On the morning of November 9, when the world woke up to game-changing news that Pfizer’s coronavirus vaccine was more than 90% effective, Anthony Fauci was sitting at a triumphant press conference at 9 p.m. But he wasn’t there to talk about Covid-19.
As head of the National Institute of Allergy and Infectious Diseases (NIAID) for 36 years, Fauci has been a major force behind research that has just proven that a long-acting injectable drug, cabotegravir, is very effective in preventing women from contracting HIV.
“I wanted the world to see that with all due respect to the extraordinary stress and strain we are experiencing with Covid, HIV remains a very important disease,” Fauci told the Guardian.
In an interview marking his 80th birthday on December 24 and the official fortieth anniversary of the HIV epidemic the following year, Fauci referred to a struggle that, probably unknown to most of the public, dominated exactly half of his life.
“My career and my identity were really defined by HIV,” said Fauci, who oversees the $ 1.8 billion HIV budget at NIAID and is the leader of the global response to HIV research. “Because I’m in a very unique position and now I’m one of the very few people who have been there since the first day of HIV.”
Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation, said: “Tony is a lodestar for HIV. And now Covid. “
Along with more than a dozen other HIV leaders interviewed about Fauci, she praised his talent for spreading the secret sciences to the masses.
“What people see of him in the context of Covid,” she said, “is what he was and still is because of HIV.”
Crisis years
In the 1970s, the Thirty-Year-Old Fauci, armed with dual training in immunology and infectious diseases, quickly became prominent at NIAID, a department of the National Institutes of Health (NIH) in Bethesda, Maryland.
“In combination with a great mentor who put me in a great project and happiness, add a little talent,” he recalled, with a modest chuckle, “we developed therapies for diseases that were formally fatal diseases that suddenly now had a remission of 93% to 95%. , if not cured. “
Thanks in particular to the development of an effective treatment for the often fatal autoinflammatory vascular disease called vasculitis, Fauci was showered with recognitions, handed them plums and earned the gratitude of many patients whose lives he saved.
“If he doesn’t do anything more in his career, it would be a great career,” said Myron Cohen, a professor of medicine at the University of North Carolina who, in partnership with NIAID, led a significant study that first proved in 2011 that antiretroviral treatment HIV prevents the transmission of the virus.
But Fauci’s life changed forever in the early summer of 1981, when the Centers for Disease Control and Prevention (CDC) released the first ominous reports of what became known as AIDS.
“I said,‘ Holy mackerel! This will explode into something we haven’t seen, ” Fauci recalled of his ancient views of new groups of gay men suffering from often fatal cases. Pneumocystis pneumonia and rare cancer, Kaposi sarcoma. Fauci soon correctly assumed that these diseases were caused by a sexually transmitted virus that affected the immune system. And he knew he had the ideal training to deal with the growing crisis.
To the shock and dismay of his mentors, he left his fruitful career path and studied aids overall and caring for people with the condition.
In a 2016 interview, Fauci said that the 15 years that researchers, many who worked in partnership with NIH, developed highly effective ways to treat HIV, “were the dark years of my life and my career, because almost every patient of mine died. And that was a horrible feeling. ”
H Clifford Lane, Fauci’s longtime best clinical director at NIAID, remarked, “There are so many ways the experience of going through HIV / AIDS has helped prepare him for what he is doing now. A whole new disease, no cure, no cure. “
Fauci was only 43 years old when he was offered a major job at NIAID in 1984. He accepted on the condition that he could continue laboratory research and clinical practice. Fiercely motivated by the deaths of his patients, Fauci, he said, “lobbied like a sonofabic for resources,” until in the early 1990s, 10% of the NIH budget was earmarked for AIDS.
Over time, Fauci established several networks of HIV clinical trials. This year, while Pfizer and Moderna brought their Covid-19 vaccines for emergency approval in part through these channels, such work proved invaluable.
Activism – and his dissatisfaction
In the late 1980s, another force of nature changed Fauci’s life and career. As David France wrote in his Oscar-nominated documentary How to Survive the Plague, and the book of the same name, AIDS activists used increasingly aggressive tactics as they pushed Fauci and a medical research facility to establish more humane and equitable treatment protocols.
“He quickly realized that it was more important to bring in activists than to be knocked on the door from the outside,” said Gregg Gonsalves, a veteran of the HIV activist group Act Up and an epidemiologist from Yale. “It was politically smart, but also tactically useful.”
In the early 1990s, what began as a fiercely contradictory relationship between Fauci and activists evolved into a working partnership. Created lifelong friendships
Fauci would help put into practice the idea of a “parallel track” system activist in which people with AIDS who could not enroll in clinical trials could still get quick access to experimental treatments that are considered safe and potentially effective. Activists were eventually allowed to join NIH committees and successfully insisted on increasing the number of women and people of color in HIV clinical trials.
Mark and Harrington, a veteran of France and Act Up, insist Fauci still deserves harsh criticism for what they described as his failure in the 1980s to quickly heed calls from activists for NIAID to more aggressively address opportunistic infections that have killed people in AIDS u.
“History,” France said, “will remember that he was a good man and that he was a key irreplaceable figure in HIV / AIDS, but that he was wrong.”
Now, continuous improvements in the care and treatment of people living with HIV have increased the life expectancy of newly discovered 21-year-olds from an additional 12 years in the late 1980s to 56 years today.
Asked in 2016 how much the NIH played a key role in tackling the global HIV epidemic, Fauci said that NIAID in particular “was a major force in drug development, vaccine work, understanding pathogenesis and developing prevention modalities. ”
“And, of course, we’ve had all of these innovations at a faster pace than for any other health condition, because its urgency matches its rigor,” said Jared Baeten, who runs the HIV treatment and prevention branch at Gilead Sciences, and who conducted a large NIH-funded study (including NIAID) that demonstrated that a monthly vaginal ring infused with antiretrovirus alleviates the risk of HIV among women.
Larry Corey, a leading manufacturer of vaccines, including HIV and SARS-CoV-2, at the Fred Hutchinson Cancer Research Center in Seattle, praised Fauci as the “ultimate guardian” of infectious disease research.
“He’s Michael Jordan from our field,” he said.
George W. Bush called on Fauci to establish what became known as the president’s contingency plan, or Pepfar, which was launched in 2004 and spends more than $ 5 billion a year on providing HIV protection and treatment to developing countries. To date, it has saved about 20 million lives.
“No matter what happens to Covid,” Fauci said, “I think my involvement in the development of the Pepfar program will probably seem so great or bigger than anything else I’ve ever done.”
Unusual friendship
During the Covid-19 crisis, Fauci’s long-standing friendship with prominent HIV activist Peter Staley deepened, providing comfort and advice in times of extreme stress.
Staley and other activist friends are deeply concerned about the day the Covid-19 pandemic took Fauci. During the early days of the crisis, the head of NIAID suffered from physical and mental exhaustion, as well as from insomnia, from so much effort. Staley said it confused his typically resilient friend. It’s not that Staley feels he always has to use children’s gloves with Fauci.
“The weird thing about our friendship is that I don’t think he has a lot of friends who are so harsh on him,” Staley said. “I often tell him that I think there are mistakes; I tell him how they play; and I tell him to upset me. And he seems to really appreciate it. “
“He’s watching me,” Fauci said fondly, praising Staley as a “good radar screen.”
Chief among Staley’s concerns is that Fauci is a “freak for control” – which, the activist said, makes the NIAID chief a “miserable manager” who lacks the wit when delegating. Referring to Fauci’s complicated relationship with Donald Trump, Staley said, “In the beginning, they were friends. They were attached to their New York roots and love of sports. It all fell apart over time. “
Staley went on to say that Fauci could be honestly to blame and that naivety had particularly compromised him with the current president.
Fauci’s friend provided political advice during 2020, as Staley put it, “moving all these horrible personalities in the White House”. Staley said Fauci’s wife of 35, top NIH bioethicist Christine Grady, gives similar advice.
“Chris and I came in from time to time, ringing alarm bells,” Staley said of the couple’s interventions regarding Fauci’s dealings with the Trump administration.
Another friend recently spoke to Fauci about a future in which he was really important to the destruction of Covid-19.
“What’s left for you?” a friend asked.
Referring to HIV, Fauci replied, “The only thing I still have left and want to do is stop this epidemic.”
Speaking to the Guardian, Fauci said he did not want to retire until that day, preferably thanks to the HIV vaccine. If he would then finally move into his emeritus years, he said, he longs to write memoirs.
“No one has ever had the situation to be an adviser to seven different presidents,” he said. “So that’s something I really want to put down in a way that younger people take advantage of the experience I’m recording.”
Then he said quite obviously, “I was just so damn busy, that I didn’t get a chance.”