say, “Hey, look, I’m not ignoring you. Let’s talk.”

I think a lot of what you’re saying is, yeah, there’s a desire to be in the paper to be relevant, but there’s also a desire to be consulted for your expertise and to be heard. There’s a quote: “There’s a difference between being contradicted and persecuted,” and I think people sometimes mistake those two things.

Next time around, should people on the inside of the White House or other public health agencies be reaching out to some of these people?

Fauci: Absolutely. Yeah, absolutely. And we have done that, and yet their response is, “You guys don’t know what you’re talking about. We’re right.” We really have, Jeremy.

And again, I don’t want to name names because I don’t want to get into that, but there were some very well-known people who held positions that were totally contrary to what we felt were good public health principles. We did bring them in and said, “Let’s talk about it,” and the response was, “Well, I know better than you about these things.” Even though their area of expertise was not in virology or epidemiology or infectious diseases, they acted like they were experts in that.

Faust: I will also say that a lot of these individuals didn’t set foot in a hospital or see a COVID patient, and I can tell that.

This reminded me of another part of your book, when you visited a field hospital in Iraq during the war, and you said, I believe, quote, nothing prepared you for what you saw. That actually struck me because nothing prepared Dr. Anthony Fauci, and you’ve seen a lot.

And I wonder if sometimes we go into things, we make policies not knowing what actually happens. We decide who to invade or what war to get involved in, or we decide what to do about a pandemic, but we haven’t really walked inside an ICU [intensive care unit]. Do you think that we are shielded, things like HIPAA [Health Insurance Portability and Accountability Act] or decorum shield people from realities that would make them think twice about everything from pandemic policy to foreign policy?

Fauci: Yeah. I think firsthand experience, Jeremy, is very, very helpful for getting you to appreciate the full extent of the challenge you’re dealing with.

That was one of the reasons why when we admitted very sick Ebola patients that I felt it was important for me to just take a 3-week period of time, put on my PPE [personal protective equipment], and be part of the team that was taking care of a patient who was desperately ill in an ICU setting. I’m not an ICU doc; I’m an infectious disease doc, but I went in there and helped out the ICU people. I was so-called supervisory to each of them, but I didn’t supervise anything. I just listened to what they told me to do because they were the experts.

But it was a very important experience for me to really appreciate that disease, to see it up close and personal.

Faust: It seemed like that disease — just to talk about the Ebola crisis, because again you’ve been at the forefront of so many fascinating and interesting crises — that was the first time I feel like, reading your book, that I got the sense that you noticed this political divide that was emerging.

That was no longer what I would call view 1.0 of Anthony Fauci, which is that everyone wants to do the right thing and both sides will surprise you in good ways and bad, into more 2.0 which was that the Republicans started to say some things that really made you seem betrayed, like they were losing their way. Why do you think that began to happen around that time?

Fauci: I just think it was the beginning of something that’s accelerated to the point where it’s just egregiously obvious in COVID, and that is the real divisiveness and the need to paint the other side as being wrong. And not only wrong, but bad. So I just think it was the beginning, sort of like the threshold of what we got into when things really exploded.

I’m just thinking now as we’re talking about this, I think the culmination — not the culmination, but one of the culminations of it was right now trying to figure out what are lessons learned from COVID? The questions you asked me in the beginning of the interview. What are some of the things that we’ve learned that we could do better the next time? What worked? What didn’t work?

All you had to do is take a look at that congressional hearing that I testified at a few weeks ago with Marjorie Taylor Greene going off the rails there. I mean, was that a “Let’s see how we can do better,” or was that an ad hominem vitriolic gotcha. That’s where we’ve arrived at, which is very unhelpful, to say the least.

Faust: And when I watch that I think to myself, what is the purpose of that kind of attack? And what is being done?

You’ve been on the record saying that we have to keep an open mind about the origin of COVID and sure, it’s most likely to be an animal virus, but we don’t know everything. But one thing that I think is disturbing is that the side that advances the lab leak theory generally is not pairing it with an outcome that is useful, such as, “Oh, if it did come from a lab, we really have to make sure that our research is done safely so that we can learn the most about pathogens and be prepared for next time.” It’s more about how can we blame somebody else and point our fingers towards either the Chinese government or Dr. Anthony Fauci.

Fauci: Right. No, that’s exactly right. It’s a total gotcha. It’s not, “How can we do better?”

Faust: But another place where you kind of got fed up — and again I go here because the future of public health is political, and I know you have always tried to rise above it — even you had trouble during Zika. You mentioned that during the Zika outbreak you lost some sleep or your blood pressure went up because there was some rider in a bill about Confederate flags and cemeteries.

Is that where we’re headed? That these crises are going to basically be opportunities for bad behavior?

Fauci: Yeah. Unfortunately it is, Jeremy. I see you read the book carefully, thank you.

Because I was struck by that. We were trying to get some funding in to respond to what was a public health crisis at the time, particularly in South America and the Caribbean, and the Republican put in this rider in the bill, which was laughable, like the ability to fly the Confederate flag at a national cemetery. Like, what are you talking about? It didn’t make any sense.

Faust: So knowing now that, going into public health, someone who wants to be the next Anthony Fauci or even along the spectrum of that, why would they do that? Aren’t they going to be dissuaded from that? Because they see that what it leads to is threats against you and your family. It leads to someone in Congress yelling and saying, “You’re not a doctor.”

What would you say to someone who is thinking about going into public health and public health research?

Fauci: You know, Jeremy, I would encourage them strongly to do it if they’re thinking about it, because the gratification and the feeling of accomplishment that you can have in the arena of public health in general and public service, which is intimately connected to public health, is worth the difficulties that we face.

It would be nice if we didn’t have that, but it would not discourage me from strongly encouraging younger people, even though they see some of the slings and arrows that we get subjected to by people who should know better. I still think the end game, the end of the day of what you can get out for yourself and for others, and the feeling of gratification you get about helping others in public health totally… all of life, Jeremy — I don’t want to get too philosophical — is a risk-benefit ratio. You take risks, and what’s the benefit? What’s the risk? And the benefit of pursuing your career in public health far outweighs, in my mind, the risks.

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