On Call: A Doctor's Journey in Public Service

Fauci reflects on the intense pressures and frequent conflicts within the COVID task force during the pandemic’s early days. For example, Fauci recounts a confrontation with Peter Navarro, a White House adviser, who forcefully advocated for hydroxychloroquine, despite insufficient scientific evidence that the drug was effective. This incident set the tone for the ongoing challenge Fauci faced throughout the COVID-19 pandemic, when he had to balance scientific recommendations with the administration’s varying stances.

President Trump’s shifting views created additional complications. Fauci describes the President’s determination to reopen the economy by Easter, which Fauci had to counter, stating that the virus did not take religious holidays into account. The messaging was complex; while Trump often expressed support for the task force’s caution, his public actions and statements, such as his “LIBERATE” tweets, in which he contradicted his own earlier decision to extend the lockdown (371). Trump, Fauci recounts, frequently contradicted expert advice, creating confusion and fueling public resistance.

In May 2020, President Trump launched Operation Warp Speed, which focused on vaccine development. However, Fauci’s guidance faced opposition, as White House figures like Mark Meadows scrutinized his media comments, perceiving them as alarmist. Fauci’s media limitations, paired with misinformation and attacks from figures like Peter Navarro, were all part of the administration’s divergent pandemic strategies. This political tension escalated into personal safety threats for Fauci. One notable incident happened in August 2020, when Fauci opened a letter sent to him, which contained a white powder that contaminated him. He feared an anthrax poisoning, which would be treatable, or ricin poisoning, which would be lethal. Security and medical teams decontaminated him, while he anxiously awaited test results with his family. Eventually, to his and his family’s relief, the powder was confirmed harmless. The letter also contained a threatening message, referencing the COVID lockdown.

Fauci recounts the events of the fall of 2020, when COVID-19 surged, reaching thousands of daily deaths. He channeled his energy into overseeing vaccine trials, with Moderna’s and Pfizer’s phase 3 trials as hopeful milestones. However, frustration mounted as the pandemic escalated. President Trump’s push for quick solutions led to a revived interest in hydroxychloroquine, amplified by his promotion of unsupported treatments and agitated responses to media questioning.

A heated Oval Office meeting further revealed Trump’s frustration, as he challenged Fauci and other officials on their messaging, especially about testing and the rural spread of the virus. Fauci insisted on sticking to scientific evidence despite pressure to align more closely with Trump’s narrative. Tensions grew as Scott Atlas, a COVID-19 advisor, advocated for relaxed restrictions and minimal public health measures, in line with the Great Barrington Declaration’s approach to achieving herd immunity. The Great Barrington Declaration was a letter signed by epidemiologists, which promoted focused protection of vulnerable groups instead of widespread lockdowns, assuming herd immunity would soon protect everyone. This approach, Fauci argues, proved unfeasible as COVID variants emerged, undermining herd immunity. Nonetheless, Scott Atlas continued influencing White House policy despite these inaccuracies. This controversial stance put him in conflict with Fauci and others on the task force, who continued advocating for masking and social distancing.

After being diagnosed with COVID-19, Trump praised the monoclonal antibody treatment he received, which was a targeted treatment involving intravenous antibody administration, arguing that the treatment should be widely available to the public. However, Fauci resisted this demand, as the treatment was still in trial and not yet approved for wide use by the FDA. Moreover, the president’s contradictory demands for positive messaging led to further media constraints for Fauci. Nevertheless, after Biden’s election win, Fauci felt renewed optimism. Vaccines soon reached the public, providing a hopeful turn in the fight against COVID-19 just before his 80th birthday.

Chapter 3 of Part 5’s Latin title translates: “Do Not Let the Outlaws Grind You Down.” At the beginning of the chapter, Fauci recounts how, on January 21, 2021, he stood at the White House podium, representing the new Biden administration’s transparent approach to COVID-19. This new approach was the opposite of the one adopted by the Trump administration, whose aim, Fauci asserts, was only staying in power. Under Biden, Fauci was named chief medical advisor—a role that made him the primary medical voice on COVID-related issues.

Fauci describes Biden team’s proactive and respectful approach, which included regular contact with key figures like Ron Klain, Jeff Zients, and other advisors dedicated to the science-led response to COVID. This approach brought together familiar colleagues and medical leaders. Moreover, regular Oval Office meetings provided direct communication with President Biden, who encouraged open, collaborative discussions.

The early days were challenging, as a national crisis raged due to the record high COVID deaths and hospitalizations. The initial vaccine rollout faced setbacks but eventually doubled Biden’s initial goal with over 200 million doses administered by the end of April 2021. Meanwhile, Fauci faced increasing personal and public pressure, becoming a focal figure in polarized political debates. Senators Rand Paul and Jim Jordan challenged him publicly, questioning mask mandates and other requirements, which they saw as an infringement of liberty.

Fauci reflects on the social impact of the virus and his unique role during this time. Though appreciated by the public, Fauci became a target for conspiracy theories and accusations, particularly from right-wing figures who claimed he funded harmful research in China. Despite these accusations, Fauci remained focused on advancing vaccinations, dealing with emerging variants like Delta and Omicron, and addressing vaccine inequity globally.

Once more, in the beginning of 2022, COVID cases surged dramatically, reaching unprecedented levels with over a million new cases in a single day, straining the US healthcare system. Thus, Fauci observed that, while Omicron’s severity was lower, its high transmissibility overwhelmed resources, emphasizing the idea that vaccinations as essential. Vaccinated and boosted individuals had significantly reduced risks of severe illness and death compared to the unvaccinated, as Fauci states.

Despite these advantages, Fauci notes that only 62% of Americans were fully vaccinated. Anti-vaccine sentiment intensified, spurred by prominent figures like Robert F. Kennedy Jr., who spread misinformation and linked Fauci to pharmaceutical interests. Fauci recounts his prior interactions with Kennedy, noting his promotion of scientifically debunked vaccine dangers, such as false connections between vaccines and autism. This misinformation fueled wide public distrust, with much anger directed at Fauci.

Fauci empathizes with vaccine hesitancy in marginalized communities. However, during the pandemic, he constantly struggled with opposition from conspiracy theorists, who alleged unfounded dangers about COVID vaccines. Fauci’s advocacy extended through initiatives like neighborhood vaccine tours and outreach with influential figures to address concerns in communities of color. He championed transparency about the safety and efficacy of COVID vaccines, aiming to counter misinformation. Despite polarized reactions and aggressive opposition, Fauci states that he remained focused on promoting public health, viewing these challenges as part of a broader struggle against disinformation and ideological divides related to public health.

In the Epilogue, Fauci reflects on his life’s work in medicine and public health. He states that, while he does not detail every infectious disease he has had to face during his career, the book offers a personal and historical view of major health crises. Thus, Fauci emphasizes the sacrifice, resilience, and occasional hostility that accompany public service. Commenting on the influence of his upbringing and Jesuit education, Fauci notes how science and medicine have become his vehicle for helping others. Looking back, he discusses how unforeseen events, such as the AIDS crisis, bioterrorism threats, and the COVID-19 pandemic, shaped his career and positioned him at the heart of national and global responses.

Fauci expresses concern over societal divides and the rise of misinformation, which he sees as a threat to public trust and health. After stepping down from his position as director of NIAID, Fauci notes that he has embraced his new role as Distinguished professor at the School of Medicine at Georgetown University, hoping to inspire future leaders. As he steps away from his official duties, Fauci anticipates more time with family and cherishes his recent role as a grandfather. He expresses hopes that his memoir will serve both as a historical account and as a personal legacy for his loved ones.