Fauci responds to Musk’s Twitter attack and rates world’s COVID response
Interview by Max Kozlov
This month, Anthony Fauci will step down as director of the US National Institute of Allergy and Infectious Diseases (NIAID) after more than 38 years in the post and 54 years at the US National Institutes of Health (NIH). The 81-year-old physician-scientist has overseen NIAID’s response to HIV/AIDS, COVID-19 and other diseases. During the COVID-19 pandemic, he was revered by some and disparaged by others, including former US president Donald Trump. On 11 December, he was attacked on Twitter by Elon Musk, who took over the social-media platform in October. Fauci spoke to Nature about Musk’s comments, the pandemic and his own legacy. In which area of infectious disease have we made the most progress in recent decades? One of the most important is HIV. In 1981, when we first became aware of the cases of HIV, [it was] a mysterious disease of unknown aetiology that was killing virtually everybody who was infected. It was one of the darkest periods of my or anybody’s professional career in infectious diseases. We went from that bleak time of not knowing what was killing all of these mostly young gay men to getting the [underlying virus], a diagnostic test and, within a few years, an entire series of drugs that, when used in combination, have completely transformed the lives of people with HIV. We have also developed highly effective prevention methods. Where will we see the next revolution in infectious disease? We’ve made spectacular advances in the development of therapies. But the one thing that’s eluded us up to now has been a safe and effective vaccine. So that’s one of the things we look forward to. The other is the possibility, although it’s a stretch, in some respects, to have a cure for HIV, where you can have durable suppression or elimination of virus in the absence of any further therapy. Former NIH director Francis Collins lamented the lack of behavioural-science research to better understand public health misinformation. Should we rethink how we incorporate social science into ‘hard’ biomedical science? Yes. It’s not that difficult to incorporate a discipline of social sciences into the discipline of the hard sciences of developing vaccines. It is very disturbing that, in our country, we have 68% of the total population vaccinated with the primary vaccine for COVID. Of those, only half have received a single booster. And importantly, [despite] the availability of an effective updated booster, only 13% of the eligible population has received it. That is almost embarrassing for us. During the pandemic, we’ve seen governments censor scientists and distort data, which makes international collaboration to prevent pandemics difficult. How can researchers toe this tricky line? That’s impossible to answer. If there are countries or groups that are not transparent, that’s a big hindrance to the global publichealth effort. And I would hope that all the countries of the world come to a realization that we’ve got to be completely cooperative, collaborative and transparent, because there’s no such thing as a pandemic, particularly of an infectious disease spread by the respiratory route, that’s going to stay in one country. We saw that very painfully with how COVID spread throughout the world and has already resulted in close to seven million deaths, and that’s probably a gross underestimate. How would you score the world’s response to the pandemic? The global community, including the United States, could have done better. The one success story has been the rapid development and deployment of vaccines. What has not been as successful is the public-health response. Take this country as an example. Over the decades, we have let our public health system atrophy [by] not replacing people who leave, not keeping equipment up to date, not getting [information] accessible in real time. We’ve had to go to other countries to get real-time information: the United Kingdom, Israel, South Africa. Entrepreneur Elon Musk has called for your prosecution, claiming that you lied to Congress and funded research that killed millions of people. How do you respond? I don’t pay attention to that, Max, and I don’t feel I need to respond. I don’t tweet. I don’t have a Twitter account. A lot of that stuff is just a cesspool of misinformation, and I don’t waste a minute worrying about it. Do you feel that your safety is at risk, given Musk’s enormous reach on Twitter? Of course it’s at risk. That’s why I have armed federal agents with me all the time. That stirs up a lot of hate in people who have no idea why they’re hating — they’re hating because somebody like that is tweeting about it. How do you advise early-career scientists who might be rethinking their career choices after seeing the vitriol directed at health officials during the pandemic? I would encourage them not to be deterred, because the satisfaction and the degree of contribution you can make to society by getting into public service and public health is immeasurable. It’s really extraordinary. It overcomes and counters all of the other bad stuff. It’s unfortunate that we are going through the attacks on publichealth officials. But the satisfaction and the accomplishments you can [achieve] in the field are great. I understand you’re still formulating your plans after you leave the director post, is that right? Well, I’m going to write and lecture, and possibly [write] a memoir. But I’m certainly not going to retire in the classic sense.