Fauci “Shares Insights on His Career” and the (On-Going) Covid Pandemic

By Lambert Strether of Corrente.

From 1984 until 2022, Anthony Steven (“Tony”) Fauci’s power base was the National Institute of Allergy and Infectious Diseases (NIAID), one of 27 institutes and centers that make up the National Institutes of Health(1). Fauci has advised every US President since Ronald Reagan. He is now a distinguished Professor at Georgetown University. Reason magazine describes Fauci’s clout:

(His post as NIAID director) made Fauci the federal government’s de facto top pandemic expert across the dozens of agencies—from the Centers for Disease Control and Prevention (CDC) to the Food and Drug Administration to the Office of the Surgeon General—that share responsibilities for preventing and responding to disease outbreaks. Fauci steered the U.S. government’s response to AIDS, Zika, Ebola, and swine flu. He oversaw billions in annual research grants aimed at stopping the next disease outbreak.

When COVID struck, Fauci was the face of public health when public health was all anyone was talking about.

Clout unblemished by democratic accountability. 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.

And clout used, naturally, only for good. Scientific American:

Researchers who Nature spoke to say that Fauci will be best remembered for his unwavering dedication to research and the development of treatments for HIV, as well as for .

Matters occurrent have prevented me from giving Tony Fauci the full yellow wader treatment, which he richly deserves; but I would also have needed to understand Fauci’s complex role in the AIDS crisis, which remains controversial. Anyhow, he’s still out there selling books doing interviews, so I thought I’d look into last week’s, which didn’t get any coverage at all, except for a few irritated tweets.

In what follows, I’m going to be quoting great slabs from that interview: “Dr. Anthony Fauci Shares Insights on His Career and Leadership of the NIAID,” published September 16, 2024 in Pathogens and Immunity(2). After each slab, I’ll add some commentary (though for most I’ll be relying on common knowledge in the NC commentariat, being, again, pressed temporally). I think we will be able to reverse engineer much of Covid policy from what Fauci says and his personal history. The quotes are more or less in order–

Fauci’s Choice of Field

(FAUCI:) The thing that attracted me about infectious diseases, and I’ll talk about immunology in a moment, was wanting to be able to have a target of my work. There are many diseases, that we all are aware of, that have multifaceted components — cardiovascular, immunity, GI, and endocrinology. . Usually the disease is preventable, and usually it’s entirely treatable; if not entirely treatable, cer-tainly suppressible, as we’ve done so successfully with HIV. Also, I wanted a disease in which the stakes are high.

Lambert here: Fauci appears to be an adherent of Maggie Thatcher: “There is no such thing as society.” For example, cholera is an infectious disease. But John Snow didn’t need to wait to find the “individual agent.” He took the handle off the Broad Street pump. The analogy between waterborne transmission of cholera and airborne transmission of Covid is exact, but a blind spot for Fauci.

Fauci’s Childhood

(FAUCI:) in a small pharmacy that he owned in the Bensonhurst section of Brooklyn. That was a very long time ago. That was in the 1940s and 1950s. At that time the neighborhood pharmacy was sort of like the hub of the neighborhood advice about medicine. And, unlike the chain pharmacies of CVS and Walgreens of today, it was kind of the doc of the neighborhood: family counselor, neighborhood psychiatrist, and person who you would go to if you didn’t have enough money to go to a physician. You could get free advice from the pharmacist. So, the idea about service to others was something that I kind of grew up with from the time I was a child.

Lambert here: So pharma — today, Big Pharma — has occupied the central position in Fauci’s worldview since he was a boy.

Fauci on Vaccine Development

(INTERVIEWER) So COVID shows up, becomes a pandemic, and amazingly an effective vaccine was developed incredibly rapidly. What are the implications of that for us?

(FAUCI) There are a lot of major implications and collateral implications. The major implication is the importance of investment in basic and clinical biomedical research. Because if you look at the investments that were made in technology, you go back and look at the first paper that modified the mRNA to allow it to avoid an inflammatory neutralization, to be able to be used as a vaccine was a 2005 paper in Immunity by Katalin Karikó and Drew Weissman

Lambert here: The question is wrong, because several effective vaccines were developed under Operation Warp Speed (of which more later). And speaking of Big Pharma, Fauci’s answer is wrong: He identifies “vaccine” with “mRNA vaccine,” ignoring inactivated virus vaccines like Sinovac, protein-based vaccines like Novavax, or adenoviral DNA vaccines like AstraZenaca. (NOTE This is not a post about the merits of various vaccine technologies. My point is that Fauci, again, has a blind spot. He is only able to focus on mRNA.)

(FAUCI) When the body shows you that it can make an adequate immune response that can , then that is a road-map to a vaccine. If you get infected with measles or infected with polio, even though there’s a degree of morbidity and mortality, the overwhelming majority of people survive and are left with immunity that protects them against reinfection. And when you have a pathogen that doesn’t change much, like measles and polio, you can use the body’s natural immune response as a roadmap to developing a vaccine. That’s exactly what happened with COVID.

Lambert here: I believe Fauci is wrong to say “clear the virus.” My recollection is that in fact the body does not neecessarily clear the virus, even taking the weasel words “the overwhelming majority” into account. Being pressed temporally, I must rely on memory, but studies keep coming out showing viral reservoirs, certainly in the gut, and also in the nervous system and the brain (I think a Swedish study of about 20 autopsies found SARS-CoV-2 in every brain).

(FAUCI) So, what Operation Warp Speed (OWS) did is not only did it finance and bankroll clinical trials of 30,000 people per trial, but it pre-manufactured the vaccine before we knew it even worked, so that as soon as . Bingo. We have tens of millions of doses of vaccine available to go. So, it’s got to be investment in science and bold investment in combination with the pharmaceutical companies. And the reason I say that is we can do that with any disease.

Lambert here: Fauci is correct that OWS had a great business model and was, administratively, a brilliant success. There are many, including me, who would quarrel with “the clinical trial showed that the vaccine was highly effective.” Notice again that Fauci erases multiple vaccines with “the vaccine” (I assume Pfizer). Finally, I don’t see why “it’s got to be” a public-private partnership. The Manhattan Project wasn’t. Etc.

Fauci on Vaccine Effectiveness

(FAUCI) What we learned from experience, and you know the people who criticize the scientists and criticize the public health officials say, “You told us it was going to protect.” . It was lower than we wanted to begin with, and it didn’t stay very long. One of the things that is curious is the duration of the protection of a mRNA vaccine. Now, I don’t know whether that’s a peculiarity of a coronavirus or the peculiarity of the mRNA platform. But we know when we vaccinate somebody, the protection is not measured in decades. It’s measured in months to a year. That’s the issue that we’ve got to work out.

Lambert here: Yeah, oopsie. “The people who criticize” are 100% correct. And take all the time you need to “work out” that issue.

Fauci on Vaccine Hesitancy

(FAUCI) Well, it’s a very difficult problem. And one of the things that we’ve learned is that vaccine hesitancy and not wanting to get vaccinated comprises a broad spectrum of people. From those who are inherently anti-vax, anti-science and those who are hesitant because they need more information. So, you’re not going to change the mind of a completely recalcitrant person, who, no matter what you say, is against it. And that person is probably more anti-science than anti-vax. But there is a substantial proportion of people who are hesitant, that (we can perhaps persuade) . If we talk in real terms and say that no intervention is 100% safe, but the risk-benefit of vaccinations over decades and decades and decades has proved overwhelmingly in favor of the positive aspect of vaccines. We just need to keep talking about that and not condemning people who are hesitant. We should not tire of reaching out to them and trying to explain to them in pure, simple, scientific terms and risk-ben-efit terms why it’s important to get vaccinated.

Lambert here: Holy moley. “You told us it was going to protect.” And it didn’t. All the “vax and relax” messaging was nothing but sugarcoating. So now you want to be seen as acting in “good faith” with “transparency”?

Fauci on Masks

(INTERVIEWER) How effective are masks —if we wear them, if we wear them well or if we wear them not well —how good are they?

(FAUCI) Thank you for asking that question, because there’s a lot of misinformation and disinformation (no kidding –lambert). A properly fitted mask worn consistently — of an N95, and to a lesser extent a KN95 — clearly is protective. They clearly are protective. Are they 100%? No, of course not. Because people wear masks, and then every once in a while they take them off because they have to go eat on a plane. People say, ‘Well, I wore it for the entire time, except when I was eating.’ Well, sorry about that.

Lambert here: There was no fog; NIOSH recommended masks in the workplace, up to and beyond N95 levels, for years before Covid (the ignorance and malice of hospital infection control is another matter). And much of the disinformation and misinformation was generated by Fauci himself, and the public health establishment.(3)

(INTERVIEWER) What about the case of mask mandates, are they worth trying? Clearly, it must be the case based on what you just said, and that was my own expectation: that they’re effective if worn properly. When we’re applying it on a mass scale, at least in the social context in the US, is that going to work in the future?

(FAUCI) Well, I think the mood of our society has said, in a perfect world, if you had a society that didn’t have that strain of independence — you can’t tell me what I’m going to do with my life — that mask mandates would work just like other mandates, because it would get virtually everybody to wear a mask. I think the pushback against any mandate of anything thus far may turn out to be counterproductive, unfortunately.

Lambert here: When I watch how social norming was engineered and operates against masks, I have great difficulty believing in “that strain of independence” at all.

Fauci on Aerosols

(INTERVIEWER) One of the issues that I took note of, particularly during the early months of the COVID pandemic, was use of the word “airborne” in describing pathogens. As you no doubt remember, initially, people were saying that SARS-CoV-2 was spread through droplets. And then, I think, over time, eventually it was accepted that it can also spread as aerosols. And there were some people who were not using the word airborne, or didn’t think the word airborne applied to droplets, which I find odd because droplets are suspended in air. Do you have any thoughts about whether that term should be used for both situations.

Lambert here: “People were saying.” Note lack of agency! The “people” were WHO and CDC (which is fighting aerosol transmission to this very day).

(FAUCI) I think that if you look at the experts who are now getting involved. They’re saying that droplets themselves hang around much longer than we thought they would. True aerosol obviously floats around for very extended periods of time. So, I think that the use of the word air-borne is probably going to avoid confusion. Anything that you get through the air, be it a droplet or a classic aerosol, is an airborne pathogen. I would think that sooner or later, if we incorporate that, it’s going to be less confusing. The people absolutely insist that this idea that if you have a droplet, it drops in 3 feet, is not so.

Lambert here: These scientists (not experts) are aerosol scientists, not “aerodynamics” scientists (and “classic” aerosol as opposed to what? A post-modern aerosol?). Clearly, aerosol tranmission is another blind spot for Fauci. In fact, you have to wonder if he’s as familiar with the literature as we would expect a scientist of his eminence to be:

Conclusion

Reviewing, I don’t think how Fauci went so wrong with Covid — that is, if over a million deaths in a field in which he is the acknowledged expert is the appropriate metric — is all that complicated. Leave Trump out of the equation, and figure Biden, given the stopgap of vaccines from OWS, could have rectifed Trump’s errors by implementing a national layered strategy with airborne transmission at the heart, including masking, ventilation, testing, and not necessarily vaccine mandates (given the other layers). None of that happened, and we got vax-only. Fauci was Biden’s chief medical advisor and “one of the leaders” of the White House COVID-19 Response Team (and given his “clout,” I would be willing to say “the leader”). Well, if I wanted to pick a dominant infectious disease expert who would bet the entire country’s farm on vax-only, what would they look like? They would look like a person with Fauci’s blind spots:

1) They would identify public health with the treatment of “individual agents”;

2) They would have put pharma at the center of their lives since childhood;

3) They would focus on a single vaccine technology, the one produced by the pharma manufacturer with the most political clout;

4) They would, “eternal sunshine of the spotless mind”-style, have the ability of note mistakes while evading accountability and promising future transparency;

5) They would butcher the implementation of non-pharmaceutical interventions;

6) They would would be ignorant or dismissive of airborne (aerosol) tranmission.

That’s Tony Fauci. No wonder we are where we are.

NOTES

(1) “Institutes,” plural, just like “Centers” in “Centers for Disease Control and Prevention.” What is it with the weirdly accretive institutional structures of these Federal Health agencies?

(2) Pathogens and Immunity ranks 107 of 265 at Research.com. They claim a 2022 Scopus CiteScore of 8.7, and a 2023 CiteScore tracker of 11, all of which I take to mean respectable, though not top-ranking.

(3) From Adler-Bell:

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.

READER NOTE

Please, no quotes from Kennedy’s The Real Anthony Fauci. Both Yves and I have cracked it, and let us just say that it is inarguably very far from being a work of scholarship, or even journalism. Also, there is one topic not covered in the interview: The Covid origins controversy. That too is out of scope for both this post and comments.

NOTES

(1) “Institutes,” plural, just like “Centers” in “Centers for Disease Control and Prevention.” What is it with the weirdly accretive institutional structures of these Federal Health agencies?

(2) Pathogens and Immunity ranks 107 of 265 at Research.com. They claim a 2022 Scopus CiteScore of 8.7, and a 2023 CiteScore tracker of 11, all of which I take to mean respectable, though not top-ranking.

(3) From Adler-Bell:

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.