Anthony Fauci’s Memoir “On Call” Journeys through a Half Century of Plagues Amid the Politics of Public Health

On Call, Dr. Anthony Fauci’s memoir, is a riveting read that ricochets through infectious disease challenges since the early 1980s. It concludes with the most insidious of afflictions – the ignorance of how science works that led to threats to his life and the safety of his family during COVID.

Dr. Fauci has saved many millions of lives, as a physician-scientist for decades as well as through the legions of medical workers he’s trained. And what a joy to read a memoir that the author clearly wrote! I loathe the politico tell-alls that are magically written, edited, and published in mere months, thanks to ghostwriters.

On Call was a trip back in time for me. It opens at the dawn of HIV/AIDS, just after I got my PhD in genetics and started my writing career. I’ve included links to some of my articles, where relevant.

Over the years, Dr. Fauci has been extraordinarily accessible to journalists, taking phone calls even from nobodies like me. During COVID, he updated us in frequent zooms. His chats often ended with memories of the Yankees and growing up in Brooklyn.

The book has a conversational tone, an easy read even for the science-shy. The eras of public health challenges unfold like the segments of Taylor Swift’s tour, the narrative rich in transitions, teasers, and predictions. Writing effectively in the first person is tricky, and Dr. Fauci does it well.

Throughout, Dr. Fauci discusses his relationships with U.S. presidents and other leaders. He also repeatedly distinguishes the roles of the NIH, CDC, and FDA, which flummoxed even top government officials during COVID. Yet the book is also global in scope. Microbes know no boundaries.

HIV/AIDS

An early chapter, “Game Changer,” evokes a day I remember clearly: late afternoon on Friday, July 3, 1981.

The front-page headline in the CDC’s Morbidity and Mortality Weekly Report (MMWR), then a small, white snail-mailed pamphlet, announced, “Kaposi’s Sarcoma and Pneumocystis Pneumonia Among Homosexual Men – New York City and California.”

It was the dawn of AIDS.

(Years later, I gave the historic MMWR to my daughter for a school paper. She received a bad grade for not having used Time or Newsweek as sources.)

The HIV/AIDS chapters focus as much on people as on the biological details, covering the activist community into which Dr. Fauci had to work hard for acceptance.

“The Search for an HIV Vaccine” chapter clearly explains how vaccines protect, as well as how progress in scientific inquiry slows when we do not know what we do not know. A virus that directly attacks the immune response presents a special challenge.

“We soon learned that HIV was very different from any other viruses with which we had dealt,” Dr. Fauci writes, a situation that would, of course, reverberate some four decades later with SARS-CoV-2.

The chapter “HIV Denialism” also echoes today. It ends with recalling the deaths of more than 330,000 people in South Africa because president Thabo Mbeki accepted advice to treat AIDS with lemon juice, olive oil, garlic, and beetroot, and not with anti-viral drugs. That concoction might make a fine salad dressing, but does nothing to halt an infection. And the HIV/AIDS chapter “An Unequal World” is also relevant in the age of COVID.

Anthrax

Jump ahead two decades. Shortly after 9/11, a few dozen people received letters laced with a white powder that turned out to be deadly anthrax spores. Some recipients died. Bacillus anthracis, a soil bacterium, was being deployed as a weapon.

Would smallpox follow, a pathogen that had long been discussed in the context of bioterror? The anthrax-in-the-mail chapter explores government preparedness for a bioterror attack – a threat that will never abate.

The anthrax scare petered out. Oddly, I had a bit of an experience with this. Shortly after the situation had resolved, I received a double-bagged letter from the FBI. The return address was from Libya, “Thanks for postman” scrawled on the outside and addressed to both my university and genetic counseling offices. Screeners had apparently deemed the missive suspicious, but it was just referencing the sender’s experience teaching with my human genetics textbook.

Influenza

The chapters on influenza in On Call begin with the 1918 pandemic.

Dr. Fauci explains the nomenclature of the virus – combinations of 18 hemagglutinin (H) and 11 neuraminidase (N) proteins that comprise the surface – and the chain of infection from birds to mammals. The 1918 virus was H1N1, and the one behind a million deaths in 1957, H2N2. In 1968 H3N2 killed some 700,000 people worldwide, then settled genetically into a typical winter flu.

Fear of a highly virulent, novel, easily transmissible influenza persists. Possible spillover from the bird virus H5N1 is particularly alarming. Meanwhile, efforts to engineer a universal vaccine/ for the changeable virus remain challenging.

Ebola

The Ebola virus disease scare in 2014 stands out for me because my husband and I were supporting a medical student, Eman, in Liberia. When half of the faculty died of the infection, the students took over public health measures, which I wrote about here.

Ebola virus fever is horrific. Fatigue, headache, and muscle pain quickly give way to severe vomiting, diarrhea, bleeding, and a rash, with torrents of body fluids spreading the infection, to which up to 90 percent of populations are vulnerable.

The virus was discovered in the Democratic Republic of Congo and South Sudan in 1976. It appeared in Guinea at the end of 2013 and spread to Liberia and Sierra Leone soon after, where people had no natural immunity. Cases and deaths mounted. Would it spread to the US?

“We all suspected that eventually someone who became infected in West Africa would travel to the United States before symptoms appeared and develop full-blow Ebola virus disease once they were here,” Dr. Fauci recalls.

That’s indeed what happened. Case #1, Thomas Eric Duncan, had helped transport an infected woman in Monrovia, Liberia, then flew to Dallas to visit family – and then became ill.

A few other health care workers contracted Ebola in the US, but the feared wider outbreak never happened. Dr. Fauci tells harrowing stories of caring for them at the NIH Clinical Center, including an emergency intubation that spewed aerosolized Ebola virus all over the medical team.

Zika

Another virus from Africa, Zika, appeared in Uganda in 1947. It made headlines in 2015 with hundreds of thousands of cases in Brazil.

Although usually asymptomatic or mild, the mosquito-borne infection crosses the placenta, causing microcephaly (tiny heads and brains) in newborns. Dr. Fauci had read about it in med school, but had never encountered a case.

By 2017, a mosquito eradication campaign that decreased cases by 95% ended the Zika public health emergency in Brazil.

Most notable about the Zika outbreak, Dr. Fauci notes, is that vaccine development began within a year – record speed at that time, and foreshadowing.

Confronting COVID and Politics

The final part of the book picks up where the first chapter left off, the dawn of COVID. Dr. Fauci focuses on the government response, especially his interactions with President Trump – to whom he is exceptionally gracious, even adding context to the famed “injecting bleach” comment that renders it a little less absurd.

The chapter “A Disease Like No Other” details development of the mRNA vaccines; one of the two inventors trained with Dr. Fauci. Vaccine development began in January 2020, just days after the first genome sequencing of the pathogen. I still look back on those times and the rapidity of scientific discovery with astonishment.

The chapter “He Loves Me, He Loves Me Not” recalls events that led to Dr. Fauci finally parting ways with the Trump administration:
• being subjected to the startling scientific ignorance of presidential adviser Peter Navarro
• Mark Meadows’ pulling him from the media
• being replaced by Scott Atlas, a radiologist, not expert in infectious disease or public health.

Dr. Atlas severely downplayed the risks of COVID, which is what Trump wanted to hear. Meanwhile, Dr. Fauci faced increasing scrutiny, hostility, blame, anger, and threats to his family for telling the scientific truth in the face of rampant and infectious ignorance.

After the Washington Post quoted Dr. Fauci on October 31, 2020, warning about the coming dangers of being cooped up inside with virus during the winter, Trump was livid. Dr. Fauci quotes the president’s warning to be upbeat and positive, rather than truthful. The command was laced not with scientific facts or medical evidence, but six F-bombs. Very helpful guidance from our leader.

Steve Bannon continued this intellectual discussion by proclaiming on his podcast that Dr. Fauci should be beheaded, and worse.

It’s a wonder that Anthony Fauci lasted as long as he did.

The final chapter is “Illegitimi non carborundum,” which means “Don’t let the bastards grind you down.” It was a theme in The Handmaid’s Tale.

Dr. Fauci shouldered misplaced blame for all the inconveniences that living, and dying, through a viral pandemic presents. He mentions Marjorie Taylor Greene’s accusing him of controlling children’s lives and guiding the economy. More recently, she’s blamed Dr. Fauci for having killed millions of people and therefore being responsible for his own death threats. Apparently ignorance and arrogance know no bounds among some individuals in power.

On August 22, 2022, Dr. Fauci announced at the White House that he would be stepping down from his post that December:

“Standing at the lectern I could not help but think about how many times I had been in this same spot, through HIV, anthrax, pandemic influenza, Ebola, Zika, and then COVID. As emotional as I felt, I wanted to make a graceful exit and decided that this moment was ripe for a public health message. Please for your own safety, for that of your family, get your updated COVID-19 shot as soon as you’re eligible, to protect yourself, your family, and your community.”

CODA

I think that Dr. Fauci’s most important contribution is explaining the dynamic nature of science. Consider masks.

The courses in virology that I took in the 1970s taught that masks can’t keep out viruses, which are small enough to pass through apertures in the material. Dr. Fauci recalled learning the mantra “masks don’t keep out viruses” too. And so early on in the pandemic, he didn’t stress their value. It turned out that masks can keep out virus carried in the microscopic goo of exhaled droplets.

In science, what we thought we knew can change, from learning more. Dr. Fauci writes:

“The controversy over masks illustrates a fundamental misunderstanding among some about science, particularly the biological or health sciences. People associate science with absolutes that are immutable, when in fact science is a process that continually uncovers new information. As new information evolves, the process of science allows for self-correction.”

He then compares the biological or health sciences to the physical sciences and mathematics.

“With mathematics, two plus two will equal four a thousand years from now. Not so with the biological sciences, where what we know continues to evolve and uncertainty is common.”

As the pandemic unfurled, and transmissibility, severity, vulnerabilities, and levels of protection changed, so too did medical advice. But that doesn’t reflect shaky science – in fact, just the opposite is true. Science is continually adapting to us learning more.

From one Brooklynite to another, thank you, Dr. Fauci, for all you have done for humanity, and for sharing your extraordinary experiences in this terrific memoir.