A Physician Makes His Final Rounds as a Public Servant: An Interview with Anthony Fauci

Photographer: Stefani Reynolds/AFP/Getty Images

Anthony (Tony) Fauci will step down this month as chief medical advisor to US President Joe Biden and as director of the National Institute of Allergy and Infectious Diseases (NIAID) at the US National Institutes of Health. Holden Thorp interviewed Fauci for an editorial published today in the journal Science that reflects on the lessons he has learned throughout his long career in public service. A lightly edited transcript of our conversation can be found below.

Holden Thorp

Holden Thorp: Thanks for doing this. I’ve got a few questions for you. They’re ones you’ve answered a lot, but they won’t be the ones that every journalist asks you. You’re sick of answering those, and you don’t need to do that today.

Tony Fauci: Okay.

Holden Thorp: My first question is about misinformation and vaccine hesitancy, with a little different spin from how you often get asked this (“I wish we knew more where hesitancy comes from”). We’ve seen this on tobacco, climate change, the Scopes trial. You dealt with it on whether HIV causes AIDS. Is it really that surprising that we had all this misinformation and vaccine hesitancy?

Tony Fauci: I think there’s something here that’s really fundamentally different. You picked out one that goes way back that I was deeply involved with, fighting against HIV denialism. The difference now is the absolutely huge impact of social media as a vehicle of misinformation or disinformation, and it seems to me that the people who are deliberately pushing misinformation and disinformation put a lot of energy and effort into it, almost as if they don’t have a day job, whereas the people who are countering it with correct information have so many other important things to do. They can’t spend their time countering every time somebody tweets something or writes something that is completely incorrect and founded on misinformation.

The era of the tsunami of social media is, to me, something I’ve never ever experienced before to this amount. It makes it so different, because when Peter Duesberg and those guys were playing the [HIV/AIDS] denialism game, it wasn’t spreading throughout our youth every time they TikToked or every time they went on Facebook, but now the system is being flooded with disinformation. So I don’t know how to counter that.

I always say, “The best way to counter misinformation is to flood the system with correct information,” and that’s still true, but you’re fighting against a big surge of a flood of misinformation.

Holden Thorp: And do we really have the channels to do that? I mean, these podcasts that spread this stuff, they can get a 100 million people to listen to them, and people think science has a big megaphone.

Tony Fauci: I know.

Holden Thorp: We have a million people a day on our website. That sounds like a lot, but it’s not 100 million.

Tony Fauci: Yeah, that’s the problem. That’s the problem.

Holden Thorp: Yeah. So you got any ideas about what to do about that?

Tony Fauci: Holden, I wish I did, but I don’t have any idea about what we really can do. We’ve got to think of something creative, because we are really fighting a losing battle here. You’re right. It is astounding to me how many people are, as you said, the 100 million people who tune in [to programs that spread misinformation], and when somebody is a validated, verified spewer of misinformation, they have more people following them than really good people who come out with the truth. I mean, we’re losing the war here.

Holden Thorp: Yeah, well, it’s all hands on deck to figure out what to do, and I’m glad you’re staying in the game with us to help us figure it out.

Tony Fauci: I am. I certainly am.

Holden Thorp: So another issue we have—and you listed some of the folks just now—is when people within the scientific community engage in this kind of thing, usually they’re [speaking] from outside their field and have suddenly decided they know virology, or epidemiology, or one of these things. But to the outside world, they’re a highly credentialed professor at a great university, and so if Joe Rogan is saying, “Well, yeah, but I got this from a Stanford professor,” that’s very hard for us to counter. Is there anything the universities, or the funding agencies, or anybody—the colleagues at their universities—can do about this?

Tony Fauci: Well, you tried to address that in a piece.

Holden Thorp: Yes, I did.

Tony Fauci: And you did a heck of a better job than I could, but it just seems to me that that is really trying to walk that fine line of not being accused of disrespecting another scientist. I ran into that like a stone wall at a congressional hearing when I, in a not disrespectful way, disagreed with the Great Barrington Declaration [an open letter published by a group of researchers in October 2020 that suggested COVID-19 lockdowns could be avoided by shielding only the most vulnerable individuals] for reasons that were very clear to me—that it was quite frankly misguided—and yet, I got thrown at me that “You’re arrogant because you’re disrespecting other scientists.” It’s not that I’m disrespecting them, but I have the same attitude as you do. Some of the people who actually were signing it and writing on that were people who knew nothing about virology or epidemiology. You don’t want to be being disparaging of anyone, but you’ve got to come back and push back against things that are not true, and it’s so difficult, as you said.

The other thing we face is you don’t want to do anything to interfere with a person’s right to express their own opinion, otherwise we are in the wrong, because we’re interfering with free speech, which is one of the foundations of our democracy. But it gets very, very difficult to draw that line between when you say you disagree with somebody. People will misconstrue that as you’re trying to silence someone else. We’re not trying to silence anybody, but you have to push back when someone gives a declaration, or a discussion, or a recommendation that clearly, given evidence-based science, is untrue. That bothers me as much as some totally off-the-wall person spouting something on TikTok, as you have someone who—as you say—they have a degree. It’s from Stanford, or it’s from Hopkins, or it’s from Berkeley, and you find out it has nothing to do with the subject matter that we’re talking about.

It’s kind of like, I guess, if you or I decided that all of a sudden, we were going to talk about the strategy of how the war is being run in a certain country when we have no military experience whatsoever, at least I don’t.

Holden Thorp: Yeah. To me, that’s the most challenging part of this, because there’s not a lot we could do about some guy who’s got a podcast, but our own community… And of course, my focus with the journal is what’s best for the scientific community, and how we figure out how to deal with this. I think it has gotten very, very complicated, but I think part of this is—and I’m curious whether you agree with this—we have a system that protects us from groupthink and does enable people to challenge us. It’s just that when there’s a consensus, we have a high barrier to disproving that consensus, which is: Submit a paper to a journal, get it reviewed, have lots of people look at the data, and then—if it really does disprove the consensus—that’s a great way to get a paper into Science.

We mostly publish papers that surprise people, and so that’s part of the process of science, which it seems to me we haven’t done a very good job of communicating. We’ve made it look like we just carry a bunch of facts around and an encyclopedia and share them with people, and that we’re not carrying on this beautiful, human, exciting process that you and I have devoted our lives to. Do you agree with that? And if so, how do we do a better job of getting people to see that?

Tony Fauci: Well, what you’ve just explained is one of the most problematic and difficult things of all, and I’ve had intensive personal experience in that, and it almost triggers pain reflexes in me as you asked the question. So the beauty of what our profession is, Holden, is just what you said, the iterative self-correcting process of science that you can’t just spout something off. If you want it to be accepted in our community, you go through the process of experimentation, data analysis, presentation of data, peer review, and judgment by your peers. And that is something that the nonscientific world perhaps, and likely understandably, think that science is absolutely immutable. So if you say something today, and evidence changes a month, a year later, that if you go along with the science and truly follow the science, you are going to evolve your thinking. And with the evolution of your thinking, you’re going to be changing things like recommendations, or guidelines, or what have you.

For those who don’t understand the iterative nature of science, you are flip-flopping, and you’ve undermined the entire scientific process. That’s the way they think, and that’s what happened, and I don’t want to get into that. You don’t want to start renegotiating mask guidance type stuff, and I don’t want to do that now either, but one of the things that maybe we could do better—but there’s a danger to this, and I’ll explain the danger in a moment—what we can do better is articulate to people that when we tell them something based on the evidence we have now, that we are dealing with an evolving situation. And at any given time, you don’t know all the answers.

What you said about Science magazine is a perfect example. Something gets published in Science. It is correct, based on the data, but you know deep down that you’re going to get in the mail and online a submission that might question that, and you’re going to give it the forum to prove that the original one—while absolutely partially true, because otherwise it wouldn’t have made it through the peer review unless it was falsified, which I’m assuming it’s not—that there’s going to be an addendum to that that will change it. And that’s the reason why papers in Science that we’ve all published build on what was previously published. There is complete—not a complete, that’s being too dramatic. There is somewhat of a lack of appreciation on the part of the public that that is the nature of science.

So there are two things that have got to go on. We in the scientific community have got to articulate the uncertainty associated with something that is a real fact now, that you always leave the door open—not to empirically changing your mind, but changing your mind on the basis of new data.

At the same time, we’ve got to do a better job as a nation of educating people for better science literacy. The science illiteracy in this country is somewhat disturbing. We’ve got to get people more attuned to understanding what science is. Anyway, that’s a bit of a long-winded answer to your question, but that’s the way I feel about it. It’s a real problem.

Holden Thorp: Yeah, I agree. And I think that it’s worth a lot. Sometimes when I talk to people about this, they say, “Well, that’s a long-term solution.” And I’m like, “Okay, we tried all the short-term solutions, so let’s do the long-term solution.”

Tony, we see a lot of people go into the administration—people we knew before they went in—and suddenly it gets a lot harder to talk to them, and we mostly deal with their press people and stuff. But you’ve always talked directly to people, and especially, I mean, before you became world famous, always talked directly to scientists, even in your government roles, without a lot of people protecting you. I assume you think that was good. Certainly we do. What can we do to get more government officials to be as comfortable as you are talking to their peers?

Tony Fauci: Well, I think maybe using as an example people like myself, that as a scientist, you have an obligation. As a human being, you have an obligation, but you have a double obligation as a scientist to speak the truth and not be evasive, because that’s antithetical to the scientific principles, and that’s what I’ve tried to do. So when people ask me a question, I don’t see any reason not to answer the question, and I think we’ve got to make it so that people in government—particularly scientists in government—feel comfortable about that. And when I talk to my scientific colleagues in government, often they’re afraid to say something, and I’m telling them behind the scenes, “But what’s the problem? You’re not going to lose your job for telling the truth. You may make some people a little concerned, but so what? It doesn’t matter. Just be open and transparent.” And I always found that that has served me very, very well.

Holden Thorp: Yeah. And we sure do appreciate it. So everyone wants to know what you’re going to do next. And you may not be ready to tell us explicitly, but you can give us the broad strokes.

Tony Fauci: Well, Holden, I’m going to tell you everything without holding anything back. The answer is I don’t know, and let me explain why. The ethical rules say you’re not supposed to negotiate the details of anything you’re going to do after you leave government until you actually leave government. So I don’t have anything that is planned or decided on, but let me give you the broad strokes of what I want to do. I obviously want to have a base [from which] to operate, whether that’s a foundation, whether that’s an appointment to a university, I don’t know yet, but I want to have something that at least I could have a staff where I’d be able to do research.

I say to myself, “So I’m going to be 82 years old when I step down. What do I have going for me? I have 54 years of experience as a scientist in the government. I have 38 years of experience as the leader of a major, major institution, and I have the privilege of having advised seven presidents of the United States.” So I have experience, and I think I have reasonably good judgment. So how do I use that now while I still—even though I’m 82—have energy, have passion, have enthusiasm, and thank goodness I still am healthy. And that is always an iffy thing. You never know when that’s going to change.

So for the time being now, for the next few years, I want to be able to write. I want to be able to lecture. I want to be able to advise when asked for advice. I’m not going to be out there throwing my advice when people don’t want it. And [I want to] use the benefit of my experience to do two things: to help people and organizations, including the federal government, or universities, or whatever, who could benefit from my experience, but also, as important, to inspire young people to either go into science, or if they are in science, to pursue it in a manner that benefits the public health and to do it with public service. That is the theme of what I’m going to do. The venue in which I’m going to do that, I’m not sure right now, but that’s what I’m definitely going to do.

Holden Thorp: Well, I don’t think you’ll have trouble finding one, and if you need an agent, let me know.

So the AAAS [American Association for the Advancement of Science, the publisher of Science] has a program, lots of programs to help scientists go into science policy. You’re the role model in every respect for them, both in terms of your public service and the science that you’ve done. What advice would you give to a young scientist maybe changing their career, a little bit less in the laboratory, more in government, to do public service the way you have?

Tony Fauci: Well, there are two things. First of all, as a theme, Holden, I would say that the gratification that you get in public service, if you haven’t done it, and you have an inkling towards it, it is just a wonderful feeling to know that what you’re doing is serving mankind. I mean, that’s really what we all try to do in science. We do it in different ways, but one of the venues is as a public servant.

The next thing I would advise is pick out something that in your gut you really are excited about. I have seen scientists that have come through my lab for the 54 years that I’ve been doing this, who sometimes get the feeling that they’re doing what people expect them to do, or what would seem to be the kind of in thing to do, as opposed to digging deep and saying, “What is it I really feel like I want to do?” And when you get passionate about something, it unleashes in you an incredible amount of energy that you didn’t even know you had. It’s kind of like an athlete who trained and all of a sudden is running much faster than they thought they could run. That’s the way it happens when you’re passionate.

And the third thing is, expect the unexpected, because a lot of times things arise as an opportunity to change direction. You should seriously look at those opportunities, because it’s happened to me multiple times in my career. I made a change in direction early on from a very successful career in immune-based diseases to all of a sudden devoting all of my time to HIV. That was the best decision that I made. I never really liked the idea of policy and administration, but when the job of the director of NIAID opened 38 years ago, I said, “Maybe I can do something with that job that’s a little bit different than other directors have done.” And it’s been an incredible ride doing that. So my advice to young people, keep an absolutely open mind for opportunities that come in front of you and always listen to your gut about being passionate about something.

Holden Thorp: Okay. What else do you want to tell us?

Tony Fauci: Well, I think that I just appreciate the opportunity, and again, science is such an amazing discipline that for anybody who has even the slightest inkling of doing that, I just want to let them know that there’s a whole world of wonder in that for you.

Holden Thorp: Yeah, amen to that. Well, Tony, I can’t thank you enough for doing this. I can’t wait to write this up.

Tony Fauci: Thank you very much. I appreciate it. Thanks a lot, Holden.

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