‘I had to fulfil my responsibility’: Fauci on his career, Covid and stepping down

Dr Anthony Fauci speaks to the Guardian via Zoom a couple of hours before his leaving do, marking the end of a 54-year career at the National Institute of Allergy and Infectious Diseases (NIAID).

"That's going to be done according to all public health guidelines," America's top public health official, wearing dark suit, blue shirt and blue-and-white polka dot tie, is quick to add. "People with masks and people online and people dialling in through Zoom, so it's not going to be the classical party."

There speaks a man who knows that there is nothing his legion of foes would love more than a scandal about the patron saint of the coronavirus pandemic response throwing caution to the winds at a bacchanalian super-spreader.

For just as he became a voice of authority and cult figure for millions - manifest in Fauci bobbleheads, candles, cupcakes, dolls, mugs, socks, T-shirts and yard signs - because he sticks to science, so Fauci has become a hate figure to millions more for the same reason. He has advised seven US presidents about a long list of outbreaks including HIV, Ebola, Zika, bird flu and pandemic flu, but one stands out: Donald Trump.

When Covid-19 emerged from China in late 2019 it was America's epic misfortune to have a president who reportedly made more than 30,000 false or misleading statements over four years, and who reportedly wanted to use nuclear bombs to stop hurricanes from hitting the US, at a moment when scientific truth was everything. More than a million Americans have died in the pandemic, the highest recorded death toll in the world.

Now that Fauci is stepping down, will he speak freely about Trump's response to what his advisers warned him would be the biggest national security threat of his presidency? Up to a point.

"I don't want to get into sharp criticisms," he says. "I think it speaks for itself. Obviously, I was put in an uncomfortable position of having to directly contradict what the president said because what he was saying was not based on any science or data and was, quite frankly, totally incorrect about hydroxychloroquine and bleach and ivermectin, when the virus is going to disappear like magic.

"I didn't like having to be contradictory to the president but I had to do it. There are some good things that happened. Operation Warp Speed [the federal effort to develop and distribute vaccines] is a resounding success and you have to give the Trump administration credit for doing that."

When Fauci was born in Brooklyn, New York, on Christmas Eve in 1940, Franklin Roosevelt had just been re-elected for a third term in the White House and Adolf Hitler was on the march in Europe. Fauci captained his school basketball team but was too short in stature to make a career of it. He studied humanities, philosophy, Greek and Latin and just enough science to get into medical school.

"I always had that feeling of wanting to serve people," he recalls. "I probably got that feeling and that background from my parents; it was fortified in my training in school. I went to a Jesuit high school and college and the theme of the Jesuit training is service for others and I could not think of a better way to serve others than by being a physician or a scientist."

After a fellowship and training in residency at the New York Hospital-Cornell Medical Center, Fauci joined the NIAID in Bethesda, Maryland, as a clinical fellow. He completed his training in 1972 and spent years successfully developing therapies for inflammatory disease (autoimmune diseases). But then, in 1981, came a mysterious scourge that would become known as Aids.

Fauci says: "It was a most unique, somewhat frightening, somewhat exciting situation to be in when you're dealing with a dramatically serious disease. You knew it was an infection but you did not know what the aetiology was. For the first few years [there was] the mysterious nature of an illness that was killing almost all of your patients.

"I went from a situation of being very successful in saving patients from 1972 to 1981 to what I refer to as the dark years of my professional life because almost all of my patients died and it was a most unusual and difficult experience."

He adds: "Every one of the patients were desperately ill and died and it was very frustrating because we would train physicians as healers and we weren't healing anybody. It was like putting a Band-Aid on a haemorrhage because everyone would be deteriorating before our very eyes no matter how hard we tried to do something to help them. As soon as you treated one opportunistic infection, another one would pop up and then another one and then another one and that was the real down feeling of frustration and sadness."

With the first anti-Aids medications still elusive, as the Reagan administration of the 1980s gave way to the first Bush administration in the early 1990s, furious activists protested against what they saw as government indifference. Protesters gathered outside the National Institutes of Health to condemn Fauci as a "murderer" and holds placards that said: "Dr Fauci, you are killing us." They even burned him in effigy and carried a mock-up of his head on a stick.

"I knew it was nothing personal against me. I represented the federal government and they wanted the attention of the federal government. In order to get attention, they had to be theatrical, iconoclastic and confrontative and they were, by putting signs up: you're a murderer, you're killing us."

Fauci ventured to a lesbian and gay community centre in New York's Greenwich Village to meet with angry activists. He would go on to bring them to the table, making it standard practice for patient advocates to have a voice in government decisions about research. Drugs were finally developed to turn around HIV and bring new hope to people living with the virus.

"One of the best things I've ever done in my entire life was to drop back and say, wait a minute, let me put aside the theatrics and the confrontation and listen to what they're saying. When you listened to what they were saying, they made perfect sense. In fact, so much so that they converted me to their activism side and we went from being confrontative with them to being collaborative to being cooperative to actually winding up being friends and colleagues."

But he reflects: "That's very different from the pushback we're getting today, where you have conspiracy theories and ad hominem attacks on people. It's so different between the good causes of the activists in the 80s and 90s with HIV and the destructive activities now of the people who are trying to be anti-science and tear down science."

This war on science was costly. The coronavirus outbreak, a moment of national crisis that should have brought Americans together, only drove them further apart as face masks became politicised totems, as divisive as abortion or guns, and disinformation thrived online.

Independent models suggest that if people had adhered to the recommendations for vaccination, a further 200,000 to 300,000 lives would have been saved. Ron DeSantis, the governor of Florida and potential presidential candidate, once championed vaccines but is now moving further right of Trump by attacking them.

Fauci, at the end of his career, found himself turned into a household name. Thousands of people signed a petition to make him People magazine's "sexiest man alive" and he was played by Brad Pitt on the late-night comedy show Saturday Night Live. But Trump and his allies began attacking Fauci, who even received death threats that required a security detail for his protection.

At the time, however, his interactions with the president were perfectly cordial. "He was never disrespectful," Fauci recalls. "The 'Fire Fauci', 'he doesn't know what he's talking about', 'everything he said was wrong' was after I no longer was with him.

"But when I was with him and seeing him in person in the Oval Office, he was fine. I didn't agree with what he was saying but he was not aggressive against me. He was a gentleman about it. It's just that I disagreed with some of the things he was saying."

But what about those excruciating White House press briefings where Fauci was forced to stand poker-faced on the podium as Trump riffed from his multiverse of madness. On one occasion, Trump jokingly referred to the state department as "the deep state department"; later a YouTuber zoomed in on Fauci's despairing reaction and added theme music from the TV comedy Curb Your Enthusiasm.

The scientist insists: "It only became uncomfortable when somebody asked about hydroxychloroquine. He said, oh, it's great, it's the wonder drug, it's going to cure.' Then one of the reporters raised their hand and said, what do you think, Dr Fauci? That's when I had to walk up to the podium and say, 'No, I'm sorry, I don't agree,' and that was tough but I had to do it because I had to fulfil my responsibility to the American public."

On another night for the ages in April 2020, Trump speculated on whether injecting disinfectant might offer a "cleaning" of the lungs. Deborah Birx, the pandemic response coordinator sitting nearby, said nothing. She later said she felt "paralysed in that moment because it was so unexpected".

Should Birx have spoken out there and then? Fauci is characteristically diplomatic. "You're going to have to ask her about that. I don't want to be making any comments about what she should or should not have done."

America's entire pandemic response will be debated for decades and Fauci will be impossible to divorce from it. Some say the closures of school and other institutions were too draconian, even though many European countries went further. China's extreme lockdowns appear to have backfired amid social unrest and a fresh surge of Covid this winter.

Fauci is willing to let history judge. "The only thing I can say is that we tried our best given our best judgment and our analysis of what was going on around us to make recommendations.

"I don't think anybody got it completely 100% right but the idea to say that you should have not put any restrictions on anything at a time when there was a tsunami of infections and New York City hospitals were getting overrun, practically - think of Elmhurst hospital, remember those pictures of the cooler trucks with bodies piling up in that - you had to do something pretty significant to slow that down.

"Shutting down temporarily, I believe, was the right thing to do. If you look at the record and go back to the clips, you'll see how many times I said, we've got to try our best to get the kids back to school as quickly as we possibly can and as safely as we possibly can. On the one hand, I was in favour of shutting things down temporarily, but I certainly felt we needed to open up as quickly and as safely as we could."

There is little appetite for restrictions now. Yet America is going into the holiday period facing a combined wave of Covid, respiratory syncytial virus (RSV) and influenza - and just 14% of people eligible for the updated Covid boosters have had them. Did Joe Biden lift protocols and mandates too soon?

Fauci says no. "He's done it to the best of our advice and his judgment. It's been done well. I do believe that."

In September Biden told the TV programme 60 Minutes: "The pandemic is over," even as nearly 400 people a day were still dying. Did the president speak too soon? Again, it's a no.

"He was talking about it's much better off now than we were back then. He's fully aware that we have a challenge ahead and that's why he's out there with us talking about why it's so important for people to get that updated booster. He's been very active in that. He's been quite upfront about the challenge ahead."

Fauci's last official day at the NIAID is 31 December. It will be bittersweet. He has been driving to that same campus every day, including most Saturdays, for 54 years and has been NIAID director for 38 (a committee has been set up to find a successor).

But he is not retiring in the classic sense. For his next chapter the octogenarian will continue to write, lecture and advise. And don't be surprised to see him back in verbal combat on Capitol Hill as Republicans, soon to control the House of Representatives, investigate the pandemic response (egged on by the likes of Elon Musk, who recently tweeted: "My pronouns are Prosecute/Fauci").

"It's going to be obvious when you see what happens whether it's good faith or not," Fauci says. "I know they've promised to pull us before the Congress and do all kinds of things. I am perfectly fine with oversight. I have a great deal of respect for the process of oversight of one branch of government with the other and I would be perfectly willing to appear before the Congress if they ask me to, because I have nothing to hide.

"I can defend and explain virtually everything I've done, which has been nothing other than to provide for the American public my best recommendations based on good public health principles. That's exactly what I've done in good faith throughout the entire outbreak and I've done that, in fact, throughout my entire tenure as director of the institute, which is now almost 40 years. So I have no problem at all with going before the Congress and explaining what we've done."