At the October 13, 1988 Presidential Debate,
Michael Dukakis and George HW Bush were asked
“Who are the heroes who are there in American
life today, who are the ones that you would
point out to young Americans as figures who
should inspire this country?”
“Jaime Escalante.”
“Valladares”
“Those people that took us back into space
again.”
“Sports heroes.”
Vice President Bush eventually responded with:
“I think of Dr. Fauci, probably never heard
of him.
You did.
Ann heard of him.
He’s a very fine researcher, top doctor
at National Institute of Health, working hard
doing something about research on this disease
of AIDS.”
Today, Dr. Anthony S. Fauci is best known
because of his position in the Coronavirus
task force and for his many media appearances.
In the U.S., he’s one of the most recognizable
faces in the current crisis.
How did this doctor go from his research lab
in Bethesda, Maryland to becoming one of the
most visible medical experts on the pandemic
today?
“Dr. Fauci.”
“Dr. Fauci thanks so much for taking the
time.”
“Dr. Fauci.”
“Dr. Anthony Fauci.”
The June 5, 1981 weekly report by the Centers
for Disease Control was a notable one.
It recorded 5 unusual cases of pneumonia.
These cases would become known as some of
the earliest reports of AIDS.
The next year, Dr. Anthony Fauci wrote an
early paper about the disease, which had increased
to “290 recognized cases” and had become
“a public health problem of essentially
epidemic proportions.”
Fauci worked at the National Institute of
Allergy and Infectious Diseases, NIAID, heading
up a lab that studied immune system response.
NIAID conducts research on diseases to help
understand, treat and prevent them.
It falls under the National Institutes of
Health or NIH -- the medical research agency
part of the Department of Health and Human
Services.
In the early '80s, the NIH had 15 institutes
- with NIAID and National Cancer Institute
leading investigation of the new virus and
disease that would become known as HIV/AIDS.
Fauci made that investigation the focus of
his career.
“Today we’re going to be listening to
Dr. Anthony Fauci, he’s going to be talking
about AIDS.”
“I’m working directly on AIDS, both clinically
and on a basic science standpoint.
It really is one of the few, or actually one
of the only subjects...where you really have
to change your lecture every month.”
Fauci was named director of NIAID in 1984,
and the then Director of Health and Human
Services highlighted Fauci’s background
in “immunology and infectious diseases”
as a main reason for his appointment.
“A major effort was directed at determining
if a variant of this virus could actually
cause depletion of lymphocytes, or Acquired
Immunodeficiency Syndrome.
And as it turned out, a variant of that virus
in fact caused the syndrome.”
Fauci’s leading early research helped define
NIAID as the central NIH institute for AIDS.
And he made it a point to be the person communicating
key findings to the public and media.
“The scientific data is overwhelming that
in fact AIDS cannot be transmitted by casual
contact.”
But it was a later political test that shows
how Fauci navigated the AIDS crisis and secured
his career.
In the summer of 1988, playwright Larry Kramer
wrote an open letter to Anthony Fauci, calling
him an “incompetent idiot”, and a “murderer.”
His opinion was broadly reflective of activists,
most notably the organization Kramer inspired,
the AIDS Coalition to Unleash Power, or ACT
UP.
In 1986, Fauci had reinforced his position
as the leading scientist for the Federal AIDS
effort.
He created a new division to focus on the
disease and earned other significant NIH posts.
But progress was slow, especially for a disease
as deadly as AIDS, where patients died, on
average, 15 months after diagnosis.
Fauci and NIAID were responsible for starting
trials for new drugs, which the
FDA, required for approval.
In June 1986, NIAID created a network of clinical
trial centers around the country, though they
were criticized as ineffective.
Activists argued that the NIH, the FDA, and
leadership up to President Reagan had failed
to take the crisis seriously.
This photo from an October 1988 protest shows
the key complaints.
At the time, the FDA’s lengthy drug approvals
required strict scientific clinical trials.
It was textbook science, but the disease killed
at a faster pace than the FDA’s process.
If you entered a trial, a certain percentage
of patients got the drug, and a certain percentage
got a placebo.
This helped test if the drugs were safe and
if they really worked — that was important,
because many AIDS drugs didn’t pan out.
But with AIDS, getting a placebo was a death
sentence.
And that meant fewer volunteers for clinical
trials.
The epidemic needed a radical approach.
But experimental approaches like aerosolized
pentamidine weren’t being approved.
The drug helped treat one of the most common
infections caused by AIDS.
Yet, trials had been delayed by NIAID, which
Fauci blamed on insufficient staff.
Under pressure, he acknowledged the approval
problem in 1988, testifying in Congress that
he would “go for what is available on the
street” if he were a patient — a blunt
rebuke to FDA policy keeping these new approaches
out of reach.
Fauci also went on to admit that it took them
a “long time” to start trials of Dextran
Sulfate, a drug that had early enthusiasm
among AIDS patients.
For the few approved options, like the then-promising
drug AZT, activists criticized the high prices
charged by maker Burroughs Wellcome.
All these issues had spawned large networks
of Buyers Clubs — AIDS patients who pooled
their resources to import non-FDA approved
drugs.
In 1990, activists staged another major protest
- this time at the NIH in Bethesda, Maryland,
where Fauci worked.
It was a turning point.
In two key ways, Fauci incorporated the sharp
activist criticisms and ideas into the government
response.
In 1990, NIAID invited activist representatives
into the administrative committees for every
AIDS Clinical Trial Group.
This allowed for the government response to
include on-the-ground knowledge.
Starting in 1989, Fauci had also voiced support
for a new program called parallel track, forcing
the FDA to consider it.
In it, patients who couldn’t participate
in clinical trials could still get unapproved
drugs, once they’d been tested for basic
safety.
Even if some drugs didn’t work, at least
they would be available to try.
The day ACTUP stormed the NIH, in May 1990,
the Federal Register published the FDA’s
plans to adopt a parallel track plan.
“I’m Doctor Anthony Fauci.”
19 years before Brad Pitt played Anthony Fauci
on Saturday Night Live, SNL castmember Chris
Kattan played him in 2001—
“Thank you.”
—during an anthrax scare.
Two decades ago, Fauci was already the face
of public health response to unusual diseases.
That included everything from Anthrax and
flu updates to running the US Government’s
massive AIDS treatment program in Africa under
President George W. Bush.
All that’s helped his relationship with
activists — Fauci called Larry Kramer “a
dear friend who was a long time nemesis….
I remember he wanted to get my attention by
writing an open letter to ‘that incompetent
idiot’ Dr. Tony Fauci.
He needed to stir the pot.”
By staying in the same role at NIAID since
1984, Fauci became a fixture across five NIH
directors, eight Centers for disease control
directors, and eight surgeons general.
They’re appointed by the President - and
Fauci’s been around for 6 of them.
As the Director of NIAID, he’s insulated
from that political element.
The AIDS response in particular illustrates
how Fauci manages stakeholders - from inside
and outside the government, and from above
and below his position.
That and his scientific expertise, has made
him a constant during a new crisis too.
“Our recent advances of being able to isolate,
identify, and characterize the agent together
with the advances in understanding the history
and pathophysiology of this disease will allow
us over the next year to come back to you
to tell you that we not only have hope and
hypothesis, but that we have real prevention
and indeed a real cure.
Thank you.”
