On Call summary

Fauci stayed on at NIH and always felt at home in the intellectual environment there. Yet, by age forty, Fauci sensed something was missing. While his work was impactful, it often dealt with rare diseases that didn’t carry broad public health implications. He yearned for a new challenge, one that would have a more significant impact on public health and reignite his sense of purpose.

That pivotal moment arrived in June 1981, when Fauci picked up a magazine published by the Center for Disease Control, or CDC. It contained an article entitled “Pneumocystis Pneumonia – Los Angeles,” which described an unusual form of pneumonia in five otherwise healthy men. Normally, this pneumonia was only seen in individuals with significantly compromised immune systems, like those undergoing chemotherapy. Fauci was puzzled. Even more curious was that all five men were gay. Fauci assumed some critical details about the disease were yet to be discovered.

Whenever a new president took office, Fauci was always concerned about how they would address the global HIV/AIDS crisis. Fortunately, when George W. Bush entered the White House in 2001, Fauci realized that the new administration was interested in making an impact on the crisis worldwide. 

During a speech in May 2001, President Bush committed $200 million to support a new international AIDS relief initiative called the Global Fund. While the Global Fund was officially established in January 2002, unforeseen events soon shifted the focus.

In 2014, the US was once again on high alert due to the outbreak of another unpredictable infectious disease. This time it was the Ebola virus, which had originated in Guinea, then quickly spread to Liberia and Sierra Leone, overwhelming these nations. The situation escalated to a Public Health Emergency of International Concern by August 2014, with over 1,000 cases and a 60 percent fatality rate by July.

The US encountered its first case when Thomas Eric Duncan, who contracted Ebola in Liberia, traveled to Dallas. A misdiagnosis initially sent him home, but he returned to the hospital severely ill and was diagnosed with Ebola, leading to widespread public anxiety and media frenzy.

In January 2020, the world’s attention turned to Wuhan, China, where reports of a mysterious pneumonia-like illness began to surface.

In a matter of weeks, worldwide cases quickly escalated and the first US case was identified. The severity of the novel coronavirus – or COVID-19 – became starkly evident. In particular, concerns mounted about the virus’s unprecedented ability to transmit, even among asymptomatic individuals.

Fauci stayed active during the early part of the Biden administration. He saw COVID-19 vaccines roll out, and observed how quickly this new virus adapted – a fact that would continue to present challenges in the years to come.

He also realized that there are systemic weaknesses in the country’s public health infrastructure, exacerbated by decades of neglect and underfunding. This includes outdated systems, local health professionals with insufficient means, and disparities in healthcare access that disproportionately affect minority and lower-income communities. All of this contributed to unnecessarily high mortality rates during the pandemic.