A Conversation with Dr. Anthony Fauci, M.D.

This transcript is from a CSIS event hosted on August 13, 2024. Watch the full video here.

Stephen Morrison: Welcome. Good morning, good afternoon, good evening. I’m J. Stephen Morrison, senior vice president here at the Center for Strategic and International Studies in Washington, D.C., where I direct our global health work. I’m delighted and honored today to join with Dr. Anthony Fauci to discuss his memoir, “On Call: A Doctor’s Journey in Public Service.” Congratulations, and thank you for being with us, Tony. It was published on June 18th, seven weeks ago.

This event is under the auspices of the CSIS Bipartisan Alliance for Global Health Security, co-chaired by former Senator Richard Burr and former CDC Director Julie Gerberding. Special thanks to colleagues here at CSIS – Sophia Hirschfield, Dhanesh Mahtani, Eric Ruditskiy, and Dwayne Gladden, in particular. Thanks, Tony, so much for taking the time to be with us today.

Anthony Fauci: My pleasure, Stephen. Good to be with you.

Dr. Morrison: So, Tony Fauci is a medical doctor and scientist. He served as the director of the National Institute of Allergy and Infectious Diseases, NIAID, for 38 years, from 1984 to 2022. He had a 54-year stint of service as a scientist and as a clinician and a practicing doctor. He pioneered work on HIV/AIDS and other infectious diseases, including tuberculosis and malaria. He also has had a profound impact on global health security approaches and biodefense, with special focus, obviously on COVID most recently, but prior to that, pandemic flu, SARS, West Nile virus, Ebola, and Zika.

In his remarkable tenure at NIAID he served seven presidents. He received, in 2005 the National Medal for Science. And in 2008, President George W. Bush awarded him the Presidential Medal of Freedom for his work on AIDS. He achieved unprecedented access and influence in the Trump administration. During the worst of the pandemic, he became a household name across the country. He also became a target, which we’ll talk about later in the show. His last role was as the chief medical advisor to the president, a position that President Biden created for him. He’s now one year and out. He started July 1st of last year as the distinguished university professor at the Georgetown School of Medicine in the Infectious Diseases Division. And he also has an appointment at the McCourt School of Public Policy.

Tony, many thanks. You’ve been very generous to me personally and to CSIS over the years. Congratulations on the launch. It’s been on the bestseller list for seven consecutive weeks. You’ve been on an ambitious tour across the country – podcasts, cable shows, book signings, TV shows, and, of course, the true mark of success, appearing on “Wait Wait…Don’t Tell Me!” at Wolf Trap. (Laughter.) 7,800 people, a standing ovation. It’s been a remarkable run. Tell us, what’s this been like? Has it been fun? And what did you learn?

Dr. Fauci: Well, it’s been a combination, Steve, of fun, a lot of fun, and exhausting. Because when you launch a book, something that I had not – I’ve written textbooks of medicine, but never a memoir. And when you launch it, you have a concentrated period of time where you just got to get out and just do the launch. So we went from New York City, I was there for a week doing different TV shows – Rachel Maddow and Stephen Colbert, and people like that, and other MSNBC, Lawrence O’Donnell, and others. Then I came to Washington and did “Politics and Prose.” And then I went on a on a bus tour to L.A., San Francisco, and Chicago. So it was exhausting, intense.

But the response and the reception that I got was really very gratifying. I mean, people really, really were very generous in their support. I mean, as you mentioned, there were 7,800 people at Wolf Trap who were very excited. And in Wolf Trap, I didn’t realize that, but they don’t say who the mystery guest is until they announce it.

Dr. Morrison: Oh, really? I didn’t know that.

Dr. Fauci: So there were 7,800 people there. And then they said and now our guest is Dr. Anthony Fauci. And the crowd just erupted in a standing ovation. So it was really very gratifying. Bottom line, it was a very positive experience.

Dr. Morrison: Have you been able to appear on some of the conservative media as well?

Dr. Fauci: No. As you would expect, I mean, the conservative media, probably without even reading the book, said it was horrible – (laughs) – without even reading it. And then, you know, the press – that’s the, you know, the validated press – loved it.

Dr. Morrison: Yes, yes. Well, I have to mention, I was chuckling when I looked at the bestseller list. Who else is on the bestseller list right now? There’s this guy from Ohio who wrote “Hillbilly Elegy.”

Dr. Fauci: (Laughs.)

Dr. Morrison: There’s this guy named Fred Trump who wrote a book called “All in the Family.”

Dr. Fauci: (Laughs.) Right.

Dr. Morrison: And there’s “True Gretch” by the governor of Michigan. So there’s something in the air about writing nonfiction books that seem to circle around a common set of issues.

Dr. Fauci: Yeah. Yeah, that’s for sure, yeah.

Dr. Morrison: So let’s talk about your early life. I was very struck by the opening of the book in talking about your Italian heritage, growing up in Bensonhurst, Brooklyn, the values instilled in you by your family and the way those values connected to the Jesuit training that you had, starting in high school and going all the way through college. So it’s just – it came across very powerfully as to how grounded and stable your upbringing was –

Dr. Fauci: Yeah.

Dr. Morrison: – in the continuity, all the way from childhood into early adulthood.

Dr. Fauci: Right.

Dr. Morrison: Say a few words about that. Like what are the foundational values that make you what you are today?

Dr. Fauci: Yeah. You know, Steve, it started at a time when I didn’t even appreciate what the ultimate implications would be. My father was a pharmacist. And this was in the 1940s and 1950s. And in the 1940s and ’50s, the neighborhood pharmacy was not like the industrial CVS and Walgreens that you have now.

Dr. Morrison: Right.

Dr. Fauci: It was kind of the hub of the neighborhood. It was the neighborhood shrink. It was the neighborhood marriage counselor. It was the neighborhood physician for people who couldn’t afford physicians. So I learned from my father when I was seven, eight, nine, 10 years old, when I was delivering prescriptions on my Schwinn bike, what it meant to care for people and care about your community.

I didn’t realize in my mind that that was sinking in, because I was a kid. I was seven, eight years old. But it was very clear that his purpose was not to make money. He was a poor businessman – (laughs) – I have to tell you. The store didn’t do very well because he constantly would give out drugs. And when people couldn’t afford it, he wouldn’t ask them to pay, which didn’t do very well as a business model.

But as you mentioned, that then continued into that service for the community when I got my training in elementary school with the nuns, gave you tough love, the Dominican nuns. But it really came home to bear when I went to Regis High School in Manhattan, which is an elite Jesuit school in Manhattan.

Dr. Morrison: Yes.

Dr. Fauci: And their theme of the school – it was an all-boys school – it was men for others; namely, do things for the community, not primarily for yourself. That was extended as I went to college at the College of the Holy Cross, another Jesuit school with the same theme; you know, men for others, service to the community. That just segued into my wanting to be a physician, because I was very excited about science and how you could make science work for the good of society. I really liked being with people because I’m a people person. I’ve always been a people person. So with the training I had from childhood through my Jesuit training, the natural thing for me was to be a physician and a scientist.

Dr. Morrison: And when you entered Holy Cross, that was in your mind already, right?

Dr. Fauci: When I entered Holy Cross, it was a premed – it was very interesting, because the balance between my affinity for humanities and yet my application and my aptitude for science, I took an almost oxymoronic course and major. It was bachelor of arts, Greek classics/philosophy-premed. So – (laughter) – I majored in the classics and philosophy, and I took just enough science courses to get me into medical school.

Dr. Morrison: Oh my gosh.

Dr. Fauci: And it was really fun.

Dr. Morrison: Yes.

Dr. Fauci: It was really fun.

Of course, that idea about learning about civilizations and about how people think about themselves, philosophy and the classics, that really helped me in my later part of my career when I went from being a pure clinician/bench scientist to taking over the institute, when I had to look at more global issues and the impact of disease on societies. My earlier training in the classics and in philosophy really helped me in that regard.

Dr. Morrison: Really helped you a lot.

Dr. Fauci: Yeah.

Dr. Morrison: Well, you indicate in the – in your memoir that when you hit the age of 40 –

Dr. Fauci: (Laughs.)

Dr. Morrison: – you started feeling restless.

Dr. Fauci: Right.

Dr. Morrison: You started feeling unfulfilled, even though you’d had this remarkable set of accomplishments up to that time in terms of being a very highly regarded doctor and clinician, but also pioneering research work. You had gone to NIH on a, first, fellowship in ’68 to ’71, and then joined the staff. So what was it at 40 that made you restless and unfulfilled?

Dr. Fauci: Well, I was very fortunate. I had a phenomenal mentor, Dr. Sheldon Wolff, who recruited me to the NIH, and he put me on a project to try and develop therapies for people with deadly autoinflammatory diseases of the vessels, what we used to call Wegener’s granulomatosis, and now it’s granulomatosis with polyangiitis, polyarteritis nodosa – unusual and maybe even rare diseases, but deadly. So we developed a therapeutic regimen based on low doses of drugs that had formerly been used for cancer, and we put the diseases into a 93 percent remission rate. So from 1972, when I was 31; to 1980, when I was 39; and then ’81, when I was 40; my career was escalating trajectory. It was really on a very, very sharp positive incline.

But as we got into ’78, ’79, ’80, the work, though transforming, was really incremental. So we had made a big advance. The rest of the world was using our therapeutic protocols. But we weren’t doing things that were any more transforming. It was important work.

Dr. Morrison: Yes.

Dr. Fauci: We were publishing in all the great journals. But it was incremental.

So I started to get itchy –

Dr. Morrison: Yes.

Dr. Fauci: – that I wanted to do something that would be more transformative. And then, sure enough, the circumstances in life – I’m sitting in my office in the summer of 1981, and what lands on my desk is the first MMWR in June of 1981 of five gay men from L.A. with pneumocystis pneumonia. To be honest with you, I thought it was a fluke and I said this is just going to go away, it was probably took some drugs that suppressed their immune system. One month later, in July of 1981, the second MMWR came out, now 26 curiously – more than curiously, phenomenally – all young otherwise-healthy gay men not only from L.A., but from San Francisco and New York City, who presented not only with pneumocystis pneumonia but with other opportunistic infections and Kaposi’s sarcoma.

That day, Steve – and I don’t mean, you know, to be melodramatic about it – that day changed my life. It changed the direction of my professional career because I looked at it and said: This has to be a new disease, and it has to be an infectious disease, because the epidemiology was screaming at you that it was a sexually-transmitted infectious disease and it was destroying the immune system. And here I am; I have my boards in internal medicine, my boards in infectious diseases, and my boards in clinical immunology. I mean, if ever there was a disease to study, that was it. It didn’t have a name. We were calling it GRID at the time –

Dr. Morrison: Right.

Dr. Fauci: – gay related immune deficiency, terrible name. And it didn’t have an etiology. And I decided to completely turn around the direction of my career and focus on admitting these desperately ill, young, mostly gay men to our service at the NIH hospital in Bethesda, and to start studying them to see if we could figure out pathogenesis. We hadn’t discovered the virus yet, so we were just trying to tease out what the pathogenic mechanisms were.

Dr. Morrison: And as you – as you explained, that decision by – that you made was not wholly accepted by your mentors.

Dr. Fauci: No.

Dr. Morrison: They were puzzled by this. And also, throwing yourself into caring was deeply traumatic. Say a bit about those things.

Dr. Fauci: Well –

Dr. Morrison: You had skeptics who were saying, what are you doing?

Dr. Fauci: Well, my mentors, who I totally respected, said things like: Tony, don’t give up your day job. This is – this is going to go away. But, to their credit, once it became clear that this was exploding, they said, you made – you made the right choice. But it was a total turning around of what I was used to, because I went from nine years, from ’72 to ’81, of having patients come to me with a disease that formerly were killing them to the person that developed the therapy that was now saving their lives. So it was all positive. You think you’re going to die. You come into my service. You walk out. You essentially have a disease in remission. And I went through eight or nine years of that, and it was just always positive.

Very rarely – it happens all the time in medicine – a patient would not respond and would die. But that was the unusual rarity. Then I bring in dozens and dozens of these desperately ill young gay men. I have a small crew, Cliff Lane and Henry Masur, the two people that were training with me. One I brought from Cornell. One was a fellow of mine, Cliff, when he came to study infectious disease and immunology. And we started bringing in these patients. And for years, Steve, almost every one of them died. So I describe it in the memoir as the dark years of my professional career, because it was like putting Band-Aids on hemorrhages. We had no therapy. For the first three years, we had no etiology. And it wasn’t until ’87 when the first drug, with AZT. And wasn’t until ’96 that we had an actual combination –

Dr. Morrison: Right, 15 years after the first report, yeah.

Dr. Fauci: 15 years we were taking care of people where we didn’t have adequate therapy. That was an experience that, I say in the book, not only for me but for my colleagues, it left you with really post-traumatic stress because you had to screen out day, after day, after day of young gay men dying a terrible death. And you’re doing everything you can, and it’s not good enough. That was dark.

But that was counterbalanced when 1996, ’(0)7 , ’(0)8, ’(0)9, 2000, 2001 when we started to develop not only triple combinations, but triple combination you could give in one pill once a day. So it went from dark despair to essentially triumph, knowing now that if a young man or a young woman comes in with newly acquired HIV you could put them on a therapeutic regimen and look them in the eye and tell them: If you take care of yourself, you’ll likely live almost a normal lifespan.

Dr. Morrison: Amazing. Now, as reading your book I was – indulge me for just a few minutes to explain – I was struck by the transformation that happened within you personally when you moved into direct NIAID in ‘84. And what do I mean by that? First of all, you had these historical forces. You had HIV – you had this HIV epidemic, and it became a pandemic. You had that. Later after 9/11 you had the bio terror threats. You have these historical forces at work. But you became – suddenly you became very deft and proactive as a political player. You were – you were building relationships. You were recognizing the power of relationships, especially in the White House or at the helm of HHS and elsewhere. You built very strong and enduring relationships, particularly with George Herbert Walker Bush and George W. Bush.

You became very deft at dealing with your adversaries, like ACT UP. You go into this account about ACT UP. Larry Kramer is issuing these vitriolic condemnations. And you flipped the table. You flipped the table. You showed humility. You changed practices in terms of regulatory practices, patient advocacy, incorporation into clinical trials and advising on science, and the like. And you did that against the common wisdom of the FDA or common practice. So you became a bit of a rebel, a bit of a radical. And you stepped out of – you know, you stepped out of the normal lanes in arguing for a doubling of the HIV budget, the creation of a special division. You pushed hard. And this was a really – when you add all of that up, it was a big, transformative moment. And it worked. So how did this – how was this all possible? Why didn’t you – this was not preordained. Nobody had defined this job in the way that it evolved.

Dr. Fauci: No. I think that’s a good point, because at that point institute directors would never do anything like that. They would do – in a very efficient, productive way – do their jobs. They would never step out of their lane. I was dealing with unusual situations, with crises. You know, I used to joke with Francis Collins, my good friend, when he was the director of the National Human Genome Research Institute. And I would say, Francis, when you go to bed at night you never have to wake up in the morning to a genomic emergency. (Laughter.) When I go to bed at night I wake up we may have another new disease that is a global health crisis. So I say that facetiously, but it really is true.

What it was was the nature of what I was facing. I was facing crises and catastrophes. We were dealing with a brand-new pandemic. We didn’t have enough resources. And I said, if I don’t step up to the plate, and take a chance, and go to George H.W. Bush, to go to the secretary, to go to Jim Wyngaarden, who was the director of NIH, and say: You know, I know that the normal tenure is to keep quiet and take what we get you, but we need more resources. I want to go to the Congress and I want to lobby for it, which you never do. And they gave me a tacit shake of the head. OK, do it if you can do it. Which I thought was really great.

And then I realized that who you know in Washington – and I don’t mean using it in a way to be self-serving – but who you know in Washington, particularly if it’s the president, or the vice president, or a member of a Cabinet, can really get things done that would otherwise not get done. So what I did is I developed relationships and said, because of the seriousness of the nature of what I’m dealing with – pandemics like HIV/AIDS, anthrax attacks, bioterror threat, pandemic flu, all the way up to what we did most recently with COVID – you needed to essentially grab the bull by the horns and do what you can do. So it was a transformation of Tony Fauci, because I had to step out of the lane of the very, you know, buttoned down institute director who did a good job of running the institute, and get out of that lane and try and bring resources in.

I did the same thing with the activists. I mean, the scientific community, understandably – and I say that in deference to them – but not appropriately, felt that the way we were doing things, with the rigid entry and exclusion criteria in clinical trials, the rigidity of the approval process by the FDA – which worked well for decades, safe drugs, effective drugs, but it took seven to 10 years to get out. The community with HIV was saying, by the time we get ill we have 10 to 15 months to live. Do the math. Larry Kramer wrote a note, an article. Said, do the math. It doesn’t work. We’re dead by the time this happens.

So they wanted a seat at the table. So when they were being – felt that they were not being heard, the scientific community, unfortunately said: We know what’s best for you. The regulatory community said: We know what’s best for you. They wanted a seat at the table so that they could get involved in the design of the strategy. So that the gay community then started to be iconoclastic, disruptive, theatrical, and –

Dr. Morrison: And competent, scientifically.

Dr. Fauci: Totally. Totally.

Dr. Morrison: I mean, people like Mark Harrington.

Dr. Fauci: They started off breaking the doors down with Larry Kramer, and then along comes Peter Staley, Mark Harrington, Gregg Gonsalves, David Barr, and people like that. So what happened is that once they got my attention, since I was the known face of the federal government, they attacked me mercilessly. But, Steve, it wasn’t personal. They just wanted to get my attention. And once I listened to them, put aside the theatrics, put aside the disruptive behavior, and listened to what they were saying, what they were saying was making perfect sense. And I said to myself, you know, this guy from Bensonhurst, Brooklyn, if I were in their shoes, I would be doing exactly what they were doing. I would be, you know, disrupting traffic. I’d be invading Wall Street. I’d be doing that.

So I listened to them, and what they were saying made sense. And that’s when gradually – it didn’t happen overnight – gradually, over weeks and months and years, we developed relationships that went from adversarial to collegial to cooperative, to now these people are some of my closest friends.

Dr. Morrison: Yes. I was struck by – was it Jim Hill, your colleague –

Dr. Fauci: Yes. My deputy.

Dr. Morrison: – who lived on Capitol Hill –

Dr. Fauci: Yes.

Dr. Morrison: – and who started brokering these –

Dr. Fauci: Right.

Dr. Morrison: – dinner conversations –

Dr. Fauci: He was a great cook.

Dr. Morrison: – and getting people to begin to listen to one another.

Dr. Fauci: Oh, Jim Hill is an important part of the book. I have an entire chapter on Jim Hill. Jim was a young gay man who was my deputy, a good scientist and was my deputy, who was one of the most likable human beings you’ll ever want to meet. And he was very influential in creating a forum to get the gay community to come down to Washington, the activist community. And his house on Capitol Hill was the forum where we would sit down and we’d hash out and we’d argue sometimes. They were very heated discussions. We didn’t always agree. But in the background was Jim Hill cooking, bringing out wine, and making sure – (laughs) – everybody was in a mood where we were willing to cooperate with each other.

Dr. Morrison: So when you look back at this transformation in your role, there was remarkably little resistance to this. I mean, governments normally don’t allow career employees to go out and design an entirely new, unprecedented, very authoritative, very influential role. It’s not in the nature of government.

Dr. Fauci: Right.

Dr. Morrison: Was it because of you personally and what you were scoring in terms of success? But it was also the urgency of this moment?

Dr. Fauci: I think it was a combination. I think it was the urgency of what I was trying to do. I wasn’t doing anything that was self-serving. It was for the cause, whether the cause would be HIV or the cause would be anthrax or bioterror. It was for the cause.

But also I didn’t just jump onto the scene with a big explosion. It was a gradual building up of confidence, respect. And once you make it clear that you’re going to be strictly honest with authorities and not tell them something they want to hear, they gain respect for you and the word gets out, so that the next time you do it, they’ll call up and say this guy Fauci is trying to do something. What do you think? Oh, he’s a straight-shooting guy. Then you go to the next stage. And over a period of years – remember, I did this with seven presidents over a period of 38 years. It became clear that people trusted you. So it was a combination of the urgency of the situation and the trust that you built up over decades.

You know, there’s one thing that I just want to bring up, which is an important part of the book, but the first time that I went into the White House, I asked a friend who was – spent six years in the Nixon White House – conservative Republican, good friend of mine, and then subsequently went to HHS – I told him I was going to go into the White House to advise the president. And he gave me a bit of advice that I would have hoped I would have come to that conclusion without his advice.

Dr. Morrison: Yes.

Dr. Fauci: But his advice helped. He said when you go into the West Wing and go under the awning into the lower level, every time you do that, tell yourself, whisper in your own ear, this may be the last time I’m walking into the White House, because if you get consumed by the headiness of the White House and how awesome it is, you instinctively want to get asked back. And if you want to get asked back, you might hesitate to tell an authority, be it the president, vice president, or a senior member of the administration, something that they might not want to hear.

Dr. Morrison: Right.

Dr. Fauci: You may get the messenger that gets thrown out. Well, you should never be afraid of being the messenger that gets thrown out, because if you’re just honest with them and tell them the truth, you’ll get asked back.

Dr. Morrison: So setting aside Trump for the moment, where were the other moments when you spoke the truth and got pushback?

Dr. Fauci: I never got pushback. I spoke the truth, I mean, and when I – when I had long conversations with President George H.W. Bush about the need to be much more flexible in embracing the gay community – you had a very conservative group in the White House – and about why we needed more resources, he said, you know, we’re getting a lot of pushback; I think that we are giving a lot. I say, you know, but it’s not enough; we’ve got to give more. I could have said: Yes, sir, you’re giving enough, doing a good job. I said: No, we really do need to give more. It was never confrontative, but he listened. You know, I didn’t always get what I wanted, but he listened.

Then there was George W. Bush. When I came to him and said – but he didn’t need much convincing because he really wanted to do something for the developing world. But when I went in and said I’ll get a proposal for you that’ll be transforming for treatment, care, and prevention of HIV in the developing world, you know, he may have – you know, he could have pushed back on it, but he didn’t. He said: Tell me more. In fact, his famous words to me that I write in the memoir, I said: This is going to cost a lot of money. And he said: Let me worry about the money; you just put the program together. Which is what I did.

Dr. Morrison: Right. Now, the accounts of your interactions with Gary Edson and Stew Simonson, and putting – in your travels to Uganda in 2001 – I actually was there when you gave that one speech – those were very heady times. And when you look back, you had the transformation that happened with the advent of triple – combination triple therapy became available, Vancouver in ’96. Then you had the Global Fund launched and PEPFAR launched in the 2002-2003 timeframe. And you had a remarkable coalition come together. You had strong presidential leadership, you had strong support within the public-health community and scientific community, but you also had the faith community, philanthropies. You had the corporate sector as a very major partner in all of this. And you had a strong and deep bipartisanship on the Hill. How did this become possible? As you look back, how did this happen?

Dr. Fauci: Well, what you just said should be, Steve, a model for what we need today, because we have come so far away from what was going on in 2001, 2002, and 2003. You said perfectly accurately everybody was coming together – the faith-based community, the scientific community, the public-health community. The Democrats and the Republicans were in unison with that. There was no space between them. The president was involved. It was just an amazing – pharmaceutical companies were involved.

You know, PEPFAR is one of the greatest things that’s ever happened in public health. It would never have happened if it didn’t have a constellation of all those things coming together under the leadership of the president of the United States.

Dr. Morrison: So today – we’re in a different situation today on HIV. And what I mean by that is I just came from Munich at the International AIDS Conference; there was a mixture of optimism about injectable long-term treatment and PrEP –

Dr. Fauci: Right, right.

Dr. Morrison: – but there’s also an angst because people are aware that the financial base for the HIV response is shrinking, political will has been shrinking. There’s a dangerous dependence on U.S. money. We account for three-quarters of all the dollars. And we’ve got all of the other factors that are coming in – the geopolitical wars that are hugely costly, climate change is now commanding lots of resources. We’ve had a generational change of guard. We’ve seen the fraying of bipartisanship up on the Hill with the difficulties in getting another five-year reauthorization.

And one of the conclusions is that we really need to reset our thinking today. And I wanted to ask you what we need to do to take account of these new realities and make sure there’s not a regression, a risk of these achievements. What’s your thinking on that?

Dr. Fauci: Yeah. We have got to come out of the blocks very aggressively to get people to appreciate this is not a novel story. When you have a successful program which is going in the right direction – saving lives, being successful – you can’t say it’s on its own, now I can turn away and look at something else; it’s going to continue on its own. You’ve got to continue to nourish it.

Historically – you and I go back long enough to remember some malaria programs where they would have eradication of malaria – not eradication, but control of malaria in certain countries; and then people said, OK, we took care of that, now let’s go do something else. No, you have to keep putting resources into keeping something suppressed. We’re not where we need to be with HIV. We don’t understand –

Dr. Morrison: Still no cure and still no vaccine, and –

Dr. Fauci: Still no cure, still no vaccine. We have great drugs. You know, U=U is great. You know, lenacapavir is a hundred percent effective in women in Africa. And we have, you know, every couple of months cabotegravir, et cetera, et cetera. All of that is great, but we can’t pull back because people are still getting infected. And those who are on drug need to stay on drug.

I think we need to just articulate that in a much more proactive way and not take for granted how well we are doing. Indeed, we are doing very well, but very well is not good enough to end a(n) historic pandemic. And we’ve got to end it. You know the metrics, we want to get down by 75 percent in five years. It’s 2024; five years is 2025. (Laughs.) And we want to be down to 90 percent by 2030. And we’re not –

Dr. Morrison: – getting there.

Dr. Fauci: We’re not on a trajectory for that.

Dr. Morrison: We’re not there.

Well, one of the problems, it seems to me, is that there needs to be outreach beyond the community of experts. There needs to be some – a new dialogue of some kind that brings in influential folks to think again about what this achievement means –

Dr. Fauci: Right.

Dr. Morrison: – because it’s just getting lost. It’s becoming a distant second- or third-tier priority. People have the false sense that the threat has subsided.

Dr. Fauci: Right.

Dr. Morrison: They don’t understand that we’ve got 40 million people living with the virus, 10 million not on therapy.

Dr. Fauci: Right.

Dr. Morrison: That we have 1.3 million deaths per year – I mean, new cases per year, and –

Dr. Fauci: Right.

Dr. Morrison: – 630,000 deaths. Those numbers are way off the targets.

Dr. Fauci: Right. But people are inured to that. They’re numb to that because it’s been that way for so long. And then I believe, Steve, that the three-year – four-year now, going on the fifth year, very difficult experience we’ve had with COVID have really taken people’s mind off that – HIV, we’ve got that under control; you know, we just lost 1.2 million people with COVID and we’re still having a summer wave now with COVID. So the last thing on people’s mind is HIV, which is unfortunate for the reasons that you mentioned and for the numbers that you gave.

Dr. Morrison: Yeah.

I wanted to ask you about CDC. You have some criticisms of CDC in your book. We know CDC’s gone through a difficult period. We put out in early 2023 a critique of its performance and with some very concrete proposals. You were helpful in that. You were one of our sources, Tom Inglesby, when we put that together. How do you think CDC’s doing now?

Dr. Fauci: I think Mandy Cohen is doing a great job. (Laughs.) I really do.

Dr. Morrison: Yeah.

Dr. Fauci: She’s really out there trying to regain the credibility. And I hope that she is able to effect things that may not be completely in her power, because one of the things, you know, when – during the year with Trump and the two years with Biden when I was chief medical advisor, we were on the phone every night with the CDC.

Dr. Morrison: Yeah.

Dr. Fauci: Literally every night with the CDC. And it became clear that sometimes they didn’t have control of getting information to them that they needed. So we have got to change that.

And my criticism of the CDC in the memoir was very gentle. It was gentle and it was because of things mostly that were not under their control, that they could not get information in real time. Once we get that nut cracked, I think we’re going to do much better. And I like what Mandy’s doing. I think she’s doing a really good job.

Dr. Morrison: That’s great.

All right, let’s talk about President Trump. In the Trump administration, your experience was radically different from your experience in the previous five presidents and radically different from the experience with President Biden. And as you describe, President Trump was simply unwilling to accept reality. He was unwilling to accept the narrative that this was hugely dangerous and growing, and that things like hydroxychloroquine were not safe and effective, and that this was not going to go away rapidly and be a transitory phenomenon. And you chose – it seems to me in reading your account you chose to stand up to him, and it became a confrontation and a power struggle. And I wanted to put on the table I think the degree to which he turned on you and unleashed his White House minions on you and gave support to all sorts of other outside actors to begin attacking you. You were really a threat to his power. You were – you could not be fired. You had higher media visibility and support. You had deep support in the American public. You had the respect of the media. You were – you were more powerful on these issues than he was. And that just seemed to set off this remarkable effort to try to damage you.

Dr. Fauci: Discredit me.

Dr. Morrison: Discredit you. And say a bit about that. And then I want to ask you if – a question around what might have been different.

Dr. Fauci: Yeah. Well, the issue with President Trump is that I got along quite well with him in the first month or so. You know, he is a very complicated character. You know, he’s very narcissistic, very self-centered, always worried about ratings and things like that. And very theatrical, in his way. Which is fine. I have no problem with that, you know? (Laughs.) We got into trouble when he crossed the line of truthfulness. And that’s when things – so what happened is that, understandably but not acceptably, he wanted desperately for this to be like flu, where come February/March it goes away, concentrate on the economy, get into the election cycle, and he gets re-elected.

When he saw it wasn’t going away, he started saying things that were untrue. It’s going to go away like magic. Those were his words. It’s going to disappear like magic. When the press would then ask me when I was standing in front of the podium, what do you think, Dr. Fauci? Or that evening after the press conference, when someone would call me up, or I’d be on CNN, they’d say: The president said it’s going to go away like magic. I say, no, it’s not going to go away like magic. Then when it became clear to him that it was not going to go away like magic, he started to invoke magic elixirs – hydroxychloroquine. It’s going to come in. It’s going to make everything all right. The press would ask me, does hydroxychloroquine work? And I would say, no. Not only is there no evidence that it works, but it can actually do harm.

Interestingly, he was getting less upset at that. He would always say – but he would say, Tony, why can’t you be more positive? You know, we would be on the phone. And then at the end of yelling at me, as I describe in the memoir, he would say, we’re still OK, aren’t we? We’re good? Like he didn’t really want to have an enmity between us. Yet, his staff, the comm staff – Peter Navarro, Mark Meadows, those guys – really tried to undermine me and discredit me. And then –

Dr. Morrison: And he was – Trump was aware of this.

Dr. Fauci: Oh, he – of course.

Dr. Morrison: He had empowered these guys.

Dr. Fauci: Of course, of course. But he wanted the best of both worlds. He wanted to say, we’re OK, aren’t we, Tony? (Laughs.) But in the meanwhile, you get somebody like Navarro who writes an editorial saying I don’t know what I’m – what I’m talking about. So it –

Dr. Morrison: And that sort of spawned other action, right? It sort of inspired Rand Paul, and Marjorie Taylor Greene –

Dr. Fauci: That’s the damage, because the White House crew, who were, you know, pushing back because I was not being cooperative with their hero. The people on the outside, every Republican that was running for the Congress, every senator that was running for the Congress, it was part of their campaign – fire Fauci, lock him up, throw him in jail, cut his head off. Because they felt that they were ingratiating themselves with the far right. They were doing it even though they had no idea who I was or what I was doing. I found it sort of ludicrous that some politicians were running, part of it was fire Fauci. You know, donate $100 to my campaign, fire Fauci. And you –

Dr. Morrison: So things sort of spun out of control.

Dr. Fauci: Yeah.

Dr. Morrison: And when I read this account I wonder, OK, were there any moments there where things – you could have done things any differently? Or, you know, the Great Barrington Declaration, or Scott Atlas shows up as a counterweight to you. You know, Deborah Birx decides to go on the road. You stood your ground. And then you become this target. As you look back, are there things you would have done differently?

Dr. Fauci: No, I don’t. I felt it was absolutely essential to preserve my professional and personal integrity, and to fulfill my primary responsibility – which was to the American public. I had to push back when he said things that were, frankly, not true. So I could say – what would I have done differently? Say, well, no, you know, maybe this does work. I couldn’t. I had to say, no. It doesn’t work. It’s not going to cure. No, the virus is not going to disappear like magic. So I really wouldn’t have done – I tried with Steve Atlas. Deb Birx was totally frustrated by him. That’s why she went – she went –

Dr. Morrison: Went on the road.

Dr. Fauci: She did a good job on the road. (Laughs.) But she said, I’ve had enough of this. I’m going to get out of here. I tried to outreach to him, but he was an unusual guy. When I said – Marc Short, vice president’s chief of staff, asked me personally to reach out so that he didn’t want to see this conflict between Deb and me – not between Deb and me – between me and Deb versus Scott Atlas. So I told Marc – I said, Marc, I will call him up and see if we could reach some sort of rapprochement. So I called him up and I said, let’s talk about this. Because I think some of the things you’re saying I just don’t agree with. And he was so haughty and said, I’ve read the same papers you have and I think that I know as much or more about infectious disease than you do. So thank you very much. OK. I didn’t say I know more about neuroradiology than he does, but. (Laughs.)

Dr. Morrison: Right. What do you think the lesson for the future is, of what you experienced? What’s the implications going to be on the next generation of leaders in public health and science?

Dr. Fauci: You know, I think you just need to speak up. I think it has to be – you have to – somebody has got to say the truth, even though it’s costly. It’s cost me dearly. It’s changed my life. I mean –

Dr. Morrison: And it’s not over.

Dr. Fauci: It’s not over.

Dr. Morrison: We still have this COVID origin conspiracy thinking on the Hill and elsewhere trailing you. You’ve still got security threats against your life.

Dr. Fauci: Yeah. Right. Yeah, but I wouldn’t do anything any different, because the only other way how to avoid it would have been to not push back against untruth. And I had to. That was my responsibility to the American public. That’s why I was there.

Dr. Morrison: Do you think this will breed excess caution in the next generation of leaders?

Dr. Fauci: I do. I think that already – not only next generation, but some of the people who are already in public health and in science – don’t want to get involved in this. They don’t want to have their family threatened and have themselves threatened. So they would just rather go do something else. That’s bad, because then you’re going to lose talented people.

Dr. Morrison: Do you think that we’re going to see a greater distribution of authority in these matters? In other words, you became a target in part because you stood up. You became a target because you had concentrated authority and influence. In this new world that we’re in, are – I don’t know that we’re going to see another Tony Fauci emerge in that way. What we’re likely more to see, I think – I’d like to hear your thoughts – is responsibility and authority spread across a number of different institutions. Does that make sense?

Dr. Fauci: I think so. One of the things that got confused in all of this is that the reason I was out there a lot is because, of all the public health officials and scientists, I had been the spokesperson for public health crises that went back 40 years. I was experienced in it. The Congress, the press, the administrations knew me, and knew that I could articulate clearly for the American public what they needed to know to make them safe during HIV, to make them get reassured during anthrax, to make them know that Ebola is not going to wind up spreading throughout Washington, D.C. Those are the kind of things that I was experienced as.

So when you’re out there year after year after year, you assume a degree of notoriety and credibility that is unusual. So when you say you don’t think there’s going to be another model like this, it’s going to be unlikely that somebody’s going to be in the same job for 40 years and involving with multiple different crises. It is very unlikely that that’s going to happen again. So I agree with you, it’s – I don’t think there’s going to be another situation where you have somebody like me being in a position after so many years being a public figure to be the one that’s articulating what’s going on. It’ll be a number of people doing that.

Dr. Morrison: Yeah. So you’re still at the center of this conspiracy around COVID origin, all these allegations. The House Select Subcommittee on the Coronavirus Pandemic is going to issue some kind of report in September. It’s part of the electoral cycle. It surfaces in Trump’s talking points and the like. When is this craziness ever going to subside, in your view?

Dr. Fauci: I don’t know. I hope soon, because it’s nonproductive and it does nothing but cause havoc and confusion and gets in the way of properly preparing for the eventuality of another pandemic.

Dr. Morrison: Do you think your book has helped quell some of these passions?

Dr. Fauci: I hope so. I hope so. But, again, there are some people who are so set on thinking in one way, you know, convinced that this is – and I got to make it very clear that I – as I say very clearly in the book – I still keep an open mind that we don’t know what the cause is. But it’s the people who are totally convinced it’s a lab leak, although there’s no data at all to substantiate that. And they go on with all kinds of conspiracies about it. You know, one of the ones that was really funny that I brought up at the hearing was that I tried to influence the CIA to argue against a lab leak by sneaking into the CIA unannounced, like a Tom Cruise or Matt Damon, you know, I parachuted in. (Laughter.) I mean, so it’s rife with conspiracies. It’s really crazy. The idea that it could be a lab leak inherently isn’t conceptually a conspiracy. But people superimpose conspiracy interpretations on that.

Dr. Morrison: Right. And we have to get beyond that.

Dr. Fauci: Oh, absolutely. Absolutely. We also got to – I think we’ve got to reestablish relationships with China as a scientific and public health partner, because historically, if you look, SARS-CoV-1 came from China. Many of the influenzas come from China. I mean, we’ve got to be able to talk in an intelligent, collaborative, collegial way with scientists throughout the world, including China.

Dr. Morrison: I agree with you entirely. I just want to remind you, in October of 2017 the deputy premier of China came here with four ministers and four agency heads in the health domain. This was the first year the Trump administration. They didn’t want to host it at HHS, or NIH, or somewhere else. So they came and asked us to host it here. And this was right at the end of Secretary Price’s tenure. But you came over. Francis Collins came over. You know, it was a remarkable gathering upstairs with the deputy premier in the building. And one of the things that just stunned me was the depth of personal relationships across the U.S. and China. I mean, there were – George Gao was there. You had people that had had strong partnerships going back 30 years, or longer.

And we’re at risk of that being broken if we allow – we have not had a senior-level conversation around health security and preparing for the next major biological threat with the Chinese for over four years. That’s a huge gap. And it’s a national security risk. But we have to figure out how to get that back. And we’ve been very active in that regard. And I’m delighted to hear what you’ve just said about the need to continue to remind ourselves that this is a gap and we need to fix this. And there are ways to do this. And we we’ve been talking to the Chinese. And they’re eager to reengage, and try to break the ice, and get things back on some civil or constructive footing. It’s going to be difficult.

Two last things. One is, tell us about your life at Georgetown. What are you – what are you doing at Georgetown now? And you seem excited about it.

Dr. Fauci: I am.

Dr. Morrison: And that’s great.

Dr. Fauci: I am.

Dr. Morrison: And you’re not losing any energy, I can see.

Dr. Fauci: No, I’m not. I’m excited by it. I’m a distinguished university professor at Georgetown with a dual appointment in the School of Medicine and the McCourt School of Public Policy. And what I do is that I give lectures, seminars, individual meetings with students, fireside chats in multiple schools on and off the campus – not just medical school and the McCourt School; I do it at the law school, I do it at the School of Nursing, I do it at the School of Public Policy, I do it at the School of Foreign Service. I’ve done a number of these –

Dr. Morrison: And there’s a lot of keen interest in having you come over.

Dr. Fauci: Oh, there is, there is. But the thing about it that is unique in a very positive way is that for the 54 years that I spent at the NIH, I was always dealing with doctoral-level people, people who are subspecialists, people who are researchers; very little continual interaction with students, undergrad students.

Dr. Morrison: Yes.

Dr. Fauci: At Georgetown, you’re surrounded by, you know, like – like, just countless numbers of these young, bright men and women – you know, 19, 20, 21, 22 – who are just delightful to interact. So it’s a brand-new experience for me.

Of course, when I was stepping down at the NIH I asked myself, you know, here I am getting pretty old. I stepped down when I was 81. You know, do I want to start writing a lot more scientific papers? Do I want to do another clinical trial? Or do I want to use the 54-year experience that I have, the 40 years of – 38 years of being a director, my experience with seven presidents, do I want to use that as an inspiration for young people who might be considering a role in public service? That was one of the reasons why I wrote the memoir. That was kind of like the textbook of what I want to do for the students.

Dr. Morrison: And I assume this brings you back to your days at the College of Holy Cross –

Dr. Fauci: Yes.

Dr. Morrison: – going back – you know, going back on campus at Georgetown, interacting with these undergraduates.

Dr. Fauci: Yeah. The spirit at Georgetown is very much similar to the spirit of Regis High School and Holy Cross. It’s high degree of integrity, service for others, honesty. It’s just – it’s a good feeling. It’s a good feeling.

Dr. Morrison: So in closing, Tony, this has just been a wonderful conversation, and I think – I think I speak for everyone here, then, our gratitude to you for your service to our country, and for the kindness and generosity that you’ve shown throughout all of this, and your insistence upon discipline and rigor and truth and results and the broader societal benefits. We’re all in your debt.

And I want to ask you, tell our listeners what gives you the greatest optimism and hope today.

Dr. Fauci: What gives me the greatest optimism and hope today, Steve, is what you just asked me about what excites me about Georgetown. It’s the young people.

You know, in this country – and throughout the world, but in this country when we experience these young people who are energetic, brilliant – you know, it just seems they’re much smarter than I was. (Laughter.) It’s very humbling to be able to talk to these young people, to see how bright they are. That gives me hope, how committed they are. They want to do good. They want to serve the community. And they’re energetic and absolutely brilliant.

Dr. Morrison: Thank you. And congratulations again for your memoir, seven weeks on the – seven consecutive weeks on the bestseller list. We’re not seeing any slackening of that. It’s just a remarkable story.

So –

Dr. Fauci: Thank you.

Dr. Morrison: It’s been fun to be with you to celebrate it. And thank you.

Dr. Fauci: Thank you so much, Steve. Great to be with you.

 (END.)