Review | Anthony Fauci covers an eventful career, covid and all, in ‘On Call’

Review | Anthony Fauci covers an eventful career, covid and all, in ‘On Call’

The old cliché has it that bureaucracies are “faceless” institutions, insensitive to the demands of the people they serve. Anthony S. Fauci, who led the National Institute of Allergy and Infectious Diseases from 1984 to 2022, is a career bureaucrat, but he also has one of the country’s most recognizable faces.

Fauci never set out to become a familiar presence on talk shows and at news conferences, but his career as a public figure is not exactly an accident. As he explains in his new memoir, “On Call: A Doctor’s Journey in Public Service,” he has always made a point of communicating with his patients — even when they make up the entire population of the United States.

Fauci had already spent more time in the spotlight than most health officials before disaster struck in 2020, but the onset of the covid pandemic — and his role as “the de facto public face of the country’s battle with the disease” — launched him to newfound celebrity. Tussles with President Donald Trump, both on and off camera, made him a political lightning rod and, to many, a hero.

Fauci’s struggles with the Trump administration feature in “On Call,” but it contains no bombshells and not much in the way of juicy new information. Fauci permits himself sharper words about the 45th president than he did during the thick of the pandemic — “he shocked me on day one of his presidency with his disregard of facts,” “he seemed to conflate COVID with influenza,” he displayed “overt hostility to much of the press,” and so on — but the doctor’s frustrations were always manifest. Few will be shocked to learn that he was annoyed by the fecklessness of the bungler-in-chief, dismayed by Vice President Mike Pence’s sycophantic adherence to the party line, and alarmed by the administration’s ignorance of the basic workings of government. Nor is it startling that Trump was a volatile boss who alternately cursed at Fauci and professed to love him, all while undercutting his scientifically sound advice in inflammatory interviews.

Perhaps slightly more unexpected and revealing is Fauci’s contention that America’s disastrous covid response was not solely the fault of the petulant man in the Oval Office: aging infrastructure and pervasive inequalities were also to blame, as were Fauci’s colleagues at the Centers for Disease Control and Prevention. Fauci allows himself several respectful but cutting criticisms of the CDC, an agency that he alleges was slow to track cases and develop effective testing technologies.

Still, the covid pandemic is only one of many crises that Fauci has confronted during his many years at the National Institutes of Health, and it takes up less than a fourth of his eventful autobiography.

His is a classic American story, with the usual modest beginnings. Anthony “Tony” Fauci was born in 1940 in Brooklyn to first-generation Italian immigrants. His upbringing was comfortably middle class: his mother was a “homemaker,” while his father owned and operated a pharmacy. The passages in “On Call” that treat his early years are wistful and somewhat bland. Fauci informs us that he was a star student with “a close-knit, happy family,” a placid child who felt that “life in Brooklyn was good.” At College of the Holy Cross, a Jesuit liberal arts college, he was treated to “a terrific curriculum”; in medical school at the prestigious Cornell University Medical College, he enjoyed “one of the happiest, most fulfilling periods of my life.” Throughout, he remained irksomely well-adjusted.

Of course, Fauci includes a smattering of personal details. He briefly discusses his marriage to the bioethicist Christine Grady, and D.C. residents will delight in his mentions of local haunts, prime among them his running route along the C&O Canal. For the most part, however, his private concerns take a back seat to the diseases he tackled with single-minded and unwavering intensity.

It was only when he landed in Washington to lead a laboratory focused on immunology at NIH that his life took off. If Fauci’s childhood reminiscences can be stiff and dutiful, his accounts of the health emergencies he has weathered as a public servant — particularly, the AIDS epidemic — are gripping. Given his expertise in infectious diseases and immunology, he was perfectly positioned to tackle the devastating new illness that emerged at the beginning of his tenure at NIH in the early ’80s.

At first, his efforts were largely confined to the laboratory, where he conducted pioneering research, and the NIH Clinical Center, where he tended to critically ill patients. Even now, he appears most comfortable in his capacity as a physician and scientist, and “On Call” is punctuated with succinct and remarkably lucid introductions to thorny medical topics, such as the nature of the immune system and the different types of influenza. But AIDS was not just a clinical conundrum for Fauci. As a resident at Weill Cornell Medical Center in New York City, he had most often succeeded in saving even the sickest of his charges; now, he watched in horror as his patients deteriorated and died.

“The median survival of our patients was nine to ten months,” he writes. These numbers had human faces: One patient whom Fauci visited on rounds in the morning had gone blind by the time he returned that night, and the doctor lost his beloved assistant to the disease. As answers continued to elude desperate researchers, Fauci exhausted himself caring for patients late into the night. These brutal shifts in the clinic distress him to this day, and he confesses that he still suffers from bouts of PTSD.

AIDS had rapidly become personal for Fauci, and soon it became political, too. “I felt compelled to break out and force more attention and, importantly, more resources toward this disease,” he writes. “But how was I going to do that? I was just the chief of a relatively small laboratory in a huge research agency.” Before long, he realized he would have to do two jobs at once: He would keep his official job as a scientist, of course, but he would also pursue an unofficial job as a public figure who could use his “visibility and scientific credibility to influence policy.”

When Fauci was appointed chief of the National Institute of Allergy and Infectious Diseases in 1984, he expanded funding for AIDS research and scandalized his conservative colleagues by establishing a program dedicated exclusively to the disease. Later, he pushed the George W. Bush administration to enact the President’s Emergency Plan for AIDS Relief (PEPFAR), a program that has saved millions of lives by distributing AIDS treatments around the globe.

Fauci’s simultaneous commitment to science and policy served him well as he navigated the many debacles that followed: the anthrax scare in 2001, the emergence of concerning new strains of influenza in 2006 and again in 2009, the Ebola outbreak in 2014, and, of course, the covid pandemic in 2020. His approach to AIDS, to which he devotes by far the most space in the book, is a reliable guide to his overriding sensibility. Implicit in his strategy is a truth that all good doctors grasp: Health is as much a political affair as a clinical one. Long before the onset of the covid pandemic, Fauci found himself at the center of a firestorm, merely because he was determined to do his job properly.

The relative dearth of intimate writing in this memoir feels apt: For decades, Fauci subordinated his own concerns to the two roles he assumed in the ’80s as a dispassionate scientist and a public servant accountable to the people. This latter role was perhaps as challenging during the dark years of the AIDS epidemic as it was during covid. Fauci is not one for sugarcoating, and he is honest about the LGBTQ+ community’s initial — and justified — outrage. A representative article, by famed playwright and activist Larry Kramer, ran in the San Francisco Examiner in 1988 under the headline, “I Call You Murderers, an Open Letter to an Incompetent Idiot, Dr. Anthony Fauci.”

But when that incompetent idiot was confronted with the disaffection of the patients he hoped to save, he did something extraordinary: He listened. “I tried to put myself in their shoes,” he writes, “and it became clear to me that I would have been as vehement as they were in demanding a more concentrated and effective effort against this emerging plague.” When Fauci asked the protesters to meet with him, “they were shocked. This was the first time in anyone’s memory that a government official had invited them to sit down and talk on equal terms and on government turf.” Their exchange would prove to be the first of many, and Fauci’s collaboration with LGBTQ+ advocates eventually evolved into a “true partnership.”

Indeed, it was a conversation with the activist Marty Delaney that persuaded Fauci to defy his superiors and call for a “parallel track” approach to the distribution of AIDS drugs, one that suspended standard procedures and permitted the dissemination of medicines even as clinical trials were underway. When a member of Fauci’s staff spoke rudely to activists whom the doctor had invited to attend an NIH meeting, he promptly fired the man. He was sorry to have to do so, he recalls, but the employee in question “was completely wed to the classical paradigm that scientists and scientists alone should participate in the development of a scientific agenda and above all that activists had no place in the process.”

Fauci, in contrast, is not wed to this counterproductive paradigm. Despite his repeated insistence that he is “apolitical,” he has always been responsive to the medical constituencies he is serving and willing to involve them in the decisions that affect their lives. Listening to communities at risk is not bad science but good medicine. Fauci is not temperamentally inclined toward radicalism — he is mild and measured for much of the book, going so far as to extend perhaps too much courtesy to the likes of Bush and Dick Cheney — but there are moments when competence and conscientiousness are revolutionary. Fauci has lived through two of them. Hopefully we will not have to endure many more.

Becca Rothfeld is the nonfiction book critic for The Washington Post and the author of “All Things Are Too Small: Essays in Praise of Excess.”

A Doctor’s Journey in Public Service

By Anthony S. Fauci, M.D.