Q&A: On eve of retirement from NIAID, Fauci tells Healio what’s next
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At the end of this month, Anthony S. Fauci, MD, will officially step down as director of the National Institute of Allergy and Infectious Diseases, which he has led for nearly 4 decades.
Throughout his career as a physician and scientist, Fauci, who turns 82 on Dec. 24, has watched the field of infectious diseases evolve amid numerous new crises — including HIV/AIDS in the 1980s, pandemic influenza in 2009, and the COVID-19 pandemic.
He has advised seven U.S. presidents, becoming one of the most visible physicians and ID experts in the United States. In addition to retiring from the NIAID, Fauci will also step down as President Joe Biden’s chief medical advisor.
In this interview, conducted during his final days in office, Fauci reflects on his time with the NIAID, looks ahead to what is next for him and the field of ID, and tells Healio whether he has any second thoughts about stepping down in the middle of a pandemic.
Healio: When is your last day as director of the NIAID?
Fauci: Officially, my last day is Dec. 31, but I'll probably stop coming into the office right before Christmas.
Healio: You’re stepping down as NIAID director, as well as White House advisor. What's next for you professionally?
Fauci: I have not established the venue in which I'm going to be operating because of ethical considerations — when you're a government official, you can’t negotiate the job that you're going to be going to after you are leaving the government until you actually leave the government. So, I don't know the venue that I'm going to be at, but I do know what I'm going to do. I'm going to be lecturing and writing and likely being [an advisor] for those who would prefer to have my advice, be it in the medical, scientific or public health field. It’s going to be predominantly teaching, lecturing and writing, and I will likely do that in the confines of some venue — whether that's a medical center venue, or whether that's a foundation venue, I'm not quite certain yet because it is not appropriate for me to negotiate that now until I actually step down.
Healio: Because you will be lecturing and doing some writing, do you have any plans to write a book?
Fauci: Obviously, that's one of the purposes in stepping down — to use the benefit of my 54 years of experience as a scientist at the NIH, 38 years as the director of the institute and the privilege of advising seven presidents to inspire younger people to go into science and perhaps to inspire people who are in science to go into public service. One of the ways to do that would be to write a memoir. So, I would imagine that it is very likely that sometime soon after stepping down, I will make a move toward doing that, but I don't have any concrete plans on that yet.
Healio: Do you have a message for ID clinicians or the ID field in general?
Fauci: My message is articulated in The New England Journal of Medicine essay that I wrote just [recently]. [Editor’s note: Fauci’s recent perspective is titled “It Ain’t over Till It’s Over ... but It’s Never Over — Emerging and Reemerging Infectious Diseases.] The message is that the field of ID is a very vibrant, dynamic field. We need to get the best and the brightest of young people into the field because it's a field that needs the best and the brightest and because it is such an important, dynamic field that has impact on virtually everything we do — the economy, our health, our social life. Just take a look at what COVID has done to the world. That’s the answer to how important the field of infectious disease is.
Healio: Do you have a message for the person who takes over your role at the NIAID?
Fauci: The message is to stick with the science — the data, the evidence — and don't get involved in politics. There's a big difference between policy and politics. You can certainly get involved in policy based on good, sound, public health principles, but stay away from public politics and the extraordinary divisiveness currently going on in this country.
Healio: Looking at your time with the NIAID, what were some goals that you had set for yourself when you first started? Did you accomplish them?
Fauci: Well, certainly, you don't really have a lot of say in what's going to happen because it's such an unpredictable field. Like, I didn't have a goal of developing lifesaving drugs for, say, HIV until HIV came. Once there was HIV, my goal was to direct the institute that was primarily responsible together with the pharmaceutical companies to develop the entire array of combinations of drugs that literally transformed the lives of persons with HIV, [turning it] from an almost certain death sentence to a manageable disease where people can live essentially a normal life span. We accomplished that goal.
Another goal was to get equity in the distribution of drugs, not only in the United States but in the developing world for countries that could not afford them because of their lack of resources. With that came the role I played as being the architect of the [President’s Emergency Plan for AIDS Relief, or PEPFAR] program. That goal was met.
Another goal is I wanted to get a vaccine for HIV. We haven't gotten there yet but I hope we will. It's a particularly difficult and scientifically challenging aspiration, but we'll see. I hope that after I leave, good work that’s currently going on will continue and we will reach that goal. [Editor’s note: Read about the complexities of developing an HIV vaccine here.]
Healio: Are there any other goals that come to mind that you wish you’d accomplished?
Fauci: A cure for HIV is another one. And a vaccine for malaria, although we are doing very well and we've made it a long way. We've had some vaccines that are not overwhelmingly good, but we have good monoclonal antibodies. However, the goal of a highly effective vaccine for malaria, one that's durable and has protection, is an unmet goal. I do think it's a reasonable goal that we likely will meet. A safe and effective vaccine for tuberculosis is another goal that I feel that we can meet. [Editor’s note: Read about efforts to develop a TB vaccine here.]
Healio: Is there anything that keeps you up at night?
Fauci: Well, yeah. We still are in the middle of a pandemic. That is still something that is troublesome, although we're doing much better than we were doing. A year and a half ago, we were having 3,000 to 4,000 deaths per day, and now we're down to around 300 to 400 deaths a day. That’s still not a level that I feel comfortable with, so we've got to do better than that.
We also only have 13% of the eligible population who have taken and received their updated BA.4/BA.5 bivalent booster. We've got to do much, much, much better than that.
Then there's always the concern of, yet again, another pandemic. We don't know when that will be — whether that will be next year, 5 years from now, [or in] 10 years or 50 years. I mean, you just don't know. But you've got to be perpetually prepared.
Healio: Do you have any second thoughts about stepping down before the COVID-19 pandemic is “over”?
Fauci: I don't think COVID is ever going to be over completely. I think we're getting it down to a low level, and I think as we enter the spring of this coming year, we likely will have it down to an even lower level. But no, I don't have any regrets at all. I think we've done much, much better now than where we were a year and a half ago.
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Healio interview
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