The Life Scientific: Anthony Fauci

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0:05Anthony Fauci:Pop quiz. What's in your kid's lunchbox? At Whole Foods Market, they've already done the studying. Over 300 food ingredients are banned from their shelves. No hydronated fats in the peanut butter and no high fructose corn syrup in the cookies. And for sandwiches, there are no synthetic nitrates or nitrites in any of their deli meat. So you can pack lunchboxes with peace of mind. Get back to school ready at Whole Foods Market.

1:04Today we're entering a world where medicine meets politics, a space that brings together scientific research, government wrangling, public pushbacks and healthcare conspiracies. My guest has not only helped prevent, diagnose and treat some of the world's most dangerous infectious diseases, he's also advised seven US presidents, from Ronald Reagan through to Joe Biden. Dr Anthony Fauci was the director of America's National Institute of Allergy and Infectious Diseases for four decades, during which time he was instrumental in developing life-saving treatments for HIV patients and leading the United States through the COVID-19 pandemic.

1:41Along the way, he's picked up something of a public profile and taken his fair share of flack, not least because of a complicated relationship with President Donald Trump. But Anthony maintains his greatest achievements are more about people than medicine. from winning over activists who initially challenged him on the government response to the HIV AIDS epidemic to spearheading a project sharing vital medication with developing nations, saving millions of lives. He says when you try to do things that are transformational, it's hard, but hopefully one day you'll look back and see them as positive and important.

2:15Dr Tony Fauci, welcome to The Life Scientific. Thank you very much. It's good to be with you. Tony, we're going to be talking about your work around HIV AIDS, a virus that shaped your life. But more recently, people remember your public messaging on COVID-19, perhaps also the differences of opinion with President Trump. How hard is it being the person who has to speak occasionally unpalatable scientific truths to power? Well, no one likes to be publicly contradictory to an authority, a political authority. But as a scientist and a clinician who's devoted his entire, you know, more than a half a century of career to science and medicine, you have a responsibility both for your own personal integrity as well as to the help of the public to make sure that what is said and what is recommended is based on good, solid scientific data.

3:12And when some people, whoever they may be, come out with statements or recommendations that are contrary to the scientific evidence, you have a responsibility to speak up and make sure that whatever is being considered is in the context of solid scientific information. Well, Tony Fauci, let's go back to the pre-medicine days where it all started. You were born in Brooklyn, New York in 1940. Your father was a pharmacist and together your parents ran the neighborhood drugstore. My parents' drugstore was a family hub of taking care of the community. The pharmacist was the neighborhood psychiatrist, the neighborhood marriage counselor, as well as someone who filled prescriptions.

4:01So from a very early age, I was incorporated into that feeling of service to the community. And I think that had a very positive influence, which led me, you know, into the field of medicine. Well, Tony, after school, you say you went to study medicine in Massachusetts. And after college, you got a place to continue your medical training at Cornell University. But I hear you were on campus there a year before joining as a student, as part of the construction crew, building a new library. Oh, yeah. I was working on a construction gang, and by pure happenstance, one of the construction assignments I had was to be a common laborer in the building of what turned out to be the library of the medical college.

4:51On one lunch hour, I walked into the front entrance to the medical school in the hospital, and I was all dirty with concrete and cement all over me. And one of the security people there looked at me like this dirty looking construction worker and said, what are you doing here? You can't walk in here. And I said rather boldly, sir, one day I'm going to be a student here. And he looked at me and laughed and said, yeah, and one day I'm going to be police commissioner of New York City.

5:32Well, you did go to Cornell. And a couple of years later secured a coveted role at the National Institute of Allergy and Infectious Diseases, known as NIAID. And it was in 1972, Tony, working alongside your mentor, Sheldon Wolfe, at NIAID's Laboratory of Clinical Investigation, that you had your first big breakthrough. This was to do with vasculitis, autoimmune conditions that inflame and damage blood vessels. What was it that you discovered? There were a group of diseases called inflammatory vasculitides, which means that the blood vessels in the lung and the kidney and sometimes in the brain would get inflamed by an autoreactive phenomenon.

6:17And the diseases had a mortality of close to 100%. And all therapies that had been tried for these diseases prolonged life a bit, but didn't cure anybody, we got the idea that if we could use those powerful drugs that were used for cancer chemotherapy, but only at a very low dose, that balanced suppressing the immune system just enough to suppress the aberrant inflammatory response, but not so much as to make the patient vulnerable to an opportunistic infection. So we designed a protocol to get the right dose for the right period of time. And much to our gratification, we induced a 93 % remission rate, which was totally transforming to the field.

7:15And that catapulted me into sort of a precocious and premature recognition in the medical community at a very young age. How then did you find that experience of success or the attention that you received? Well, the one thing you learn when you're trying to accomplish things is you have to have a degree of humility and not take yourself seriously to just do your work and do as best as you can. And so although I was obviously pleased, I still felt that there were a lot more things to be done. And I concentrated more on what needed to be done than on what I had already accomplished. Well, it certainly paved the way for your progression up the ranks of NIAID.

8:02And in 1980, you became head of its laboratory of immunoregulation. But there wasn't much time to celebrate because almost immediately you're confronted by this new and fatal virus. those very early days of HIV before the disease was understood, they must have been a really dark time for you and your colleagues. Yeah, I referred to it as the dark years of my professional life, and it even spilled over, you know, into my personal life in the sense that you can't every single day, try your best to save the lives of mostly young men and wind up seeing almost all of them dying. It was a very dark period, but a stimulus to do whatever we can to find out what was causing it.

8:56Could we do anything about it? Could we develop drugs for it? And how can we turn around this horrible pandemic. It must have also been a very frustrating time. I mean, listeners may remember that for a while, there was a real confusion around how the virus was contracted and spread. Yeah. And the general public were very concerned, you know, that don't go to a restaurant with a gay waiter, because you may get it done, which is crazy. I mean, it's not spread by casual contact at all. But that confusion was not just among the public, but even amongst the scientists themselves. In 1983, Tony, you published an article suggesting routine close contact as within a family household might be behind the spread, which was based on data available at the time.

9:42You corrected it once new information showed that wasn't the case. But it feels like a good example of how blindsided the scientific community was initially by this virus. Right. Whenever you're dealing with a new disease, you really have to consider it as a moving target. You've got to take the information you get at a given time and make decisions based on that. As new information comes, you analyze that information and you make decisions or recommendations based on the latest and most accurate scientific data. That's what science is all about. It's a self-correcting process. It is strange because in politics, admitting to mistakes is a weakness.

10:29In science, it's a strength. Otherwise, we wouldn't make progress if we stuck to whatever we always believed. In the mid-80s, Tony, you were made director of NIAID and also started advising the government on HIV-AIDS issues. With your White House role, you essentially became the face of the federal response to the HIV-AIDS epidemic and at the same time, of course, a target for criticism. Some felt it was an overly slow response, others that the gay community was being sidelined. At one point, protesters even turned up outside your office and burnt an effigy of you. How did you handle that level of anger and aggression?

11:07Well, I think the gay community were quite correct in that the way the scientific and the regulatory community were handling HIV AIDS was the standard way you would handle any other disease. Being very conservative in clinical trials and taking quite a long time to approve new drugs. And for other non-emergent diseases, this worked very well. But when you're dealing with a disease in which a person, they have an average of 10 to 12 to 15 months to live, something that takes years to do doesn't fit in with the very difficult situation. So what the gay community did, they tried to have a seat at the table so that they could have input into what the best approach is.

12:03One of the best things I did in all my life was instead of running away from them, I said to myself, let me listen to what they were saying. And what they were saying was making absolutely perfect sense. So I decided to bring them into our circle and to listen to what they had to say. And you discovered the first drug to treat AIDS in 1987. Yes, but even though it was the first drug, AZT, which slowed down the disease, soon, in almost everyone, the virus mutated to a resistant form and the patients relapsed, which led to our appreciation that we needed to develop combinations of drugs. And we did achieve that years later to the point where we are today, where we've completely turned around the projected course of a person with HIV.

13:03This is what you call the Lazarus effect. Yeah, it was because, you know, most of our patients were either dying or going to hospice. And then when we started this triple combination in 1996, that had the effect of completely and durably suppressing virus replication. So right now, if a 25-year-old comes into my clinic newly infected with HIV, I could tell that person that if they take their medicine regularly, it is very likely they would lead an almost normal lifespan. Quite remarkable. So by the mid 90s, you've made this huge progress in treating HIV AIDS. It was no longer a death sentence, as you say, or at least not in countries where these drugs were available.

13:52But that wasn't the case everywhere, which is why you turned your sights to Africa. Yes, I became very disturbed because by the time we got to the year 2001, one, even though drugs were available on the other side of the world in sub-Saharan Africa, they were not accessible. And the fact is that 90 percent of the infections with HIV are in the developing world and 67 percent are in sub-Saharan Africa. So I was pushing to deliver drugs and prevention to people in lower income countries, particularly sub-Saharan Africa. And the president told me to go to Africa.

14:37Anthony Fauci:And I did. I went there and I spent the next several months working with his staff to put together the president's emergency plan for AIDS relief or PEPFAR. And that was in 2002. And then 20 years later, we all got together with the president and his staff and looked at the data. And at that time, the program had already saved 25 million lives. Very remarkable. Pop quiz. What's in your kid's lunchbox? At Whole Foods Market, they've already done the studying. Over 300 food ingredients are banned from their shelves. No hydronated fats in the peanut butter and no high fructose corn syrup in the cookies.

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16:08Well, when it comes to infectious diseases, there's always more work to be done. And of course, in 2019, coronavirus struck. That January, Tony, 2020, you were asked to join the White House Coronavirus Task Force, set up by President Donald Trump in his first term. And once again, you became the public face of an administration's health messaging. But as we heard so often at the time, this pandemic was unprecedented. The experts were finding their way as things evolved. How difficult is it to deliver safe and credible guidance and keep the public on side when the situation keeps changing like that?

16:46It isn't easy and it has caused a considerable degree of confusion because, first of all, we did not do everything perfectly well. No one could do that when you're dealing with a raging outbreak that was unprecedented. But what the public didn't understand, and perhaps we in the public health arena did not articulate it forcefully enough, is that when you have a moving target, what you know in January, when you get to February and March, you change what you're saying because the scientific process, as I mentioned a bit ago, is self-correcting. However, the public got confused about why are the scientists telling us something one day and then a month later, they're telling us something different.

17:40And unfortunately, this took place in the middle of a profoundly divisive political situation. It was the ideal breeding ground for misinformation and conspiracies. But of course, it wasn't, as you say, only a public pushback. Many listeners will remember instances of the president himself contradicting your advice. What was that period like for you? Well, it was for me very difficult because, you know, having served so many presidents as a public servant, I have a great deal of respect for the office of the president of the United States. So when the president was saying things that were not correct based on scientific information, I was obligated to preserve my own personal integrity, but also to fulfill my responsibility to the American public to publicly contradict him when I was asked.

18:40I didn't proactively, you know, go against what he was saying. But when the press would ask me and say, the president said it's going to disappear like magic when the springtime comes and I had to say, no, there's no indication that it's going to disappear like magic. And then the president started listening to people who were saying things that were not based on science, that hydroxychloroquine is going to be the cure all or ivermectin is going to be the cure all. And based on the scientific data, I had to say, no, I'm sorry, I disagree. Unfortunately, that generated a wave of vitriol and antagonism and attempts to discredit me, which was very, very difficult.

19:26But I had to do it because I had to stick by my scientific principles. In 2021, Joe Biden was sworn in as president and he asked you to stay on as chief medical advisor. And when it came to the Covid vaccine, the vaccines were hailed by many as a game changer. But others were extremely suspicious about just how quickly they've been developed and possible unanticipated side effects. There were also more bizarre conspiracy theories. For example, the vaccines were a way for you or Bill Gates or whoever to microchip the global population. Having previously seen misinformation snowball with HIV, did you anticipate that sort of reaction?

20:05No, I think the amplifying effect of social media that we're all experiencing now is unlike anything we've seen in prior decades. I mean, you get a conspiracy theory, you put it in the social media, it explodes. And after people repeat it so many times, it becomes true to a substantial proportion of the people. It seems amazing that that's the case, but it does literally become truth to people, even though it's based on no solid information. One of the big fallouts, of course, from Covid and the rise of vaccine misinformation has been a drop off in people getting their children vaccinated. Just recently, measles resurfaced in the US.

20:53It had been eliminated nationwide back in 2000. But this new outbreak's been linked to declining child vaccination rates. So I'm very concerned about that. Very concerned. Because, you know, when you have a certain percentage of the population fall below that critical level of vaccination, once you start getting cases of measles, you potentially could have a major outbreak. So it is conceivable, I hope it doesn't happen, but it is conceivable that we could have a major outbreak of measles if people do not vaccinate their children. I hope that speaking truthfully and openly about the dangers of this will overcome the disinformation that says don't worry about it.

21:41Well, Tony, after spearheading the national COVID vaccine rollout in December 2022, you stepped down as chief medical advisor and as director of NIAID. After all you'd been through, was there a wrench or a relief? It was the time to step down because I was 81 years old. And I said to myself, thank goodness, I'm still energetic. I'm still passionate. What can I do to continue to make a positive impact on society. So I decided the best thing I could do is hopefully inspire young people particularly, but everyone, of the importance of science, medicine, and perhaps even get some young people to consider a career in public service.

22:30So I did two things. I wrote my memoir, and then I took a position as a distinguished university professor at Georgetown University, where I am right now speaking to you at Georgetown University, and I'm loving it. Like many countries, the US put together a government committee to review its pandemic response. You gave evidence to them last year and were challenged on various issues from the guidance around masks and distancing to a lack of transparency at the Institute, to allegations of a cover-up over COVID's origin. Now, on that last point, the leading theory amongst the majority of scientists is that this was a natural case of zoonosis, a virus jumping from animals to humans.

23:14But there are those who believe it was developed in a lab in Wuhan. In fact, this has become an extremely divisive debate in US politics. How much of a role does the science play in that particular debate, would you say? Well, I think, first of all, when you don't know definitively what the origin is, you have to keep an open mind. And that's what all of us have done. The idea about a cover up is nonsense. All the indication indicates that we weren't trying to cover anything up. But you have to say to yourself, if it is a lab leak versus a natural occurrence, even though both of those are possible, being possible doesn't mean equally probable.

23:57So you've got to look at your question, what does the science tell us? And right now, a number of very competent evolutionary virologists are looking at the data and feel strongly, although not definitively, and I'm underlying not definitively, that this is most likely an evolution of a natural spillover from an animal host. When you look at the data of this being a lab leak, there's no firm data at all to indicate that that's the case. Is it still possible? Absolutely. Do you keep an open mind that it might be? Absolutely. But the definitiveness, the way people declare that it's absolutely, is not based on any data that I've seen.

24:48My favourite saying for scientists is that we should always keep an open mind, but never so open that our brain falls out. Very good. Very good. With the benefit of hindsight, looking back on how the US and indeed the rest of the world handled the pandemic, what do you hope we've learned? What's going to help us deal better with any similar threat in the future? I mean, I think in the United States, one of the things I hope is that if we ever get confronted with another devastating outbreak like this, that we put aside political divisiveness and recognize that the common enemy is the virus. In some respects, we acted like the enemy was each other and the virus was out there doing what the virus was going to do.

25:37So, you know, obviously, when you're dealing with such a devastating situation, you could always do better. Mistakes are always made. But what one needs to do is to learn from that and not turn it into a greater wedge of divisiveness. We've talked about the flack you received for being a high profile figure during the pandemic. And listeners may know, one of former President Joe Biden's final official acts last year was to grant a preemptive pardon to you, despite the fact, I should say, that you haven't been charged with any crime. What was your reaction to that? Well, I think that the degree of accusations based on no reality against me was so strong that President Biden felt that it would be important to protect me from really essentially false accusations that would be pursued against me.

26:35And that's the reason why he said you should get a preemptive pardon, even though there was absolutely no admission of doing anything wrong. You've been very clear that you don't want to comment on President Trump's cabinet picks, including his health secretary, Robert F. Kennedy Jr. But speaking more broadly, how are you feeling about public health policy in the United States right now? Perhaps also research funding, which we hear a lot about at the moment. Yeah, I mean, I'm not going to comment on anything about what President Trump is doing, but I could say that the attacks on science right now and the cutting of very important scientific programs that have been lifesaving, not only in the United States, but throughout the world, is very ill-advised.

27:19And it would be really very tragic to lose the capability of doing so many of the good things we've been able to do through biomedical research and science. It's been a frenetic few years for world health in general. With so much to think about and indeed learn from, what would your advice be to the current US administration about improving and protecting the health of the American people, making American health great again, if you will? Well, I think you look at our track record and the investments in the fundamental basic and clinical research has been absolutely awesome in its positive impact, not only to the citizens of the United States, but to the rest of the world.

28:04We cannot lessen that because that is not only important for making the world a healthier place, but internationally, it's an important source of what we call soft power, the way we did with PEPFAR. So I hope that we continue this very strong investment in basic and clinical research. Tony Fauci, thank you very much for sharing your life scientific. My pleasure. It's really great to be with you.