Dr. Anthony (Tony) Fauci is an internist, specialist in infectious diseases who spent his entire career at the NIH (National Institute of Health) in Washington as a clinician and researcher. For almost forty years, from 1984, he was responsible for the department responsible for research into infectious and immunological diseases. But Tony Fauci is best known as an advisor on health issues to seven presidents of the United States, continuously from Reagan to Biden, in a transpartisan manner. He also worked with Republican and Democratic administrations. He had to manage the emergence of infectious diseases in a world where they were thought to be on the verge of extinction. His notoriety is therefore immense, hero for many, demon for others. Anthony Fauci recounts this experience in a memoir titled We call (“On Guard”), published recently (Viking edition, not translated).
A fascinating work, which reads like an adventure book. However, there is talk of major risks for our health. Fauci experienced the emergence of AIDS in 1981, the threats of influenza epidemics (1997, 2003 and 2009), bioterrorism with the anthrax episode in 2001, the emergence of Zika and of course the Covid pandemic from 2020. So many experiences calling for rapid and coordinated reactions from public health authorities, which he knew how to instigate. This book is an essential testimony to the importance of scientific expertise – what is known, what is not – among political decision-makers. Fauci was able to gain the trust of the presidents of the United States, their advisors, and the chambers (Senate and representatives) to make them aware of the threats and the need for energetic and… costly interventions. He was able to mobilize the scientific community, but also industrialists, to engage in research into these diseases (origins of AIDS, finding drugs, vaccines). It must be said that Fauci had financial leverage through NIH research funds, but he also obtained additional credits on numerous occasions.
Facing Donald Trump, an incredible fight
His qualities, his intelligence, his foresight, allowed him to involve the communities of patients concerned in these efforts. It is remarkable to see the extent to which he was able to take into account the concerns and demands of the American homosexual community regarding AIDS. It was not easy given the certainly understandable aggressiveness of the activists, but he also knew how to establish bonds of respect and trust. He was thus able to launch the direct involvement of patients in AIDS studies. It was overall a success, American research developed effective treatments to contain the hitherto inevitable evolution of the virus. Aware of the global nature of the progression of HIV, he was able to convince presidents that an aid fund would make antiretroviral treatments available in poor countries.
Fauci maintained throughout his career a capacity for judgment independent of the political and industrial worlds, a quality required for an expert. He was able to benefit from the fact that the American administration is open to the idea that scientific research is an asset, if only as an element contributing to the greatness of the country. But Fauci was also able to perceive the limits and dangers of his action during the Covid pandemic. Faced with Trump, despite his remarkable communication skills, Fauci had a hard time. This president made as many declarations of love as he threatened him, harassed him and tried to prevent him from speaking out, for example when Trump wanted to promote hydroxychloroquine as a treatment for Covid. Fauci courageously resisted, for the benefit of his country’s public health. He was also able to see the fact that promoting the best scientific research, although it is essential, is not enough to develop an effective public health policy in a country handicapped by a failing healthcare system for the poorest.
His work is an indispensable testimony, retracing a contemporary and exemplary human adventure, which touches on what is most dear to us, our health.
Alain Fischer is president of the Academy of Sciences and co-founder of the Institute of Genetic Diseases.
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