Anthony Fauci in conversation with Walter Isaacson at the New Orleans Book Festival

Yeah. Well, that sort of belies the saying like father like son, for sure. Um, I um... Well, Walter, as we discussed before, um, I guess it's a question of resiliency. It's really unfortunate what's going on right now, but you were saying how does growing up in Brooklyn and having a Jesuit education, which is founded on service for others and integrity and honesty, I just developed the approach to life of focusing on what is important, what your mission is, uh, and as a scientist and a physician is to do whatever I can to preserve and protect the health of the American public. And since the United States is such a leader in health and science, perhaps they have an impact on the world. Everything else in the things that are going on right now with the anti-science approach is really very unfortunate and is going to have implications, negative implications far beyond what people are realizing.

Well, there's a phrase that they... You know, Regis High School. Yeah, a Jesuit priest in Regis High School when I was a first-year student, thinking that all of this work that we had to do studying Latin and Greek uh was overcoming us, he told me one day, "Illegitimi non carborundum." Which means, "Don't let the bastards wear you down."

Well, you know, I didn't realize it at the time, Walter, but my father who had a pharmacy in the working-class Bensonhurst section of Brooklyn, New York, uh, in the 1940s and early 1950s was very different than the industrial pharmacies of today, the CVS's and the Walgreens. And that was sort of like the hub of the community help center where you were... Besides giving prescriptions, you know, you were a marriage counselor, you were uh advising people who had delinquent children. And in the neighborhood I grew up in, that was not an uncommon thing. So, I was instilled with, even though I didn't consciously realize it, how important service to the community was because he really cared a lot about the neighborhood and he did whatever he could to make it a better place in a very unselfish way. It was not a good business model. We certainly didn't make a lot of money because many people were poor enough that they couldn't pay for the prescriptions and he very generously would say, "Well, don't worry about it. We'll put that on a tab and you could pay it later." Sometimes they would never get to paying it. So, even as young as 8, 9, 10, 11 years old, I was imbued with that feeling of it's important for service to others. That got really underscored and amplified as I went into my 8 years of Jesuit training in high school and in college where the theme of the Jesuit training is always service for others. It was an all-boys school, so at the time it was men for others, but right now it's people for others and you worry about taking care of others and doing whatever you can and that's kind of shaped my entire professional and in many respects...

Yeah, people often ask that because if you look at the courses I took in high school were the preparation for college. It was very heavily weighted in the classics and the humanities. Uh, certainly we had science, but science was not the dominant theme. It was mostly the humanities and the classics. When I went to college, I had a very interesting uh course definition. Uh, it was Bachelor of Arts, Greek Classics/Philosophy-Pre-Med, which is almost oxymoronic. Where they gave us just enough uh science to get into medical school, but the core was people uh as the core of what you do. And it really shaped how I looked at science and medicine. I mean, obviously, fundamental basic science is core to everything that we do, that I've done in my career, but it's always been with the major theme is for humanity's sake. So, I think those 8 years of training, going all the way back, as you alluded to, Walter, from when I was a child of 7, 8, 9 years old, with my family, that had the theme of what I do being it's important. So, I think of medicine and science as a person who has a disease as opposed to a disease that's afflicting a person. And I think when you take that attitude, it gives you a different perspective on medicine and science.

For decades.

Well, um, I think it's a reflection of what I tell students when I have the privilege and opportunity to deal with them, is the lack of linearity in one's career arc. Of course, when I went to medical school, I was absolutely convinced that what I wanted to do was to get through medical school, do a few years of residency, get a specialized fellowship, and go back to where I began my training in New York City at the New York Hospital Cornell Medical Center, and practice medicine. I knew exactly where I wanted to do it on 71st Street and 1st Avenue in New York City. But what happened was that there was something a little turn in the road when I went down to the NIH to do a fellowship in a combination of infectious diseases and immunology, I became aware of the beautiful potential of biomedical research, which I call kind of the amplifying effect, whereas you can go into a room and have a major impact on the individual patient that you're taking care of, but if you can make a discovery or create a clinical protocol that would have the amplifying effect of not only the patient that you're taking care of, but perhaps tens and hundreds and thousands of patients. And that's when I decided that instead of wanting to go back to New York City and practice medicine, I wanted to stay at the NIH and do fundamental basic and clinical research, and I did that for 54 years.

I'm terrified of that. Uh, and I don't... That's not hyperbole, uh, Walter. What's going on right now appears to be an indiscriminate discontinuation of programs that have already proven to be life-saving. Uh, whether it's a program of HIV prevention or whether it's a program of the development of vaccines, which of all of the medical interventions, if you were to rank what they are, vaccines are unquestionably right up there among the most important life-saving. And if you look at what's happening right now, it seems to be almost a diabolical, across-the-board cutting of things that are related to the prevention of disease and the treatment of disease. I just hope that doesn't continue, and I hope somehow people realize that that is going down the wrong pathway, because if you look at what biomedical research... I mean, obviously, Francis and I, Francis Collins and I have been at the NIH for a very long period of time. The NIH is, among other institutions, one of the most important. It certainly is the largest and most impactful biomedical research organization in the world, in history. And if you're starting to systematically take it apart, that is not going to be good for mankind. That's for sure.

Or vaccine hesitancy or other words, if you put vaccine... If you put vaccine hesitancy around, you can't do that. And a number of other things. Obviously, we're all aware of the DEI that's been kicked out, but there are a lot of other very important words that really have been essentially canceled, which is really unfortunate and very paradoxical because you hear that one of the complaints was that the scientific community was censoring opposing opinions, which when you examine it carefully, it wasn't censoring opposing opinions. It was saying that if you have an opposing opinion, it should be based on data and evidence, not just on your opinion.

Well, mRNA is a vaccine platform. A vaccine platform means it's one of the ways that you can deliver a particular immunogen, whether that's an immunogen that would protect you against polio or measles or COVID or HIV or even in cancer therapy. The development of mRNA as a highly flexible, adaptable mechanism of delivering an immunogen was one of the most important scientific advances in the last several decades, and in fact won the Nobel Prize just last year for Katalin Karikó and Drew Weissman. So, there's no doubt that it is an extraordinarily important platform for vaccines as well as the delivery of other important interventions. The problem is in the arena that we appear to be living in of disinformation and untruths, there was this theme out there that the mRNA vaccines were causing more deaths than COVID, which is utterly outlandish because if you look at the data of the billions of people who have received vaccination, life-saving vaccination for COVID, people who are unvaccinated have a hospitalization and death rate like that. People who are vaccinated, it's down like that. So, the data, as we were talking about opinion versus data, the data are overwhelming for the life-saving capability of mRNA vaccines.

Well, that gets back to what we were saying about opinion versus data. There is no molecular mechanism that would allow that to happen. So, what are you talking about?

June and then July of '81. Right. I just joined Time. We put it on the cover. You were important, but tell me about seeing that spike and why did you figure something out?

Well, you know, again, Walter, that gets back to what I talk about, the lack of linearity in one's career, because at the time I was on a very successful track of developing therapeutic protocols for autoinflammatory diseases and we were doing very well. I was on a good career trajectory from 1972 to '81. In 1981, in June of '81, I noted on a publication that comes out every week from the CDC called the Morbidity and Mortality Weekly Report, a very unusual report. The Morbidity and Mortality Weekly Report is kind of a surveillance. They say, well, you know, a food poisoning in Minnesota or five cases of this in New Mexico. This was five young, previously healthy, curiously gay men from Los Angeles who presented with a very unusual pneumonia called pneumocystis, which you only see in people who are immune-compromised. When I read it, I thought it was a fluke, to be honest with you, in all transparency. I thought it was some drugs, some uh poppers that they would take to enhance sexual satisfaction, and I thought it would just go away. One month later, in July of 1981, another MMWR appeared on my desk. This time, 26, no longer curiously, but amazingly, all young, previously healthy gay men, not only from LA, but now from San Francisco and New York, who were presenting with the strange pneumonia, plus a whole host of opportunistic infections that you only see in immune-compromised people, and a strange cancer called Kaposi's sarcoma. That MMWR, and I say that without exaggeration, Walter, changed my life, because it just literally spurred me on to say, "I'm going to change the direction of my career." And even though I was on a pretty good pathway, I turned around my lab, handed over what I was doing successfully to trainees that had been with me for a few years, and devoted all my attention to admitting, taking care of, and hopefully getting some research insight into this strange disease. And I did that in the fall and winter of 1981. And that was 44 years ago. And what has happened since then has been the arc of my career, because I still, now, right now, consider myself someone whose major interest is in immune-compromise, and particularly HIV.

But just to add one aspect to it that people need to appreciate related to the question you asked me about interfering with the research flow that has been so productive at the NIH is that during those first years, '81, '82, '83, '84, '85 were the dark years of my professional career because I had been used to taking care of people with serious diseases that I developed protocols to make them better. So, the theme was you came in to see me thinking you were going to die and we gave you the protocol that we developed and we saved your life. Starting in 1981 when I began admitting to the NIH Clinical Center these desperately ill, young, mostly, not exclusively, but mostly young gay men were the dark years of my career because no matter what I did, they all died within 10 to 15 months with a terrible disease that devastated their community. What we did was turn on the engine of biomedical research and year by year, first discovering the virus, developing a diagnostic test, developing first one drug that was slightly effective but not quite, then two drugs and then a combination of drugs which when put together in a single pill, to get a person who now can walk into an office and say I was recently infected with HIV, I'm in my mid to late 20s, you can give that person a single pill once a day and they could live a life which you could project accurately would be essentially a normal lifespan except for maybe one or two years. Which is one of the most important advances in biomedical research that literally...

I was surprised until I listened to what they were saying. And but now, back then, um, the community which was mostly young gay men, there were some injection drug users and some other people in the community. But what was happening was that you had a disease that was very novel and it was killing people within a period of a year or less of the time they became clinically ill. So the community was terribly frightened, were frustrated and were trying to get the establishment, and when I say establishment I mean the scientific establishment and the regulatory establishment, to get them to understand that what had been going on in the biomedical research community with very rigid entry and exclusion criteria in clinical trials, the lack of availability of drugs outside of the clinical trial, and the FDA which was doing a great job in protecting the safety of the American public at the same time of getting drugs out, but the process would take 7 years. You know, when as Larry Kramer, the icon of activism, said, "Do the math. We're infected. We're going to die in 12 to 15 months, and you're talking about an approval process that takes 7 to 10 years." So, what they did is that they protested that the system wasn't working for them. I was a very visible person because I was one of the few people at the time that was full-time involved in HIV, and I was pushing the system to get more resources, which was one of the reasons why I accepted the job as NIAID director because I wanted to get more resources for AIDS and infectious diseases. But what the activist community did when the scientific community didn't listen to them, and they said something, Walter, which in retrospect, thinking about it, may have been understandable, but was unacceptable. We, the scientific community, said, "We know what's best for you. We'll do it this way." And they were saying, "No, no, you don't know what's best for me. I'm the one that has the disease." So, when the scientific community didn't listen to them, they started to become iconoclastic, disruptive, and theatrical. And since I was a known face, I became the face of the federal government. So, that's when they started to attack me in the press, Larry Kramer, his iconic article in the San Francisco Examiner saying an open letter to an incompetent idiot, Dr. Anthony Fauci.

He called me a murderer.

Well, he certainly got my attention, but what I did was I said to myself, "Wait a minute. These young people can't be wrong." Put aside the theatrics and listen to what they were saying. And what they were saying was making perfect sense to the point that I was convinced that if I were in their shoes, I would be doing exactly what they were doing. I would be protesting. I would be shutting down Wall Street. I would be invading St. Patrick's Cathedral the way they did. So, when I started to listen to what they say, it made perfect sense. So, I said, "Now I've got to embrace them." And that was one of the best things that I've ever done in my career was to bring them in, sit down with them, and say, "How can we work together to make the process work better for you without compromising the scientific process?" So, they were completely correct, and the subtext of your question was, "How does that compare with the anti-science attacks on me and my colleagues now?" It's, you know, you say it's like apples and oranges. It's like peanuts and elephants difference because they were correct. And what they were doing was based on an important need for change. What's going on now is the indiscriminate anti-science, anti-vax is totally different because even though a person can have their opinion, they're going against all the available data. Whereas the community back then were saying, "Let's take a look at what's going on now, and let's adapt ourselves to that process." So, it's really very different.

You know, I hope so. Um, well, because I mean, Francis Collins, my dear friend and colleague, is actually starting to write about that right now. About how, you know, we've got to believe that there are better angels in everyone, that there is some commonality of people really despite what they're saying, which appears to be completely contrary to some of the things, that there has to be a common feeling that we're all much more alike than we are different. Because if you look at things now, the amount of divisiveness looks like we have like two separate tribes in this country that are very, very different from each other. And you know, when times of stress, we should have come together more than we did, particularly in COVID. And what happened was COVID, I think, exacerbated the divisiveness that was already in the country.

Well, when you're dealing with a situation at the time, which was in March, when the uh coronavirus task force back then said what we really need to do because there were about 4,000 deaths per day and there were freezer trucks that were parked in front of many of the hospitals because so many people were dying of COVID that they couldn't fit them in the morgue. They had to put them in freezer trucks. That is a completely unprecedented emergency situation. So, the thing that needed to be done is that you needed to have physical distancing, which, you know, people say lockdown. We didn't lockdown. China lockdown. We definitely closed a lot of things down. So I think if you really are fair and stop the finger pointing, in the beginning it was absolutely essential. The only way to immediately shut down the 4 to 5,000 deaths per day was to shut things down for a while. That was the right choice. The thing we need to re-examine is how long you did that. How long schools were closed, how long industry was shut down.

Maybe it was, so yeah, I think what people are getting confused is the idea of shutting things down temporarily was the right decision. Everyone agrees.

What happened is that there became almost an ideological divide. One thing is very clear. Masks work. You see a lot of people say, oh, masks don't work. Masks worked. The other thing that's...

That there's the rub, Walter. A proper mask, an N95 or a KN95...

properly worn all the time. If someone comes in and says, you know, I don't know what happened. I wore a mask for most of the time, then I went to the restaurant, I took my mask off and I had my meal and I got infected. Masks don't work. Well, you took the mask off. That's the problem.

Well, yeah. So, that again is another very sensitive problem that all of us who were... First of all, we've got to be humble about the fact that the public health community did not do everything correct. And you wouldn't expect everyone to do everything correct when you're dealing with an emergency the likes of which we hadn't seen in over 100 years. People were dying and everyone was trying to save lives. There was no, you know, various attempts... 'I think I'll shut things down because I want to ruin the economy.' It's, you know, I want to save lives. That was what happened. The lesson learned, without finger pointing, is to what extent... And you know, it's very interesting because given the tone of the country, we need to examine again the whole issue of what a mandate is, because mandates worked very well in schools for decades and decades. In order to get your child in school, you had to be vaccinated with measles, mumps, rubella, polio. What that did was essentially eliminate these terrible diseases from our children. So, it does work, but given the divisiveness in the country, understandably, and we need to re-examine it. I'm totally open to re-examining that. The idea about mandating something, if done in a very, you know, heavy-handed way, could have the negative consequence of turning a lot of people off. We just need to examine whether that was the right thing. I don't know whether it was, but we need to examine it.

Yeah. Well, first of all, let's just go step by step briefly and succinctly. First of all, we don't know definitively where it came from. Okay? So, when you don't know definitively, people who say it's a slam dunk, it's this, it's a slam dunk, it's that, that's not appropriate because we don't know. But then, as a scientist, I can say even though one or the other, a lab leak versus a natural occurrence, are the two possibilities, that as a scientist, even though both are possible, they are not necessarily equally probable. So, then you say to yourself, let's look at data. And what are the data for a lab leak? There are none. There's the proposal that it could be, but what are the scientific...