Dr. Fauci On Vaccinations And Biden's 'Refreshing' Approach To COVID-19

Feb 4, 2021
Originally published on February 6, 2021 6:53 pm

Less than three weeks into the new Biden administration, Dr. Anthony Fauci, the infectious disease expert who has headed up the National Institute of Allergy and Infectious Diseases since 1984, is encouraged by the new president's approach to the COVID-19 pandemic.

"It was very clear what President Biden wanted ... and that is that science was going to rule," Fauci says. "That we were going to base whatever we do, our recommendations or guidelines ... on sound scientific evidence and sound scientific data."

But there was something else that Biden promised, which Fauci found equally reassuring: "He said, 'We're going to make some mistakes along the way. We're going to stumble a bit. And when that happens, we're not going to blame anybody. We're just going to fix it.' "

"Boy, was that refreshing," Fauci says.

Fauci has worked with seven presidents, from Ronald Reagan to Joe Biden. Much of his career has been devoted to researching viruses and the immune system. During the AIDS epidemic, he made major contributions to the understanding of how HIV affects the immune system and was instrumental in developing drugs that could prolong the lives of people with HIV.

During the COVID-19 pandemic, Fauci became something of a medical celebrity as a member of the former administration's coronavirus task force who publicly disagreed with President Donald Trump about COVID-19 treatment, the value of masks and about the timeline for reopening. In return, Trump called Fauci an "idiot" and tweeted about firing him.

"What I think happened is that the [Trump] White House, in general — the president — was looking for people who were saying things that were compatible with what his feeling was about, where he wanted to go," Fauci says.

Looking ahead, Fauci says the pandemic is far from over — especially as the virus mutates and new strains emerge. He says controlling the spread of the virus will help tamp down mutations. The key is to vaccinate "as many people as quickly and as efficiently as you possibly can" and "to double down on the public health measures of uniform wearing of masks, physical distancing, avoiding congregate settings — particularly indoors."

Fauci notes that any vaccination efforts should address the needs of the larger global population.

"You've got to be able to get — with the help of the developed world — the entire world vaccinated," he says. "As we allow this infection to exist to any degree in any part of the world, it will always be a threat. So we've got to approach this the way we approach smallpox, the way we approach polio, and the way we approach measles and other devastating global outbreaks."


Interview highlights

On the major new mutations in the coronavirus and how that affects our strategy to fight it

I think people need to understand something that's very important: RNA viruses — SARS-CoV-2 is an RNA virus — will mutate, and the more the virus replicates, the more opportunity you give it to mutate. So when you have so much infection in the community, as we have had in the United States over the last few months, where you literally have hundreds of thousands of new infections per day — we were up to between 300,000 to 400,000 [cases] a day. We're down now between 100,000 to 200,000 per day. But we still have 3,000 to 4,000 deaths per day. That means the virus has almost an open playing field to replicate, [which] means you give it an opportunity to mutate.

So even though this is a challenge, we should not be set back by this. We can meet the challenge and you meet the challenge by first getting a handle on the degree of mutations by doing good genomic surveillance, No. 1, but No. 2, by doing whatever you can to prevent the replication of the virus — by vaccinating as many people as quickly and as efficiently as you possibly can.

And also to double down on the public health measures of uniform wearing of masks, physical distancing, avoiding congregate settings, particularly indoors.

One of the things that we do know is that the vaccines that we have, although they are less effective in preventing disease ... when you look at serious disease with hospitalizations and deaths, the vaccines still have a pretty important, positive effect even on the mutants.

But we don't want to get confident about that. We've got to be able to match future vaccines and upgrade them to be able to be directed specifically at these troublesome mutants that have evolved.

On the misleading idea that a good way to conquer COVID-19 might be to simply let more people get infected and gain immunity that way

[Trump] wanted to focus on things other than the pandemic. So anyone who would come in, like [coronavirus adviser] Dr. [Scott] Atlas, and say, "Just let people get infected, you'll get herd immunity and everything will be fine" was a welcome strategy or a welcome philosophy.

But as it turns out — and we know right now very clearly — that that was an incorrect strategy, if you actually pursued a strategy of "don't try and intervene. Don't wear a mask. Don't worry about congregate settings, just let the virus take its course and try and protect the vulnerable." ... We cannot effectively protect the vulnerable [that way], because they were such an important part of our population.

So if you look at the number of people right now who have died, it's close to 450,000 people. And if you look at the seroprevalence in the country — how many people already will have gotten infected — there are certain areas where it's high, 20-plus%. But as an average for the country, it's probably somewhere less than 20%, which means that if you wanted to get the 70 or 85% of the people that need to be infected to give you herd immunity, a lot more people will have died. We've already had 430,000 [to] 450,000 people who have died, and we aren't even anywhere close to herd immunity.

On the origin of the FDA's "emergency use authorization," which has been used to speed COVID-19 vaccines to market

To get a drug out as quickly as you possibly can, based on the fact that the benefit looks like it was better than the risk and you didn't have to fully show efficacy yet, originated way back during the years of HIV. Compassionate use of a drug — even before you get an emergency use authorization — originated way back in the days of HIV, because we didn't have compassionate use to any great extent until we got into the situation with HIV in the early and mid 1980s. So there's a very good connection between some of the things that we're doing now with interventions for COVID-19 that actually originated way back when we were doing HIV in its very early years.

On two things he learned from the AIDS epidemic that he's applying to the COVID-19 pandemic now

One of them is the importance of getting the community involved and dealing with the community and their special needs. ... We have a disparity here that is striking and needs to be addressed — that if you look at the incidence of infection and the incidence of serious disease, including hospitalization and deaths, brown and Black people suffer disproportionately more than whites. ...

So I think that shines a bright light on what we probably should have done all along and certainly must do in the future, is to address those social determinants of health that actually lead to the great disparity of suffering in COVID-19 among brown and Black people. We had the same sort of thing with the disparities of infection in certain demographic groups with HIV. So from an epidemiological standpoint, there were similarities there.

We also learned the importance of fundamental basic science in getting solutions. ... Back in the early days, getting infected with HIV was a virtual death sentence for the overwhelming majority. ... It was the fundamental basic science of targeted drug development that allowed us to develop combinations of drugs — first single drugs and then a couple at a time, and then triple and more combinations of drugs — that ultimately completely transformed the lives of people living with HIV, to the point where you went from a virtual death sentence to being able to lead essentially a normal life, as well as not infecting anybody else. ...

We know now that something we've called "treatment as prevention" [works] — which means if you treat someone who's living with HIV and suppressed the level of virus to below detectable, you make it essentially impossible for that person to infect someone else. So we got there through basic science.

On being vilified by AIDS activists early on in the AIDS crisis, who believed the government should expand access to experimental medicines, and how that compares to being vilified during the COVID-19 pandemic by people who are anti-science and anti-mask

That really is a stark contrast. The [AIDS] activists were justified in their concerns that the government (even though they weren't doing it deliberately) were not actually giving them a seat at the table to be able to have their own input into things that would ultimately affect their lives. So, even though they were very theatrical, they were very iconoclastic, they seemed like they were threatening, ... never for a single moment did I ever feel myself threatened by the AIDS activist.

In fact, one particular situation, I think, was very telling. At a time when there was a lot of pushback against the government and not listening to the valid concerns of the activists, I was invited to go down — and I went with just one of my staff at the time — to go down essentially alone to the gay and lesbian community center in the middle of Greenwich Village to meet with what must have been anywhere from 50 to 100 activists in this meeting room. Just me and one of my staff. And they were angry with the federal government because they felt the federal government was not listening to them, and they were right — I think they had a really good point.

Not for a second, did I feel physically threatened to go down there, not even close. I mean, that's not the nature of what the protest was. And I think one of the things about it was that not only were they not threatening at all in a violent way, but ultimately they were [also] on the right side of history.

On his early research into the AIDS epidemic, visiting gay bathhouses to gain a better understanding of the then-mysterious outbreak that was killing gay men

This was the very, very early years of the outbreak. In fact, it may even have been before we even discovered that HIV was the cause. And we were seeing these large numbers of mostly gay men who were formerly otherwise well, who were being devastated by this terrible, mysterious disease. And it was so concentrated in the gay community that I really wanted to get a feel for what was going on there that would lead to this explosion of a sexually transmitted disease. So I did. I went to the Castro District [of San Francisco]. I went down to Greenwich Village and I went into the bathhouses to essentially see what was going on.

And the epidemiologist in me went, "Oh, my goodness, this is a perfect setup for an explosion of a sexually transmitted disease!" And the same thing going to the gay bars and seeing what was going on. And it gave me a great insight into the explosiveness of the outbreak of a sexually transmitted disease. So I think it was important, because it gave me a really on-the-ground feel for what was actually dynamically going on.

On whether COVID-19 will be with us forever like influenza

I don't think we need to make that assumption. That certainly is a possibility — that you would have enough virus floating around and changing from year to year, that you would have to treat it in some respects, the way we treat seasonal influenza, where you have to upgrade the vaccine almost every year.

There is a way, if done properly, to avoid that, and that is, for example, if we successfully vaccinate 70 to 85% of the people in the United States and dramatically diminish the level of infection — if we were living in a vacuum in only the United States, then I don't think we'd have to worry about seasonal turnover and having to match. But we live in a global community and unless we get the rest of the world adequately vaccinated and unless we don't have the opportunity of this virus to mutate in a place that doesn't have access to vaccines, we will always be threatened.

Fresh Air's interview with Dr. Fauci was recorded as part of a WHYY Zoom event at which Fauci accepted WHYY's annual Lifelong Learning Award.

Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

Copyright 2021 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. My guest, Dr. Anthony Fauci, America's top infectious disease expert, has become a hero to many Americans for his scientifically based straight talk about the coronavirus. He became a medical celebrity during the press briefings from President Trump's coronavirus task force, which Dr. Fauci served on. He's been the head of NIAID, the National Institute of Allergy and Infectious Diseases, since 1984, working with seven presidents from Reagan to Biden. None of that stopped Trump from calling Fauci an idiot, retweeting time to fire Fauci and, eventually, preventing Fauci from being interviewed on certain TV shows and publications.

But as you've probably noticed, Dr. Fauci has been unmuzzled by the Biden administration. Dr. Fauci and his family have faced death threats from extremists, and he's been the subject of bizarre conspiracy theories about the virus. Much of Dr. Fauci's career has been devoted to researching viruses and the immune system. He's made major contributions to the understanding of how HIV affects the immune system, was instrumental in developing drugs that could prolong the lives of people with HIV and is continuing to conduct research into the body's immune response to HIV. Our interview was recorded last night as part of a WHYY Zoom event at which Dr. Fauci received WHYY's annual Lifelong Learning Award. WHYY is where FRESH AIR is produced.

Dr. Fauci, thank you so much for talking with us. And I just want to thank you for everything you've done. I want to start with your new role as President Biden's chief medical adviser. What did he tell you he wanted you to do? And how does that compare to what you did in the Trump administration?

ANTHONY FAUCI: Well, it was very clear what President Biden wanted, not only of me but of the entire medical team. And it was really very encouraging because he said it publicly and he said it privately to us, and that is that science was going to rule, that we were going to base whatever we do - our recommendations, or guidelines or what have you - based on sound scientific evidence and sound scientific data. But he also said something that was also very encouraging. He said, we're going to make some mistakes along the way. We're going to stumble a bit. And when that happens, we're not going to blame anybody. We're just going to fix it. And, boy, was that refreshing to know that we were going to let the good scientific method and truth guide whatever we say and whatever we do. And when we don't know something, we're going to admit that we don't know it and try and figure out how we could find out what the good data is and what the evidence is.

GROSS: So like everybody, I'm alarmed to find out now that there's, like, new mutations of the virus. And there's, apparently, like, a hybrid that has, like, the worst of both worlds. It's more transmissible and also more resistant to vaccines. So how does that change your calibration of the future? I know you want us to keep wearing masks and to keep social distancing and washing our hands and all of that and to, if anything, amp that up. But how does that change your calibration of where we go from here, what the next strategy is?

FAUCI: Well, I think people need to understand something that's very important, that RNA viruses, of which SARS-CoV-2 is an RNA virus, will mutate. And the more the virus replicates, the more opportunity you give it to mutate. So when you have so much infection in the community, as we have had in the United States over the last few months, where you literally have hundreds of thousands of new infections per day - we were up to between three and 400,000 thousand per day. We're down now between one and 200,000 per day. But we still have, you know, three to 4,000 deaths per day. That means the virus has almost an open playing field to replicate, means you give it an opportunity to mutate.

So even though this is a challenge, we should not be set back by this. We can meet the challenge. And you meet the challenge by first getting a handle on the degree of the mutations by doing good genomic surveillance, No. 1. But No. 2, by doing whatever you can to prevent the replication of the virus, by vaccinating as many people as quickly and as efficiently as you possibly can and, also, to double down on the public health measures of uniform wearing of masks, physical distancing, avoiding congregate settings, particularly indoors. One of the things that we do know is that the vaccines that we have, although, they are less effective in preventing disease, that when you look at serious disease with hospitalizations and deaths, the vaccines still have a pretty important, positive effect even on the mutants. But we don't want to get confident about that. We've got to be able to match future vaccines and upgrade them to be able to be directed specifically at these troublesome mutants that have evolved.

GROSS: Is COVID now like a forever virus? Like, is it always going to be around in one form or another? Will we always be having to deal with it?

FAUCI: You know, Terry, I don't think we need to make that assumption. That certainly is a possibility, that you would have enough virus floating around and changing from year to year that you would have to treat it, in some respects, the way we treat seasonal influenza, where you have to upgrade the vaccine almost every year. There is a way, if done properly, to avoid that. And that is, for example, if we successfully vaccinate 70 to 85% of the people in the United States and dramatically diminish the level of infection, if we were living in a vacuum in only the United States, then I don't think we'd have to worry about seasonal turnover and having to match. But we live in a global community. And unless we get the rest of the world adequately vaccinated, and unless we don't have the opportunity of this virus to mutate in a place that doesn't have access to vaccines, we will always be threatened.

GROSS: So I think everybody looked to you during the Trump administration as the voice of science and facts and reality. And I think we all wonder how you dealt with certain Trump falsehoods. Like, I know you were not at the coronavirus press briefing when President Trump suggested that we inject disinfectant, while we're on the subject of disinfectants.

FAUCI: Right. Right.

GROSS: But when something like that happened, did you talk to him afterwards? Did you try to explain, like, that's really terrible advice, that's kind of poisonous, it's toxic? Like, what kind of conversation would you have with him after he said something that was clearly false...

FAUCI: Yeah.

GROSS: ...And, maybe, even dangerous?

FAUCI: Well, I mean, I didn't have the opportunity at that particular time because I wasn't there - about the bleach thing. But one thing was very clear. And I think this was very clear to the general public. I don't like to rehash it a lot. But there were times when things would be said at a press conference that I had to disagree with from a scientific standpoint. And although I didn't take any great pleasure in that, I did have to get up to the podium and say, I disagree with you. And that, in some respects, got me on the wrong side of some of the people in the White House who were not particularly pleased with that. But I did have to, sometimes, correct the record to make sure that we didn't get information out there that was, in fact, incorrect. That was not an easy thing to do.

GROSS: How did you try to control the expression on your face when you heard something that the president said that you knew was, like, really wrong and possibly dangerous?

FAUCI: Well, usually I was able to, but I think sometimes that slipped by as often, you know, would get out.

GROSS: As we've seen from the photos (laughter).

FAUCI: I've seen those photos. Yes, I have. I have.

GROSS: (Laughter) All right. Trump appointed Scott Atlas to serve as his coronavirus adviser. And he's a radiologist, an expert in MRIs. He's not an infectious disease expert. I think the president saw him on Fox. And one of the things he said on Fox, that Scott Atlas said on Fox last April, was that we should basically wait for herd immunity. And I'll quote what he said, you know, because he said that we should let younger people, who are less vulnerable, get the virus. He said, quote, "We can allow a lot of people to get infected. Those who are not at risk to die or have a serious hospital-requiring illness, we should be fine with letting them get infected, generating immunity on their own. And the more immunity in the community, the better we can eradicate the threat of the virus.

So he was arguing for herd immunity. He was advising Trump. Did the president - did Trump, when he was president, make decisions based on the premise of, let's let people get it, and we'll eventually get herd immunity?

FAUCI: No, I'm not sure, Terry, because by the time that situation arose in the White House, where Dr. Atlas was, you know, speaking to the president on a regular basis, those of us on the task force did not have as much access to the president. So it was very, very difficult to counter that. I think that had more of an impact on Dr. Birx because Dr. Birx, her office was in the White House. She lived in the White House. I was based at the NIH, so I would go down there as part of the task force, but I didn't have to live in that environment. So I think the negative aspect of - any that occurred was very difficult for Dr. Birx. It did not impact me as much.

GROSS: Did Trump say to you, I don't want to talk to you anymore? Or did you suddenly just not have access?

FAUCI: It was a lack of access, yeah.

GROSS: Even when you wanted to talk with him?

FAUCI: Yeah. I - Terry, I would prefer not to rehash things back then. I don't think that that's productive, if we could sort of steer away a little bit from that.

GROSS: The reason why I'm asking is it's a really important chapter of medical history and American history and global history for us to understand what happened during the Trump administration, during the pandemic. So just for the sake of history, I think it's really...

FAUCI: Sure.

GROSS: ...Important to know how we got where we are today and how things perhaps could have been better controlled than they were.

FAUCI: Right. Right. OK.

GROSS: So would you be comfortable answering how - if you knew if Trump was shooting for herd immunity? Because so many people feel like there wasn't enough attention paid in the White House to the pandemic. Was that part of a herd immunity strategy or just a lack of attention?

FAUCI: You know, I don't know because I can't get into people's heads. But what I think happened is that the White House in general, the president, was looking for people who were saying things that were compatible with what his feeling was about where he wanted to go. He wanted to focus on things other than the pandemic. So anyone who would come in, like Dr. Atlas, and say, just let people get infected, you'll get herd immunity and everything will be fine, was a welcome strategy or a welcome philosophy. But as it turns out - and we know right now very clearly - that that was an incorrect strategy.

If you actually pursued a strategy of, don't try and intervene, don't wear a mask, don't worry about congregate settings, just let the virus take its course and try and protect the vulnerable - the fallacy in that approach is that we could not effectively protect the vulnerable because they were such an important part of our population. So if you look at the number of people right now who have died, it's close to 450,000 people.

And if you look at the zero prevalence in the country, how many people already will have gotten infected, it's almost certain - there are certain areas where it's high, 20-plus percent. But as an average for the country, you know, it's probably somewhere less than 20%, which means that if you wanted to get the 70% or 85% of the people that need to be infected to give you herd immunity, a lot more people will have died. We've already had 430-, -40-, -50,000 people have died, and we aren't even anywhere close to herd immunity.

GROSS: We're listening to the interview I recorded at a WHYY Zoom event last night with Dr. Anthony Fauci, who is now President Biden's chief medical adviser. We'll hear more of the interview after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Anthony Fauci, who is now President Biden's chief medical adviser. He served on Trump's coronavirus task force. We spoke last night as part of a WHYY Zoom event.

If I remember correctly, early on in some of the coronavirus press briefings, the people who were speaking weren't wearing masks and sometimes were standing pretty close together. Was that at Trump's direction? And did you ever feel vulnerable at any of those press briefings? Did you ever want to wear a mask and be told or feel like you weren't allowed to?

FAUCI: Well, you know, back then there was, I guess, an understandable misperception that if you get tested every day, that all of a sudden you were OK in the White House, and you were not going to get infected. So at that point, not everyone and very few people were wearing a mask because in order to walk in the door of the White House, you had to get tested, literally every day you walked in, which was a good thing. But then what became clear from the superspreading event that did occur in the White House...

GROSS: You're talking about the Amy Coney Barrett event.

FAUCI: Yeah, right. Getting tested every day did not protect you from either getting infected or infecting somebody else because the tests were not 100%. And you could get tested and still be infected because of that window when the test is not necessarily positive. So once it became clear that there was the possibility of a superspreader situation, even though people were all getting tested, that's when it became very clear that we had to wear a mask. And at that point, people like myself and Dr. Birx and Dr. Redfield and Dr. Hahn and others, we would be wearing masks there, but not everyone else was wearing masks. And under those circumstances, even if it was semi-frowned upon to wear a mask, we still wore a mask, but it was only after it became clear that testing every day to get into the White House was not a shield against getting infected.

GROSS: Well, what was your attitude toward the people who weren't wearing masks? And they were putting you at risk by not wearing a mask.

FAUCI: Yeah. Well, my way around that was to wear a mask.

GROSS: Did you come across anyone in the Trump administration who believed that the coronavirus was a hoax, including Trump himself?

FAUCI: No. No, I think everyone knew that this was a real phenomenon. Whatever they said publicly or not, I think virtually everybody that I came into contact with realized that this was a real phenomenon.

GROSS: Were you ever pressured to say something that you knew wasn't true, and if so, how did you push back?

FAUCI: Well, I think I mentioned to you - and it's very clear, it's on the record, it's all recorded on TV - that when something was said that I felt wasn't true, I did not hesitate to go to the microphone and disagree or, not necessarily at the microphone on TV, but when reporters asked me afterwards, I did not hesitate to disagree. I didn't take any great pleasure out of disagreeing with the administration or with the president, but sometimes I had to do it. So I never felt a situation where I could not say something. I did always say what was on my mind. That disturbed some people sometimes, but I felt I needed to do that to preserve my integrity, but also to give the correct message to the rest of the country.

GROSS: You've made it clear that there have been death threats, like serious ones, directed at you, at your children and your family. And I'm wondering if they ever coincided, like, if they would spike during periods when Trump would, for instance, call you an idiot or when his trade adviser, Peter Navarro, would publish an op-ed in USA Today saying that you were wrong about everything that he spoke with you about, that, you know, he had contact with you about. Steve Bannon had said that your head should be on a spike. Did you see threats against you rise during those periods of, you know, inflammatory and totally wrong kind of communications?

FAUCI: You know, I don't think it could be one-to-one that every time something like that happened, there was a spike. But there certainly was not just an even level of threats. It would exacerbate when something was said publicly, when I disagreed and the press picked up on that, that I disagreed. So, yes, there was ups and downs of threats. There always was a baseline level of threats. But you're absolutely correct that when certain circumstances arose, the intensity and the degree of threats would go up.

GROSS: We're listening to the interview I recorded last night with Dr. Anthony Fauci, who is now President Biden's chief medical adviser in addition to remaining the director of NIAID, the National Institute of Allergy and Infectious Diseases, a position he's held since 1984. After we take a short break, we'll hear how he was the target of AIDS activists early in the AIDS epidemic, then befriended and worked with them, leading to medical reforms that are benefiting us today during the COVID pandemic.

I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dr. Anthony Fauci, America's top infectious disease expert. He served on Trump's coronavirus task force and had his differences with Trump. He's now President Biden's chief medical adviser. Dr. Fauci has served as the director of the National Institute of Allergy and Infectious Diseases since 1984, working with seven presidents from Reagan to Biden.

I want to compare now to the early days of the AIDS epidemic because you were then, as you are now, the head of NIAID, the National Institute of Allergy and Infectious Diseases. And at first, you were vilified by AIDS activists for not responding quickly enough by getting experimental drugs that were still in trial to people who would die without any therapeutic intervention. And in that sense, they had absolutely nothing to lose by trying a drug that may work and may not.

FAUCI: Right.

GROSS: And, you know, you listened to the activists and, eventually, managed to get reforms so the drug trials could continue while the people with AIDS could get access to some of those drugs. But during the period when activists were really angry with you and there were protests and there were signs saying, like, F Fauci and an image of - I think you were burned in effigy. And there was an image of your head on a spike. Were those threats that you had to take seriously in the way you had to take them seriously now?

FAUCI: No, absolutely not. That really is a stark contrast. The activists were justified in their concerns that the government, even though they weren't doing it deliberately, were not actually giving them a seat at the table to be able to have their own input into things that would, ultimately, affect their lives. So even though they were very theatrical, they were very iconoclastic - they seemed like they were threatening. But never, for a single moment, did I ever feel myself threatened by the AIDS activists.

In fact, in one particular situation I think was very telling, I went down at a time when there was a lot of pushback against the government in not listening to the valid concerns of the activists. I was invited to go down. And I went with just one of my staff at the time to go down, essentially, alone to the gay and lesbian community center in the middle of Greenwich Village to meet with what must have been, you know, anywhere from 50 to 100 activists in this meeting room, just me and one of my staff. And they were angry with the federal government because they felt the federal government was not listening to them. And they were right. I mean, I think they had a really good point. Not for a second did I feel physically threatened to go down there, not even close. I mean, that's not the nature of what the protest was. One of the things about it was that not only were they not threatening at all in a violent way, but, ultimately, they were on the right side of history.

GROSS: Was there a turning point for you, where activists convinced you to change your mind? And...

FAUCI: Oh, yeah. Of course.

GROSS: What was it? What was the turning point?

FAUCI: Well, the turning point was - you know, I can't, you know, get into my own head and psychoanalyze myself. But it was very clear when they were protesting in a way and, really, being very confrontational with me - you know, Larry Kramer's famous article on the front page of the San Francisco Examiner saying, I call you a murderer, an open letter to an incompetent idiot, you know, I'll never forget that. He wanted to gain my attention. And he certainly did gain my attention. But there were other activists, younger activists, who, when you listen to what they were saying and put aside the dramatics, the theatrics, the iconoclastic behavior and listen to what they said - which I did because I felt if these young men were going to this extent, they must be suffering terribly.

So I tried to become and easily became as empathetic as I possibly could be and say, let me put myself in their shoes. If I were in their position, what would I be doing? And I rapidly came to the conclusion that if I were in their position, I would be doing exactly what they were doing. So at that point, when I got that settled in my own mind, I invited them in. I invited them into this room, right where we're actually sitting right now, when they came and wanted to demonstrate on the NIH campus. And I said, let's sit down and talk about how we have a lot of things in common. We're both going through the same thing. Let's see how we can work together.

Now, we didn't settle everything and make everything all nicey-nicey (ph) in that one meeting. It took weeks and months and months of getting to know each other, getting to trust each other. And then, when I started to allow them to be part of virtually everything we did on our advisory committees, on our clinical trial groups, we integrated the activists into the process that we were doing that very, very heavily involved them, their lives and their health. And things really turned around. Yeah.

GROSS: I read that, you know, during those days, you went to one or more of the gay bathhouses in New York, I assume, in your suit and tie.

(LAUGHTER)

FAUCI: Yeah. I took my suit and tie off.

GROSS: Did you (laughter)?

FAUCI: Yeah.

GROSS: Can you tell us what that was like, like, what you learned by doing that that you didn't know before?

FAUCI: Well, this was the very, very early years of the outbreak. In fact, it may even have been before we even discovered that HIV was the cause. And we were seeing these large numbers of gay, mostly gay men, who were formerly otherwise well, who were being devastated by this terrible, mysterious disease. And it was so concentrated in the gay community that I really wanted to get a feel for, you know, like, what was going on there that would lead to this explosion of a sexually transmitted disease. So I did.

I went to the Castro District. I went down to Greenwich Village. And I went into the bathhouses and to, you know, essentially, see what was going on. And, you know, the epidemiologist in me went, oh, my goodness. This is a perfect setup for an explosion of a sexually transmitted disease. And the same thing going to the gay bars and seeing what was going on. And it gave me a great insight into the explosiveness of the outbreak of a sexually transmitted disease. So I think it was important because it gave me a really on-the-ground feel for what was actually, dynamically going on.

GROSS: The president at the time was Reagan during those early days of the epidemic. And Reagan was supported by the religious right that had a very anti-gay agenda. And that was kind of very central to their political agenda. Do you think that that interfered with the kind of funding you needed for research into AIDS at the National Institute for Allergy and Infectious Diseases?

FAUCI: You know, I think it did to some extent. You know, it's an interesting situation. You know, as you said very correctly, Terry, that Ronald Reagan was supported by the religious right groups that did not have a degree of empathy at all in any way for the LGBTQ community. I think that the president himself did not inherently feel that way. But I believe, because of a large part of his constituency was that way, what he did not do is he did not use the bully pulpit of the presidency to gain support and attention to what was going on right in front of everyone's eyes. We were having the evolving of a pandemic, of a terrible disease, that because of the fact that so many people for years after they get infected could be relatively asymptomatic that we didn't appreciate, at first, the full extent of the disease until we had a test that could see if somebody was infected.

GROSS: We're listening to the interview I recorded at a WHYY Zoom event last night with Dr. Anthony Fauci, who is now President Biden's chief medical adviser. We'll hear more of the interview after a break. This is FRESH AIR.

(SOUNDBITE OF AARON PARKS' "SMALL PLANET")

GROSS: This is FRESH AIR. Let's get back to the interview I recorded last night with Dr. Anthony Fauci at a WHYY Zoom event. Dr. Fauci is now President Biden's chief medical adviser and served on President Trump's coronavirus task force. Dr. Fauci's been the director of NIAID, the National Institute of Allergy and Infectious Diseases, since 1984. When we left off, we were talking about Dr. Fauci's work during the early days of the AIDS epidemic.

What are some of the things that you learned from the AIDS epidemic that you feel you're applying now to COVID, to the pandemic that we're living in now, including how experimental drugs are handled?

FAUCI: Well, I mean, there are several things that we could discuss. I mean, one of them is the importance of getting the community involved and dealing with the community and their special needs. Now, you mentioned that in our discussion over the last several minutes about the activist group. We have a different type of a situation here in the United States with COVID. We have a disparity here that is striking and needs to be addressed, that if you look at the incidence of infection and the incidence of serious disease, including hospitalization and deaths, brown and Black people suffer disproportionately more than whites and the general population.

So I think that shines a bright light on what we probably should have done all along and, certainly, must do in the future, is to address those social determinants of health that actually lead to the great disparity of suffering in COVID-19 among brown and Black people. You know, we had the same sort of thing with the disparities of infection in certain demographic groups with HIV. So from an epidemiological standpoint, there was similarities there. We also learned the importance of fundamental, basic science in getting solutions. As you know - you probably remember - back in the early days, getting infected with HIV was a virtual death sentence for the overwhelming majority, almost all of the people, with few exceptions for those who were what we call elite controllers.

But it was the fundamental, basic science of targeted drug development that allowed us to develop combinations of drugs, first single drugs and then a couple at a time, and then triple and more combinations of drugs that, ultimately, completely transformed the lives of people living with HIV to the point where you went from a virtual death sentence to being able to lead, essentially, a normal life - as well as not infecting anybody else because we know now that something we've called treatment as prevention, which means if you treat someone who's living with HIV and suppress the level of virus to below detectable, you make it essentially impossible for that person to infect someone else. So we got there through basic science.

GROSS: What about access to therapeutics? Like, one of the things you did for HIV is that you helped change the process, reform the process so that people who were sick, and that was a death sentence, could get access to certain experimental drug while the drugs were still being tested.

FAUCI: Right.

GROSS: So are we benefiting in any way now from the reforms from then?

FAUCI: That a really great question, Terry, because the foundation for the Emergency Use Authorization, the foundation for that, to get a drug out as quickly as you possibly can based on the fact that the benefit looks like it was better than the risk and you didn't have to fully show efficacy yet, originated way back during the years of HIV. Compassionate use of a drug even before you get an emergency use authorization originated way back in the days of HIV because we didn't have compassionate use to any great extent until we got into the situation with HIV in the early and mid-1980s. So there's a very good connection between some of the things that we're doing now with interventions for COVID-19 that actually originated way back when we were doing HIV in its very early years.

GROSS: Here's something that I would imagine really makes your head spin. During the early days of the AIDS epidemic, people were protesting, like, we demand to have more attention and more therapies. Like, help save our lives. Like, science, do something, and do it now. And now it's like the protests are, sure, you say masks will save our lives; sure, you say vaccines will save our lives. We don't want them. Like, you're trying to save our lives. No, thanks. We're not going to do that. So does that make your head spin?

FAUCI: Yeah, it makes my head explode a bit...

(LAUGHTER)

FAUCI: ...Not just spin. Yeah. I mean, of course. It's very frustrating when you are a scientist, a physician or a health care provider or a public health person, that when you have interventions that are capable of saving people's lives - and because of the divisiveness that I mentioned a little bit ago that seems to be permeating our society at this present time, hopefully not to last forever, but it certainly is permeating society now - that you can have actually people who are looking at things that could conceivably save their lives and are actively pushing back against it because they equate it with a political stance or a political statement. That is very frustrating.

GROSS: So I haven't left time for a question that everybody wants an answer to. And I don't think there really is one, but I'll ask you anyways. Like, when and how does this end - or at least get under control so that we could start beginning to live our lives again and not feel like we're confined to a bubble?

FAUCI: Yeah, I think it's going to be two major step process, Terry. One is within our own country, and the other is globally. In our own country, if we get the overwhelming majority of people - I would say 70 to 85% of the people - vaccinated, that we could get this down to the point where the level of infection is so low that it is not a threat of any consequences to most people and you could start to approach some degree of normality, the things that we were able to do before this happened to us.

If you're talking about the long game of that being durable, you have to address the entire planet. Namely, you've got to be able to get, with the help of the developed world, the entire world vaccinated - what we did with smallpox, what we did with polio and what we did with measles. Because as long as we neglect the rest of the world - when I say we, I mean not only the United States but the developed nations that are rich enough to make a difference - as long as we allow this infection to exist to any degree in any part of the world, it will always be a threat. So we've got to approach this the way we approach smallpox, the way we approach polio and the way we approach measles and other devastating global outbreaks.

GROSS: Dr. Fauci, thank you so much for doing this interview. It's just been such a great pleasure to talk with you. I wish you good luck in your new role as chief medical adviser to President Biden. I wish you good luck for your sake and for ours. Thank you again.

FAUCI: Thank you, Terry. Great to be with you.

GROSS: My interview with Dr. Anthony Fauci was recorded last night at a WHYY Zoom event at which he was presented with WHYY's annual Lifelong Learning Award. Dr. Fauci is now President Biden's chief medical adviser and has been the director of the National Institute of Allergy and Infectious Diseases since 1984.

After we take a short break, podcast critic Nick Quah will talk about the end of the Trump-era podcasts. This is FRESH AIR.

(SOUNDBITE OF ANAT COHEN'S "NIGHTMARE") Transcript provided by NPR, Copyright NPR.

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