Глава 1
From Brooklyn to the Frontlines: The Journey of a Medical Maverick
On a crisp November day in 2020, a simple phone call changed everything. Sitting in a neighbor's backyard with his wife Christine, part of their pandemic "COVID pod," Dr. Anthony Fauci stepped away to take a call from Pfizer's CEO Albert Bourla. After nearly a year of 16-hour workdays combating a virus that had already claimed 230,000 American lives, Fauci wasn't prepared for the news: Pfizer's vaccine showed over 90% efficacy. Tears welled in his eyes as he comprehended the magnitude of this breakthrough-a game-changer developed in just ten months. A week later, Moderna announced similar results. This pivotal moment came just six weeks before Fauci's eightieth birthday, representing the culmination of a remarkable journey from Brooklyn to becoming America's doctor during the most significant public health crisis of our lifetime.
The book "On Call" has become a cultural touchstone, reaching #1 on the New York Times bestseller list and earning praise from figures ranging from President Obama to Oprah Winfrey. Its appeal transcends political divides, offering rare insight into how science, medicine, and public service intersect at the highest levels of government during times of crisis.
Глава 2
From Bensonhurst to Medical Excellence: The Making of Dr. Fauci
Born on Christmas Eve 1940 to first-generation Italian Americans, Anthony Fauci grew up in Brooklyn's tight-knit Bensonhurst neighborhood. When he was eight, his father purchased Fauci Pharmacy in Dyker Heights, moving the family to the apartment above-a modest step up the economic ladder. Though they relocated just eight blocks away, it felt like leaving the country given their tight neighborhood culture.
Young Tony thrived in this environment, excelling academically while developing a passion for sports, particularly basketball and baseball. In the neighborhood hierarchy, you were either an athlete or a tough guy-there was no room for admitted bookworms. The neighborhood ethos shaped his character, teaching him resilience and pragmatism that would serve him well throughout his career.
His parents embodied values that would define his life's work. His mother, described as beautiful, petite, and empathetic, showed deep compassion for human suffering. His father, a shy, ethical, religious man, worked tirelessly six days a week in his pharmacy, which became more than just a business-it was a combination doctor's office, pharmacy, and "psychiatrist's couch" for the neighborhood. His father's extraordinary generosity, keeping running tabs for customers who couldn't pay, frustrated young Tony but instilled in him a profound sense of service to others.
The family's Italian heritage remained central to their identity, with Sunday dinners rotating between their home and grandparents' houses, featuring multi-course Italian feasts. When children weren't supposed to hear adult conversations, the language switched seamlessly to Italian-a cultural touchstone that connected him to his roots.
His academic journey took a decisive turn when he qualified for the elite Jesuit-run Regis High School in Manhattan. Despite the three-subway, hour-long commute each way, he embraced this opportunity. On his first day, when he introduced himself as Anthony Fauci, Father Michael Flanagan called him "Tony"-and the name stuck for life. At Regis, he thrived in the intellectually rigorous environment with its classical curriculum and "Men for Others" motto that perfectly aligned with his family's values.
Though he became captain of the basketball team, encounters with superior players like Alan Seiden made him realize his dreams of playing college basketball were unrealistic. As Coach Lou Carnesecca later joked when they received Lifetime Achievement Awards together, "Tony, I have taught a lot of young basketball players a lot of skills and tricks, but I know for sure, you cannot teach someone height."
Глава 3
The Crucible of Medical Training: Finding Purpose in Patient Care
Fauci's medical education at Cornell was transformative, with his third and fourth years bringing pure joy as he began working directly with patients. He quickly recognized the importance of combining the art and science of medicine-providing care, compassion, and comfort alongside scientific precision. This holistic approach would become his hallmark throughout his career.
During his fourth year, personal tragedy struck when his mother visited him complaining of weakness and bloating. His attending physician diagnosed her with cancer, and she died just eight weeks later. With no luxury to properly grieve, he buried her and was back on call the next night-an early lesson in the emotional resilience required in medicine. Six months later, he graduated number one in his class.
His years of internship and residency were when he truly found himself. Mentors noted his "instinctively good clinical judgment" and ability to remain calm under life-and-death circumstances. He developed a strong interest in infectious diseases, attracted to conditions that could be serious enough to kill but could be prevented, treated, and cured. This led him to apply to the NIH, where he was interviewed by Dr. Sheldon "Shelly" Wolff, who became his mentor and hired him for a fellowship in infectious diseases and clinical immunology.
Under Wolff's tutelage, Fauci thrived. Wolff was an excellent physician and scientist, street-smart from Newark with an uncanny ability to spot talent in young physicians and give them independence while offering support. Ten years Fauci's senior, he became more than a mentor-something between an older brother and uncle, tempering Fauci's emotions with wisdom whenever he got worked up about academic setbacks.
Fauci's research focused on the emerging field of human immunology, particularly vasculitis syndromes like Wegener's granulomatosis (now called granulomatosis with polyangiitis), which had nearly 100% mortality. Their treatment protocols using cyclophosphamide and steroids achieved a remarkable 93% remission rate. Despite professional success and recognition, by age forty he felt unchallenged, dealing with unusual diseases lacking broad public health impact. He was at a crossroads-until a mysterious new disease would change everything.
Глава 4
The AIDS Crisis: Medicine's Darkest Hour
On a summer Friday afternoon in 1981, while sorting through mail at his NIH office, Fauci came across the CDC's Morbidity and Mortality Weekly Report describing five previously healthy homosexual men with Pneumocystis carinii pneumonia in Los Angeles. This puzzled him-this type of pneumonia typically only affected people with severely compromised immune systems. Initially dismissing it as a curiosity, a month later he read another report that gave him goose bumps: twenty-six homosexual men with the same pneumonia, some also with Kaposi's sarcoma and other rare infections only seen in immunocompromised patients.
The pattern suggested a new infectious agent-something beyond comprehension, as he hadn't heard of such a thing in recent history. He had no idea that this mysterious disease would ultimately afflict millions worldwide and profoundly impact his entire life and career.
By February 1982, his team was ready to receive AIDS patients at NIH. During a blinding snowstorm, he received a call about their first patient, Ronald Rinaldi, who had a healthy identical twin. The years from 1982 until the late 1980s were the "dark years" of his medical career, consuming him completely.
Ron's case exemplified their helplessness. Despite treatments including bone marrow transplantation and lymphocyte infusions, his condition deteriorated. One evening during rounds, when Fauci greeted him with a smile, he responded with "Who's there?"-he had gone completely blind from cytomegalovirus infection. After comforting him, Fauci returned to his office and burst into tears-not just from sadness, but from profound frustration and anger. This was just one of hundreds of similar stories on their ward.
The grief they experienced was chronic and pervasive. As physicians trained to heal, they felt helpless watching wave after wave of young men receive death sentences. They couldn't give up-burnout wasn't an option. The patients needed their clinical skill and empathy even if they couldn't cure them. Years later, Fauci recognized he had a form of PTSD from this period, as did many colleagues who worked in the AIDS trenches-though their suffering was nothing compared to that of their patients and their families.
Глава 5
From Laboratory to Leadership: Taking the Helm at NIAID
In summer 1984, NIAID director Richard Krause accepted a position at Emory, and Fauci was considered a top candidate to replace him. Though he loved his lab work and patient care, the opportunity to advocate for increased infectious disease funding, particularly for AIDS research, intrigued him. When NIH director James Wyngaarden offered him the position, he accepted with two non-negotiable conditions: continuing his AIDS research as Laboratory of Immunoregulation chief and maintaining patient care responsibilities.
At 43, he became possibly the youngest NIH institute director ever. He spent six months learning the institute thoroughly before implementing his vision, discovering a lack of urgency among senior staff toward AIDS research. Despite protocol against "budget busting," he advocated for doubling the AIDS budget and succeeded, increasing it from $66 million to $147 million for FY 1986. This taught him valuable lessons about challenging conventions and building relationships to advance legitimate causes.
As NIAID director, he wanted to witness the AIDS epidemic firsthand in its epicenters, starting with Greenwich Village. This area held deep personal significance-his parents were born in nearby Little Italy, and he had fond memories of visiting as a child and enjoying its vibrant culture as a student and young doctor. But in 1985, he was shocked by what he saw. Young men with telltale Kaposi's sarcoma spots on their faces and physical wasting walked the streets. The positive electricity of the neighborhood had been replaced by an atmosphere of pain, suffering, and imminent death.
Hospital visits in Manhattan, Brooklyn, and San Francisco revealed the same devastating reality-20 to 40 percent of beds occupied with AIDS patients. It was clear they needed a highly focused research effort, which led him to create the Division of AIDS within NIAID-an unprecedented move that faced considerable pushback as there had never been a research program devoted to a single disease. This was his first real introduction to the sometimes painful process of leadership. He rejected the concept that he was paying too much attention to a disease affecting only a few thousand people that many thought would disappear.
He learned that a leader in controversial areas cannot make everyone happy-if you do, you're probably not a good leader. Having doubled the AIDS budget and created the Division of AIDS, he now faced the challenge of persuading the White House, HHS, and Congress to commit even more resources to entice the best scientists and public health experts to join the struggle.
Глава 6
From Adversaries to Allies: The Activist Revolution
By the early 1980s, the gay community was deeply frustrated with the government's inadequate response to the AIDS epidemic. President Reagan hadn't publicly mentioned AIDS until September 1985, by which time over 15,000 cases and 8,000 deaths had been reported. As the new NIAID director, Fauci felt responsible not only for conducting research but also for speaking out about the pandemic's seriousness.
Larry Kramer, the undisputed father of AIDS activism, began as a successful screenwriter whose screenplay for "Women in Love" earned him an Academy Award nomination. His controversial 1978 novel "Faggots" predicted health catastrophes for the gay community years before AIDS emerged. In 1981, Larry gathered friends in his Greenwich Village apartment, forming what would become Gay Men's Health Crisis. Frustrated with what he saw as community apathy, he left to form ACT UP in 1987, which became the prototype for disease advocacy organizations.
Despite Kramer's confrontational style-calling Fauci a "murderer" in the San Francisco Examiner for not demanding enough AIDS funding-Fauci understood his anger and refused to dismiss him. In February 1989, he made a pivotal decision to invite protesters into his office, marking the first time a government official had engaged activists as equals on government turf. This meeting transformed his relationship with the activist community and expanded his role beyond NIAID director to becoming their advocate within the federal bureaucracy.
Marty Delaney's impact extended far beyond their initial "parallel track" victory. He became Fauci's trusted advisor, calling him at home at 11 PM East Coast time with his trademark opening: "I figured that you would be awake, so can we talk?" In twenty minutes, Fauci would learn more about the frontline realities than from five official briefings. Despite their friendship, he remained brutally honest: "Tony, this clinical trial is not asking the right question." His counsel proved so valuable that Fauci appointed him to NIAID's AIDS Research Advisory Committee and National Advisory Council.
Though the parallel track victory improved Fauci's standing with some activists, disagreements persisted about research priorities and community input. He tried addressing these by making himself available and meeting activists on their turf. Against his staff's objections, he invited activists to previously closed NIAID AIDS Clinical Trials Group meetings. When a senior official rudely introduced them, he was furious and asked him to find another job. This decision to include activists proved invaluable, as their input helped design user-friendly clinical trials.
By 1992, key activists formed the Treatment Action Group (TAG), shifting from confrontation to scholarly policy work. Meanwhile, Larry Kramer remained complicated-during a meeting in Montreal, he urged Fauci to "chain myself to the White House fence." As their relationship evolved, Larry worried their growing friendship would compromise his ability to attack him. After a heated exchange on Nightline, Larry called him afterward acting as if nothing had happened. Despite his portrayal of "Dr. Anthony Della Vida" as complicated in his play "The Destiny of Me," they developed a deep friendship. When Larry's health deteriorated from HIV and hepatitis B, Fauci admitted him to NIH-life imitating art. Before his death in May 2020, their final conversation ended with mutual expressions of love-a complex relationship, indeed.
Глава 7
The Lazarus Effect: Transforming AIDS from Death Sentence to Chronic Disease
By the mid-1990s, with no vaccine in sight, effective antiretroviral drugs became the holy grail. After AZT's approval in 1987, progress was incremental until pharmaceutical companies developed a new class of drugs called protease inhibitors. Initially, these drugs were tested as single agents, which often led to rapid resistance. Merck nearly abandoned their protease inhibitor program until Fauci strongly encouraged his colleague Ed Scolnick to pursue combination therapy.
When indinavir was combined with AZT and 3TC (which targeted a different viral enzyme), the results were stunning-virus levels dropped below detection and patients showed dramatic clinical improvement. These results were presented at the International AIDS Society meeting in Vancouver in July 1996 to thunderous applause. As soon as the session ended, CNN rushed Fauci out for an interview, and the news exploded globally. AIDS was no longer a death sentence.
The impact was immediate and profound. Patients who had been near death walked out of hospitals within weeks of starting combination therapy. They called it the "Lazarus effect"-people who had been preparing to die now needed to plan their futures. Hospices closed due to lack of patients. HIV/AIDS transformed from a hospital disease to one managed in outpatient clinics. Treatment evolved from twenty pills daily to a single daily pill by 2006.
This breakthrough exemplified the synergy between NIH-funded basic science and pharmaceutical innovation. By 2007, a twenty-year-old with HIV on combination therapy could expect to live into their seventies-a life expectancy approaching that of the general population. Despite some long-term toxicities, studies clearly showed that immediate treatment was far better than delaying it. By 2015, guidelines recommended treating all HIV-positive people immediately, which both prevented illness and eliminated transmission to sexual partners. This represents one of the greatest achievements in medical history.
Despite these advances, a global disparity emerged. By 2000, AIDS was no longer a death sentence-but only if you lived where AIDS drugs were available. Fauci's joy for patients who would have previously died was tempered by the reality that millions in developing countries, especially sub-Saharan Africa, were dying simply from lack of access to these lifesaving drugs.
The prohibitive cost of antiretroviral drugs ($15,000-$18,000 annually per patient) put treatment beyond reach for most in developing countries. In May 2000, President Clinton issued an executive order to help developing countries import and produce generic HIV drugs without trade retaliation. That same year, both the U.S. government and UN Security Council declared HIV/AIDS a global security threat, recognizing its impact on political and economic stability.
Глава 8
PEPFAR: The Greatest Humanitarian Achievement of a Generation
In January 2003, after months of secret planning with a small White House team, Fauci spent an entire day helping draft the State of the Union announcement for what would become the President's Emergency Plan for AIDS Relief (PEPFAR). That night, watching President Bush announce the $15 billion initiative to prevent 7 million infections and treat 2 million people brought tears to his eyes.
The genesis of this program began with Fauci's 2001 trip to Uganda, which crystallized his concern about the AIDS crisis. At Mulago Hospital's antenatal clinic, HIV positivity among pregnant women had dropped from 40-50% to 20% through counseling-still devastatingly high. The clinic was packed with women, many visibly suffering from AIDS, who could afford minimal treatment for opportunistic infections but had no access to the antiretroviral drugs saving lives in developed countries.
The hospital wards were horrifying-beds jammed together, patients overflowing into hallways and verandas. Most couldn't afford treatment for opportunistic infections, let alone antiretrovirals. Fauci remembered a frightened 17-year-old girl with HIV and likely cryptococcal meningitis who couldn't receive proper diagnosis or treatment, and a man in his thirties with untreated HIV and tuberculosis.
Nine months after his return, as the Global Fund was established in January 2002, President Bush sent Tommy Thompson and Fauci to assess the situation in several African countries. Fauci returned convinced that preventing mother-to-child HIV transmission was an immediate priority. With Dr. Mark Dybul's help, they developed a five-year plan to save 146,000 babies annually for about $100 million per year.
On May 29, 2002, Fauci presented this plan to President Bush in the Cabinet Room. Despite an awkward turf battle between USAID Administrator Andrew Natsios and Tommy Thompson, the president approved the plan, saying simply, "I like Tony's plan, and so let's implement it."
After the successful meeting, Treasury Secretary Paul O'Neill invited Fauci to breakfast to discuss his recent Africa tour with Bono, where they'd witnessed the devastating impact of HIV/AIDS, particularly on children. On June 19, 2002, Fauci joined President Bush in the Rose Garden to announce the $500 million Prevention of Mother to Child Transmission program. But Bush had bigger plans-he asked Fauci to work with Josh Bolten on a much broader global HIV/AIDS initiative, saying, "As a rich country, we have a moral responsibility to not allow people to die from a preventable and treatable disease because of where they happened to have been born."
PEPFAR became the largest global health initiative for a single disease by any country in history. Today, over $100 billion has been spent through PEPFAR in more than fifty countries, saving twenty-five million lives and counting-a testament to what can be achieved when science, compassion, and political will align.
Глава 9
From Ebola to COVID: When Nature Becomes the Ultimate Bioterrorist
Throughout his career, Fauci had warned that nature was a more formidable bioterrorist than any human group. This belief was validated repeatedly, from the SARS outbreak of 2003 to the Ebola crisis of 2014-2015, and ultimately with COVID-19.
When Ebola reached American shores in 2014, Fauci was mobilized to calm public fears, appearing on all five major Sunday TV shows on October 19. Nina Pham, a nurse who contracted Ebola while caring for a patient in Dallas, arrived at NIH's Special Clinical Studies Unit on October 16. Fauci, who had recertified himself to care for Ebola patients, greeted her with other senior staff.
With no approved Ebola treatments, they provided supportive care including IV fluids and fever control. As Nina improved and virus levels decreased, Fauci could enter her room with modified protective gear, developing a rapport with her and her family. As she prepared for discharge, she worried about stigmatization. To counter this, Fauci publicly hugged her at her October 24 discharge ceremony, a gesture photographed and shared worldwide.
In January 2020, just two days after being alerted by a reporter about a mysterious virus from China, Fauci gathered NIH scientists to begin vaccine development for what would become known as COVID-19. Barney Graham, a leading vaccinologist at NIAID's Vaccine Research Center, promised to start work on a vaccine within days of receiving the viral genomic sequence. Their collaboration with Moderna on mRNA vaccine technology-pioneered by Nobel Prize winners Katalin Kariko and Drew Weissman-provided a faster, more precise platform than traditional vaccine development methods.
For months, Fauci divided his time between NIAID and the White House, even canceling a birthday trip with his wife Christine. By February 11, when WHO officially named the disease COVID-19, the task force was addressing issues like the Diamond Princess cruise ship with infected Americans while vaccine development progressed rapidly with both Moderna and Pfizer-BioNTech using Graham's stabilized spike protein design.
When COVID devastated Italy in February, Fauci's Italian colleagues warned him they were being overwhelmed despite their first-rate healthcare system. This convinced him America would face a similar disaster. What worried him most was community spread, particularly in Seattle. When his colleague Larry Corey reported that 1% of people with flu-like symptoms tested positive for COVID, Fauci knew this represented just the tip of an iceberg.
Глава 10
Truth in a Time of Crisis: The Personal Cost of Public Service
As the COVID-19 pandemic unfolded, Fauci found himself in an increasingly difficult position. He realized this wasn't the White House he'd known since the Reagan administration. The president's hostility toward the press was jarring, and he knew his presence might be interpreted as acceptance of this behavior. More problematic was that he knew some of Trump's claims about the pandemic were false, and he had to contradict them.
He approached this challenge by treating the American public as his patient-following the medical principles of honesty, humility, and realistic reassurance. He took no pleasure in contradicting the president, but felt he had a responsibility to tell the truth. When Trump made a "Deep State Department" joke during a briefing, Fauci put his hand to his forehead in dismay-a gesture that was caught on camera and made him a hero to some and enemy to others.
This led to serious threats against his family, with his wife and daughters receiving harassing messages and death threats. Despite his anger, he remained focused on his work, though physically it took a toll-he was sleeping only four hours nightly, losing his voice, and dropping weight until Christine insisted he take better care of himself.
By early April, as COVID cases and deaths rose dramatically across America, his relationship with the administration grew increasingly strained. During a Situation Room meeting, Peter Navarro burst in and aggressively accused him of having "blood on your hands" for not endorsing hydroxychloroquine, dumping unreviewed papers on the table. He was stunned by this unprecedented breach of decorum, though Vice President Pence eventually ended the confrontation.
The issue of masks perfectly encapsulated the contradictory messages from the administration. When the CDC recommended everyone wear cloth masks in April, President Trump announced the guidelines but promptly added he wouldn't wear one himself: "I just don't want to wear one... sitting in the Oval Office behind that beautiful Resolute Desk... I don't see it for myself." This instantly politicized masks-those refusing to wear them were seen as supporting the president, while mask-wearers were viewed as surrendering liberty.
On January 21, 2021, Fauci's first White House briefing under President Biden felt "somewhat of a liberating feeling" as he promised transparency, honesty, and science-based decisions. Under President Biden, the White House COVID-19 Response Team comprised physicians and public health professionals dedicated full-time to the pandemic. Biden insisted on meeting with them regularly in the Oval Office, sitting informally by the fireplace to encourage open discussion.
Despite the White House return to normalcy, the political divide in America had worsened. In March 2021, Senator Rand Paul aggressively challenged Fauci during a hearing, claiming masks were "theater" for vaccinated people. A month later, Representative Jim Jordan demanded to know when Americans would get their "liberty and freedoms back," accusing Fauci of assaulting Americans' rights.
Глава 11
Legacy of Service: Lessons for Future Generations
On January 1, 2022, as the pandemic entered its third year, U.S. cases peaked at over one million in a single day. Hospital systems were severely stressed, though by month's end, cases began to plateau and decline. Despite Omicron affecting both vaccinated and unvaccinated people, the data showed vaccinated and boosted individuals had a forty to fifty times lower chance of dying from COVID compared to the unvaccinated.
Looking back, Fauci saw the COVID response in two buckets: scientific and public health. The scientific response was exemplary-developing safe, effective vaccines in under eleven months through public-private partnerships built on decades of research investment. The public health response, however, revealed America's weaknesses: an antiquated, understaffed infrastructure; healthcare disparities affecting minorities and low-income communities; high rates of underlying conditions; lack of real-time data; ineffective contact tracing; and unclear CDC communications.
With hindsight, he acknowledged they should have better communicated their limited knowledge and the evolving nature of the pandemic. They later discovered aerosol transmission and asymptomatic spread were more significant than initially thought, which would have influenced earlier recommendations on masks and distancing. The pandemic revealed how political division hampered the response-like an army at odds with its navy instead of focusing on the common enemy.
By August 2022, Fauci had decided to step down from all positions, including chief medical adviser to the president. He publicly announced his retirement on August 22, saying he hoped to be remembered as "someone who gave my all 24-7, and left it all on the field." While he received gracious messages from former presidents and people worldwide, some politicians were less kind, vowing investigations and making threats.
On January 4, 2023, he walked down the hall for the final time, looking back at the building that had been his second home for almost forty years. As he drove away from NIH, he grasped the extraordinary breadth of his fifty-four years of service. What began as a career in infectious diseases became something he never expected-a life at the center of global health crises.
From AIDS to bioterrorism threats to COVID-19, he followed his passion for science and medicine, taking risks without being intimidated by challenges or self-congratulatory about triumphs. He's immensely proud of helping enable people with HIV to live normal lives and grateful to President Bush for involving him in PEPFAR, one of history's most important lifesaving initiatives. The COVID pandemic consumed his final three years, culminating a half-century journey where he did everything possible to promote sound public health practices aimed at saving lives-a legacy that will inspire generations of scientists and physicians to come.
