Fauci: HIV, COVID-19 pandemics taught us to ‘expect the unexpected’
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Key takeaways:
- The HIV and COVID-19 pandemics were decades apart but shared many lessons.
- Among the lessons for clinicians are to “expect the unexpected,” Fauci said.
Despite being decades apart, the HIV/AIDS and COVID-19 pandemics shared many lessons that can be applied to future pandemics and health emergencies, Anthony S. Fauci, MD, and his former chief of staff wrote in a new paper.
“Upon stepping down as a physician scientist at the National Institutes of Health for 54 years and as Director of the National Institute of Allergy and Infectious Diseases for 38 years, I reflected on many of the experiences and challenges that I and the institute have had,” Fauci told Healio. “My career as NIAID director was bookended by two of the most impactful pandemics in human history — HIV/AIDS and COVID-19. There were lessons that we have or at least should have learned from both pandemics.”
He added: “Upon reflecting [on] these experiences, it became clear that there were some lessons that were common to our experiences with both of these pandemics.”
In the paper, Fauci and Gregory K. Folkers, MPH, MS, explored these lessons and shared the ones they found to be the “most relevant.”
A presidential responsibility
One major lesson taken from both HIV/AIDS and COVID-19 is that “with pandemics, political leadership at the highest level is critical,” Fauci and Folkers wrote.
According to their paper, President Ronald Reagan, who was inaugurated in January 1981 — 5 months before the first case of AIDS was reported — did not make a speech about the disease until May 1987, after the incidence of HIV in the United States had exceeded 100,000 new infections per year. This, they wrote, was a failure to call attention to an emerging epidemic and created missed opportunities to rally public efforts to help those infected or at risk.
An example of positive political leadership, according to Fauci and Folkers, was President George W. Bush introducing the President’s Emergency Plan for AIDS Relief, which provides treatment and care to developing countries, particularly in Africa. By 2023, the program saved more than 25 million lives, according to the paper.
Fauci and Folkers criticized what they called a “lack” of leadership during the COVID-19 pandemic by President Donald J. Trump, who they said “frequently minimized the seriousness of the pandemic.” Trump “missed opportunities for pollical leadership in promoting policies and practices to mitigate the impact of a raging pandemic,” they wrote. (Fauci served on Trump’s COVID-19 task force.)
“Moving forward, it is essential that the scientific community — and the public at large — support leaders who pledge to embrace evidence-based decision-making in science and public health,” Fauci and Folkers wrote.
Trust the science
Another lesson from the two pandemics is that “misinformation and disinformation are the universal enemies of pandemic control,” they wrote.
According to Fauci and Folkers, years after it was determined that HIV causes AIDS, Peter Duesberg, PhD, a molecular virologist, claimed that AIDS was instead the result of noninfectious factors, including recreational and pharmaceutical drug use and sexual promiscuity. This “AIDS denialism” was echoed by Nobel Prize in Chemistry winner Kary Mullis, PhD.
“It was remarkable that these otherwise accomplished scientists made such claims based on no credible scientific information and in the face of copious amounts of scientific evidence that negated their assertions,” Fauci and Folkers wrote.
These claims took hold and ultimately had widespread, negative impacts on public health efforts, similar to the misinformation and disinformation that “have been rampant” throughout the COVID-19 pandemic, according to Fauci and Folkers. The primary difference is that the spread of disinformation during COVID-19 was made worse by online platforms that “amplify untruths faster than at any other time in history,” they wrote.
‘A perpetual challenge’
Another lesson is that “emerging infectious diseases are a perpetual challenge,” Fauci and Folkers wrote.
Although the medical community was “stunned” by the unexcepted appearances of both HIV/AIDS and COVID-19, “history should have warned us that this would happen,” they wrote.
“From before recorded history, civilizations have been devasted and shaped by the appearance of emergent infectious diseases, from the plague of Athens in 426 BC to the bubonic plague in the 14th century, to the pandemic influenza of 1918, among others,” they wrote. “Pandemics have always emerged, long before our time; we have seen them emerge in our lifetime; and they will continue to emerge long after we are gone.”
Because of this, Fauci and Folkers said the only way to meet the challenge is to be “perpetually prepared.”
Many other lessons can and should be taken from both pandemics, they said. In their paper, Fauci and Folkers cited lessons such as “prior scientific advances are the foundation of successful pandemic preparedness and response,” “increased attention to the human/animal interface is critical for pandemic prevention,” and “inequities, health disparities, stigma, and discrimination are amplified in pandemic settings.”
According to Fauci, though, the biggest takeaway for clinicians reverts back to the first lesson in the paper — “expect the unexpected.”
Fauci and Folkers wrote that in 1981, when the first cases of AIDS were reported, “the appearance of an unrecognized infectious agent causing a new disease with the potential to spread among humans” had not happened in recent memory. Decades later, more than 88 million people have acquired HIV and 42.3 million people have died.
Although many aspects of the HIV/AIDS and COVID-19 pandemics were unexpected and could not be anticipated, “it seems inevitable that the unexpected will happen again.”
“As a clinical scientist myself, the biggest takeaway of the paper for clinicians is to expect the unexpected,” Fauci said. “Both HIV/AIDS and COVID-19 provided clinicians and health care personnel in the trenches with unique and unprecedented challenges With brand new diseases such as novel pandemics, the clinician must be prepared for this.”
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