White House Coronavirus Update Briefing, courtesy of The White House

Doctor Do-Little | The Case Against Anthony Fauci

Sam Adler-Bell

There is no one in American government — or perhaps any government — quite like Dr. Anthony Fauci. His position, with its mixture of informal power and public visibility, scientific authority and beltway influence, is sui generis. Few other unconfirmed civil servants have access to as many rooms in the executive interagency; no public official commands as much respect in the world of science and medicine. As director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984, he has advised six presidents (and now a seventh) on domestic and global health issues — HIV/AIDS, SARS, Ebola, Zika, and MERS — and overseen decades of research on infectious disease, pandemics, and virology. Under his stewardship, NIAID’s mission has been reshaped around his personage: its priorities are his priorities, its research agenda is his research agenda. And that agenda has borne fruit: breakthrough treatments for HIV and other deadly diseases and now, a vaccine for Covid-19. As Stanford microbiologist David Relman told The New Yorker in April, “Tony has essentially become the embodiment of the biomedical and public-health research enterprise in the United States.”

Although Fauci has no statutory authority to preside over a public health crisis, he has become the nation’s de facto Doctor-in-Chief during this pandemic. His face — elven and expressive — is the face of the medical establishment’s response to the novel coronavirus. I doubt most Americans can name the (outgoing) U.S. Surgeon General, CDC Director, or Fauci’s nominal boss, the director of the National Institutes of Health (Jerome Adams, Robert Redfield, and Francis Collins, respectively), but everyone knows Dr. Fauci. His plaintive but never pessimistic patter and disarming outer-borough rasp are soothing sonic features of our daily dirge of death, doom, and statistics. I was relieved when I first saw Fauci on TV — sometime in March 2020 — thinking dimly to myself, for the millionth time, “Ah, an adult in the room.” Amid a ceaseless current of chaos and grief, Fauci’s egoless display of competence, his grandfatherly warmth and irony, were ports in a storm. 

But a comforting bedside manner has done little to mitigate catastrophe. Over 400,000 Americans are dead, twice as many as any other country. Infections, hospitalizations, and deaths are currently at record highs. And although we have a vaccine, the rollout has already been stymied by a dearth of resources and coordination. As one public health expert told The New York Times on January 17, our pandemic response has been “a colossal failure at every level of government.” And herein lies a paradox. America is suffering from a disease outbreak whose morbid scope is the consequence of world-historic negligence. We are desperately and needlessly sick. And yet, the man known as “America’s Doctor,” the undisputed personification of public health research and pandemic preparedness, faces no reputational consequences. On the contrary, Dr. Fauci remains one of our most beloved public figures.  

What explains this? Liberals, who otherwise harshly condemn the federal government’s pandemic response, are especially besotted with the diminutive virologist. For fans of the #Resistance, a well-timed facepalm during one of the Mad King’s early soliloquies guaranteed Fauci’s place on a Mount Rushmore of replacement patriarchs, alongside James Comey and Robert Mueller. (Fauci later insisted the gesture was innocuous; he was merely obscuring his face to dislodge a lozenge from his throat.) Still, Democrats’ devotion has never waned. They see in Fauci a lonely champion of “truth” and “facts” in a White House otherwise hostile to “science.” Brad Pitt earned an Emmy nomination for portraying the 80-year-old physician on Saturday Night Live. One Hamilton-inspired TikTok (“My name is Dr. Anthony Fau-CHEE…”) went viral. Just since the beginning of the “third wave” of Covid infections in October, Fauci has received leadership awards from the National Academy of Medicine, the FBI Agents Association, the Arthur Ashe Institute for Urban Health, and the Boy Scouts of America. Joe Biden has asked Fauci to stay on at NIAID and serve in his administration as a chief medical advisor. D.C. Mayor Muriel Bowser proclaimed “Anthony S. Fauci Day” on December 24. 

Fauci’s celebrity, however, cannot obscure empirical reality. As America’s Doctor would surely agree, the numbers don’t lie: 2,824 Americans died of Covid-19 on Anthony S. Fauci Day. 

Anthony Fauci is no doubt a dedicated public servant, respected by his colleagues, beloved by many Americans. But the puzzle remains: why has the man most closely associated with the public health response to the pandemic entirely avoided accountability for its failure? 

 

First, the most straightforward defense: it wasn’t his fault. He did the best he could, but Fauci’s better instincts were thwarted by Trump and his coterie of idiots. Of course, there’s truth in this. The uneasy peace between Trump and his medical advisors started to unravel almost before it began. By the end of March, Trump was sweating the stocks and tweeting that the “cure” must not be worse “than the problem itself.” He clashed with Fauci throughout the spring — over masks, hydroxychloroquine, school openings, and Easter. By summer, Trump was publicly lambasting the good doctor, leaking anti-Fauci talking points to the press and sidelining him in task force meetings, which were themselves increasingly rare. Scott Atlas, the libertarian radiologist and herd-immunity advocate whom Trump hired based on his Fox News appearances, was calling the shots.

But Fauci seldom contradicted the president’s lies outright, opting for tact and de-escalation instead. “I can’t jump in front of the microphone and push him down,” Fauci said in late March. “OK, he said it. Let’s try and get it corrected for the next time.” On July 4, Trump said 99 percent of Covid cases were “harmless.” Fauci characterized this as a misinterpretation. (“I’m trying to figure out where the president got that number…” he said.) Though Fauci has a reputation for bluntness, as the Financial Times’s Hannah Kuchler observed, “he clearly also tries to hold back, believing he will make a bigger difference to the course of the pandemic if he keeps his job.”

This logic pervades the most common defense of Fauci’s record. “Tony is unique, in that he has such credibility with politicians that he’s been able to insert hard facts into the conversation,” Nobel laureate biologist David Baltimore told The New Yorker in April. “That has been wonderful for our country and the world.” In this view, Fauci was handling Trump, just as he handled previous presidents, including a reluctant Ronald Reagan during the AIDS epidemic. When he pulls his punches, it’s always for the greater good; namely, the cause of remaining in the room. Stepping too far out of line, contradicting Trump with too much vigor, would have imperiled his standing. “The argument for Fauci saying more,” wrote Molly Roberts in The Washington Post, “… is also an argument for self-exile.” And then what? Truth and facts would have had no advocate inside the White House. As Fauci himself told the Times on Sunday, “I felt that if I stepped down, that would leave a void. Someone’s got to not be afraid to speak out the truth.”

At a briefing in July, Trump mused, “It’s interesting: [Fauci’s] got a very good approval rating. And I like that, it’s good. Because remember, he’s working for this administration. He’s working with us.” Winding his way to his point, Trump said, “So why don’t I have a high approval rating… with respect to the virus?” After a pause, he deadpanned, “It can only be my personality, that’s all.” 

As is often the case with Trump, he had a point, just not the one he meant. The liberal apologia for Fauci was internally contradictory. As one scientist said to me, “We can’t deify Fauci’s response to the pandemic as fantastic while simultaneously condemning Trump, when for months, the two were hand in hand.” Indeed, Fauci is only blameless if he was utterly powerless to stop the administration’s disastrous plans. And if he was powerless, he should’ve resigned and communicated the truth bluntly to the public long ago. Otherwise, he knowingly lent credibility to an abject failure he couldn’t control. 

To put an even finer point on it, the precise conditions that would maximally exonerate Fauci — i.e., Trump is solely at fault; Fauci had no influence — are conditions under which Fauci absolutely should have bolted. The more aberrant Trump’s behavior, the more he diverged from the medically prudent course of action, the greater Fauci’s responsibility to leave and blow the whistle. If Fauci knew better but didn’t say, what use was he inside the room? If he didn’t know better, then he shares the blame. 

In recent days, Fauci and Covid task force coordinator Dr. Deborah Birx — another veteran AIDS researcher who’s received slightly less deferential treatment from the media than her male counterpart — have undertaken a goodwill tour. Birx told CBS that denialists in the White House “derailed” the pandemic response, putting out information she knew to be false. Fauci joked with Rachel Maddow that Trump had forbidden him from coming on her show and told the White House press corps, “The idea that you can get up here and… let the science speak, it is somewhat of a liberating feeling.” Meanwhile, liberal pundits like Ezra Klein have praised Biden’s “maddeningly obvious” Covid plans, describing their simplicity as a “damning indictment” of Trump’s negligence. But if Biden’s life-saving interventions are so straightforward and crucial, why weren’t Fauci and Birx loudly demanding them months ago? 

“To keep their jobs” should not be a satisfying answer — not for the living or for the dead. 

 

Frank assessments of Fauci’s performance are hard to come by. Those in a position to judge him from an informed public health or virological perspective are not inclined to do so. Fauci is seen as the general of an army fighting a common enemy; dissension in the ranks will only harm the war effort. Unanimity has been the watchword. Moreover, Fauci’s reputation precedes him. He’s trusted. Experienced. Idolized. Few would be so bold as to contradict the Great Man. And finally, more cynically, NIAID’s yearly budget is $5.5 billion; to a significant extent, Fauci decides which labs, projects, and salaries in the field get funded.

But efforts to assess Fauci are frustrated by another familiar dynamic. The only place one finds consistent criticism of Fauci is in right-wing media, where it’s usually tainted by bullshit and bad faith. Just as the instinct to exculpate Fauci leads liberals to blame everything on Trump, conservatives have foisted the administration’s failures onto Fauci. It’s a depressing dance, the Trump-era two-step. The more liberals claim Fauci as a #Resistance mascot, the more the right relishes smearing him as a pro-Biden plant, spurring liberals to identify with him even more. Rinse and repeat. In this way, Fauci — like Mueller before him — became a “hero of the resistance” and an “enemy of Trumpism” without ever doing much of anything to earn either epithet.

Still, for Fauci, the public record is not uniformly flattering. For the first few months of 2020, Fauci appeared to toe the administration’s line that the emerging disease was not a major threat. On January 26, just days after China locked down the eleven million residents of Wuhan and started building a new 1000-bed hospital, Fauci said, “The American people should not be worried… It’s a very, very low risk to the United States.” (He added, “It’s something we, as public health officials, need to take very seriously.”) A month later, on February 29, when many scientists believed thousands of undetected cases were present in the US — testing was still non-existent — Fauci said, “The risk is still low… there’s no need to change anything that you’re doing on a day-by-day basis.” And on March 9, after superspreader events on four cruise ships had been reported, Fauci told Fox’s John Roberts, “If you are a healthy young person, there is no reason if you want to go on a cruise ship, [not to] go on a cruise ship.” 

Had Fauci joined the smaller chorus of scientists sounding the alarm — most of them outside of the federal government — he might have been marginalized, treated by the White House as an eccentric Cassandra who could safely be ignored. On the other hand, Fauci’s influence over the biomedical establishment is difficult to overstate. If Fauci had embraced more dire predictions in early 2020, many other prominent scientists would’ve followed suit. It’s impossible to say how much difference Fauci’s warnings would’ve made. But those countries that took the outbreak seriously, early — imposing lockdowns, travel bans, and mask mandates right away — are those that have weathered it best.   

Then there was the mask fiasco. In February and March, Fauci, the World Health Organization, and the CDC all recommended against protective masks for non-symptomatic members of the public. Their line was: don’t bother. On February 19, Fauci told USA Today, “In the United States, there is absolutely no reason whatsoever to wear a mask.” On March 8, as scientists estimated tens of thousands of undetected Covid cases in the US, Fauci told 60 Minutes, “There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is.” In the same interview, laying the foundation for a fog of disinformation that is still very much with us, Fauci suggested wearing a mask might actually increase the risk of contracting the virus, “Often, there are unintended consequences — people keep fiddling with the mask and they keep touching their face.”

Two weeks later, at an April 3 press briefing, the White House reversed its guidance. Now authorities were advising us to wear “non-medical cloth” face-coverings in public spaces. (Fauci didn’t attend that briefing, prompting a round of “where is Fauci?” speculation from his fans on Twitter, but also sparing him the embarrassing display.) Surgeon General Adams, who had tweeted on February 29, “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus,” acknowledged that the shifting guidance had been “confusing to the American people.” (I’ll say.) And Trump, adopting a vague and unhelpful line on masks, one he’d maintain basically until contracting the virus himself, said, “It’s going to be, really, a voluntary thing. You can do it. You don’t have to do it. I’m choosing not to do it, but some people may want to do it, and that’s okay. It may be good.”

The flip-flop was a blow to the integrity of public health experts. It fueled and credited the suspicions of conspiracists — right-wing media outlets continue to insist that masks don’t help, cause health problems, and that mandating them is an oppressive imposition of the liberal nanny state. And it provided an opening for Trump to sow further doubt and confusion. “Dr. Fauci said don’t wear a mask,” Trump complained to Fox News in July. “Our Surgeon General, terrific guy, said don’t wear a mask. Everybody was saying don’t wear a mask. All of a sudden, everybody’s got to wear a mask. And as you know, masks cause problems too.”

When the guidelines changed, Fauci cited two factors: (1) the Covid taskforce had feared that a run on medical-grade masks — specifically, N95s — would deprive healthcare providers dealing with sick patients every day, and (2) new confirmation that asymptomatic carriers were transmitting the virus. In retrospect, neither of these explanations was sufficient. The latter explanation relied on a scientific ambiguity. Asymptomatic spread had in fact been confirmed in January 2020, by Fauci himself. “In the beginning… it was not clear whether an asymptomatic person could transmit it to someone while they were asymptomatic,” Fauci told a White House press briefing on January 31. “Now we know from a recent report from Germany that that is absolutely the case.” At the time, there remained some uncertainty as to whether asymptomatic infection was a “major driver” of transmission. The answer to this question was a moving target. (It still is.) But the mask flip-flop did not rely on new, definitive proof that people without symptoms could spread the disease. We knew that already. Moreover, as Fauci is aware, people in East Asian countries regularly wear masks to prevent the spread of respiratory illnesses. They’ve continued to do so during this pandemic. The efficacy of masks was not a new discovery.

As for the mask shortage, that was a real problem. But Fauci and other officials wanted to have it both ways: mislead the public to protect the stockpile of medical masks and maintain the public’s trust for future interventions. (If not stupidity, it was, at least, hubris.) If, instead, government officials had been honest about the efficacy of masks from the beginning, we could’ve ramped up production in February and March to meet demand. By early April, Taiwan, which has reported a total 884 cases of Covid and seven deaths, was producing fifteen million masks per day for its 24 million citizens. 

In July, Fauci was asked whether he regretted originally advising against masks. He replied, astonishingly, “I don’t regret anything I said then because in the context of the time in which I said it, it was correct… When it became clear that the infection could be spread by asymptomatic carriers who don’t know they’re infected, that made it very clear that we had to strongly recommend masks.” But that wasn’t true; Fauci knew about asymptomatic carriers at least three months before the CDC changed its guidelines. This was simple face-saving, an attempt to rewrite the record in his favor. Apparently, it worked.

 

Almost every profile depicts Fauci as a Galilean advocate of pure science doing battle with an irrational public and a mendacious executive. He is “direct,” “blunt,” a “truth teller,” a “straight-talker,” a “voice of reason;” he “shows how technocrats can also use candor as a way to preserve credibility.” As David Relman, the microbiologist, told The New Yorker, “Nobody is a more tireless champion of the truth and the facts.” Fauci himself assiduously attends to this image. “I have a reputation, as you probably have figured out, of speaking the truth at all times and not sugar-coating things,” he told FT. “Everybody knows I’m going to tell them exactly what’s the truth,” he said in April. Asked what accounts for his celebrity during the pandemic, Fauci replied, “I believe, in fact I’m certain, that the country, in a very stressful time, needed a symbol of someone who tells the truth, which I do.” 

We now know that Fauci — in addition to his subterfuge about masks and asymptomatic transmission — lied to the public about herd immunity, gradually raising his estimate of the percent of the population that needs to be inoculated to defeat the virus. As The New York Times reported in December, “Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.” This admission betrays his carefully cultivated image. Clearly, Fauci is willing to indulge in pious fictions when he decides they’re necessary. In truth, the cult of Fauci is based on a character; a performance that has served him, and sometimes the public, very well. 

The Washington Post’s Molly Roberts charted the invention of this posture in a July 2020 profile. (Subhed: “One man, six presidents and the fragile balance between politics and science.”) During the AIDS epidemic, Fauci was seen by activists as slow-walking the approval of desperately needed treatments and wasting money appropriated to combat the crisis. The radical AIDS advocacy group ACT UP targeted him with particular ire. “It doesn’t take a genius to set up a nationwide network of testing sites, commence a small number of moderately sized treatment efficacy tests on a population desperate to participate in them, import any and all interesting drugs… from around the world for inclusion in these tests at these sites, and swiftly get into circulation anything that remotely passes muster,” wrote Larry Kramer, the playwright and activist, in an open letter to Fauci in 1988. “Yet, after three years, you have established only a system of waste, chaos, and uselessness.”

“I have been screaming at the National Institutes of Health since I first visited your Animal House of Horrors in 1984,” Kramer wrote. “I called you monsters then, and I called you idiots… and now I call you murderers.” 

After a particularly disruptive protest at the NIH in October 1988, Fauci famously decided to invite the ACT UP activists into his lab. That visit led to a dialogue. And eventually, in 1990, Fauci pushed to allow infected patients access to experimental drugs before they were fully approved by the FDA. Though activists had already won some loosening of the FDA’s “compassionate use” policies, this move, wrote Roberts, was a radical departure from “good old-fashioned, take-it-slow science.” Fauci broke and rewrote the rules in response to grassroots pressure — and perhaps, to his budding friendships with figures like Kramer and Peter Staley, another ACT UP veteran. Indeed, when some NIAID scientists resisted his new approach, Fauci fired them. The remaining ones knew the score. (“They’re smart, these scientists,” Fauci said. They fell in line and kept their jobs.) This, according to Roberts, “was the birth of the Fauci protocol.”  

The AIDS crisis convinced Fauci of two conclusions simultaneously: (1) that science is never devoid of politics, and (2) that the wisest strategy for achieving his aims — in the politicized world of science — was to pretend, at least in public, that he didn’t know or believe conclusion #1. “He put the two lessons together and came up with his signature bedside manner,” Roberts wrote. In other words, Fauci would operate with the knowledge that politics were inescapable, while insisting, fervently, that “science,” “facts,” and “reason” can (and must) be quarantined from power and partisanship. The idea of a strict division between science and politics was itself a noble lie, one he has publicly endorsed ever since. As Fauci continued to advocate for AIDS research, he did so in the idiom of “pure” science, eliding altogether the social dimensions of the disease, and thereby (in theory) inoculating the public against prejudice and providing cover for conservative politicians to get on board. (Fauci became close friends with George Bush Sr.; Bush Jr. awarded him the Medal of Freedom.) “It isn’t really politics,” Fauci told Roberts. “It’s staying out of politics. What I learned is don’t be political. Be medical. Be scientific… It’s when you get into the politics that you get in trouble.”

Thus, the two Tony Faucis were born: one, the shrewd political operator who has survived six presidential administrations, as Roberts wrote, “an A-list party get in D.C. social circles” who moves “freely between TV green rooms, think-tanks and the city’s tonier salons, mixing easily among both Democrats and Republicans;” the other, the humble man of science, the blunt truth-teller, who couldn’t possibly know or care about the petty striving and mudslinging of the world of smoked-filled rooms. This approach, I suspect, has profited both Fauci and the presidents he has served. His pristine, apolitical reputation lends credibility to the White House during a health crisis, but his appreciation for realpolitik means they can rely on him to appreciate the circumstances when science must take a backseat to politics. “The folks I know who know Fauci tend to respect and/or admire him,” tweeted Nicholas G. Evans, a bioethicist at UMass Lowell. “But no one denies he’s more Game of Thrones than Mr Rogers [sic].”

In another moment of lucidity in May 2020, Trump said of Fauci, “He wants to play all sides of the equation.” I think that’s right. In the past, Fauci has plausibly played all sides to the benefit of the public. His shrewd AIDS advocacy assuaged homophobic politicians, motivated apolitical scientists, and met the demands of activists and patients. In the case of Covid-19, it’s harder to see how Fauci’s machinations have helped anyone — except Anthony Fauci. 

 

The Fauci protocol failed during this crisis for multiple reasons. One, Fauci overestimated the amount of harm he could prevent by remaining in Trump’s good graces. By declining to firmly correct and denounce Trump’s self-serving misinformation, and thereby produce a definitive break, Fauci made a disastrous miscalculation. He needed to pick a side, and it should’ve been the one opposite Trump. Instead, he maintained a mealy-mouthed détente with the president — thereby depriving the public of the truth — in futile hope of righting the ship from the inside, which he clearly could not do. In October, scientists estimated that universal mask compliance — enforced by federal law, perhaps — could save 100,000 lives by February. Another estimate projected 70,000 could’ve been saved between August and December. 

Two, Fauci underestimated how much good he might’ve done from the “outside.” As I’ve emphasized, the medical and public health establishments have worked in lockstep with Fauci throughout the crisis. Barely anyone has contradicted him; almost everyone has looked to him for leadership. When he moved, they moved. For many public health professionals, the very fact that Fauci stayed where he was — at Trump’s side — was itself a signal that the White House wasn’t fucking up too badly. By the same token, if Fauci had publicly denounced the White House’s approach, he would have united the entire medical and scientific community behind him. The effect of such a collective action is difficult to predict, but it’s not unthinkable Trump could’ve been removed from office, especially if Fauci had sufficiently damning evidence to share. At the very least, if Fauci had signaled that the White House should be ignored by anyone serious about public health, it might have enabled more coordinated state-level action.

Overall, Fauci’s gambit — which was to play a shrewd inside game to preserve an illusion, from the outside, that science and facts were safe from political contamination  — had the effect of delegitimizing science and precluding the possibility of a political solution. By fudging the facts to assuage the president and moving the goalposts to manipulate the public, Fauci, however inadvertently, helped to undermine public trust in the medical response, creating openings for conspiracy and demagoguery to fill the gap. Meanwhile, by lending legitimacy to the White House’s approach, he forestalled a political showdown — one that could have seriously altered the course of the past year. 

The lesson of the AIDS crisis was not that pure medical science offers the solution to public health crises. Rather, it was that, sometimes, collective political action is necessary to create the conditions for scientists — like a young Anthony Fauci — to do what’s right. Fauci forgot this lesson, or he never truly learned it. Perhaps, like the American people, he came to believe his own mythology, his own noble lie: that science and politics can be separated. If so, perhaps no deception of the Trump era has been more destructive.

Sam Adler-Bell is a freelance writer in New York. He co-hosts the Dissent Magazine podcast Know Your Enemy.

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