Fauci talks about AIDS and COVID during SF visit

  • by Liz Highleyman, BAR Contributor
  • Monday July 15, 2024
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Dr. Diane Havlir, left, chief of the HIV, Infectious Diseases and Global Medicine Division at Zuckerberg San Francisco General Hospital and Trauma Center, interviews Dr. Anthony Fauci June 25 at Manny's, where he was promoting his new memoir. Photo: Liz Highleyman
Dr. Diane Havlir, left, chief of the HIV, Infectious Diseases and Global Medicine Division at Zuckerberg San Francisco General Hospital and Trauma Center, interviews Dr. Anthony Fauci June 25 at Manny's, where he was promoting his new memoir. Photo: Liz Highleyman

With his new memoir a national bestseller, Dr. Anthony Fauci was in San Francisco recently to talk about his accomplishments and regrets over half a century as a leading national health official.

Speaking to a capacity crowd late last month at Manny's, the gay-owned cafe and event space in the Mission district, Fauci, the former head of the National Institute of Allergy and Infectious Diseases, was in town June 25 to promote his new book, "On Call: A Doctor's Journey in Public Service" (Viking).

While Fauci, 83, is best known to the general public as the face of the government's COVID response, many locals admire him for his leadership on HIV/AIDS, to which he devotes the bulk of his nearly 500-page tome. Fauci gave several shout-outs to the city in his interview with Dr. Diane Havlir, chief of the HIV, Infectious Diseases and Global Medicine Division at Zuckerberg San Francisco General Hospital and Trauma Center.

Fauci "was a hero among medical scientists decades before he became a household name," Havlir said. She recalled the time in 2010 when she told him that the city would offer immediate treatment to everyone diagnosed with HIV, bucking the consensus at the time. "That's a bold move," Fauci replied. Before long, universal treatment became the global standard of care.

Born and raised in Brooklyn, New York, Fauci joined NIAID after completing his medical residency in the late 1960s, embarking on a successful career developing effective treatment for a deadly autoimmune inflammatory disease. His combined training in infectious diseases and immunology proved invaluable when the AIDS pandemic struck.

In the summer of 1981, a copy of the CDC's Morbidity and Mortality Weekly Report landed on his desk, describing a group of five young gay men in Los Angeles with a strange type of pneumonia. "I got chills looking at this," he recalled. It appeared to be a brand-new disease, and based on its epidemiology, it was spreading by sexual contact.

Soon very ill young men began arriving at the National Institutes of Health Clinical Center. During the "dark years," with no good treatments, it felt like "putting Band-Aids on a hemorrhage," Fauci said. Although discouraged by mentors who thought it would derail his career, he said his shift to AIDS "was the best thing I ever did in my life."

Fauci was appointed director of NIAID in 1984, a position he agreed to accept only if he could continue his research and patient care. He soon came under fire from people with AIDS who were consumed by pain, fear, and anger. Writing in the San Francisco Examiner in 1988, the late ACT UP co-founder Larry Kramer called him an "incompetent idiot." But Fauci listened to the activists, and "they made perfect sense," he recalled. "I said to myself, 'if I were in their shoes, I would do exactly what they were doing.'"

Fauci described a 1989 town hall meeting in San Francisco where Project Inform founder Martin Delaney — "the intellectual, cerebral version" of Kramer, he said — convinced him to publicly support a "parallel track" that allowed people who did not qualify for clinical trials to access experimental therapies. After a protest at NIH headquarters, Fauci invited several activists to the table. "It turned out to be one of the greatest collaborations of an advocacy group with the scientific and regulatory community," which to this day serves as an example for people with other diseases, he said.

Fauci, who describes himself as non-political, is proud of working effectively with seven presidents from both parties.

In the late 1990s, Fauci persuaded former President Bill Clinton (D) to start the multidisciplinary NIH Vaccine Research Center. Despite decades of research, the hope for an HIV vaccine remains unrealized. For years, Fauci told audiences at AIDS conferences that he believed such a vaccine was possible, but the failure of several large clinical trials has dampened his certainty. Nonetheless, basic science done at the center laid the groundwork for the development of COVID vaccines in less than a year.

Fauci offered enthusiastic praise for former President George W. Bush (R), who launched the President's Emergency Plan for AIDS Relief, or PEPFAR, in 2003. After visiting Africa in 2000 and seeing that people there were still dying like they did in the U.S. in the 1980s, Fauci decided something needed to be done. "Fortunately, for me, for the world, for Africa, for all of us, President George W. Bush felt exactly the same way," he said. The program, which provides HIV prevention and treatment in low-income countries, has been credited with saving 25 million lives worldwide.

COVID pandemic

As Fauci dealt with Ebola virus and Zika virus outbreaks during then-President Barack Obama's (D) administration, he began to see hints of the politicization of public health that would define the COVID era. Fauci first heard about the coronavirus early in January 2020 when a reporter called him and said something strange was going on in China.

As the face of the pandemic response, Fauci was lauded by many, and his likeness appeared on candles, socks, and doughnuts. He graced the cover of a fashion magazine (InStyle), threw out the first pitch at baseball games, and did a memorable Instagram interview with Stephen Curry of the Golden State Warriors. But he also took the brunt of criticism about lockdowns, shifting advice on masks, school closures, and vaccine mandates. Eventually, the vitriol reached a point where he and his family received death threats and required a security detail.

Such precautions were evident at Manny's. The windows of the community space at 16th and Valencia streets were covered, and the audience was subject to bag checks and metal detectors reminiscent of major stadium events. After Fauci's talk, onlookers on the sidewalk craned their necks over a police cordon as he was whisked away in a black SUV.

Fauci's penultimate chapter on former President Donald Trump's (R) administration is entitled, "He Loves Me, He Loves Me Not." At first, his relationship with Trump was "really good," he said, but it deteriorated by the summer of 2020 and worsened in the run-up to the November election. While Trump himself went from cursing Fauci to praising him, his staff and millions of his fans were furious, accusing him of undermining the president. Despite his respect for the office of the presidency, Fauci felt he had to correct Trump's misinformation. "I had my own personal integrity to preserve," he said.

Even after his retirement at the end of 2022, Fauci continues to face accusations — on social media, in the conservative press, and at congressional hearings — about issues ranging from his role in covering up an alleged lab leak of the coronavirus, which he denies, to funding cruel experiments on beagles.

The political division around COVID and the resulting erosion of trust in science are among Fauci's big regrets. Like everyone involved in the pandemic response, he made some errors, which he was sometimes slow to acknowledge. He admits that he and other health officials should have made it clearer from the beginning how little was known about the virus and that recommendations would change as information evolved.

"If you have a society that doesn't have any faith in the scientific process, particularly a society that is really torn apart by misinformation and disinformation," he said, "people are so used to hearing things that are not true that they don't know, or even care anymore, what's true. And once you get to that, then you have an erosion of society, erosion of the social order, and I think an erosion of democracy."

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