Fauci responds to Musk’s Twitter attack and assesses the global COVID response
This month, Anthony Fauci will step down as director of the US National Institutes of Allergy and Infectious Diseases (NIAID) after more than 38 years in office and 54 years at his parent organization, the US National Institutes of Health (NIH). He has led the Institute under seven US Presidents, overseeing its research and response to the HIV/AIDS epidemic, the Ebola outbreak that began in West Africa in 2014, and the COVID-19 pandemic. The 81-year-old doctor and scientist became a household name during the pandemic, during which he was revered by some as a trusted advisor and belittled by others, including former US President Donald Trump, who saw his advice as contradictory and overbearing. On December 11, he was attacked on Twitter by Elon Musk, who took over the social media platform in October. Fauci spoke to Nature about Musk’s comments, the pandemic, and his own legacy.
As you think back over your decades at the NIH, in which area of infectious diseases have we made the most progress?
One of the most important is the area of HIV. When we first became aware of the cases of HIV in 1981, [it was] a mysterious disease of unknown etiology that killed virtually all those infected. It was one of the darkest periods of my or any infectious disease career. We went from that dark time of not knowing what was killing all these mostly young gay men to getting this [underlying virus], a diagnostic test and, within a few years, a whole range of drugs that combined have completely changed the lives of people living with HIV. We have also developed highly effective prevention methods using pre-exposure prophylaxis and [can treat] People who are infected, bringing virus levels below detectable levels so they don’t spread it to others.
Where will we see the next revolution in infectious diseases?
One of the holy grails of infection research is a safe and effective vaccine against HIV. We have made spectacular advances in the development of therapies, both to treat and prevent disease. But the only thing that has eluded us so far has been a safe and effective vaccine. That’s one of the things we look forward to. The other is the possibility, although in some ways it’s a long way off, to have a cure for HIV where you can achieve permanent suppression or elimination and eradication of the virus without further therapy. We’re not there yet, but it’s an ambitious goal.
Her former boss, former NIH director Francis Collins, bemoaned the lack of behavioral science research to better understand misinformation about vaccines and other aspects of public health. Do we need to rethink how we integrate the social sciences with “hard” biomedical science?
Yes we do. And you do it just by doing it. It’s not that difficult to integrate a social science discipline into the hard science discipline of vaccine development. It is very worrying that in our country 68% of the total population is vaccinated against COVID with the primary vaccine. Of these, only half received a single boost. And what is important [despite] the availability of an effective bivalent BA.4/5 booster vaccine update, only 13% of the eligible population have received it. It is very worrying and almost embarrassing for us that we have so little enthusiasm to get a life-saving vaccine.
Beyond vaccine hesitation, how can behavioral science play a role in pandemic response?
Another aspect that has been brought to the fore by COVID-19 is the importance of mental health and acknowledgment of the associated burdens [the pandemic] has had an impact on society: not only health workers, doctors and nurses, but also the general population, including children. [Their] growth and development was [shaped] not only from missing out on personal school, but also from the stress of losing grandparents and parents and seeing the disruption to the normal flow of their childhood. All of this has had a strong negative impact on mental health.
During the COVID-19 pandemic, we have seen governments censor scientists, skew data, and otherwise act in bad faith, complicating international cooperation to prevent pandemics. How can researchers pull this tricky line through?
That’s impossible to answer. When there are countries or groups that are not transparent, it is a major impediment to global public health efforts. And I hope that all countries in the world come to understand that we need to be fully cooperative, collaborative and transparent in everything we do because there is no such thing as a pandemic, especially an infectious disease that is transmitted through the respiratory tract , that will remain in one country. We saw that very painfully as COVID spread across the world and has already resulted in nearly seven million deaths and that’s probably a gross underestimate.
How would you rate the world’s response to the pandemic?
It is very difficult to give a Mass [answer], because when you are dealing with such a massive virus, you will suffer fatalities. But the world community, including the United States, could certainly have done better. The only success story was the rapid development and introduction of vaccines. What hasn’t been as successful is the public health response. Take this country as an example. Over the decades we have allowed our public health system to atrophy [by] don’t replace people who leave, don’t keep equipment up to date, don’t get [information] accessible in real time. We had to go to other countries to get real-time information: UK, Israel, South Africa. While in our reporting system, states are not required to report to the CDC [US Centers for Disease Control and Prevention]– The CDC must ask them to participate in the response. That really needs to change.
On Sunday, entrepreneur Elon Musk called for your indictment, claiming you lied to Congress and funded research that has killed millions of people. How do you react to the tweets?
I don’t pay attention to that, Max, and I don’t think I have to answer. I don’t tweet. I don’t have a twitter account. Much of this is just a cesspool of misinformation and I don’t waste a minute worrying about it.
Does Musk’s massive reach on Twitter make you feel unsafe?
Of course it’s endangered. That’s why I have armed federal agents with me all the time. This fuels a lot of hate from people who have no idea why they hate – they hate because someone like that is tweeting about it.
With that in mind, what advice would you give to young scientists who may be reconsidering their career choices after seeing some of the vitriol aimed at you and other public health officials during the pandemic?
I encourage you not to be put off because the satisfaction and magnitude of contribution you can make to society by entering public service and public health is immeasurable. It’s really extraordinary. It overcomes and counters all the other bad things. It is unfortunate that we are going through the attacks on public health officials. But the satisfaction and the benefits you can [achieve] in the field are great. And it certainly replaces all that other stuff.
I understand you’re still formulating your plans after you left the director’s post, is that correct?
Well, I will write and speak, and possibly [write] a memory. But I will certainly not retire in the traditional sense.
This article is reproduced with permission and was first published on December 13, 2022.