Episode Summary

Dr. Robert Gaynes, distinguished physician and professor of infectious diseases at Emory University, joins Meet the Microbiologist for the 2nd episode in a unique 3-part series, in which we share the impact of scientists at the heart of various paradigm shifts throughout scientific history. Here we discuss the life and career of Tony Fauci, the scientist who has been recognized as America’s Top Infectious Diseases Doctor and “voice of science” during the COVID-19 pandemic.

Gaynes is author of Germ Theory: Medical Pioneers in Infectious Diseases, the 2nd edition of which will publish in Spring 2023. All 3 scientists highlighted in this special MTM segment are also featured in the upcoming edition of the book.

Get the 1st ed. of Germ Theory, now. The 2nd ed. coming Spring 2023

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Ashley's Biggest Takeaways

  • Fauci was born in Brooklyn, New York.
  • He was a 2nd generation American whose grandparents came from Italy.
  • Fauci’s father was a pharmacist in Brooklyn and was very influential in his life.
  • During high school, Fauci worked behind the counter at the family pharmacy and even delivered prescriptions by bicycle.
  • He attended a Jesuit high school in Manhattan, and attended the College of Holy Cross.
  • After college, Fauci attended Cornell Medical School in Manhattan, which was his first choice of medical school.
  • Fauci graduated first in his class in medical school in the mid 1960’s, right in the midst of the Vietnam War.
  • During that time, after completing their initial residency training, virtually all doctors were drafted into one of the military services or the U.S. Public Health Service.
  • Fauci accepted into the NIH program within the U.S. Public Health Service, where he acquired training and a fellowship in Clinical Immunology and Infectious Diseases.
  • Fauci became the Director of the National Institute of Allergy and Infectious Disease (NIAID) in 1984.
  • Fauci served as advisor to 7 U.S. presidents, including Ronald Regan, George H.W. Bush, Bill Clinton, George W. Bush, Barack Obama, Donald Trump and Joe Biden.
  • 15 years after the creation of PEPFAR, Fauci reported, in the New England Journal of Medicine, that PEPFAR funded programs had provided antiretroviral therapy to 13.3 M people, averted 2.2 M perinatal HIV infections and provided care for more than 6.4 M orphans and vulnerable children.

Featured Quotes:

Gaynes: “I don't think it's really a stretch to realize how much microorganisms have affected and disrupted our lives.”

“In the long history of western medicine, history that goes back some 2,500 years, the idea that a microorganism can actually cause human disease is actually comparatively recent. It's only about 150-170 years old. I embarked on the 1st edition of “Germ Theory” to understand how we got here, how we learned this, and I did it by profiling some of the scientists, physicians and others who made some of the most important contributions to the germ theory of disease.”

“In terms of Dr. Fauci, I have realized his central role, not only as the voice of science during the COVID 19 pandemic, but all the other contributions that he's made in his ~40 years as the director of the U.S. National Institute for Allergy and Infectious Diseases (NIAID). Contributions that are much less well known. And I thought they bore some scrutiny to understand how the United States, and the world, have benefited from these contributions, his knowledge and his experience.”

“In his first 9 or 10 years at the NIH, he wrote over 100 scientific papers and book chapters, and received great recognition for his work on these unusual diseases. But he never gave up his interest in clinical infectious disease when he was on the clinical service at the NIH.”

 “He now had an interest in the body's immune response, and a strong background in diagnosing and treating infectious diseases. This, which is now in the very early 1980s, put him in a perfect position to study one of the most important microorganisms of the 20th century—HIV.”

“In June 2022, and we had our first interview, I talked with him about when he knew that AIDS, as it's now known, was really going to be a problem. This is what he said.”
 
Fauci: “I remember sitting back and saying to myself, this could be a brand-new disease. Because remember for those 9 years, in addition to my research, I was the infectious disease consultant for the NIH. And I never saw anything like this. Why all young gay men? And then why a very specific immunological defect, a diminution dramatically in their CD4+ T cells? I said, ‘Whoa, we have a likely infection that's destroying the immune system.’ And I just looked up and said, ‘If ever, my training was directly geared into this. I'm board certified in infectious disease. I'm board certified in immunology. And I'm a practicing immunosuppressive guy,’ it was like I was created for this disease.”
 
Gaynes: “Fauci (unlike a lot of other scientists who ignored ACT UP and other activists) began to reach out and [initiate] a dialogue with members of ACT UP. And I want to use his explanation to let you understand what his thinking was.

“One of the best things I did was when they were out there disrupting to get attention. I said, ‘Let me do something. Let me dial down the rhetoric, the theatrics, the attacks on me personally and listen to what they were saying. Because nobody was listening to what they were saying. And when you listen to what they were saying, they made absolutely perfect sense. And I did what I often do, even with a patient, put myself in their shoes and say, ‘What would I do if I were a young gay man that was either having a disease that we barely understood, and I was seeing all my friends die?’ I would do exactly the same what they did. So that's when I said, ‘I got to listen to these people.’ And once I did, that, we began a year’s long process of building up trust. It wasn't overnight. Finally, over a period of time, we really trusted each other, and they knew I was a person of my word. And I would never go back on my word—even though there were things we disagreed on, even at the best of our relationship.”

Gaynes: “One of their great complaints was the speed at which, for example, potential AIDS drugs were being tested and approved. And he felt that it was important to get a patient advocate on the committees that we're developing protocols for testing these drugs.”

Fauci: “I made it very clear that well informed and well-intentioned activists have a major, major positive impact on the scientific agenda, its development and its implementation. And it allows you to see what actually works in the trenches. It takes away that separatism between the Ivy Tower and what's going on in the community. It brings them together so that instead of making proclamations of what you can do with the community, you link up with the community and say what is feasible?”

“As they're ready to have a memorial for me someday, which will happen, I would love them to say one of the best things that I've ever done was to open up the door of the activist community.”

Gaynes: “The average approval time for some critical drugs fell from a decade to less than a year, and the character of various placebo-controlled trials was altered for good. And we now accept the idea of having a patient advocacy on various committees at all levels in science. But it was all owed to the insistence of Tony Fauci. And in many ways, not only were these changes done for the way AIDS drugs were approved, but they were also adopted for other diseases, ranging from cancer to all Alzheimer's disease. The impact of this can't be overstated.”

“His interaction with George W. Bush was perhaps the most important interaction he had with a US President."

Fauci:
“My interaction was really positive. I knew him before when he was in the White House with his dad. And we just talked to each other. And he relied on my judgment about how we could best protect the country against the bioterror attack, which after 911 was a real possibility. He gave me $1.5 billion in my institute to build up a bio defense program, I had the opportunity to convince him of something that he had an open mind for… instead of using all the resources to prepare for the unlikely threat of a deliberate bioterror, why don't we broaden it and protect the country against, what I told him was the worst bioterrorist, which was nature? Could we use the money not only to worry about smallpox and tularemia? But to worry about pandemic flu, and to worry about coronaviruses and to worry about other things. And he said, ‘That's a good idea; do it.’ So that's when I really got to know him.”

Gaynes: “Well, we talked a bit about when he was first aware of how bad the COVID 19 pandemic was, was, or when it was going to really be a global health concern. And if you remember, back in 2003, when the SARS-CoV-1 outbreak that began in China, one of the problems was that the Chinese officials initially covered up the outbreak for weeks before they revealed the epidemic. And they apologized and pledged openness for future outbreaks. That openness was severely tested in 2020. So I asked when he was aware of the looming threat, and this is what Fauci said.”

Fauci: “We were not allowed in there to see what was going on. And then, after a while—a couple of weeks—when we saw the Chinese building these 10,000 bed hospitals over a 10-day period, we said, ‘Wait a minute, why would they be building 10,000 bed hospitals with a construction program to put up buildings, in literally 2 weeks, unless something really bad was going on there. And that's when I knew they had a problem. The real question was, could it be contained?”

Gaynes: “Fauci has always recognized that politics and intrudes in scientific matters, particularly in times of crises, but he did say that the COVID-19 pandemic was something different."

Fauci:
“The divisiveness along party lines was as deep and profound as I've ever seen it under any circumstances. And instead of taking, what I call, the unified approach of putting ideological differences aside, and realizing the common enemy is the virus, and let's all pull together against this virus, decisions about masking, about vaccines, about shutting down about congregating—about anything—were sharply divided along ideological lines, which is the worst possible thing that you can do when you're trying to get your arms around and control a deadly outbreak.”

Gaynes: “One of the things that I try when I teach medical students is that, in medicine, you need to be very careful about using the words ‘always’ or ‘never.’ But there are times when you can use those words. And one of the things that I've learned is that when you play politics against diseases, diseases that affect public health, the diseases always win. Always.”

“The story of COVID-19 is still incomplete. But there are lessons that we can already take from this pandemic. [Fauci spoke to some of these]."

Fauci:
“One is scientific preparedness and response, and the other is public health preparedness and response.”

 
“Early on, we've got to get the rest of the world to remember that no one is to blame when there is an outbreak. So no one should feel that they have to cover up or downplay something. They need to be as open and honest as possible. We've got to make sure that we have the capability of globally responding as a global community, not as individual nations. We need to continue to support the basic and clinical biomedical research. But we've got to do much better in our public health security plans and our capabilities of being transparent, interactive, cooperative, collaborative.”

Links for the Episode:

From the ancient worlds of Hippocrates and Avicenna to the early 20th century hospitals of Paul Ehrlich and Lillian Wald to the modern-day laboratories of François Barré-Sinoussi and Barry Marshall, Germ Theory brings to life the inspiring stories of medical pioneers whose work helped change the very fabric of our understanding of how we think about and treat infectious diseases.

Get the 1st ed. of Germ Theory, now. The 2nd ed. coming Spring 2023

The second edition of Germ Theory, which will include chapters on Françoise Barré-Sinoussi, Barry Marshall and Tony Fauci, will publish in Spring 2023. Keep an eye on our site for updates.

Let us know what you thought about this episode by tweeting at us @ASMicrobiology or leaving a comment on facebook.com/asmfan.

Tony Fauci 1984 in front of a microscope