Dr. Anthony Fauci, the face of this nation’s pandemic response, retired at the end of 2022 as director of the National Institute of Allergy and Infectious Diseases and as President Biden’s chief medical adviser. In this wide-ranging exit interview with Globe Magazine editor at large Neil Swidey, Fauci discusses everything from his struggle for work-life balance, to the one message he would have delivered differently early in the pandemic, to the uncertain road ahead for all of us. Read on for highlights, which have been edited and condensed.
Swidey: How’s retirement life?
Fauci: Well, it isn’t exactly retirement. I get invited to do 100 different speeches and write 100 different opinion pieces. So I haven’t taken a day off since I left, literally. That’s my DNA.
When was your last real vacation?
See, if I tell you that you’re going to think I’m some sort of a weird person. It was probably around 15 years ago. We went to Costa Rica, for one of the kids’ birthdays. But I absolutely need to get away from the fact that I get guilt feelings when I’m not working all the time. I don’t think that’s a healthy thing.
You and I talked two years ago. A lot of people look much worse for wear two years later. You somehow look younger. What’s going on?
It’s really genetic. I don’t have makeup on. I’m 82 years old. My father lived till he was 97. And like me, he had almost smooth skin till the time he died.
You should reverse-engineer that and make a bundle for your kids with Fauci’s Face Cream. Have you at least binge-watched a show?
My wife and I follow Chicago P.D. And there’s a new series called The Offer, which is the inside story of how The Godfather was made. That’s one of my favorite pictures of all time.
President Biden has declared the end of the coronavirus public health emergency as of this May. Would you have advised him to do that?
Ultimately, we’re going to have to get out of the emergency mode to really get to some degree of normality. I know it’s a controversial thing. I think, on balance, it was the right decision. As long as we don’t forget that we have to figure out something for the uninsured, because you can’t leave them in the lurch. You’ve got to get them to have essentially equal access to the interventions — [COVID treatment drug] Paxlovid and the vaccines.
We now have south of 50,000 COVID hospitalizations a day. A year ago, it was 160,000. Do you feel like we’re being vigilant enough?
Are we much, much better off now than we were a year ago? Absolutely. We were having 3,000 to 4,000 deaths per day. Now we’re at 450 to 500. Even though that’s infinitely better, it is not in my mind a satisfactory equilibrium point. If you look at the deaths, it is striking that almost all of them are in people who either are unvaccinated, or who are vaccinated but are nowhere near up to date on their boosts, or people who were vaccinated, got infected, but did not take Paxlovid.
You took Paxlovid when you had COVID and had a rebound of COVID symptoms, as did President Biden. Does the fear of rebound scare too many people from taking it?
There’s this feeling that if you take Paxlovid, you’re absolutely going to get a rebound. Well, there are rebounds even without Paxlovid. Also, people say, “Oh, don’t take Paxlovid because you could get serious drug-to-drug interactions.” Well, most of the drugs that appear to be contraindications for Paxlovid are ones you can either pause for six or seven days, or take at a lower dose. So we’re not really using all the cards in our deck.
At the start of 2020, you were one of the few things that Republicans and Democrats agreed on. In a 1988 presidential debate, George H.W. Bush named you one of his heroes. His son awarded you the Medal of Freedom. Yet today, you’re just one more “issue” put through the MSNBC-vs.-Fox News sorting mechanism. Is bipartisanship officially dead?
I’ve been very consistent: Always stick with the science. And I found, much to my dismay, that starting with the Trump White House, that turned out to be an inconvenient truth.
The political divide is like something I have never seen. I’m not a Democrat, I’m not a Republican. I was loved by the Bushes and Reagan. And the same with the Clinton-ites, and the Obama-ites, and the Biden-ites. In the 38 years that I’ve been the director of the institute, and the seven presidents that I’ve advised, I’ve never been in a situation, except for with Trump, where there was any conflict with what I had to say. When I had to tell George H.W. Bush and Reagan inconvenient truths about what we were doing with HIV — like we’re not doing enough — they took it with respect. All of a sudden, because I’m a very public person in the context of the [COVID] outbreak that is involving everybody in the world, I find myself in the middle of it. And you’re right, I got caught up in it.
But the people who are attacking me verbally and otherwise, to the point of generating the need for me to have armed federal agents with me all the time [Fauci points to the door of his home office, and out his window] and the cameras that are in the trees in my yard — it seems inexplicable that should happen. Someone who has done nothing but promote common sense, medically proven ways of behaving, and it’s become almost like, “We’ll fight to the death.” I mean, that’s really bizarre.
So, I don’t have an answer, but I can’t believe that all of those people are bad. They’re just not. They’re angry. Probably, they’ve been treated unfairly and now they’re getting back at whoever’s been treating them unfairly. Unfortunately for me, I seem [culpable in their view]. Despite the fact that, if you look at my track record, with all due respect, I’m probably responsible for saving maybe 30 to 40 million lives in the world. With the development of HIV drugs, with the PEPFAR program. My team was a major player in developing the COVID-19 vaccine. So it isn’t like I’ve not helped society. And yet some people want to kill me.
You’ve said the critics who lashed out at you during the AIDS crisis in the ‘80s ultimately forced you to listen and make changes. But the COVID backlash seems different, even if there’s a legitimate critique in there somewhere. This time, there have been lots of lies and harassment of your family. Was it harder for you to listen for the smaller bucket of legitimate criticism within that big bucket of maliciousness?
It’s more difficult, not impossible. I think you’re onto something. When the AIDS activists were coming with my head on the spikes, saying, “Fauci, you’re murdering us,” it was very obvious that it wasn’t real hate. It was attention getting. Lucky for me, I had enough insight to say, “Let me just put aside the theatrics and listen to what they have to say.” It’s different here. These people really believe that I’ve killed them. They really believe that I’ve taken their liberties away. They really believe I made the virus. It makes it difficult.
But even with that, I am somebody who always feels there are better angels within everyone. Maybe goes back to my Jesuit training [as a student at the College of the Holy Cross]: They may hate me, but I don’t hate them. I really don’t. I wish that we would be able to sit down and talk. I know that some of the people who are really, really angry have not been treated very well by society. They’ve been left behind economically and otherwise. And there may be a reason there, a little kernel, that is the seed for what exploded into real enmity. It is not impossible, but it is more difficult to be sympathetic with that. I have three daughters — they attack them with violent sexually connotative things.
If you were granted one do-over for a decision you made during the pandemic, what would it be? The early mixed messaging on masks?
If I had to do it over again, I maybe should have dug into that a little bit more deeply and not said in the beginning, “You don’t need to wear a mask.” But you know how quickly I turned. I mean, it wasn’t like I spent six months saying don’t wear a mask. I spent three weeks saying that, and then I said everybody should be wearing a mask.
Do you think performative mask-wearing exacerbated the partisan divide on COVID? The way that some people would virtue-signal by wearing masks for the five minutes they walked in and out of a restaurant, but then kept it off for the hour they spent eating?
There’s been a lot of disparaging kind of feeling toward people who don’t versus do wear masks. I can tell someone that wearing a mask, protecting yourself from getting infected, is good for you. And if you have an 85-year-old mother, at home with diabetes and obesity, wearing a mask is also very likely to protect her. But if I don’t see you wearing a mask, I’m not going to criticize you. I’m going to say, “This is what we know.” But sometimes the connotation is that you’re a bad person if you don’t wear a mask, and I think that feeds the animosity.
Are we ever going to know the definitive origin of COVID? And did authorities mishandle the question of whether it was from a Wuhan lab leak?
The lab leak issue was always a possible explanation. Go back and look at my unredacted e-mails. I was the one that said, “Let’s look into this. It’s really important.” And yet there’s this meme out there that I tried to suppress the lab-leak theory, which is ludicrous. Go look at the [expletive] e-mails. Unbelievable! Holy smokes!
If you look at the history of evolving outbreaks, 75 to 80 percent of them are zoonotic, jumping species [from animals to humans]: HIV, Ebola, influenza, Zika, MERS. Could it have been a lab leak? Yeah, but what is the evidence for it? The evidence is 2,000 tweets that said it should be. What is the evidence for it being a spillover [from animals to humans]? Some very unbiased, molecular evolutionary virologists from five or six different countries have examined it, put it in the peer-reviewed literature and feel, even though it isn’t 100 percent, it is much, much more likely that it’s a natural spillover.
Now, will we ever know? The only way we’ll know is if China opens up and we get American scientists, Canadian scientists, Australian scientists to go there and do the kind of surveillance in the wild. But the problem is that they’ve attacked the Chinese so badly. The Chinese authorities act suspicious, even when they have nothing to hide. But if you look at the viruses that the Wuhan investigators were working with, anybody who even knows a little bit about virology will tell you that it would be molecularly impossible to turn [those viruses] into this virus. Even if you deliberately try to do it, you couldn’t do it. That’s a fact.
Are we better prepared or in worse shape for the next outbreak?
If we abide by the lessons learned, we’ll be better prepared. I look at preparedness and response in two buckets: one is the scientific bucket; the other is the public health bucket. We did extremely well in the scientific bucket. Work by Barney Graham and Kizzmekia Corbett in the [National Institutes of Health] laboratory [helped] us get a vaccine in 11 months, which was totally unprecedented in history.
What about public health preparedness? Not so good. Why? The local infrastructure for doing the kind of clinical, epidemiological, immunological, and virological surveillance was not there. The CDC, thank goodness, are starting to look at the fact that they need to almost remake themselves to be able to get data in real time, where it doesn’t take two or three months to figure out what’s going on. In the UK, in South Africa, and in Israel, they get data in real time. We have a disjointed system.
Are you going to take up any hobbies once you get real free time?
I’d love to go fishing. Not deep-sea fishing, just the Potomac River or a pond or lake to catch some bass. I really like it, but my wife laughs at me when I say that. She says, “You better start enjoying some of the things that you really want to enjoy and stop talking about them.” In an interview 35 years ago, I said, “Oh, I love to fish.” And I must have gone fishing four times since that interview.
EVENT: On February 27 at noon, Dr. Fauci will be interviewed by Globe medical and biotech editor Anna Kuchment. Sign up for the free virtual event, part of the Globe’s Health & Biotech Week, at globe.com/healthandbiotech.
Neil Swidey is the Globe Magazine editor at large. He can be reached at email@example.com.