How does one describe a middle-class boy, born and raised in a working-class neighbourhood of Brooklyn, New York, who rises above his humble beginnings to become an institution par excellence – a doctor, clinician, scientist, science administrator, and public health expert? Over his 54-year career in public health, he became the go-to man for seven Presidents of the United States, from Ronald Reagan to Joe Biden, managing numerous public health crises, including two of the worst pandemics in a century – HIV/AIDS and Covid-19.
In the intervening years, he guided research and helped shape public policy interventions on a multitude of public health catastrophes arising from numerous infectious diseases, including SARS, MERS, anthrax, avian influenza, measles, swine flu, Zika, and Ebola. Additionally, he led the USA’s bioterror countermeasures in the wake of the 9/11 terrorist attack.
Motto of Life
His motto was: “You don’t worry about that. You just keep telling the truth.” His contributions earned him both accolades and criticism, yet he remained undeterred, consistently telling the truth as he understood it, and correcting himself when new facts emerged. He remained steadfast despite hate mail, harsh media coverage, and death threats to him and his family, earning the moniker “most trusted doctor in America.”
Not Just an Autobiography or Memoir
This is the story of 83-year-old Dr Anthony Fauci, as recounted in his own words in his 455-page book, On Call: A Doctor’s Journey in Public Service. Make no mistake, On Call is neither an autobiography nor a memoir in the traditional sense – it is much more. It urges readers to appreciate the value of public service and encourages society and governments to develop a robust public health infrastructure grounded in science. Above all, the central message of his book is to “keep going when things get hard” and to cultivate empathy and the ability to listen in order to help others.
On Call
In On Call, though restrained and gentlemanly in tone, Fauci tells a riveting story of his very public professional life with rare candour, without remorse or rancour. In September 2022, when Fauci resigned from his federal public health service positions, Science magazine wrote matter-of-factly: “In 1984, when Anthony Fauci took over as head of the National Institute of Allergy and Infectious Diseases (NIAID), his wife gave him a plant for the new office. Both the palm and the 81-year-old physician are still there, the giant plant now crowding the office of one of the most celebrated—and polarizing—scientific figures in U.S. history. But not for much longer. Fauci announced on 22 August that he would step down at the end of the year from both NIAID and his post as the chief medical adviser to President Joe Biden.”
As one navigates through the 455 pages of On Call, the unmistakable message emerges: Anthony Fauci is arguably not only the most famous—and most revered—scientist, physician, and public health administrator in the world today, but this straight-talking, towering figure is also one of the few scientists that America and the world (post-Covid) recognise by name.
As one delves deeper into his decades-long career—both in what he has written in the book and what he has left out—one cannot help but admire the way he speaks truth to power, even to the President(s) of the United States. Unsurprisingly, he was thrust into the epicentre of many public health crises under both Republican and Democratic administrations.
On Call is the story of this remarkable “America’s doctor,” who, over nearly six decades, bravely fought many infectious diseases, epidemics, and pandemics. It traces his journey in unearthing causes and consequences, doggedly pursuing aetiology, and fighting to invent safe vaccines and treatment protocols for life-threatening maladies.
Standing Tall
Anthony Fauci became a household name globally when he emerged as a trusted voice of America during the Covid-19 pandemic. However, the longest part of his professional career—and the longest portion of his book (pages 22 to 166)—was devoted to combating HIV/AIDS. Fauci was first introduced to the disease early in his career when it initially surfaced and was mistakenly referred to as “Pneumocystis carinii pneumonia” and “Kaposi’s sarcoma” among homosexual men.
In 1981, Fauci made a pivotal decision to dedicate his career to fighting this devastating illness, which was claiming young lives violently. Despite warnings from friends and advisors that he might be making a potentially career-ending mistake, Fauci committed himself to this cause and never looked back.
In the chapter titled “Up Close and Painful,” Fauci recounts his early encounters with the lethal HIV/AIDS epidemic. He describes how the ten years of training and experience he had accumulated in treating and curing very ill patients seemed to evaporate as he faced an influx of terminally ill patients suffering from a disease he neither knew the name of nor had a cure for. Fauci reflects on this period in the book, noting, “It felt as if we were putting band-aids on a haemorrhage.”
It was as dire as it could get.
Devastatingly Devastated
In 1982, Dr Fauci was devastated when Ron Rinaldi, an early HIV/AIDS patient, died a miserable death after contracting cytomegalovirus, which attacked his retina and made him blind. Fauci writes about Ron’s blindness, noting that “it is the one scene among many that comes back to him often.” He also reflects that although he could not fully appreciate it at the time, he would soon encounter hundreds of similar stories in his ward.
Discussing the grief following Ron’s painful death, Fauci writes: “I had experienced grief before. I lost my mother to cancer when I was twenty-four, and I knew how it felt to lose someone I loved deeply. But the loss we were experiencing now was different by several magnitudes. It was chronic, pervasive… And now I was seeing wave after wave of men, often in their twenties and thirties, handed a death sentence with none of my training or temperament providing a bulwark against that horrible, inevitable outcome. Helpless was the only way to describe it, as if we were battling an unseen enemy in a war zone—an enemy that was steadily overtaking us.”
It was a decades-long war against this unseen enemy that Fauci made the mission of his life.
The Activist
The HIV/AIDS mission gave him immense satisfaction, even though he faced criticism, including being called “murderer Fauci” in op-eds and having his effigies burned for allegedly not doing enough. However, by championing the cause, Fauci built relationships with activists, often welcoming them to his office and private dinners, while other government officials refused to meet with patient advocates.
This approach made Anthony Fauci authentic in the eyes of activists, the public, and presidents alike.
The High-Point
The high point of Fauci’s relentless fight against HIV/AIDS was arguably his relationship with President George W. Bush. It was Bush who appointed Anthony Fauci as the chief architect of the largest HIV/AIDS prevention and treatment programme—the President’s Emergency Plan for AIDS Relief (PEPFAR).
Discussing the impact of PEPFAR, Fauci writes in On Call that, in terms of lives saved during his career, PEPFAR, with more than $100 billion invested in helping over 50 countries prevent and treat HIV infections, stands out as a significant achievement that saved millions of lives, particularly in Africa.
Just the Beginning
The fight with HIV/AIDS became the initial stepping stone that established Fauci as the go-to man for American Presidents. But that was not all. He would go on to fight many more battles against infectious diseases—West Nile Virus under Bill Clinton, anthrax and bioterror countermeasures under George W. Bush, and anthrax and Ebola under Barack Obama. And, of course, Covid-19 under both Trump and Biden.
Dare to Dare
Fauci writes that he did what he could because of the absolute trust of Presidents, except one, which I will discuss later. The truth is that from 1987—barely three years after becoming Director of NIAID—Dr Fauci became an advisor to American presidents, vice presidents, and ministers, starting with President Ronald Reagan and Vice President H. W. Bush, and this role continued for four and a half decades.
In all his decades-long interactions with prominent figures in Washington, Fauci adhered to the sage advice of his friend Dr James F. Dickson III (a veteran of the Nixon administration). The first piece of advice was: “Some people might fall into the trap of never wanting to disappoint a powerful figure, and so they slant their advice towards pleasing rather than advising. Don’t fall into that trap.” The second was: “If you are consistent and totally honest, you might risk being dropped as an adviser, but this approach with the right kind of President and Vice President can also engender respect and a durable relationship.”
It is precisely this commitment to telling the truth based on scientific evidence and the best judgement, delivered without sugar-coating, that saw Fauci through seven American presidents, including the mercurial Donald Trump, and hundreds of Congressional hearings.
No one Says No to the President
There is a famous saying in America: no one says no to the President. Fauci faced this dilemma within five years at the helm of NIAID. With the elevation of George H.W. Bush to the presidency, it was time to appoint a new Director of the National Institutes of Health (NIH), which, apart from being the parent body of NIAID, also oversees more than twenty institutes with diverse mandates such as cancer, heart disease, diabetes, neurological, and mental disorders.
President Bush decided that Dr. Fauci should take on the role. However, Fauci was not interested. He knew his calling was to be a hands-on scientist in the lab and a clinician treating severely ill AIDS patients, not to administer the NIH. The problem was who would tell the President.
On October 30, 1989, Fauci was driven to the White House by Dr. Louis Thompson, Secretary of HHS, in his official car. The two were ushered into the Oval Office, where the President offered Fauci the chair of NIH, which he declined stoically with measured words: “Mr President, I believe that I can serve you and the country better if I remain where I am. This is what I want to do, what I love to do, and what I do very well, and I believe that in the long run, this is what you would want me to do, so I will have to respectfully decline your offer.”
This was a rare instance of a civil servant saying no to the President of the United States. But President Bush responded, “You know Tony, I respected you greatly before today, but now I respect you even more. The country needs you. So go back and do your thing, and I promise you we will stay in touch.”
Having set the record straight, Fauci always spoke the truth rather than saying what would please the President of the United States.
Expect the Unexpected
Having said that, there was never a dull moment in the professional life of Fauci, for whom expecting the unexpected became the norm. Whether it was dealing with sudden outbreaks of infectious diseases, epidemics, and pandemics, or managing relations with Presidents to whom he became a top advisor, his career was anything but predictable. This also made him the most trusted communicator to the public.
It was not easy being Dr Anthony Fauci. For fifty-four years, he worked 24/7, often managing with just three to four hours of sleep at the best of times. Life was always a road less travelled for him. He and his family faced constant challenges, including hate mail, public rebukes from activists, and more than one death threat forcing his house to have a Secret Service detail stationed outside for protection. One extreme case of hostility that Fauci faced was as the murderer of five million people by Senator Rand Paul.
It would not be out of context to say that Fauci did not merely treat infectious diseases but rather ‘served the public and humanity for 54 years.’ This truth is aptly captured in the title of his book: On Call: A Doctor’s Journey in Public Service.
Warrior Par Excellence
Few Indians knew of Anthony Fauci before Covid-19. As a public health researcher for the past two decades, I had some awareness of his role as an HIV-AIDS crusader, but nothing had prepared me for the colossus that emerges from reading his 455-page memoir. All I can say is that few individuals, of any age, possess the experience, expertise, résumé, or stamina of the 83-year-old Dr Anthony Fauci. Although he has retired from public service, as he writes in the epilogue of the book, he continues to lecture and write, and to encourage and inspire people to pursue careers in science, medicine, and public health. He adds, “There are a lot of things that are unfinished business, and they will be finished sometime because science is going to do it.”
Fauci is cautiously optimistic about the “future of science” and most recently, in an interview with People’s Magazine on 2 July 2024, he said: “Better angels will come out.”
Pertinacious Amid Controversies Galore
Among the many battles Fauci has fought, the toughest was battling a losing war against Covid-19. While speaking plainly and defending scientifically evidenced facts endeared him to the confused and frightened populace across America and the world, he also became the target of extreme frustration, ongoing criticism, and frequent violent threats. He was blamed for the collapse of the economy, turmoil in the stock market, job losses, school closures, loss of life, and even for the trillions of dollars lost to the US economy.
During the Covid-19 pandemic, Anthony Fauci was repeatedly compelled to refute the falsehoods spread by President Trump, which strained his relationship with Trump and the Republicans. In the chapter “He Loves Me, He Loves Me Not,” Fauci recounts one of the many telephone calls from Trump, where he became the target of the President’s rage. Trump shouted in anger at Fauci for his accurate remarks made during a video interview with Howard Bauchner, the editor-in-chief of JAMA, where Fauci stated that “immunity for coronavirus was usually six months to a year….”
At the Centre of the Maelstrom
The role of Dr Fauci in guiding America and the world, sanely and calmly through Covid-19 earned him the trust of millions during one of the most terrifying periods in modern global history. However, when he continued to tell the truth about Covid-19 as he understood it, his voice was silenced. He was prevented from speaking to the press without the White House’s permission by the Trump administration. In his own words, “the truth generated a lot of hostility towards him in one administration (read Trump).”
It has been a year and a half since Fauci left federal public service, but controversies persist, and he remains at the centre of the storm. For some, it is “In Fauci we trust,” while for others, it is “Even my dog hates Fauci,” with many coronavirus deniers, conspiracy theorists, and anti-vaxxers blaming Fauci personally for struggles with school closures, mask mandates, and vaccine recommendations.
All of the above was despite the fact that the “SWAT team” of vaccine researchers under Fauci’s guidance, along with scientists at his institute, aggressively pursued a Covid-19 vaccine. Astonishingly, in less than a year, they brought one out in partnership with Moderna that was even more effective than Fauci had dared hope, achieving an efficacy of over 90 per cent. According to the Commonwealth Fund, it is estimated that this vaccine saved 3.2 million lives in the United States alone and prevented 18.5 million hospitalisations.
Rearview Mirror – The Legacy
Dr Anthony Fauci’s legacy is immense for one person. In his own words, once he embarked on a career in infectious diseases and immunology, his period of quiet and predictable life came to an end. This was completely upended in 1981 when he made fighting the suffering and death caused by AIDS his vocation. The illness brought him profound pain, but being part of a group that enabled AIDS patients to live normal lives gave him immense satisfaction.
Fauci repeatedly found himself at the forefront of the unknown—facing life-threatening diseases such as Ebola and Zika, as well as threats like anthrax and smallpox.
Dr Anthony Fauci leaves behind a legacy that is difficult to encapsulate in a “book review.” To fully grasp it, readers must turn to On Call, which has been on the bestseller list for three months. It is clear that in his remarkable fifty-four years of public service, he changed the course of numerous infectious diseases. This is the same Fauci who, in 1988, was labelled “murderer Fauci” by Larry Kramer, America’s best-known AIDS activist, in an article in the San Francisco Examiner. Over the following three decades, Kramer and Fauci became close friends, with Fauci emerging as America’s foremost doctor on HIV/AIDS.
On the eve of his hanging boots from public service in 2022, Dr Anthony Fauci told Science magazine in an interview, “I’m not going to sit in my house.” This book is the finest testament to what he has done since his retirement.
A Call for India to Embrace a Fauci-Like Approach
I humbly posit that it is now time for Dr Anthony Fauci’s prophecy that “better angels will come” to become true. When it comes to infectious diseases, one cannot predict “what tomorrow will be like”. A telling example of the need for many more figures like Dr Fauci in India is illustrated by a recent event. Just last month, Fauci himself was hospitalised for eleven days after contracting the mosquito-borne West Nile virus. He described this as the worst illness of his life, something like being “hit by a truck” noting that it will take months for him to fully recover.
For the benefit of readers, there is currently no vaccination or specific treatment for West Nile virus infection. This is just one of many emerging threats—Monkeypox is another. The central message I take from reading the book is that India needs to seek out its own Dr Fauci and develop a robust infectious disease prevention and treatment infrastructure to ensure the safety of its citizens.
The author is Multidisciplinary Thought Leader with Action Bias, India Based International Impact Consultant, and keen watcher of changing national and international scenarios. He also is an independent book reviewer He works as President Advisory Services of Consulting Company BARSYL. Views expressed in the above piece are personal and solely those of the author. They do not necessarily reflect News18’s views.