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To honor the third anniversary of In the Bubble, Andy calls up his friend and former NIH director Dr. Anthony Fauci to reflect on the pandemic and the indelible mark it left on his career. Fauci shares his advice on how often to get boosted, offers his opinion on COVID’s origin, and compares the HIV/AIDS activists challenging public health officials in the 1980s to those protesting him today.

Keep up with Andy on Twitter and Post @ASlavitt.

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Check out these resources from today’s episode: 

• Watch PBS’s new documentary on Dr. Fauci: https://www.pbs.org/video/tony-a-year-in-the-life-of-dr-anthony-fauci-zjnloe/
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Al Franken, Andy Slavitt, Tony Fauci, Senator Sanders, Zach Slavitt

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Welcome. Tony Fauci is my guest today, you’re in for a treat. Coming up this week is the third anniversary of in the bubble. So want to do a little bit of reflection here as we kick off the interview, and you’ll see why I think Tony makes the perfect guest for her third anniversary week. You may you may know if you’ve listened to the show since the beginning, that I originally started this podcast with my son Zach, who at the time was a surly teenager. Now he’s just a certainly college student. And we had a load of fun. I mean that the origin story of this show was Zach, during the pandemic, sitting around listening to me talk to people on the telephone saying, Hey, Dad, why don’t you do a podcast? Just take all those conversations you’re having with people and broadcast them, people will find them super interesting, because no one knows what the heck is going on. And, you know, what I heard was my son probably for the first time in five years saying, Dad, hey, maybe we could do a project together. So I was gonna say yes, no matter what he said, if he just said, Hey, Dad, let’s mulch the yard. You know, we would have been having a mulching business instead of a podcast. But it was really fun work. You’re doing this with Zach and he was the sidekick and gets us for a while. For those of you who listened back then. And for those you who didn’t, I want to just play a couple of those clips from that time because it was a pretty funny dynamic, me with my teenage son. Daiquiri actually told me he has a question for you. Can you bear a question from Zach?

Al Franken  01:45

I would love a question from Zach. Zach, you’re doing a great job on the podcasts. I love the facts you come up with thanks. I love the research you’re doing. I love that you’re not trying to come off as anything other than an 18 year old boy. I like that just sound like a, kind of a bored 18 year old. Suffering his dad.

Senator Sanders  02:09

Senator Sanders. I was just wondering, how do you think that Democratic Party can unify for the upcoming election in the next several months, given that there were some turnout issues with the previous election?

Senator Sanders  02:25

Well, Zach, I think what we are trying to do? That’s a very good question. And thank you for your interest in politics.

Andy Slavitt  02:33

We have our will there be sports version. Today with Adam Schefter. The senior NFL analyst for ESPN? How do you like my sports voice?

Zach Slavitt  02:43

Sounds like your podcast voice to me.

Andy Slavitt  02:45

Just the same as trying to throw on I was trying to throw it on like an ESPN Sports voice didn’t. A little bit. Okay, good. Good. Why are these antibody tests important? Is it important because the further of your food you’re having. Okay, I have more questions for Zach. But he literally has food in the oven that he wants to attend to, which is I think, what happens when you mix business and home pleasure, go ahead, go get your cooking challenge. What are you eating? Salmon, salmon? You healthy, good? You know, I don’t think I knew what to expect when we started this show. And overtime, we had some we’ve had some really great and interesting people on and if you want to go back into the archives to listen to some good episodes, there’s no charge for that. We keep them all available for free. You just have to listen to our sometimes annoying commercials, great sponsors, but I know the good commercials can be annoying sometimes. But you know, there’s some really good ones including a kind of very edgy, kind of confrontational episode with Facebook. Some interesting political shows, with Anthony scare Moochie and Frank Luntz, Jamie Raskin on January 6, people like Pete Buttigieg. So really funny people like Tina Fey, who’s even funnier than I am. She tries. […]. I thought our episode with Ken Burns was a really good one to listen to. And then of course, a lot of people from the health world in the public health world people from Sanjay Gupta to Scott Gottlieb, Larry Brilliant. And of course, our guest today, Tony Fauci has appeared three times in the past during different stages. You know, the goal of the show has always been to take people from fear to calm from speculation to expertise from playing an outside guessing game to an inside look in the bubble, from the sense of trying to create outrage, and anger over the headlines to creating just a bit of an understanding and some diplomacy. You know, I’d say I’ve been surprised by a few things since starting the show. I haven’t always gotten it right. I think there’s a solid 10% of episodes that probably I would never listen to it again. But fortunately, it’s just in the 10% range. And you probably can all have your own judgments of those. In the beginning, if I listened back to some of my early interviews, I think I talked way too much. You know, when I hear my but when I hear some of the episodes, I still think sometimes I talk too much. I forget that I’m actually interviewing somebody. And you know, we’ve had loads of fake very famous people on the show. And interestingly, those aren’t your favorite episodes, your favorite episodes are when we bring on real experts, oftentimes, I know to you. And I got to say that the producers, the people who make the show happen, do an amazing job of finding exactly the right people for the topic. And those are the shows you actually love the best. And when it works, you know, these are moments when I actually forget that there’s a microphone in front of me and the guest forgets that there’s a microphone in front of them. And we just go deep, we just have, we just have a deep conversation and it gets pretty revealing, headed off. And I think it’s pretty funny, because that’s just how people are when they talk. And so I liked those episodes the best. And I think they’re the ones I learned a lot from. My favorite thing to hear is when people tell me that they listened to an episode, and they just feel like the point of view may have evolved or changed a little bit. And that’s, that’s really fun to do. So thank you all who listened over time, I wouldn’t be able to make the show if you didn’t listen. Thanks, obviously also to the team, Kyle and Catherine and Martine. James and Noah who make the show sound so good. And the people who worked on the show in the past, just thanks for all that. So Tony Fauci is one of my favorite people to talk to. He’s perfect for this anniversary week, because he’s someone who I have enough of a regular conversation with and have worked closely with the conversation for casual. The question, the topics are no less meaningful and important. But conversations casual, I think that’s like, my favorite formula for the show is somebody who will have a more casual conversation with me than they would on CNN. And therefore, they’re just a little bit more likely to be more revealing, and give what they’re truly thinking instead of the canned answer. And that, I think, absolutely is what you’re going to hear today from Tony, there’s a number of questions that I wanted to talk to Tony about, including the best advice for people right now. And where we are with COVID. And where we think things are going, I wanted to talk to him about the origin of the virus, the controversy over the lab leak versus the animal spillover. I wanted to ask him about a lot of the controversy that’s followed him throughout his time in public health, and most recently, with a lot of the attacks he’s gotten on himself and his family COVID from people who are not very well meaning back to the people who attacked him early in his career around HIV and AIDS who were very well meaning and what some of those differences are. And I just think he does is always a great job of telling the truth and really kind of broaden your understanding. It’s wonderful. And so with that, let’s bring him on.

Andy Slavitt  08:18

Hey.

Tony Fauci  08:19

Andy, how are ya?

Andy Slavitt  08:21

Good? How are you? Why wearing a suit?

Tony Fauci  08:23

It was only out of respect for you, Andy. That’s alright. I mean, you know, we got to show a lot of respect here.

Andy Slavitt  08:29

Yeah, I was gonna say you. I would expect nothing less than that. Well, good. Well, this will be fun. I’m so appreciative. You’re coming back. And welcome back.

Tony Fauci  08:40

My pleasure. Good to be with you.

Andy Slavitt  08:42

You’re doing our third anniversary of the bubble show. Oh, this is our third anniversary. We’ve done like 400 shows and you’ve done like, you’ve done four of them. You’ve done like 1% of our shows. We’ll get into how you’ve been and I want to get into talking a little bit about the arc of your career, but I thought we’d start if it’s okay with you just by talking about COVID A little bit, because I think people feel like we’re at kind of a point when a number of people are trying to wrap a bow around where we are with the Ph. D. Ending the public health emergency. Dr. Fauci retiring. Of course, the biggest piece of news, the White House team disbanding shortly, and the virus still looming out there. But in a perhaps more predictable way. Are we given prior vaccination and prior infection? Are we at a at a steady state, kind of are we at that magical endemic state?

Tony Fauci  09:37

Yeah, well, you know, it’s actually a bit complicated, Andy, because if you look at where we are now, compared to where we were a year, a year and a half ago, it’s a dramatic difference. In both infections and hospitalizations and deaths. We were having about 800 to 900,000 infections in about three to 4000 deaths a year to a year and a half ago. Now. This remarkably diminished for any of a number of reasons. But it’s still not really at that level low enough that I think many people in the public health arena would feel is something that we should be very comfortable about where we’re averaging about, you know, 350 to 400 deaths per day, occasionally a day will occur where it’s 500. So that brings us to an average of somewhere between 2003 1000 deaths per week, which is really not, in my mind, something that we should feel entirely comfortable about, I believe, as we go on, as long as we don’t have a major major shift in a variant that’s so remarkably different. And we haven’t seen that in a while, everything we’ve seen has been a sub, or a sub  variant of Omicron. Ever since Omicron, appeared on the scene in November, December of 2021, we have not really seen any major changes. And I think that the hybrid immunity of many people either be infected, vaccinated and are both that we seeing somewhat of a steady state. So you use the terminology, maybe we can sort of tie a bow around it. I think we’re starting to get our arms around it. I don’t think we haven’t knocked in and nodded yet. I think we need to go a bit lower than where we are right now. But clearly, we’re much better off than we were, like I said, a year and a half ago.

Andy Slavitt  11:31

Yeah. And I think there are a lot of people who would say they don’t feel like we should be talking about rounded, but they may feel like the policymakers, government Congress, the administration is attempting to tie a bow around it just because of the kind of confluence of events happening. And is it affects saying I mean, if you talk about 100 250,000 deaths a year or something like that, living with that effectively added that to our current array of diseases that people die from. And it’s something that could be as high as three, four or five times the flu, right? That doesn’t feel very good. But it also feels like the public has become accepting of sort of whatever it will be, it will be. Do you sense that that’s the prevailing attitude? Or do you think that there is something out there, which says, Hey, there’s more that can be done?

Tony Fauci  12:22

I think it’s a combination of both. I think if you look in general, after three full years, going into our fourth year now, of this, everybody wants this behind us, we want to look ahead, what’s next. And there’s a prevailing feeling of alright, we can accept the perfection. But let’s not let the perfect be the enemy of the good. We all want to move on. And we want to move on practically speaking. And we want to move on from a conceptual standpoint, one of the issues with that is that we don’t have a homogeneous population in our country or anywhere in the world. And when you have people who are elderly, somewhat frail, who have underlying conditions, or even people who are not elderly, you’re immune compromise, the risk of a virus that’s potentially deadly, and has proven itself to be deadly to the tune of over 1,100,000 Americans dying, it is very difficult to get that group to say, well, forget it, it’s over, we’re going to move on because for them, it’s not over, it’s for the most part, it’s still a threat. So that’s that we have to deal with a bit of a complicated situation for most of the population versus a certain segment of the population for

Andy Slavitt  13:42

you know, I’m noticing anecdotally that people who had COVID, early i.e. before the first vaccines came out, reported having had much rougher many of those reported having lingering symptoms a long time later. And people who have it have gotten more recently. Again, this is almost purely anecdotal, report the lesser symptoms, perhaps because they’ve been vaccinated, perhaps because they’ve had it once or twice before. And that’s causing people to feel like, hey, if I get it, it won’t be so bad. And I’m, without a doubt carving out a number of people to whom this is quite dangerous for and to whom we have to watch out for. Is there any evidence to suggest that that’s true, that having had a recent infection, or some other combination of events, or the or a weakening of the virus is playing out or is that purely speculative?

Tony Fauci  14:42

Well, it’s speculative that the virus is weaker and less inherently pathogenic. What we are seeing is that if you look at the totality of people who’ve either been vaccinated with or without updated, boosted together with those who’ve been In fact, it is enough broad immunity at the community population level, that that in and of itself could account for the fact that it appears that we’re having a lesser degree of severity and with a lesser degree of severity is a lesser likelihood that there’s going to be long COVID. And people, because we know now that the factors that mitigate against long COVID, and those that make it more likely to have long COVID, there’s no doubt that when you look at the sub lineages of Omicron, you’re dealing with a population in this country and in the world, we’ve had now considerable experience with one variant or another of COVID, when it first hit the ancestral strain. In the first months of 2020, you were talking about essentially a completely naive population, I mean, logically, so that could explain a lot of the severity of the long COVID all those other things. It’s so complicated. Now, when you’re dealing with you’re three years into an outbreak, and you have a […] of people vaccinated, boosted, not boosted infected, that makes it very difficult to make declarations about the inherent pathogenicity virus.

Andy Slavitt  16:29

Well, you remind me that that first year was so scary for so many people. And every time I hear people with some sediment of how we made too big a deal out of COVID, or we were too restrictive, or whatever they would say, I think bad people have short memories, because that first year, before we had the mRNA vaccines, people were dying in pretty much helpless. It felt very random. The cases were very severe. It wasn’t that people didn’t want to get back to normal life it was that we couldn’t. And so I think there’s a selective memory that goes on maybe because it was a traumatic year for everybody.

Tony Fauci  17:10

There’s no doubt I mean, you can call it a number of things. And the one of the things you could call it is selective amnesia, about what actually happened. Just think now remember, the meatpacking trucks, the Kula trucks parked in front of Ellmers hospital and parked in front of Mass General in Boston and the Brigham and places like that, where we were concerned that we would have to do the amount of triaging of who we can take care of which would be unimaginable. In the United States, we would we came perilously close to that. So I think people need to remember that experience when they criticize, what considered to be very dramatic interventions that were done, such as restrictions and shutting down and things like that. They really need to remember how things were back then.

Andy Slavitt  18:04

Yeah, selective amnesia. It’s also the other thing people don’t get credit for is, it seems, from today’s standpoint, that it’s inevitable that we had the vaccine when we did, but it wasn’t a sure thing. No, we were incredibly fortunate that of the foresight of people like yourself, and Barney Graham and others that had spent decades getting us ready for something like this. So that we were able to do that. But there’s another, another world that counterfactual that thank God we didn’t have to live in, where it could have been four years before we saw a vaccine. And we didn’t know, up until the end of 2020, that that was going to be the case. And that was also scary, because people just didn’t know how long this was going to last.

Tony Fauci  18:52

Exactly, exactly. You know, and, you know, one of the surprises because of the relatively unprecedented nature of it, was the fact that we have a deadly outbreak that just continues with successive waves. We’ve just never seen that before. I mean, three years’ worth of waves is just really unprecedented.

Andy Slavitt  19:18

Alright, let’s take a quick break. And I want to come back and talk about what advice we have for people about getting boosters. So as people go forward, I’m curious how often you think you will get boosted the recommendation is for it to be once a year. I know people who are older or have otherwise vulnerable are thinking, Well, wait a minute, does it immunity only lasts? You know, we’ve been told for a matter of months, not for an entire year. And so I think some people are wondering, will it make sense for them to get boosted again in the spring? Before we get to the annual recommended booster in the fall? How are you thinking about it for yourself?

Tony Fauci  20:22

No, I think you framed it up pretty accurately. And the as you know, the FDA right now, as you and I are speaking, seriously considering the idea of recommending that you have vaccination, boosting, updated boosting be available to people before the pre-determined cycle. You’ve heard us a year ago, talking about the idea of getting people into a rhythm of getting boosted. And why not at the same time as you get the full boost? Or the fall vaccination of a flu shot. But then the question appropriately arises, what about people who are elderly who have underlying conditions and those who are immunocompromised because you know, if they diligently got their updated VA4 or 5 boost when it was available in September, early October, now you’re talking October, November, December, January, February, March, already 6 to 7 months into it. And in those people who likely don’t have as robust and immune system, as an otherwise healthy young person, it makes sense to at least consider giving those people the immune compromised the elderly with underlying conditions of booster before you get to the classical rhythm of a full boost. Together with influenza, I think that makes sense to at least seriously consider it.

Andy Slavitt  21:54

We’re talking very specifically to my mother here. Because she asked me that question. And I didn’t have a great answer for so I think that’s helpful. Now, I think I’m probably going to tell her to figure out how to get one in the spring, although, you know, the process might be a bit different than it’s been in the past, we may have to go through our physicians to get a prescription, I would imagine, can we shift to talk about the source of the virus and what we know. You know, it is pretty confusing. If you read the newspaper or look at the clippings. It feels like almost every given week, somebody is saying there’s evidence that it came from raccoon dogs. In the wet market in Wuhan. There’s another report that comes out saying, well, it looks likely that this came from a lab, although the evidence in all cases seems circumstantial, and it seems like people doing their best to guess. So I just have two questions. One is, does the preponderance of evidence tell you anything? And secondly, why does it matter?

Tony Fauci  22:55

Okay, so I think the first thing that you’ve got to realize we don’t know definitively. So you’ve got to say to yourself, and I’ve said this all along, despite the fact that it’s been distorted, that you have to keep a completely open mind about what the origin is, because nothing has been definitively proven. With that as a tenant that you guide yourself by that if you get convincing evidence that’s definitive, in one versus the other, a so called lab leak, versus a natural occurrence jumping from an animal to a human, that when evidence becomes definitive, that you should go with the evidence and embrace that. And I will, and I hope everyone else does that. Because there has been a degree of polarization about all this have strong opinion. I’m shocked here in Casa blanca.

Andy Slavitt  23:53

Blanca. Okay, you’re making news on our show, Tony. With that revelation.

Tony Fauci  23:59

Yeah. So no, but let me let me go on, indeed, because it is really important. So do you say to yourself, take a look at what we know, all of the intelligence and other services seem to agree on one thing that it is engineered. So the question is, when you say lab leak, what are you talking about? Are you talking about someone who was out in the field trying to gather viruses that got infected and then came into the lab and did what played with it a little bit? Or what do you mean by a lab leak? Now, what do you mean by a natural occurrence, namely out of the wet market? Although we must all keep an open mind if you look at the scientific data from qualified evolutionary biologists who’ve done careful studies involving epidemiology virology, geospatial studies, although not definitive, the most studies that come out, lean strongly towards this being a phenomenon that was a jump ease of species from an animal host into a human very likely in the environment of a wet market. Is there precedent for that? There is very, very strong precedent for jumping species from an animal to a human. Going back to pre-history, but let’s go into well, you know, history, pandemic flu of 1918, bird to human swine flu, 2009, pig to human Ebola, SARS-CoV 1, MERS. So this is not an unusual phenomenon, and the evidence point to but does not definitively show that that’s the case. And then you ask yourself, what is the evidence for a lab leak? Right now? It’s the circumstance of it being in a city that happened to have a lab that’s looking at Coronavirus is, but it could have easily have been in Beijing or Shanghai or other cities that also study it. So I mean, again, it’s still an open question. And that’s the reason why we really ought but did the second part of your question was does it matter?

Andy Slavitt  26:23

Yeah. I wonder which would be worse news?

Tony Fauci  26:26

Well, you know, I It depends worse news. But what you can do about it, I you know, I think that if, in fact, it was something that was manipulated in a lab, which the intelligence people say it wasn’t, it wasn’t engineered, the thing you want to do is make sure that you get uniform and universal international standards of the kinds of experiments that can be done and the conditions under which that can be done. stricter regulation, stricter oversight, if it were a natural occurrence, you’ve got to pay very close attention to the animal human interface, which apparently the Chinese did not do. Because they violated their own so called regulation of not bringing these wild animals that are exposed to bats and bat viruses, to not bring them into the wet market. And this photographic evidence and the that they did that they violated what was their own regulation of doing that. So the way you want to avoid the kind of natural spillover is, make sure we pay close and serious attention to the infringement on the environment, and deliberately putting wild animals that come from places that might have viruses that are capable of infecting humans, to put them in an environment like a wet market, where people easily interact with those animals. So it doesn’t matter what the original origin is, you can mitigate against both of those possibilities, which is what we should be doing, right?

Andy Slavitt  28:12

Yeah, he’s doing anyway, we should be doing anyway. Alright, let’s take one final break. And I want to come back and talk about the pushback that you receive as the leader of the scientific community from the AIDS activists versus the quote unquote, COVID activists, although I’m not sure that’s the right phrase, we’ll be right back. I want to talk a little bit about the art of infectious diseases over the course of your career, Tony, you know, from HIV, to SARS, to merge to Ebola, to COVID. Can you just give us your sense, as you step back from it all a bit on what this tells us about the evolution of viruses where that heads us? How we should be thinking about the frequency, the severity, and maybe reflect on kind of what we have learned and how things changed along the way?

Tony Fauci  29:31

Yeah, I mean, one of the things that is very, very clear, and we’ve lived through it, at least in my generation, which is older generation, as it were given my age, but pandemics and emerging outbreaks occur. There are viruses you know, this gets back to your question a little bit ago and the about the origin I mean, 75 or more percent of all new infections. evolved from an animal jumping from an animal reservoir to a human. And we have ample experience with that. outbreaks and emerging infections occur, they have occurred before recorded history. They have recurred during our own historical perspective, and they are occurring right now. So the idea that emerging infections occur, the real question is how do you prevent them from becoming a pandemic? And that gets into what we’ve discussed. And you and I discussed it in detail when you were in the government is, what does pandemic preparedness mean? It’s a combination of scientific investment, like we made in the platform technology, and in the immunogen design, to be able to get an intervention like a vaccine very quickly the way we did with COVID. But it also involves having a public health infrastructure, both domestically and interrelated, globally and internationally. So what it tells me from my own personal career, going back to the very early years of HIV, that there are different types of outbreak and the AIDS is very much different than a respiratory borne highly infectious virus, like COVID 19, and SARS–CoV–2, but these outbreaks do occur. And we really need to develop a corporate memory of what are the things that went right and what went wrong, and realize that there will be other emerging infections, and there will be the potential. And that’s why you talk about pathogens of pandemic potential. They are out there. And we’ve got to make sure that we put a program that’s sustainable, that allows us from both the scientific and the public health standpoint, to be able to address them, I just worry, and the that our corporate memory is going to be very short limbs.

Andy Slavitt  32:07

Yeah. When he talked about that. Yeah. That selective amnesia, the politics. But to put a finer point on what you just said, which I think is really important. What would you describe as the biggest success or disaster avoided? As we face something like that? Boy, this could be really bad. And it wasn’t because of the way we intervened. And then what would you describe as our biggest disappointment? The one that we just couldn’t get our arms around, that we just have the most disappointment over? Or the you have the most disappointment over?

Tony Fauci  32:37

Well, you know, that’s, it’s a complicated issue, because the things that influence the success, failure, disappointment or not, are multifaceted, I mean, sure, if you take HIV AIDS, it is stunning the success of the development of lifesaving drugs, that when I was and I have personal, face to face experience with this, of having personally taken care of hundreds and hundreds and hundreds of persons with HIV, who in the early years, virtually all with few exceptions died. And we developed by investment in biomedical research, a very aggressive approach. We developed lifesaving therapies that now if given to a person early, relatively early, and even not so early in infection, you could get them to lead essentially, a normal disease free life. That is the profound success in HIV. The disappointment through no one’s fault, is the elusiveness of developing a vaccine that’s highly effective for HIV. And that would be the nail in the coffin of HIV, even though treatment is prevention and pre exposure prophylaxis and long acting antivirals for treatment and prevention are really transforming HIV, there is still a scientific disappointment. And that is the lack of our ability at this point to get a vaccine go to something like COVID. Which, if you look at what could have happened, had we not had the scientific investment in platform technology and imaging designed together with the will to put billions of dollars into operation warp speed. How many more hundreds of 1000s of Americans and millions of people worldwide would have died if we didn’t do that. I mean, that was really, you know, You’re escaping a bullet without some bullet even though we did get hurt and are still getting hurt with COVID. Could you imagine what it would have been like without a vaccine?

Andy Slavitt  35:01

Hard to even picture. The one thing that I think is interesting and maybe interesting as a loaded word, as I think about the arc of that storyline from HIV to COVID, is the controversies around public health that evolved. And I’ve heard you talk about, in contrast, the kind of controversies in the politics between HIV activists, and COVID. I don’t know if I’d call them activists, but COVID deniers, people who have been very much on the side of driving a lot of the controversy of the COVID response, I’m curious to have you reflect on the similarities and differences in kind of the controversy and public response?

Tony Fauci  35:51

Yeah, so HIV AIDS is a little bit more complicated, because in the United States and other parts of the world, it very heavily selectively involve men who have sex with men and injection drug users, commercial sex workers, people who already are somewhat disenfranchised. So there’s a stigma associated with that. And that complicated, the issue early on, and somewhat improved. But the pushback on the part of the constituencies, in this case, predominantly, but not exclusively, men who have sex with men, was that they were trying to get the government to appreciate that the rigidity of the scientific process and the rigidity of the regulatory process was ill suited to the uniqueness of HIV AIDS, a brand new disease, killing almost everybody with no interventions at all. I mean, we were putting band aids on hemorrhages, treating opportunistic infections. But you know, at least my I think traumatic experience that I had for years, which still affects me, I think I have a still a degree of post-traumatic stress. Having done that, for so many years, sure, is that it was too rigid. And they were telling us, listen to us, get us involved in the dialogue, we can help to make this more user friendly, and more equitable, to get people to have access to drugs that are not necessarily already approved, in essence, compassionate use the authorities early on, including myself, thank goodness for a very short time, we’ll put it back by the provocative, disruptive, theatrical way they were trying to gain attention. And the scientific and regulatory community ran in the other direction when they did that. So one of the things that I feel so much, much better about what I did was open up my mind to listen to what they said, and what they said, made perfect sense. And when we started to listen to them, I said I would put myself in their shoes, I would do exactly what they were doing. And they helped improve the process. But they weren’t conspiratorial. They weren’t saying what they were saying based on distortions and on realities and untruths. They were trying to make the system better. The kind of pushing back we’re seeing right now has such a profound degree of political divisiveness associated with it, that it almost distorts reality. It is not productive. I mean, you’ve got to keep an open mind that you could always do better, and you’ve got to reexamine your approaches. But to do it in a way where public health officials have villainized, you know, and threatened is just horrible. It certainly is not helpful.

Andy Slavitt  39:13

Yeah, I mean, it’s really interesting listening to you, because in the case of HIV AIDS, you were the sort of personification of science. People wanted to know who to protest against. And you very famously sat down with activists, and listen to them. And as you said, you took care of hundreds of AIDS patients. And, as you just said, what I think I heard you say is, it’s not that science can’t take criticism. In fact, science can benefit from criticism, and having an open mind and that’s made science work. But it feels like this criticism is of a different flavor. With COVID. It feels like I can’t imagine. I think you probably wouldn’t do this because I know I’ve seen you toured neighborhoods. It talked to people who are vaccine hesitant But the difference between being vaccine hesitant, and the sort of anti-scientific COVID kind of violent anti-science responses is significant. I can’t picture the same conversation happening between you and the people who are spreading the falsehoods about COVID. In the same way, because I don’t see these people are being of goodwill. Do I have it wrong?

Tony Fauci  40:24

I think you have it right. I don’t think everyone that has an issue with the way the public health response has rolled out, is someone of ill will, but I think there are enough of them that are that really complicate the situation. I mean, the idea of death threats against health officials, the idea of, of trying to totally intimidate and not wanting to at least engage in a dialogue is the same sort of mentality, I cannot help but come to that conclusion. You know, that led to the storming of the of the Capitol on January 6, right? I mean, what kind of mentality has you do that? You know, it’s, it’s, it’s just profound divisiveness?

Andy Slavitt  41:14

How did you not get intimidated? I mean, it felt at least publicly that you were not going to back down from what you thought was right, in the face of really scary behavior from people.

Tony Fauci  41:26

It’s not in my nature to back down when you know that what you’re doing is the right thing, particularly when the motivation is that I mean, my entire motivation of my whole professional life has been to prevent disease and alleviate suffering and prevent death. That’s My nature. That’s my DNA. And that’s what we were trying to do and are trying to do. Yeah. And if people push back in a threatening way, there is no way I’m going to back down on that, Andy, no way.

Andy Slavitt  41:57

You get that from your ancestors? Where do you get that from? Because it’s, it can be scary. I mean, I dealt with much less of it much, much less of it than you did. But I know it can be scary.

Tony Fauci  42:07

Yeah. I mean, it’s I kind of phase out. The thing I don’t like, much more than any threat on me is the attempt to intimidate and harass my wife and my children, which really tells you something about the character of the people that are doing that

Andy Slavitt  42:23

exactly right. When it goes from professional to personal. being criticized professionally, as a public servant, or public figure feels very much within bounds. I mean, it feels to me like you’re sort of there and you’re a people servant, and you’re there to take the professional criticism. But you’re absolutely right, that boundary. That is, to me a very bright line, your family, your personal life, your personal safety. I think you’re right, that is a symbol of society, that’s unmoored to basic civility.

Tony Fauci  42:55

Yeah. I think your is the right word, there is a lack of civility.

Andy Slavitt  43:01

So as we finish up, your career spanned. It’s such a remarkable period of time in government. And I’m wondering how you’re thinking about reflecting now in what you are focusing on next to really, you know, put some of the capstones or hand off a legacy to next generations, like how are you thinking about this remarkable careers serving seven Presidents, tackling some of the scariest moments in our country’s history, investing ahead of the curve in preparation, and having the mRNA platform? What feels most important to you personally? No,

Tony Fauci  43:45

that’s a great question that I’ve asked myself and, and I’ve come to a conclusion, which is one of the reasons why Andy I decided to step down at the time that I stepped down because I felt I have at least a few, hopefully more, but at least a few years of, of really being energetic and passionate and motivated to do things and I think one of the things that I can continue to contribute to society, above and beyond another vaccine, or another drug or another paper and the New England Journal of Medicine or one of the other journals would be to serve hopefully as an example and possibly even an inspiration for younger people who are either in science or considering going into science that they may want to understand and appreciate the enormous opportunities and the gratification of going into service, public health and even public service. That it can be an extraordinary, impactful and, and gratifying experience. So I have the benefit, as you said, just on the basis of the number of years and the circumstances that I’ve been involved with going all the way back from the very early days of HIV, that this is something that if people have any inclination to do it, you can make a great contribution to society, which I think that that to me would be one of the best things I can do in the coming years.

Andy Slavitt  45:24

But how do you advise younger people who are interested in the science and interested in the public benefit? But I really don’t like the messiness of the politics. I mean, as we sit here today, Tony, it is quite possible that one of the major parties in this country will run a candidate for president who’s running without question on an anti-science, anti-public health platform. I mean, that is core and part of Ron DeSantis, his identity, that’s a core part of his popularity. How do you advise people who may be thinking about this career? And all of the strange political pitfalls that you’ve got to deal with?

Tony Fauci  46:06

Andy, it may sound strange, my answer, but it’s all the more reason to get into it. You can’t back off and say, because you have leaders who are least professing this lack of an appreciation of science, that’s no reason to back away from a field that’s critical. Totally critical to the benefit of society. You can’t you can’t back down that gets back to your point in the question. And the comment you made a few minutes ago when you said, How come you haven’t backed off on this and backed down, that that would be essentially giving in to something that’s antithetical to what we stand for?

Andy Slavitt  46:53

Well, Tony, for the millions of people that admire you from afar, I can say that I’ve been very fortunate to be able to say that as much as I’ve admired you from afar, the closer one gets, the more that admiration has grown, in seeing how you conduct things, I know it will be an example to younger people. I think the legacy of the people that come after you will be an exciting, exciting thing to watch. So with gratitude on both a public level as well as a personal friendship level. Thank you.

Tony Fauci  47:29

Thank you so much, Andy. It’s a pleasure to be with you. And I have told you before we miss you. But you’re doing good stuff here with the podcast. I think it’s very helpful to people. It’s an excellent, an excellent show, and I follow it.

Andy Slavitt  47:46

Thank you, Tony.

Tony Fauci  47:48

Alright, thanks a lot. Take care.

Andy Slavitt  48:03

Okay, thank you, Tony. Wednesday, we’re gonna continue our anniversary week with Ashish Joshi, the White House COVID coordinator, another perfect guest to have on this week. And then Friday, we’re going to dig in to some of the seemingly are sides of what we’ve experienced with COVID in the COVID response with New York Times reporter Sheryl Stolberg, she’s really had to beat the COVID Beat from New York Times. And she’s written a really interesting, edgy piece on how people are using the origin story as a wedge right now. And it takes a look at how public health’s going to be used as political weapon going forward. So that’ll be interesting. And I think a perfect way to spend our week. Hope it’s becoming springtime near you. It should be if you’re living anywhere but Minnesota. That’s all for now. We will talk on Wednesday.

CREDITS  49:03

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.