Anthony Fauci in 1984. Credit: NIAID
One of the most influential (and a case could be made for the most influential) scientists of the last century is stepping away from the public health role he has held for nearly 40 years.
But to hear him tell it, it could have been over before it even started.
In 1968, Anthony S. Fauci, M.D., completed his residency training in internal medicine and decided to undertake a 3-year combined fellowship in infectious diseases and clinical immunology at the National Institute of Allergy and Infectious Diseases (NIAID).
Unbeknownst to him, scholars and experts at the time were openly questioning the relevance of the field of infectious disease, especially with the advent of highly effective vaccines and antibiotics.
“Despite my passion for the field I was entering, I might have reconsidered my choice of a subspecialty had I known of this skepticism about the discipline’s future. Of course, at the time, malaria, tuberculosis, and other diseases of low- and middle-income countries were killing millions of people per year. Oblivious to this inherent contradiction, I happily pursued my clinical and research interests in host defenses and infectious diseases,” Fauci recently wrote in a Perspectives article published in The New England Journal of Medicine.
Anyone who was questioning the field of infectious disease in the 1960s was probably singing a different tune by the summer of 1981 with the recognition of the first cases of what would become known as AIDS.
“If there is any silver lining to the emergence of HIV/AIDS, it is that the disease sharply increased interest in infectious diseases among young people entering the field of medicine,” writes Fauci in his reflection article.
The other silver lining is that Fauci didn’t reconsider his subspecialty in 1968, leaving him open to play a critical role in HIV/AIDS research during the crisis in the 1980s and still today. Fauci was part of NIH-led and funded teams that—after a slow start—made groundbreaking contributions to understanding how HIV destroys the body’s natural defense system and progresses to AIDS.
Fauci altered the clinical trial system to expand access to investigational therapies for HIV, and designed the PEPFAR program, which is credited with saving an estimated 21 million lives across more than 50 countries.
What was once a death sentence is now a disease that can be controlled with antiretroviral therapy, prevented from spreading via a pill or injectable, and has gone into remission in three different individuals. A person with HIV/AIDS now has a standard life expectancy—and Fauci’s scientific (and administrative) fingerprints are all over that accomplishment.
Of course, emerging infections did not stop with HIV/AIDS, however, no disease was more impactful during Fauci’s tenure as NIAID director than SARS-CoV-2 and the COVID-19 pandemic.
“COVID-19 [is] the loudest wake-up call in more than a century to our vulnerability to outbreaks of emerging infectious diseases,” writes Fauci. “The devastation that COVID-19 has inflicted globally is truly historic and highlights the world’s overall lack of public health preparedness for an outbreak of this magnitude.”
As unprepared as the U.S. and the world may have been—as evidenced by the 6.6 million global death toll—the unprecedented speed with which safe and highly effective COVID-19 vaccines were developed resulted in millions of lives saved.
“One highly successful element of the response to COVID-19 was the rapid development—enabled by years of investment in basic and applied research —of highly adaptable vaccine platforms such as mRNA (among others) and the use of structural biology tools to design vaccine immunogens,” said Fauci.
Indeed, mRNA vaccines are now taking center stage after decades of being considered far-fetched. Scientists are working on mRNA vaccines for a plethora of diseases, including HIV, cancer and Lyme disease. Perhaps an mRNA vaccine will emerge, again, as the treatment for the next epidemic/pandemic infectious disease. Because make no mistake about it, there will be more emerging infectious diseases.
“As one of my favorite pundits, Yogi Berra, once said, ‘It ain’t over till it’s over.’ Clearly, we can now extend that axiom: when it comes to emerging infectious diseases, it’s never over. As infectious disease specialists, we must be perpetually prepared and able to respond to the perpetual challenge,” concludes Fauci.