After Fauci who will serve?

When we turn public servants into political targets, we risk losing the very people we need most.

In my opinion, Anthony Fauci is one of the great public servants in American medicine. He earned that respect long before COVID.

Yesterday, I watched an 85-year-old physician who devoted fifty-six years to government service sit before a Senate committee and invoke his constitutional right not to incriminate himself.

Dr. Fauci spent more than half a century serving the American people through AIDS, anthrax, Ebola, SARS, Zika, influenza, and finally COVID-19. Whatever you think about his communications during the pandemic, his life has been one of extraordinary public service.

And I found myself asking a question I couldn’t shake:

Who, in their right mind, would choose that life today?

Rand Paul - the Senator and doctor

Senator Rand Paul was clear in his intent. He wanted to prosecute Fauci. To make him say something that would contradict an earlier statement, and then charge him with lying to Congress. Fauci, following his lawyers advice, took the fifth and didn’t take the bait.

Senator Paul had Fauci before the committee many times during the pandemic. Their exchanges became some of the defining moments of the pandemic, with each side believing the other had been exposed. From my perspective, Fauci consistently had the stronger scientific argument. Senator Paul returned to them again and again in the years that followed.

In the anti-vaccination community, believe COVID was made in a lab, leaked by the lab and unleashed on the world by Fauci and Bill Gates.

Many forget, Fauci was praised by both Presidents Trump and Biden for his work. Many of us saw him as the beacon of science and medicine during a dark time. We appreciated his careful and measured tone.

We understood that we were making things up as we went. Those of us on the front line, when the breath of another person could kill you, were reusing N-95 masks. We were upset our personal protective equipment was outsourced to China, who was now using all of it for their pandemic. But we were hopeful, because the gene was sequenced in early January, and mRNA vaccines promised something to come.

Did we make mistakes? Yes. Plenty of them. But we learned. We had never been in a situation where the world was shut down. I remember being told our Hawaiian vacation was to be terminated because visitors were to return to the mainland. Returning to California the day Newsom said to shelter in place was the least cars I’d seen on the 405 in Los Angeles.

Returning to a hospital overrun with patients, many on vents, many who would die. No room for elective patients.

I looked forward to hearing Dr Fauci, calmly explaining things as we knew it with the information we had then. Whether it be flattening the curve - by sheltering in place. He predicted if we did that we could limit deaths in the US to 100,000 by Memorial Day. While many misquote Fauci as saying things with certainty, if you look back, he always couched them in the science as we knew it then - possibilities, probabilities, what percentages the research showed.

Senator Paul became convinced that NIH funding to research in Wuhan ultimately caused the pandemic. That belief drove years of hearings, investigations, and finally yesterday's appearance by Anthony Fauci.

I read the papers so you don’t have to

Paul released thousands of pages of documents in preparation for the hearings. Including emails ending with phrases such as, "Please delete this email after reading." Physicians often send messages like that—not to conceal crimes, but because they don't want patient information or preliminary discussions preserved indefinitely in someone else's inbox.

Or Fauci’s diary, where he, like any good scientist, entertains all possibilities about the virus, its origin, its transmission. Any good scientist, any good physician, would entertain even the remotest possibility with this novel virus.

Paul even mocked Fauci for writing about his newfound fame. I found that criticism curious. Politicians seek fame. Scientists are usually surprised by it. I've gained a measure of fame through social media, and I'm still amazed by it.

The documents did not support the sweeping conclusions that Fauci orchestrated the pandemic or engaged in the broad conspiracy.

Now a brief glimpse into Fauci’s career

Fauci Pre Covid

I first learned of Dr. Fauci when I was a medical student, seeing his name as one of the editors of Harrison's Principles of Internal Medicine—the textbook in medicine. There wasn't another one. Before the internet. Before Google. Every medical student knew the names of the people who wrote Harrison's, and Anthony Fauci was one of them. He was already considered a giant in infectious diseases.

By the time He had published multiple articles about infectious diseases, and was well known in the world with strong academic credentials based on many peer reviewed publications, his leadership at the NIH

Fauci HIV and Community Protests

He was once accused by AIDS activists of perpetuating a system that kept drugs from reaching them. Dr. Fauci sat down and listened to them, and found some of their concerns legitimate. Fauci used his position to advocate for a fast-track system at the FDA for pharmaceuticals. He redirected research and treatment efforts toward community-based health systems where the majority of patients could participate in research and receiving therapies closer to home.

The acceleration in research and drug development transformed HIV infection from a fatal disease to the treatable disease. Science widely recognizes him for his work with HIV. And the communities who once protested against him now consider him one of their great advocates.

Fauci’s actions remind me of Abraham Lincoln, who took those who were his critics, and made them his advisors. The best way to destroy an enemy is to make them a friend.

The Pandemic

Then came the pandemic, and it was horrific. We had all predicted it would come, we assumed it would be influenza, who knew it would come from the coronavirus. Humans were mildly familiar with coronavirus. There are some that infect children, causing symptoms of “a cold.”

When this one landed, we had a preview of what could happen. And within a few weeks of hitting the shores of America, our healthcare system was overwhelmed.

My hospital had to close elective operations, turn away visitors, and quickly I was doing tracheostomies because those who did them normally, the head and neck surgeons, feared people with COVID-19.

Government Service

It is in the public interest to have physicians of the caliber of Anthony Fauci. Not only for what they would quietly contribute over a career, but because there will be another pandemic. Not if, but when.

When that happens, those of us in medicine will need someone who speaks for science, with the humility that uncertainty demands. Medicine and science are not explained in absolutes. We need someone who can explain what we know, what we don’t know, and how those answers may change as the evidence changes. Someone who can advise politicians, if they are willing to listen.

But my question remains - after seeing this, who would want to spend a career devoted to public service only to be 85 years old and have to spend a day pleading the fifth.

Instead he should have spent his day realizing that many of us, who were on the front lines, appreciated this man, for who he was, for how he kept our hopes up in the darkest hour of our medical careers.

Instead, he should have spent that day hearing from those of us who were on the front lines. Because we will continue to thank him for being a steady voice during the darkest months of our professional lives. We didn’t always have the answers. Neither did he. But he never pretended otherwise, and for many of us, that honesty gave us hope when we needed it most.