AAlthough I hesitate to use the hackneyed phrase “It seems like yesterday,” that’s how I feel as I prepare to leave the National Institutes of Health after more than five decades. Looking back on my career, I see lessons that could be useful to the next generation of scientists and health care workers who will be called upon to meet the unexpected public health challenges that will inevitably emerge.
In 81, I still vividly remember the first time I drove onto the bucolic NIH campus in Bethesda, Md., in June 1968 as a 27-year-old newly minted physician who had just completed residency training at New York City. My drive and all-consuming passion at the time was to become the most qualified doctor I could, dedicated to providing the best possible care to my patients. It is an integral part of my identity, but I had not realized how unexpected circumstances would profoundly influence the direction of my career and my life. I would soon learn to expect the unexpected.
I share my story of a love of science and discovery, in hopes of inspiring the next generation to pursue health-related careers – and stay the course, no matter the challenges. and the surprises that may arise.
It was during my residency training that I became fascinated with the interface between infectious diseases and the relatively nascent but burgeoning field of human immunology. As I cared for many patients with common and esoteric infections, it became clear that doctors and other healthcare providers needed more tools to diagnose, prevent, and treat diseases.
To merge these interests, I accepteda fellowship at the National Institute of Allergy and Infectious Diseases at the NIHto learn the intricate ways in which cells and other components of the immune system protect us against infectious diseases. In doing so, I would follow the NIH tradition of bench-to-bedside research in translating laboratory discoveries into patient care and, in turn, bringing knowledge from the clinic back to the laboratory to improve science.
Despite having no prior training in basic scientific research, I was unexpectedly captivated by the potential it had to make discoveries that would benefit not only my patients, but countless others I would never meet. maybe never, let alone that I would deal with as a doctor. My new found love for this work posed a major conflict to my well-established plans for practicing medicine. Eventually, I chose to take both paths: becoming a research scientist and a physician caring for patients at the NIH, where I have been ever since.
There are so many discoveries that can happen inside a lab and in the clinic – even when you least expect it. Early in my career, I was able to develop highly effective therapies for a group of deadly blood vessel diseases called vasculitis syndromes. Patients who would otherwise have died have instead experienced long-term remissions due to the treatment protocols I have developed. My foreseeable future seemed well mapped out: I would spend my life working on conditions related to abnormal immune system activity.
Then, in the summer of 1981, doctors and researchers became aware of a mysterious disease spreading mainly among young men who have sex with men. I became fascinated with this unusual disorder, which would become known as HIV/AIDS. The “trademark” was the destruction or alteration of the very cells of the immune system that the body needed to defend itself against it. I also felt a strong empathy for gay men, mostly young, who were already stigmatized and now doubly stigmatized, as the disease was wasting their bodies, stealing their lives and dreams.
Much to the dismay of friends and mentors who felt that I was going to short-circuit an ascending career, and against their advice, I decided to completely change the direction of my research. I would eventually dedicate myself to AIDS research, caring for these young men at the NIH hospitalwhile probing and unraveling the mysteries of this new disease in my lab — something I’ve been doing now for over 40 years.
I never aspired to an important administrative position and relished my identity as a field doctor and clinical researcher. “But I was frustrated with the relative lack of attention and resources devoted to the study of HIV/AIDS in the early 1980s. ‘And again, an unexpected opportunity’ presented itself when I was asked to lead NIAID, and I accepted, on the condition that I could continue to care for patients as well as lead my research lab. This decision transformed my career and opened up opportunities to positively influence medicine and health world in a way that I had never imagined.
Beginning with President Ronald Reagan, I have had the opportunity to personally counsel seven presidents during my 38 years as director of NIAID. Our discussions focused on how to respond to HIV/AIDS, as well as other threats such as avian flu, anthrax attacks, pandemic flu in 2009, Ebola, Zika and Covid-19. I always speak the unvarnished truth to presidents and other senior government officials, even when such truths may be uncomfortable or politically inconvenient, because extraordinary things can happen when science and politics work hand in hand.
In the mid-1990s, life-saving HIV antivirals were shown to be safe and effective, largely through studies supported by NIAID. They were made available in the United States in 1996. At the turn of the 21st century, people with access to these drugs could expect near-normal lifespans. But access for people living in sub-Saharan Africa and other low- and middle-income regions was virtually non-existent.
Driven by his deep compassion and desire for equity in global health, President George W. Bush commissioned me and members of his staff to develop a program that could provide these drugs and other care to people from resource-poor countries HIV levels. It was the privilege and honor of my life to be an architect of what would become the President’s Emergency Plan program for AIDS Relief, which saved 20 million lives worldwide. PEPFAR is an example of what can be accomplished when decision-makers aspire to bold, science-backed goals.
If the furthest book from my NIH career is HIV/AIDS, the closest book is Covid-19. This pandemic was not completely unexpected, since emerging infectious diseases have challenged humanity throughout history, but some diseases can transform civilizations, and Covid-19 is the most devastating respiratory disease pandemic to afflict the humanity since theflu pandemic of 1918. And there is a lot to learn from this ongoing experiment with Covid-19.
The United States is reminded of the importance of continuing to invest in basic and clinical biomedical research. The major successes of the Covid-19 pandemic have been driven by scientific advances, especially life-saving vaccines that have been developed, proven safe and effective in clinical trials, and made available to the public within a year – an achievement unprecedented.
Other lessons are painful, such as the failures of some national and global public health responses. We must also recognize that our fight against Covid-19 has been hampered by the deep political divisions in our society. In ways we have never seen before, decisions about public health measures such as wearing masks and vaccinating with highly effective and safe vaccines have been influenced by misinformation and political ideology.
It is our collective responsibility to ensure that public health policy decisions are based on the best available evidence. Scientists and health workers can do their part by speaking up, including to new and old media sources, to share and explain in plain language the latest scientific findings as well as what remains to be learned.
Thinking of this 27-year-old man who arrived on the NIH campus in 1968, I am touched by the tremendous privilege and honor I have had to serve the American and global public.
I have experienced tremendous joy and benefited from the training and learning of the hundreds of brilliant and dedicated physicians, scientists, and support staff working in my laboratory, in NIH clinics, and in the divisions of NIAID research and national and international research collaborators.
Looking ahead, I am confident that the next generations of young doctors, scientists and public health practitioners will experience the same enthusiasm and sense of fulfillment that I felt as they responded to the immense need for their expertise in maintaining, restoring and protecting people’s health. around the world and meet the continual and unexpected challenges they will inevitably face.
Anthony Fauci is the director of the National Institute of Allergy and Infectious Diseases and President Biden’s chief medical adviser.