AIDS. SARS. H1N1 influenza. Ebola. Covid-19. Monkeypox. Infectious disease outbreaks often come and go, though some persist over the long haul, much like the man who has occupied the campus of the National Institutes of Health in Bethesda, Md., as director of the National Institute of Allergy and Infectious Diseases since 1984: Dr. Anthony Stephen Fauci.
I came of age in the 1980s — the age of AIDS — but in a way, this was the beginning of the age of Tony, as many call him, because he’d be there through all of it, for each and every one of the nation’s adventures with infectious diseases. The telegenic, calm guide with the unmistakably Brooklyn accent took heat from AIDS activists as they descended on the National Institutes of Health’s Building 31 in 1990. He hugged Nina Pham, a Dallas nurse, in front of cameras after she recovered from Ebola, to soothe a nation’s fears about the virus in 2014. He was deadpan presence in the background of President Donald Trump’s news conferences on Covid-19. He advised presidents since Ronald Reagan on what to do in the face of these scourges.
As the Yale historian Frank Snowden has noted, from the middle of the 20th century until the advent of AIDS — during what he called “an age of hubris” — scientists had largely declared mission accomplished in terms of the battle against infectious diseases, as antibiotics put microbial threats distinctly into the past. If AIDS was the comeuppance for our arrogance as scientists, over the years, rightly or wrongly, Dr. Fauci gave the impression that science could handle these challenges, eventually, through the methodological, step-by-step work of research and the application of what we learned expeditiously into the clinic, into the field.
This wasn’t the Pollyannaish scientism of the 1950s, ’60s and ’70s — a notion that science would conquer infectious diseases once and for all — but the idea that at least there could be progress. When protease inhibitors arrived in the mid-1990s to change the course of the AIDS epidemic, giving life to many people who faced certain death, this optimism seemed borne out, at least to many of my friends and colleagues who had watched a generation perish to the disease.
As Dr. Fauci prepares to retire at the end of this year, one has to wonder if this is the end of an era as well. Don’t get me wrong: No one I know thinks that our gains on AIDS and the progress we’ve made in other areas of infectious disease control — particularly on vaccine-preventable diseases — are trivial accomplishments.
But with Covid-19, something has changed. it tested a fundamental equilibrium among science, public health and politics in America. Most administrations, I argue, simply don’t care much about science and public health; it’s not a priority for them. On AIDS, Mr. Reagan ignored it, and Bill Clinton paid lip service to it. George W. Bush came the closest to making it a priority, with the establishment of the President’s Emergency Plan for AIDS Relief, but by the time of Barack Obama, activists were protesting again about an administration’s neglect.
But Covid-19 caught the attention of politicians, and not in a good way. For decades, Dr. Fauci and other scientists could advise presidents, even sway them for good on occasion, because so little was at stake politically for these leaders. But with Mr. Trump and President Biden, too much was riding on their short-term political fortunes to indulge scientific and public health evidence and advice too much or for too long.
I’ll never forget an email I sent to Dr. Fauci and other health leaders during the Trump administration at the start of the Covid-19 pandemic, begging them to speak up and provide scientific leadership in the chaos and mismanagement that scientists and the public saw happening around us. But there was little the good doctor could do, and he even acknowledged this was a unique situation.
With the election of Mr. Biden, many in public health had hoped for someone to lead with the science, but soon pollsters were urging his administration to take the win over Covid-19, declare the crisis over, stop talking about mitigation efforts and get people to understand that Covid-19 would simply be with us for a long time.
If the age of Dr. Fauci was one in which we looked forward to progress, even if always piecemeal, the current era is the age of “We have the tools.” It is a distinct new pessimism of spirit, cynicism of the will, born of the hubris of some physicians but mostly of the political calculations of others that doing more on this pandemic is untenable. The sound you hear is the thud of resignation in the face of the suffering of so many over the past two and a half years and a summer in which we add hundreds to the dead every day in the United States.
In the darkest days of the AIDS epidemic, Dr. Fauci never gave up. We didn’t sit with the mounting dead and our pitiful armamentarium of weak drugs and suggest we had the tools. We fought, and we argued, for sure, but we moved ahead together, never satisfied with the status quo. If he weren’t retiring in December, I’d imagine him working to his very last breath until there was a cure for AIDS.
We should all have his resolve and commitment, even if Dr. Fauci lives in a world of dire constraints, of the men and women of politics, who dream small and think about the next election always, rather than the nature and qualities of their legacies, of which Dr. Fauci’s is assuredly great.
Gregg Gonsalves (@gregggonsalves) is an associate professor of epidemiology at the Yale School of Public Health, a longtime AIDS activist and a 2018 MacArthur fellow.
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