IHI Forum: Dr. Fauci Reflects on the Challenges from a Distinguished Career

By Jay Kumar

As he reflected on his work during the HIV/AIDS crisis and the COVID-19 pandemic, Dr. Anthony Fauci urged attendees at the IHI Forum to continue the hard work of patient safety and healthcare quality despite the current environment of mistrust.

“What we are trying to do, to preserve the health of our patients, is much, much more important than that other stuff,” he told IHI President Emeritus Donald Berwick in a lively conversation before a packed house. “Don’t give up what you’re doing.”

The current polarization of opinions about medicine is challenging, said Fauci, who served as director of the National Institute of Allergy and Infectious Diseases (NIAID) for 38 years and advised seven presidents on medical and public health preparedness.

“Healthcare providers are under attack by a substantial proportion of the population, which is led by a substantial proportion of leaders of this country,” he noted.

The attacks picked up during the COVID pandemic, but Fauci said he tried not to let them distract him.

“Our mission for the health of this country is too important,” he said, noting that the attacks have extended to supporters and his family.

“That’s the new cowardly thing that’s being done. They’re not just attacking you, they attack your family,” said Fauci. “I have three daughters who get attacked because of me.”

When he was focusing on helping develop a COVID vaccine, Fauci said he tuned out the noise.

“In order to get that intensity of effort, you’ve got to have the focus of a laser on what you’re doing,” he said. “Don’t get distracted, just focus on what you do.”

Fauci also gave credit to President Donald Trump for investing in the development of a COVID vaccine. “It wouldn’t have happened without Operation Warp Speed,” he said, adding that it was a high-risk investment.

“That investment globally has saved tens of millions of lives,” which in turn saved $1 trillion, he said.

Defending science

Despite the successful development of a COVID vaccine, the pandemic stoked controversy over trust in science.

“We certainly have a significant and unfortunate amount of mistrust in science and scientists,” said Fauci. “It is unfortunate that there is a lack of understanding of what the scientific process is.”

The information we had about COVID in January 2020 ended up changing as we learned more about the disease, he added. The disease was spread by people with no symptoms, something that wasn’t known when it first emerged. Some were skeptical that the message about how the disease spread was changing, but Fauci said if the data about the disease changes, the recommendations need to change.

“That was complicated by the fact that sometimes the messaging was garbled,” he said. “We could have done a better job with that.”

Now, four years later, there are multiple strains of COVID, and the Omicron strain has about 50 branches, said Fauci.

“It’s a very dynamic situation and that’s very difficult. Both sides have to be better,” he said. “The scientific community has to be much clearer in how we explain the situation.”

The conspiracy theorists have gotten a lot of attention, which hasn’t helped. But as Fauci said, “You’re not going to hear each other unless you listen to each other.”

Listening to your critics

In the case of the AIDS crisis of the early 1980s, “the scientific community wasn’t listening to the activist community,” Fauci said.

Researchers were struggling to understand the deadly new disease, he added. The standard way the biomedical community worked on disease research wasn’t working with HIV, and the seeming lack of attention to the issue from the federal government led activists to ramp up their efforts.

“I was the public face of the outbreak,” said Fauci. “They started attacking me.”

But when he decided to listen to the activists’ complaints, Fauci realized “what they were saying was making absolute perfect sense.” He met with them and eventually the clinical trials process changed and a drug to treat HIV was developed.

Fauci gave President George W. Bush credit for encouraging him in 2000 to lead the effort to help African countries fund the production of HIV drugs, which Fauci said eventually saved 25 million lives.

The next big thing

Asked by Berwick what he thinks the next big disease outbreak will be, Fauci noted that decades before COVID hit, he was quoted that he always feared the evolution of a virus that jumps from animals to humans.

“Along comes COVID and my worst nightmare comes true,” he said. “Now it’s the same thing…It could be an influenza or it could be another coronavirus.”

As a generalist, Fauci said, he’s distressed by the chronic health issues plaguing the U.S. such as hypertension, drug abuse, and obesity. These problems are especially difficult for minority populations and the underprivileged.

“The life expectancy in our country is going in the wrong direction,” he said. “For the richest country in the world, that’s beyond unacceptable.”