Dr. Fauci: The Man Behind America's Pandemic Response

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Hello, everyone. I'm Guy Kawasaki. This is the Remarkable People podcast. And today we truly, truly have a remarkable person. It's Dr. Tony Fauci, and he was the director of the National, National Institute of Allergy and Infectious Disease. He was the advisor in this kind of role for seven presidents. Seven presidents. So he was involved during these times of HIV, AIDS, respiratory infections, tuberculosis, malaria, Ebola, Zika, COVID 19. He really has this amazing background. He has the Presidential Medal of Freedom. It's the highest civilian award. It was given to him by 2008 by George W. Bush and Dr. Foucher. Tony, he said, I can call him Tony. I gotta tell you, we have 52 remarkable people a year, but you are near the top. You have had, I think, more impact than just above anybody else on our podcast. So I just want to express my deep, deep, sincere appreciation for the work that you've done. I personally think you probably saved my family's. I don't know if their lives, but certainly their health. So I just want to thank you in terms of many, many millions of people who want to express this gratitude for your work through your career.

Thank you. I appreciate that, Guy. Thank you very much.

And I hope you get a second Medal of Freedom where you get a Nobel prize or a MacArthur Fellowship or whatever the hell you want. You deserve it all.

Thank you.

Let's start with something easy. So now it seems to me that disease control isn't exactly rocket science at this point. We kind of know what to do, but why are people so stupid and we just don't do what it takes and take care of these problems? What stands in the way of this Guy?

I don't think it's that people are stupid. I think that they don't have a full appreciation for the relationship between good public health practices and the ability to contain, for example, an outbreak. There are certain fundamental core principles of public health that when you have the situation that we faced during the COVID pandemic, where There was a great degree of divisiveness in the country and I wanted to distinguish divisiveness from diversity of opinion. Diversity of opinion is fine, but the profound divisiveness that we had as we were trying to contain a historic pandemic the likes of which we have not seen in over 100 years, it became very difficult. And what evolved out of that was a distrust in science and even somewhat of an anti science attitude. We saw that in the fact that we had a totally life savings vaccine by every single parameter that has been measured in the United States and throughout the world. The COVID vaccine has literally saved millions and millions of lives. And yet there were people who for ideologic or other reasons refused to take the vaccine, essentially putting themselves and their family in danger. So again, I don't think that can be classified as being stupid. I think it's somewhat misguided by a anti science attitude, which is really unfortunate.

So here's the hypothetical. Let's say we could get the world to shut down for six weeks. Six weeks. Everybody just stays put for six weeks. Theoretically, could we just wipe out many infectious diseases?

No, I don't think so. When you say wipeout, Guy, you've got to distinguish, and this is a really good issue that you bring up. There's a difference between controlling infections, eliminating infections, and eradicating infections. We have only been successfully eradicated one human infection in the history of mankind, and that's smallpox. We've eliminated infections in certain geographic areas by good public health practices. And predominantly the major force in that was vaccination. For example, we have officially eliminated polio and eliminated measles in the United States. Measles still exists in different parts of the world. Polio still exists, but you eliminate it by creating a situation by vaccination and diminishing the opportunity of a pathogen, in this case a virus, to infect people, that you can actually eliminate its occurrence. We don't do that with a lot of different infections. For example, HIV right now in the United States is under better control than it was back in the 1980s. But big but it hasn't been eliminated and it certainly hasn't been eradicated. Whereas infections like polio, smallpox, measles, yellow fever, malaria, we've eliminated them in the United States and other developed nations. So I don't think, Guy, that if you just lock people up for six weeks, you're going to get rid of all infections. That's just not going to happen.

But what happens when people are saying that if you get MMR Your kids will have autism and then there's all these anti vax things. So these things that have been, quote, eliminated can return?

Absolutely. In fact, that's one of the big caveats when you use the word eliminate. Because if you eliminate but don't eradicate, there is always the possibility of the return of that particular pathogen. And we have excellent examples of that in countries that have suspended the broad general measles vaccination. There's been outbreaks of measles in those countries. We've seen that in the uk We've seen that in certain European countries, which is the reason why we're very concerned about the skepticism on the part of some about continuing to vaccinations which have essentially eliminated infections in this country.

Now let's suppose, Tony, that I give you this magic wand and with this magic wand you can redesign the clinical trial system. How would the Tony Fauci clinical trial system work?

There are clinical trials guy, that are being conducted, that have been conducted particularly in areas that we most recently have been involved with. For example, the clinical trial to prove the safety and the efficacy of the COVID vaccines, the clinical trials that proved the safety and the extraordinary efficacy of some of the HIV drugs that have saved now millions of lives. The clinical trial. I don't need a magic wand guy, because it's pretty well established that if you do a well controlled clinical trial in which all of the parameters of getting a definitive answer and the gold standard of that, when you can ethically do it would be a randomized placebo controlled trial, which is exactly what we did with the COVID vaccines in which we tested it in tens of thousands of people. And at the end of less than a year, it was demonstrated that the people who were in the treatment group, namely the vaccine group, compared to the placebo group, had a very, very highly significant diminution in infection to the tune of more than 90% efficacy. So there are good models for clinical trials. I don't need a magic wand. It happens.

But, but it seems to me, I read in your book that you were somewhat in conflict with the CDC about the pace and the, the number of trials and the number of patients in the trial. And there was a moral issue that you see such efficacy in the early days that rather than taking it to the full term, let's push it out now. So isn't that a fundamental change in how clinical trials were done?

No, not necessarily. And I wasn't really a guy, I have to correct you on that. I wasn't in conflict with the CDC on that. What happens in a clinical trial is that you have what's called a data and safety monitoring board. That is an independent board, not the people who are doing the trials, but an independent non conflicted board of experts that intermittently look at the data for two reasons. One, are there any safety issues in which the vaccine or the intervention in question is doing more harm than good, which would trigger you to stop the trial? On the other side of the coin, are the results so good that you would be unethical to continue the trial because the people who are in the placebo absolutely should be receiving the intervention? There's no conflict there. But the reason there's discussion is that often, sometimes, rather than to let the trial go to its full pre intended completion, you stop it earlier because the results are so good you want to get the benefit of that intervention as quickly as possible and to as many people as possible.

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Do you believe that we are truly post pandemic and now it's the 10th leading cause of death? It used to be the fourth. But are we considering the impact of long Covid or is everything as rosy and good as some politicians might have us believe?

Well, whenever there is a infection in the community that's causing suffering and death, you can't say everything is good and rosy. It certainly is better now in January of 2025 than it was in January, February, March and April of 2020, when it was an explosive global pandemic that lasted in its explosive form for at least two or three years. For the last year or so, even though there have been new variants and there are still a number of infections. If you look at the data guy, the number of infections per day are dramatically lower than they were a couple of years ago. The number of deaths, even though we're seeing deaths throughout the world from COVID it is remarkably lower due to the efficacy of the vaccine and the fact that. That most people have already been infected and they have a degree of background immunity. But we still need to take Covid seriously. We don't need to shut anything down. We don't need to have the kind of restrictions that we had early on. But we shouldn't forget about it, because people are still getting infected. And as you said, long Covid is a serious issue that we need to contend with, because even if a small fraction of the hundreds of millions of people who've been, in fact, the billions of people who've been infected with COVID even if a small fraction of them have long Covid, that's a serious public health problem.

And there's a term that politicians love to use called herd immunization. And is herd immunization really relevant? Herd immunity?

Not herd immunization. Herd immunity.

Excuse me. Pardon me. That. That's why you're Tony Fauci and I'm Guy Kawasaki. So. So herd immunity for something like Covid, is that realistic or does Covid. Because it's right down at the DNA level and it's. It mutates so fast, it's herd immunity. Just an irrelevant concept.

It's not irrelevant, but it's very. It's a unique situation. With COVID the two fundamental factors that are necessary to get herd immunity is that you have to have an infection by a pathogen that doesn't change from month to month and year to year, number one. Number two, when you get infected or you get vaccinated, you have to have durable immunity measured not in weeks and months, but measured in many years. If you get durable immunity and a virus that doesn't change, then you conceptually can get herd immunity when you have a certain percentage of the population is protected, that would protect the small percentage of people that don't have protection. But if you have a virus like Covid that changes. We have multiple variants over the last five years, number one. And number two, even when you get infected and recovered or when you get vaccinated, the durability of protection is very low. It's measured in months to a year, not years to a decade. So the concept of herd immunity in many respects does not hold for Covid.

Okay, so Right now, about 20% of Americans are getting vaccinated for these booster shots and stuff. Is that critical mass?

No, it's not. We're not utilizing a vaccine that is highly effective and safe. Obviously, if you've been vaccinated or infected, you have a Degree of protection. If you want to increase that degree of protection, then a booster will help you to get a greater degree of protection. So it doesn't mean if you don't get boosted, you have no protection. But if you do get boosted, you have a greater degree of protection than you do if you don't get boosted.

My logic would be like, for the 30 minutes of effort and basically free booster, why wouldn't you get it?

That's a good question. But unfortunately, there's a bit of inertia in the population about getting boosters. Because in many respects, Guy, understandable, but unfortunate that people don't want to be bothered with COVID anymore. They don't want to think about it. They don't want to do anything about it. They just want to go on with their lives, which is very understandable. But from the standpoint of protection in an optimal way, it's unfortunate.

Now, I get this impression, and I'm obviously not a scientist, but that the treatment of AIDS took a long, long time to figure out. But the treatment of COVID seemed, like, magical. It was bada bing, bada bang. It was there. So is the latest technology in mRNA, is that the silver bullets? From this day forward, we're gonna just be knocking out these viru quickly.

Now, it's complicated, Guy, because you don't want to mix up the development of a vaccine for Covid with the development of treatments for hiv, even though it took a while to get treatments. We have spectacularly effective treatments for HIV right now. When I was taking care of persons with HIV every day back in the 80s and the 90s and the early 2000, and even to this day, I still see occasionally patients with HIV. But back in the 80s, before we had any drugs, it was a virtual death sentence for persons living with hiv. Now, you could take one pill that contains two or three antiviral drugs that can suppress the virus to below detectable levels that persons can lead essentially a normal lifespan. That's very different than drugs for Covid because drugs for Covid, it's a transient infection, whereas HIV is a chronic, lifelong infection. So there are some drugs for Covid, you know, you get paxlovid and remdesivir and others, but nothing like the incredible power of the drugs against hiv. On the other hand, we don't have a vaccine yet for hiv. Whereas we did something, we being the scientific and pharmacological community, we did something that was completely unprecedented, that from the time the virus sequence was made public in January of 2020 to the time, we had conducted clinical trials in tens of thousands of people and developed a vaccine that was safe and highly effective, was less than 11 months, which is completely unprecedented in the history of vaccinology. Usually it takes seven to 10 years to get a vaccine, but that's where the technology came in to allow us to do things that we could not do before.

And this technology specifically is MRNA.

It's MRNA, but it's also what's called ImmunoGen design, where the MRNA is the platform to deliver the vaccine, whereas the immunogen is what we call the business end of the vaccine. And scientists at nih, in the institute that I used to develop, my team, were able to design the immunogen in a stable form that was highly immunogenic. So when you combined the MRNA platform technology with the very, very successful immunogen design, that's why we had the very, very successful Covid vaccines.

So are we now much better prepared if bird flu mutates and becomes more contagious, human to human?

The answer is, in many respects, yes. When I think of pandemic preparedness and response, I generally put it in two separate buckets. The scientific preparedness and response and the public health preparedness and response. If you look at our track record, we've done spectacularly well with the scientific preparedness and response for Covid because we have a vaccine that never would we have thought we'd have a vaccine in less than a year. However, from a public health standpoint, we had somewhat of a fractionated response. We didn't have a uniformness in our public health response. In some respects, I'm not so sure we're that much better prepared from a public health standpoint than we were from a scientific standpoint. So we've got to do better in our public health response.

This is a question I almost hesitate to ask you, but when I was preparing for this interview, I asked some friends, what would you ask Tony Fauci? And one of them said, I saw a clip where he says on msnbc, when you get vaccinated, you can feel safe. You're not going to get infected. And I realized that's like six seconds. And who knows what came before after that. But can you explain the context of that?

Yeah, vaccinations, for the most part, not all, but most of them protect you against clinically apparent disease, whereas it doesn't necessarily have as much capability of protecting you against infection. So you can get an asymptomatic infection if you're vaccinated, but you won't go on to get seriously ill, require hospitalization or die. So vaccines, including Covid, are much better and very effective in protecting you against clinically apparent and severe disease. Not as good protecting you against infection as an event, even though you might be asymptomatic with that infection.

But when people quote those six seconds, it's as if you're saying, get a vaccine, everything is great.

No, I never said that. And whoever's doing that is misquoting a guy. I never said that. I said that you would be protected against severe disease. I've said that maybe a thousand times on television.

Okay, so let me say that if I'm a young person and I'm interested in public health or medicine, and then I see what, what happened to you and Dr. Birx and how you were treated by politicians and the public, I must admit I'd look at that and say, do I really want to get into medicine? Do I really want to get into public health? So what's your advice to people who might be interested in this field, but they're a little taken aback by what happened to you?

Yeah, it's unfortunate that I and many of my colleagues in medicine, science and public health have been attacked by for reasons that are still difficult to understand, but instead of being supported, have been attacked. But what I tell younger people when they ask the question that you're asking is that why would you want to get involved in public health and in medicine if you get treated the way many of us have been treated? And I say that the gratification that you will get from doing something that ultimately could save people's lives, alleviate suffering, is so much more overwhelming than the negative thing. So the positive aspect, guy, completely outshines the negative things. So even though it would be nice if people appreciated what public health people were trying to do, even for those whatever fraction of the population doesn't feel that way and is very much attacking public health officials, that still the gratification that a young person or even an older person would get by contributing to the public health of the country and the world just completely overrides and outshines the negative aspect.

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You were on the receiving end of much AIDS activism. So from the receiving side of activism, what's your advice to people who want to be good activists?

If you want to be a good activist, you should try to get as much correct information that you can work with the people in authority to try and get them to understand what particular issue that you have with the way things are being done. I must say, the AIDS activists in the 80s and early 90s were a epitome of a good example of what activists should do. They did their homework for the most part, not completely, but for the most part, they got their facts straight and they confronted the establishment, the scientific and regulatory establishment, and said, you know, you've got to keep us at the table and you've got to consider our viewpoint about things because we're the ones that are at risk and or suffering from this infection, hiv, so perhaps we can contribute to the ultimate effort to address it. And they were completely correct. When you have activists that don't do their homework, that don't understand all the facts of what's going on, then that is counterproductive. But the AIDS activists were very much value added to the effort.

And this is even when Larry Kramer called you a murderer?

Absolutely. He was trying to gain my attention. And deep down, Larry Kramer got it right. He felt we needed to do more. And once he got my attention, we became not only collaborators and colleagues, but we became very good friends. And when, until the day he died, he was a very good friend of mine, I just.

I have to ask this Question. Because you are one of the most stunning examples I've ever seen in my career. What's your advice when you need to contradict your boss? When your bosses take this, you know, drink Clorox or whatever, and, you know, it's just absolutely wrong. What's your advice now when you have to contradict your boss, you don't want.

To contradict for the sake of contradicting, but you have to stick by your principles and your values. And when you're working in a situation where someone is saying or doing something that is dangerous to the health and welfare of others, you have a moral obligation to speak up. And that's how I felt when I had to do something that I wasn't happy with. I was not comfortable with it, but I had to publicly contradict the President of the United States. And I have a great deal of respect for the office of presidency of the United States, but I had to do it because I had to fulfill my responsibility to the American public. So my advice to people are, when it comes to important matters like the health of a population that you're responsible for, you just have to take the consequences of speaking up. And most of the time, the consequences are that people will agree with you. And if they don't, that's part of the risk you take of being in this kind of a profession.

I loved in your book the story of how your parents were both very concerned with human welfare and how that influenced your career path. I think a lot of parents are listening to this podcast. Can you just explain how your parents influenced you for the rest of your career?

Yeah. From the time I was a child, old enough to remember Guy, my father, and this is back in the 1940s and 1950s, he was the neighborhood pharmacist. He owned a pharmacy. And back then, the pharmacists are unlike now with the chain drugstores of CVS and Walgreens, which is somewhat very businesslike and impersonal. Whereas he was kind of like the neighborhood psychiatrist, the neighborhood doctor, the neighborhood counselor, and he cared very much about the community. So I, from the time I was able to understand things and reach the age of reason, I saw my family devoted to service to the community. And that really laid the foundation for me going into medicine and ultimately going into the public service concept of medicine. So they had a very, very strong influence on me, as did my schooling. I went to a Jesuit high school, a Jesuit college, and in those environments, the theme of my educational institutions was service to others. And that's been the Prevailing theme of my professional life, in the tradition of.

A president, outgoing president, writing a letter to the incoming president. Let's say you wrote a letter to the next National Institute of Allergy and Infectious Disease director. What would your letter say to him or her?

It's a her, and I respect her very much. It's Dr. Jeannie Marasco who took my place, and I think she already has the principles that I think are important for someone to direct an institute like that is stick with the science, be transparent, keep an open mind, and have a very passionate support of biomedical research. And I would put that in the letter, but I don't need to, because I think she already understands that.

Okay, and here's my last question, which might take some explaining, but my favorite story in your whole book is about how you were dealing with a patient who was wanting to go back to Brazil. And you don't speak Portuguese, so he was answering a question in Portuguese, and Christine, who became your wife, told you that? Yeah, he said he'll go back and be careful, but really, he was saying quite the opposite. And I want to know how it ever came out that finally Christine said, tony, let me tell you what he really said. How did that happen?

I can tell you exactly how it happened, Guy. I had been dating her for, oh, a couple of months, and I had fallen in love with her. So it was very clear that I was in love with her, with Christine. And Christine was in love with me. And we were sitting at a restaurant one day, and after the appetizers came, she says, you know, I have something to tell you. And I said, what? And she said, remember when I translated from Portuguese to English, what that patient told me? He didn't tell me that he was going to do what you said, namely, stay in bed, elevate his leg and take care of his wound because he had a vascular ulcer on his leg. He actually told me he was going to go to the beach, drink a lot of Kashasa, and dance all night. So at that point, it was really funny, and I bark out laughing.

That is one of the best stories I've heard in five years of interviewing people for remarkable people. I have to tell you, I just want to thank you. I want to thank you not just for this time to interview you, but really for your entire decades of service to public health. And I don't think life in America would be what it is without you and people like you. So thank you very much, Tony.

You're very welcome, Guy. Thank you for having me. It's A pleasure to be with you. Take care.

Alrighty. And oh, you know what, Are you on the board of directors of the Doris Duke Museum?

Yes, I am, because I was there.

Talking to the executive director. He says, yeah, Tony Fauci is on our board. I said, how in the world is Tony Fauci on a board on this thing in Diamond Head that has to do with Muslim art? What?

The Doris Duke foundation is a foundation that has multiple interests. One of them is in Hawaii. The other one is for Duke Farms in New Jersey. It's for medical education, it's for child welfare, it's for the performing arts. So it's a broad umbrella foundation that supports these noble causes. And one of them is Shangri La in Hawaii.

Literally Shangri La. Alright, Tony, I'm gonna let you go. Have a great weekend, Happy New Year, and I wish you all all the best. And oh, can I ask you, I swear, one last question? One last question. Okay, I promise you, don't pull me off. I just want you to tell me, like, I read this story that you got West Nile virus from a mosquito bite in your backyard. And I heard that. I said, so he treated thousands of HIV AIDS patients and he was standing on these podiums with people who weren't masked up and he did all these dangerous things and it comes down to a mosquito in his backyard gives him West Nile virus. Did I repeat that story right? Is there not some great irony there?

You bet it is. The irony of the year that an infectious disease doctor like myself, sitting in his own backyard in northwest Washington D.C. in the middle of the city, gets bitten by a mosquito and gets a disease that almost killed me. Because West Nile is a very serious disease. So I'm lucky to have recovered completely. But given my age guy, the seriousness of my illness, I'm very fortunate to have recovered completely.

That was an interview with a truly remarkable person. And the impact that he has had on human welfare is basically immeasurable, actually. And I hope you learned about infectious diseases, but also about public health and public service. He's just a stunning example of that. So this has been remarkable people. My thanks to Tony, of course, for being on the podcast and Madison producer co author Tessa Diesmer, who is the researcher. Louise Magana and Alexis Nishimura and Jeff C. And Shannon Hernandez. We are the Remarkable People team. And we not only want to make you remarkable in 2025, we want to keep you healthy. So that's why we have people like Tony Fauci. Until next time, thank you and mahalo and Aloha this is remarkable, people.