If any heroes emerge from the COVID-19 outbreak, one of them will likely be a man widely considered one of the heroes of the AIDS epidemic — Anthony Fauci.
Fauci, who has been unafraid to speak the truth about the new coronavirus strain and counter the misinformation put out by Donald Trump, has been director of the National Institute of Allergy and Infectious Diseases since 1984, but he was dealing with AIDS almost from the time it was identified.
He joined NIAID, which is part of the National Institutes of Health, as a senior researcher in 1972, after completing medical school and his residency. “Over a period of 10 years, from 1972 to 1981, I was a rather successful clinical immunologist-type person with a clinical interest in infectious disease,” he told the Science Speaks blog in 2011. Then he started reading about gay men in major American cities developing Pneumocystis pneumonia, something seen in cancer patients and people with severely depressed immune systems.
When he read the second report on the outbreak of PCP in gay men who seemed healthy otherwise, “It was the first time in my medical career I actually got goose pimples,” he told the blog. “I no longer dismissed it as a curiosity. There was something very wrong here. This was really a new microbe of some sort, acting like a sexually transmitted disease.” He began treating and doing research on the men with these infections.
“As soon as I began seeing these patients with this mystery disease with no name, I decided I needed to change my career direction,” Fauci told The Lancet last year. “My mentors were shocked that I was abandoning a promising career, but my priority was admitting these unusual patients, studying them, and hopefully helping them. I had gone from saving the lives of people with autoimmune diseases to admitting patients with a virus with a near 100 percent mortality. The frustration and bleakness of those years was almost suffocating. Those were the darkest years of my career.”
What would soon be dubbed gay-related immune deficiency, or GRID, then acquired immune deficiency syndrome, or AIDS, and eventually, the human immunodeficiency virus (HIV), was identified as the cause. When Fauci started seeing patients with the syndrome, the median survival time after diagnosis was 28 weeks.
When Fauci became director of NIAID, he and other federal government officials, including President Ronald Reagan, were much criticized for a slow response to AIDS. Reagan may not have taken the criticism to heart, but Fauci did.
“When the activists started to appropriately react to the rigidity of the clinical trials [to research anti-HIV drugs], for instance, they started storming the NIH and burning people like me in effigies, and Larry Kramer, now a close friend, was calling me a murderer,” he told Science Speaks. “The best thing I’ve done from a sociological and community standpoint was to embrace the activists. Instead of rejecting them, I listened to them.”
In his Lancet interview, Fauci said, “I realized that most of what they were saying made perfect sense.” (Kramer, it should be noted, has remained willing to criticize Fauci, as he did in a 2015 Advocate commentary, saying Fauci and other government health leaders were dragging their feet on an AIDS cure.)
In the 1980s, Fauci helped to speed up clinical trials and open them to some patients who had been rejected earlier. The first treatment for HIV, AZT, was approved by the Food and Drug Administration in 1987, but it was hardly a panacea, as it had many side effects. But Fauci also oversaw research into drugs that proved a life-changer and life-extender for people with HIV, the combination therapies introduced in 1996.
“We went from 28 weeks median survival to now, in 2011, where the mathematical modeling of a 20-something-year-old person with recently diagnosed HIV who is put on antiretroviral therapy will live at least another 50 — that’s five zero — years,” he told Science Speaks. “That is one of the most profound accomplishments in the relationship of biomedical research and drug development and clinical outcome.”
He counts the development of these drugs as one of his career highlights, along with playing a major role in formulating President George W. Bush’s program to fight HIV and AIDS overseas, which became known as the President’s Emergency Plan for AIDS Relief, or PEPFAR. His efforts have won much praise from his peers.
“By the time I finished my training in infectious disease in the 1990s, patients in high-income countries with HIV were surviving and able to come home, and pediatric AIDS was almost wiped out,” Paul Farmer, Kolokotrones University Professor of Global Health and Social Medicine at Harvard Medical School, told The Lancet. “More than anyone else, Tony Fauci was responsible for this turnaround. He then transferred this success to the poorest regions of the world … [and] was an architect of President George W. Bush’s massive and humane AIDS program, today known as PEPFAR.”
Fauci, while addressing other public health crises such as SARS, Ebola, and now COVID-19, has remained tuned into HIV and AIDS. He’s an advocate for making treatment as prevention and pre-exposure prophylaxis more widely accessible, and he’s enthusiastic about research into an HIV vaccine. He may at times be overly optimistic about some things, like how soon an HIV vaccine can come to fruition, but that does help convince Congress to come up with the money, Thomas Frieden, former director of the Centers for Disease Control and Prevention, recently told The New York Times.
But in getting the word out about COVID-19, Fauci hasn’t been afraid to contradict Trump’s unrealistic projections. After Trump said a vaccine would be available soon, Fauci told reporters no, more like 12 to 18 months, the Times notes. He also corrected Trump’s talk about a cure to say there was a greater possibility of a treatment to lessen symptoms and there was no basis for the president’s prediction that COVID-19 would be gone by spring. But he did it all tactfully.
“I think Tony is playing the same exact role that he has in the past — to make sure the science is accurate and clear,” Donna Shalala, the former secretary of Health and Human Services and now a member of the U.S. House, told the Times. “During a health emergency, it’s the scientists and physicians that are the credible people to the American public, not politicians.”
“There are a lot of world-class scientists, but Tony has a special set of skills,” she added. “An ability to communicate, high integrity, and an understanding of politics — and to know to stay out of politics in order to protect scientists.”