America's Doctor
Portrait: Anthony Fauci
Tony Fauci has developed a knack for telling people what they don't want to hear. It's not an unusual role for a physician, but few have to deliver undiluted bad news to an entire country. As director of the National Institute of Allergy and Infectious Diseases, Fauci has emerged as the nation's go-to guy when it comes to explaining the new facts of life with bioterrorism. Since last October, he has been ubiquitous, appearing before Congress and on every known news show to say that there most certainly will be more bioterror attacks, that some people will inevitably be injured or killed before a response can be mounted, and that we will never be 100 percent safe. He knows that people want to hear him say that their risk is zero. "But it's not. I'm sorry, it's not."
Fauci has had practice as America's straight-talking doctor. A generation ago, he first entered the national spotlight as the government's AIDS expert, telling a frightened public that science could offer little hard data to allay its concerns. "That's what I do; that's my life!" he says. "I'm an infectious disease guy!" Sprawled in a leather chair in his of-fice at the National Institutes of Health in Bethesda, Md., Fauci talks of "category A" infectious agents--the really bad ones--as if he's handicapping football games. Tularemia--deadly, but you can treat it with antibiotics. Plague, same thing. "The other ones are Ebola and the hemorrhagic fevers, and we're making very good progress toward an Ebola vaccine," he says, in a voice remarkably like that of another Brooklyn-born overachiever, Woody Allen. "Smallpox and anthrax, in my mind, are the two biggies."
Treating fear. His lesson is motivated by a deep belief that if people understand the science and can evaluate the risk for themselves, their fear becomes manageable. And at the same time that Fauci is being a doomsayer, he's shepherding along research to create new defenses against anthrax and smallpox, reducing the risk--and the fear--as much as possible. Fauci's tell-all approach is a complete turnaround from the early days of bioterror, when federal officials alternated between evasiveness and false assurances they later had to eat.
Just days before the first inhalation anthrax case was discovered in Florida, Health and Human Services Secretary Tommy Thompson appeared on 60 Minutes and told a jittery population it was "safe," adding: "We're prepared to take care of any contingency, any consequence that develops from any kind of bioterrorism attack." As it quickly became evident that the government wasn't the least prepared, public anxiety soared. Thompson drafted Fauci to join a small group of advisers and, as Fauci says, "be the voice of reason and give a scientific--a cold, analytical, truthful, yet reassuring--statement to the American people." Fauci is one of the few people who can combine cold and reassuring and make it work. "You walk a tightrope between telling it like it is and making it too scary," says C. Everett Koop, who got to know Fauci well when he served as surgeon general in the early years of the AIDS crisis. "He does it well. He won't drop his integrity just to make it come out right politically."
"Tony has a great skill for taking complex medical issues and boiling them down to simple kernels of information," says Clifford Lane, clinical director of NIAID, who has worked with Fauci since the earliest days of AIDS. Indeed, that skill has defined Fauci's entire career. Fauci, who came to NIH right after finishing his medical residency, remembers reading the first reports of unusual infections in gay men back in 1981 and getting goose bumps, thinking that this could be an infection transmitted by blood or sex and that he had no idea what it was. "As every month went by, I became more convinced that we were dealing with something that was going to be a disaster for society." Fauci, who was working in a laboratory at NIH, started studying the mystery disease and bringing patients there for treatment. "As a scientist, you're quite used to living in a pretty quiet, secure world," says Lane. "All of a sudden that part of your life is in a fishbowl. You had the feeling you couldn't do anything right, because people were still dying."
AIDS and anger. Fauci became a point man not only in research on the HIV virus but in dealing with the terrified, angry people it infected. "He swallowed some really tough moments," says Robert Gallo, codiscoverer of the AIDS virus. Gallo remembers when AIDS activists--who felt that NIH was not moving quickly enough to get the anti-HIV drug AZT on the market--screamed "murderer!" throughout a speech Fauci gave at the New York Academy of Sciences. "He just kept giving his talk," Gallo recalls. "I would have walked out." When Larry Kramer, the playwright and AIDS activist, called Fauci a "monster" and "incompetent idiot" and insulted his wife, Fauci made a point of meeting with him. "Tony was always a lot more willing to listen to them than I was," says Christine Grady, Fauci's wife, a nurse and bioethicist whom he met at an AIDS patient's bedside. "He always looked for the messages." One message: The activists had something to offer the scientists. Fauci invited Kramer and other activists to take part in NIH decisions on treatments, an invitation that horrified many researchers at the time but has since become common practice at NIH and other medical institutions. Fauci and Kramer became good friends, and still E-mail each other frequently.
Fauci says: "What I learned from HIV/ AIDS was that from the beginning you gotta level with people, you gotta tell them what you don't know, and you've got to explain risks in a way that is realistic without making someone feel better than they should." He has followed that prescription precisely in addressing bioterrorism, although he realizes it's a bitter pill. Americans, he says, aren't used to dealing with risks they can't control. "Fear about bioterrorism is an absolutely appropriate natural response," he adds. "How you handle this fear and channel it into something productive--such as accelerated preparedness, alertness, awareness--that's the tricky issue."
Channeling that fear, for Fauci, meant expanding his usual six-day workweek to the point where he was sleeping two or three hours a night. That let the famously hard-working physician keep up with his basic HIV research and continue running NIAID, where he has served as director since 1984, and see AIDS patients. "It was totally adrenaline and Starbucks," he says. At the same time, he was hustling to speed up antibioterror research already underway, including the testing of antiviral drugs that could be used to treat smallpox and developing new smallpox vaccines. Those projects have been vastly expanded since September 11 and will grow more once the $248 million in new bioterror funding slated for NIH is divvied up. Studies on diluting the government's existing stock of smallpox vaccine are almost completed. "By early February we're going to know if we have 75 or 150 million doses, and when we have that, I think we're in good shape," Fauci says. "It's not enough to have a vaccine for every person, but if you have 150 million doses, you can do some real serious vaccination there."
Reducing risk. HHS's contract with Acambis and Baxter International to produce 155 million fresh doses by the end of next year is designed to fill that gap. But Fauci is most excited about research underway to develop a completely new smallpox vaccine. Rather than employ the live vaccinia virus, as the classic vaccine does, the new vaccines would be based either on a weakened vaccinia virus or on just harmless chunks of the virus--the same technique used to make hepatitis vaccines. Those vaccines would be much less risky to people with HIV, organ transplants, and other conditions that weaken the immune system and would make it safe enough to vaccinate the entire population. Fauci says the new vaccines are probably three years away. "So pretty soon we're going to have smallpox wrapped up."
In Washington, life is starting to get back to normal. Fauci's almost back to his regular schedule of 14-hour days and has resumed picking up his three daughters, ages 15, 12, and 9, after diving or gymnastics practice. "We actually, amazingly, have dinner together every night, but it's usually around 9 o'clock," says Christine Grady. The strains of the past few months seem to have left few scars. Fauci, who just turned 61, looks easily 15 years younger, whippet-thin and energetic. Maybe, as Grady says, it's just good genes, or maybe, as his longtime colleague Lane says, it's that "he's so impassioned about what he does."
Those passions may soon be tested anew. In 1989, Fauci was twice offered the job of NIH director by George H. W. Bush and twice turned it down. The job is again vacant, and Fauci's name is at the top of most lists. He smiles when asked about that. "I like what I'm doing now."
Bio
"People really need to know the truth, and they need to know what you don't know."
BORN Dec. 24, 1940; Bensonhurst, Brooklyn
FAMILY Married to bioethicist Christine Grady; three daughters
EDUCATION B.A., College of the Holy Cross, 1962; M.D., Cornell University Medical College, 1966
This story appears in the January 28, 2002 print edition of U.S. News & World Report.