Reviewer: Vincent J. Cirillo, Ph.D.

August 21, 2024

Two brand new viral diseases, AIDS and COVID, form bookends to Dr. Anthony Fauci’s sixty-year career as a physician, research scientist, administrator, and public health advocate. Most readers of On Call will jump immediately to the final three chapters that deal with COVID and the Trump administration, because COVID is still with us in endemic form, Fauci is still appearing before hostile congressional committees, and Trump is the 2024 GOP presidential candidate. In short, this story is fresh in the minds of the readers. Therefore, this review will take the unusual approach of starting with an aging Fauci contending with the COVID pandemic and proceeding backwards in time to his youth and the AIDS epidemic— mimicking the movie The Curious Case of Benjamin Button (2008).

The COVID Era

In a way COVID, Fauci, and Trump will always be linked. For example, on 3 June 2024, during the House Select Subcommittee on the Coronavirus Pandemic, Jamie Raskin (D-Md) correlated the “BIG LIE” that the 2020 election was stolen from Trump with the “BIG MEDICAL LIE” that Fauci was responsible for the COVID pandemic.¹ While the origin of the coronavirus is still debated, Fauci argues that it is most likely a natural spillover from an animal reservoir to humans – just as the SARS outbreak of 2002-2003 resulted from a natural spillover from a bat to a civet cat to humans.

Dr. Fauci, Director of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), first met President Trump on 29 January 2020 to brief him on a novel viral disease emanating from Wuhan, China. Two weeks later WHO designated the new disease COVID-19. With the number of cases and deaths from COVID rising daily, Trump, who was seeking a second term, anxiously sought some elixir that would cure the disease before the 2020 presidential election. The infamous “disinfectant” press briefing of 23 April 2020 fits into this category. While Dr. Deborah Birx, White House Coronavirus Task Force Coordinator, squirmed in her chair, Trump spewed his nonsense: “And then I see the disinfectant, where it knocks it out in a minute, one minute. And is there some way we can do that by injection inside or almost a cleaning?”² After this ridiculous suggestion of injecting bleach into people, the daily press conferences ended. Trump, however, did not give up, peddling hydroxychloroquine, an anti-malarial drug, as the magic bullet. Fauci warned Trump that hydroxychloroquine did not work and could be harmful. (The FDA later revoked emergency use of hydroxychloroquine after it was found to cause heart problems and even death.)

Fauci believed he had convinced Trump to tell the American people the truth about the seriousness of the COVID pandemic, suggesting that honesty would be the best policy. The very next day Trump spoke at a campaign rally where he exclaimed “COVID was the Democrats’ new hoax” (p. 360). This was the first but not the last time Trump double-crossed Fauci. In a stunning misjudgment of character, Fauci assumed that Trump, like some of his predecessors, “respected people who were not afraid to stand up to him (p. 400).” Fauci learned the hard way that the opposite was true. Trump surrounded himself with sycophants, from whom he demanded loyalty that went unrequited in return.

Fauci’s bêtes noires in the Trump administration were Mark Meadows, Trump’s chief of staff, Peter Navarro, Trump’s economic advisor, and Kaleigh McEnany, White House press secretary. The objective was to silence Fauci to cover up the fact that the pandemic was not under control. To their everlasting shame, they colluded to muzzle Fauci, stop him from appearing on the Sunday talk shows, and to discredit him with falsehood-laden op-eds. These actions caused a rift in Fauci’s relationship with Trump.

About this time, Trump named a new special assistant to the president. Scott Atlas, a neuroradiologist, told the president exactly what he wanted to hear. Fauci worried that Atlas was gaining too much influence within the White House and that his advice could be deleterious. People were getting sick with COVID every day and dying in great numbers. Atlas also undermined the efforts of Dr. Birx to the point where she resigned in January 2021.

There was a growing skepticism and distrust of science and scientists. As a scientist myself, I never thought I would witness such a loss of faith in science in my lifetime. Further, the spread of misinformation and disinformation through social media became the true enemy of public health.

Fauci was “consumed with anger” when he and his family were barraged with hate mail and death threats. He was especially outraged when his daughters were harassed with sexually explicit messages and threatened with violence. Fauci himself received an envelope containing white powder at his office at NIAID. Thankfully, it was neither ricin nor anthrax, but a harmless substance. Fauci was given a security detail for protection at home. “I think it’s safe to assume,” Fauci writes, “that the people who were lying about me and those who believed the lies for the most part were among the people who believed that the 2020 presidential election was stolen and that the January 6 attack on the Capitol either was justified or was a harmless demonstration” (p. 424).

In Operation Warp Speed, a multibillion-dollar program to accelerate the development of COVID vaccines, Fauci shows one of his finest qualities (fairness), when he states, “Operation Warp Speed was a transformational program, a public-private partnership about which the Trump administration should be justly proud” (p. 385). NIH’s Vaccine Research Center (VRC) collaborated with the pharmaceutical firms Moderna, Pfizer, and BioNTech to develop the mRNA process which proved faster and more precise than the old vaccine methodology. On 22 December 2020 the FDA approved the COVID vaccines – the fastest vaccine creation in history.

Fauci retired with the rank of rear admiral on 22 August 2022, but the abuse continued, as witnessed by the virulent rhetoric of recent congressional hearings. Attacking Fauci became a badge of allegiance for MAGA Republicans, the most villainous of whom were Senators Rand Paul (R-Ky) and Marjorie Taylor Greene (R-Ga), and Representative Jim Jordan (R-Ohio). They were trying to find a scapegoat for the more than 950,000 Americans who died of COVID-19.

Jerome Groopman, Professor of Medicine at Harvard Medical School, opined, “Even if the COVID-19 pandemic had not occurred, Fauci’s career would still have been one of the most consequential and most prominent in American medicine in the past fifty years.”³

The AIDS Era

Anthony Fauci was born on 24 December 1940 to first-generation Italian-American parents. He was educated in Catholic schools. He was taught by the Jesuits at Regis, an elite high school in Manhattan, and later at the College of Holy Cross in Worcester, Massachusetts. Under their religious guidance he learned a lifelong lesson: public service over personal gain. Fauci entered Cornell University Medical Center in September 1962 and graduated first in his class. Medicine was never a job for him, but a vocation. Following a residency and fellowship, he was hired by NIAID as a senior investigator researching the interface of infectious diseases and the immune system.

After reading a couple of articles in the summer of 1981 describing thirty-one homosexual men who had Kaposi’s sarcoma and/or Pneumocystis carinii pneumonia – rare conditions seen only in individuals with compromised immune systems – Fauci suspected that he was dealing with a new disease, one that was depressing the immune system and rendering these patients susceptible to opportunistic infections. Henry Masur, an intensive care specialist in Fauci’s group, was the lead author of an article in the December 1981 issue of the prestigious New England Journal of Medicine that described the first AIDS patients. At this time AIDS was known as gay-related immune deficiency or GRID. On 24 September 1982 the Centers for Disease Control (CDC) named the disease “Acquired Immunodeficiency Syndrome” or AIDS.

In 1984 French scientists Luc Montagnier and Françoise Barré-Sinoussi identified the causative agent of AIDS as human immunodeficiency virus (HIV). For this work they shared half of the 2008 Nobel Prize in Physiology or Medicine.

In November 1984 Fauci, now director of NIAID, fought hard to get NIAID’s annual budget for AIDS research increased to $147 million. While drug development was highly successful, an AIDS vaccine “is still nowhere in sight” (p. 146). In public lectures, TV interviews, and magazine articles Fauci raised awareness of the seriousness of the AIDS epidemic. He cited the alarming statistic that fifty percent of AIDS patients died within nine to ten months after diagnosis.

The NIH’s National Cancer Institute collaborated with scientists from Burroughs Wellcome Pharmaceutical Company to develop azidothymidine (AZT), the first drug effective against HIV in vitro. At this time Fauci became the government’s public face of AIDS research and the target of activists, notably Larry Kramer who published a newspaper article in June 1988 titled “I CALL YOU MURDERERS: An Open Letter to an Incompetent Idiot, Dr. Anthony Fauci.”

Most AIDS patients wanted access to drugs before they were approved by the FDA, because their life expectancy was years shorter than the drug approval process. In February 1989 Fauci invited several activists to meet with him at NIAID, which led to the “parallel track” initiative wherein experimental drugs were made available to AIDS patients outside of clinical trials. Kramer shouted, “Tony, I have called you a murderer in the past, but you are now my hero” (p. 107). Kramer died in May 2020. In their last phone conversation Kramer said, “I love you, Tony.” Fauci tearfully replied, “I love you too, Larry” (p. 117). “Which of Fauci’s current adversaries would be capable of such a transformation?”⁴

In a groundbreaking study on how HIV avoided detection in the body, Giuseppe Pantaleo and Fauci coauthored a paper in Nature (1993) in which they demonstrated that HIV was actively replicating in lymphoid tissue even when the patient showed no symptoms. This information was of great importance, because the lymphatic reservoir proved to be the major stumbling block to curing AIDS.

The era of highly effective anti-HIV treatment began with a regimen containing a triplet combination of antiretroviral drugs, the results of which were presented at Vancouver in July 1996. The combination of indinavir, AZT, and lamivudine produced incredible results. Blood levels of virus were undetectable and patients improved dramatically. Fauci was interviewed by CNN and explained that AIDS was no longer a death sentence. Life expectancy approached that of a normal population. Soon multiple pills were combined into one, called Atripla. Virus titers were so low HIV could not be passed onto an uninfected sexual partner. These drugs made it possible to end the HIV/AIDS epidemic without the need for a vaccine.

Somehow, with his long workdays and personal obligations, Fauci found the time to edit the frequently updated medical textbook Harrison’s Principles of Internal Medicine used throughout the country by medical students and residents in training.

On Call has no printed endnotes. Thus, the reader is inconvenienced by having to go to a designated URL to access them. The major flaw in this book is the absence of an index, making it needlessly difficult – if not impossible -- for readers to find information they seek.

References

^1. Benjamin Mueller and Sheryl Gay Stolberg, “Fauci Calls Claims He Hid Leak of Covid from Lab ‘Preposterous.’” N.Y. Times, 4 June 2024, p. A17.

^2. Deborah Birx, Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It’s Too Late (New York: HarperCollins Publishers, 2022), p. 190.

^3. Jerome Groopman, “The Plague Doctor: Anthony Fauci on What’s Ailing America,” The New Yorker, 24 June 2024, p. 50.

^4. Ibid., p. 54.