What Did Dr. Fauci Really Think During the ‘Dark Years’ of the AIDS Crisis?

How Did Politics Sabotage the US Response to Ebola and Zika Before COVID-19 Even Started?

Step inside the high-stakes world of public health with Dr. Anthony Fauci’s memoir, On Call. From his early breakthroughs in HIV/AIDS research to the politicized chaos of the COVID-19 pandemic, discover the untold stories of the doctor who served seven presidents.

Go beyond the headlines and conspiracy theories—read the full summary below to hear the fascinating truth directly from the man who lived it.

Genres

Health, Nutrition, Politics, Biography, Memoir, Society, Culture

Get a better picture of one of the world’s most famous doctors

On Call (2024) is a unique memoir that offers an insider’s perspective on the challenges and triumphs of battling some of the most significant public health crises of our time. It provides valuable insights into the intersection of science, politics, and society, making it an essential read for anyone seeking to understand the complexities of modern public health in the US.

You’re not alone if you only came to know Dr. Anthony Fauci in the wake of the COVID-19 pandemic. But Fauci has been an important figure in public health since the 1980s, when he was at the forefront of AIDS research.

As we’ll see in the sections ahead, Fauci was also the face of the US’s response to a number of viral threats and outbreaks over the years, including the anthrax scare in 2001 and the Ebola threats that came later. For many, Fauci has been a reassuring figure, representing the calm, caring presence of a family doctor. For others, he’s come to represent the polarizing time surrounding the COVID-19 pandemic. In this summary, we’ll trace how Fauci went from being a basketball fanatic in Brooklyn to becoming one of the most recognizable doctors in history.

A bright Brooklyn boy

Anthony Fauci’s journey began in Brooklyn. Born on Christmas Eve in 1940, his parents were first-generation Italian-Americans who married young and settled in Bensonhurst, Brooklyn, where they raised Fauci and his older sister, Denise.

Fauci recalls his childhood fondly. His father was a hardworking pharmacist, and the drugstore that he owned was a popular community hub. When he wasn’t at school, Fauci would help out at the store and deliver prescriptions on his bicycle.

Fauci thrived at school. He did well academically but he also loved sports and played on the school’s basketball team. He dreamed of going pro but soon realized that he wasn’t at the same level as some of his more athletic classmates. Instead, he focused on his interests in science and the humanities. Influential teachers at Regis High School helped him realize that becoming a physician would allow him to blend his love for science with his desire to help others.

In 1958, Fauci received a full scholarship to Holy Cross College, where he continued his pre-med studies. From there, he went to Cornell Medical College in 1962, where he became a student doctor and embarked on what was one of the most rewarding times in his life, working directly with patients and discovering a passion for clinical medicine.

Throughout his medical training, Fauci developed a keen interest in infectious diseases. The idea of combating diseases that were both deadly and curable captivated him. After his residency, he decided to join the Public Health Service, leading him to the National Institutes of Health, or NIH, in 1968. There, at the age of 27, he began his fellowship in the emerging field of human immunology, studying the body’s defense mechanisms against infections and cancers.

A new purpose in life

Fauci stayed on at NIH and always felt at home in the intellectual environment there. Yet, by age forty, Fauci sensed something was missing. While his work was impactful, it often dealt with rare diseases that didn’t carry broad public health implications. He yearned for a new challenge, one that would have a more significant impact on public health and reignite his sense of purpose.

That pivotal moment arrived in June 1981, when Fauci picked up a magazine published by the Center for Disease Control, or CDC. It contained an article entitled “Pneumocystis Pneumonia – Los Angeles,” which described an unusual form of pneumonia in five otherwise healthy men. Normally, this pneumonia was only seen in individuals with significantly compromised immune systems, like those undergoing chemotherapy. Fauci was puzzled. Even more curious was that all five men were gay. Fauci assumed some critical details about the disease were yet to be discovered.

The mystery deepened a month later when he saw another report. This time, the cases pertained to 26 men in New York City and California. The report gave him goosebumps, something that had never happened before in his 15-year medical career. By late 1981, Fauci had dropped everything to focus his research entirely on this new disease. This involved admitting patients to the NIH Clinical Center to study their immune deficiencies.

Fauci’s first major publication on the subject came in June 1982. He predicted that the disease had the potential to spread beyond the gay community – a grim prophecy that soon came true. By mid-1982, the CDC officially named the disease AIDS (which stands for Acquired Immunodeficiency Syndrome), and confirmed that it was not confined to gay men.

The period from 1982 to the late 1980s are what Fauci describes as the “dark years” of his career. The continuous loss of patients to AIDS resulted in a chronic and pervasive grief. It led to lasting feelings that Fauci likens to post-traumatic stress disorder, a sentiment shared by many of his colleagues from that era.

Fortunately, there were breakthroughs that helped everyone through those years. In 1983, Fauci and a colleague discovered something strange in AIDS patients’ B cells – they were hyperactivated, which was highly unusual given the immune deficiency seen in these patients. This finding hinted at an immune response to an unknown virus. Soon, French scientists Luc Montagnier and Françoise Barré-Sinoussi identified this virus as HIV, or human immunodeficiency virus.

In 1984, the researcher Robert Gallo confirmed HIV as the cause of AIDS. This breakthrough shifted the battle, allowing for targeted diagnostics, prevention, and treatment efforts, and inviting a wave of new researchers into the field.

On a personal note, Fauci’s life was also evolving. In 1985, he married Christine, who became his closest confidante and the mother of their three daughters. Professionally, his role took a significant turn in 1984 when he was appointed director of the National Institute of Allergy and Infectious Diseases, better known as NIAID. This new responsibility required him to oversee a much larger operation and budget within the NIH.

After securing increased funding, Fauci established the Division of AIDS within NIAID and initiated the National Cooperative Drug Discovery Groups, which partnered academic institutions with pharmaceutical companies. This led to the development of AZT, the first drug to show effectiveness against HIV and reduce AIDS-related deaths.

These efforts were crucial in the ongoing battle against AIDS, but it was only the beginning. Throughout the ’80s and into the ’90s, Fauci worked hard to both secure funding from the White House and to research a possible HIV vaccine. A breakthrough occurred when the drug Indinavir was combined with AZT and 3TC. This triple-drug combo drastically reduced the virus levels in patients, transforming AIDS from a death sentence to a manageable condition. Over time, treatment regimens became simpler, eventually leading to Atripla, a once-daily pill approved in 2006. This success story is a testament to the collaboration between NIH-funded science and pharmaceutical ingenuity, as well as Fauci’s determination to improve health outcomes on a global scale.

Thinking global with AIDS relief

Whenever a new president took office, Fauci was always concerned about how they would address the global HIV/AIDS crisis. Fortunately, when George W. Bush entered the White House in 2001, Fauci realized that the new administration was interested in making an impact on the crisis worldwide.

During a speech in May 2001, President Bush committed $200 million to support a new international AIDS relief initiative called the Global Fund. While the Global Fund was officially established in January 2002, unforeseen events soon shifted the focus.

After the events of 9/11, potential chemical and bioterror attacks from al-Qaeda became the urgent threat. The NIAID was appointed with developing countermeasures like diagnostics, treatments, and vaccines to address the bioterror threat, meaning this was now Fauci’s responsibility. The massive undertaking resulted in the $6 billion Project BioShield.

But for several weeks in September and October 2001, panic ensued when a series of people were exposed to anthrax powder that arrived through the mail. For Fauci, daily media briefings became a new, all-consuming demand.

Despite intense speculation, al-Qaeda was eventually ruled out. The FBI’s investigation pointed to Bruce E. Ivins, a biodefense researcher at Fort Detrick, Maryland. In July 2008, Ivins died by suicide after being informed of impending charges, leaving many questions unanswered. The anthrax attacks, which killed five people and sickened seventeen, marked a terrifying chapter in US history.

With the anthrax scare in the rearview mirror, and the newly established Global Fund in place, President Bush wanted a more direct impact on the global HIV/AIDS crisis, especially in southern Africa.

Fauci worked long and hard on developing the project that became the President’s Emergency Plan for AIDS Relief, otherwise known as PEPFAR. It consisted of a $15 billion initiative over five years. This program became the largest global health initiative ever for a single disease. Its impact has been monumental. Over 20 years, more than $100 billion has been invested, saving 25 million lives across 50 countries.

Fauci navigated several other outbreaks in the years that followed, including SARS and the H5N1 virus, known as bird flu. These threats eventually dissipated, but with all his experiences as head of NIAID, Fauci continued to be a sought-after expert for the incoming President Barack Obama and his administration in 2009.

But before that changeover occurred at the White House, Fauci was honored by George W. Bush with the Presidential Medal of Freedom for his work with HIV/AIDS and the PEPFAR program. It is the highest civilian honor one can receive, and it left him deeply humbled.

Viruses become politicized

In 2014, the US was once again on high alert due to the outbreak of another unpredictable infectious disease. This time it was the Ebola virus, which had originated in Guinea, then quickly spread to Liberia and Sierra Leone, overwhelming these nations. The situation escalated to a Public Health Emergency of International Concern by August 2014, with over 1,000 cases and a 60 percent fatality rate by July.

The US encountered its first case when Thomas Eric Duncan, who contracted Ebola in Liberia, traveled to Dallas. A misdiagnosis initially sent him home, but he returned to the hospital severely ill and was diagnosed with Ebola, leading to widespread public anxiety and media frenzy.

To calm the nation and clarify facts, Fauci appeared on TV shows. However, the hysteria persisted. Fauci began to receive disturbing hate mail and even a civil lawsuit accusing him of being part of a conspiracy to bring Ebola into the US. Unlike previous outbreaks, irrational fears and political tensions surrounded this epidemic, with various media personalities like Bill O’Reilly stoking the flames. The congressional hearings that followed reflected the deep political divide in Washington.

By spring 2016, the Ebola outbreak in West Africa was officially declared over, marking a significant milestone after over 28,000 cases and 11,000 deaths worldwide. The epidemic largely subsided due to rigorous infectious disease control measures.

And yet, another threat was already emerging, this time closer to home in the Americas – the Zika virus. Similar to dengue and yellow fever, Zika is transmitted primarily by Aedes aegypti mosquitoes. Although historically known for mild symptoms or no symptoms at all, Zika took a devastating turn in 2015 with a massive outbreak in Brazil. Pregnant women infected with Zika began giving birth to babies with microcephaly, a condition where infants are born with abnormally small heads due to brain damage.

Recognizing the potential risk, President Obama convened a meeting in January 2016 with top advisors, including Fauci. They emphasized the immediate need for mosquito control and avoidance strategies, while stressing the critical importance of developing a safe and effective vaccine.

Despite their efforts, securing funding for the Zika plan proved contentious. A proposed $1.9 billion budget request faced resistance in Congress, primarily due to political disagreements. For instance, Zika funding could only pass if it was part of a bill that also defunded Planned Parenthood or modified the Affordable Care Act.

As the standoff continued into the summer and fall of 2016, partisan politics overshadowed the public health crisis at hand. The prolonged debate highlighted the detrimental impact political divisions can have on mounting a fast and effective response to an outbreak.

The twin challenges of COVID and a new administration

In January 2020, the world’s attention turned to Wuhan, China, where reports of a mysterious pneumonia-like illness began to surface.

In a matter of weeks, worldwide cases quickly escalated and the first US case was identified. The severity of the novel coronavirus – or COVID-19 – became starkly evident. In particular, concerns mounted about the virus’s unprecedented ability to transmit, even among asymptomatic individuals.

President Trump sought reassurance and guidance, prompting Fauci’s involvement as an advisor. Fauci became a familiar face in media appearances, a role he had assumed before, but this time on a global scale. He believes that this heightened media presence gave many people the impression that he had an outsized role in determining the government response to the pandemic, which he did not. His role continued to be head of NIAID, and as an expert advisor on the White House coronavirus task force.

Fauci’s interactions with President Trump during this period were complex. Their private discussions were usually candid and respectful, yet Trump’s public statements often contradicted the scientific truths that Fauci was determined to convey. This led to confusion and frustration.

One of the most contentious issues was the use of the anti-malarial drug Hydroxychloroquine as a treatment for COVID-19. Some within the Trump administration wanted to hail the drug as a cure. But despite anecdotal reports in its favor, the lack of clinical studies and the potential for harmful side effects led Fauci to publicly refute such an endorsement. This stance was essential to maintaining medical integrity. But the public contradiction of the president resulted in Fauci receiving death threats, which in turn led to Fauci’s family receiving a security detail.

Despite these difficulties, Fauci remained committed to his ethical principles of providing transparent and reliable information. This dedication stemmed from a deep sense of responsibility. To put it simply, he saw the American public as his patient and felt duty-bound to deliver the same care and empathy he would in any other clinical setting.

Throughout the crisis, President Trump would veer between expressions of camaraderie and anger. Meanwhile, Trump’s focus on media ratings and public perception sometimes overshadowed the gravity of the pandemic’s humanitarian challenges.

That said, the Trump administration can be proud of Operation Warp Speed, an initiative that accelerated clinical trials and the manufacturing processes for vaccines. As a result, the Moderna and Pfizer vaccines came out at an impressive pace, offering hope amid the ongoing crisis.

Retiring with hope for the future

Fauci stayed active during the early part of the Biden administration. He saw COVID-19 vaccines roll out, and observed how quickly this new virus adapted – a fact that would continue to present challenges in the years to come.

He also realized that there are systemic weaknesses in the country’s public health infrastructure, exacerbated by decades of neglect and underfunding. This includes outdated systems, local health professionals with insufficient means, and disparities in healthcare access that disproportionately affect minority and lower-income communities. All of this contributed to unnecessarily high mortality rates during the pandemic.

The issue of inaccurate and dangerous information spreading online and through social media also presents a big challenge to the future of public health. As does the politicization of public health decisions, which can further complicate efforts to implement cohesive, science-driven policies across the nation.

Fauci reflected on all of this as he made his decision to retire after decades of public service. Supported by close advisors and his wife Christine, he announced his departure from NIAID in August 2022.

Looking ahead, Fauci remains optimistic about the future, particularly placing hope in younger generations to overcome societal divisions. He plans to continue his legacy by teaching at Georgetown University, sharing his experiences, and inspiring future leaders in medicine, science, and public policy. More than anything else, Fauci hopes the country can maintain a spirit of unity and civility in addressing the challenges that lie ahead for public health and society at large.

Conclusion

The main takeaway of this summary to On Call by Anthony Fauci is that this dedicated doctor from Brooklyn has played pivotal roles in combating HIV/AIDS, Ebola, Zika, and most notably, COVID-19. Along the way there have been personal and professional challenges, the complexities of the US public health system, and the impact of political and social factors on health crises. Fauci reflects on the importance of science, resilience, and adaptability in facing unprecedented challenges. He also shares his motivations for retiring and his hopes for inspiring the next generation through teaching and public engagement, emphasizing the critical need for unity and trust in science to address future health threats.