KEY PLAYER IN AIDS FIGHT RE-EMERGES
11 Jun 2003
Source: Baltimore Sun, November 10, 2001.
Key player in AIDS fight re-emerges
NIH's Fauci advising administration on bioterrorism threat
By Susan Baer, Sun National Staff
BETHESDA - Dr. Anthony S. Fauci has devoted his career to unraveling the mysteries of AIDS, a deadly and once-unknown enemy in the world of infectious diseases.
Now, the scientist who rose to fame two decades ago while spearheading the government's AIDS effort has re-emerged as a key adviser and spokesman in the administration's war against a deadly new threat: bioterrorism.
Fauci's knack for articulating medical complexities in a calm and accessible way has made the 60-year-old director of the National Institute of Allergy and Infectious Diseases one of most sought-after figures to address the bioterror threat.
His presence is sought at congressional hearings, at White House media briefings, on such television talk shows as Face the Nation and Hardball, and, behind the scenes, on the phone line to top government officials.
"I value his counsel very highly," said Tommy G. Thompson, secretary of health and human services. "I seek it out and usually act upon it. He's been a tremendous adviser, supporter and friend."
The prominence of Fauci, and of a handful of other medical professionals, reflects a striking new reliance on scientists by an administration that has defied the research community on such issues as global warming and embryonic stem-cell research.
It also seems to signal the government's recognition that it needed more authoritative voices to ease public anxiety, especially in light of criticism that its early response to the anthrax scare was slow, confusing and ineffective.
"The public needs facts from credible sources, and there really is no one more credible than Tony," said Steven E. Hyman, director of the National Institute of Mental Health.
Indeed, after stumbles by Thompson in the early days of the anthrax outbreak - including his suggestion that the first victim might have contracted the disease from a contaminated stream and his unrealistically rosy view of the nation's preparedness - the administration has been pleased to let Fauci handle much of the medical discussion.
"They are very comfortable with my being [one of the people] to explain what the scientific, rational basis of what we're doing is," Fauci said in an interview in his NIH office, where the awards, certificates and photos that cover his walls spill out to the reception area.
Leaving his AIDS work to his lieutenants for now, Fauci takes part in a daily conference call with Thompson and other officials.
Along with his public appearances, he fills his marathon days by briefing lawmakers, writing position papers, reviewing bioterrorism research, answering reporters' queries and handling information requests from nations that suddenly view the U.S. government as an authority on bioterror.
Fauci's goal in conveying information to the public, he said, is to "strike that balance between giving them accurate information and keeping them informed and yet reassuring them in an appropriate way. I am not one to reassure people unrealistically that everything is going to be OK."
Germ warfare was not Fauci's area of expertise. But for the past three years, he has presided over a team that has studied bioterrorism and had presciently put anthrax and smallpox at the top of its list of possible threats.
Though the nation is rapidly escalating its readiness for an attack, Fauci said, it is unrealistic to expect "perfect preparedness."
"When you have an unknown enemy with mechanisms and tools that, in some respects, are invisible, you can never be perfectly well-prepared," he said.
Fauci, who lives in Northwest Washington and receives his mail from a post office where small traces of anthrax were found, said he has not allowed himself to become nervous about possible bioterror attacks.
As Fauci says, he uses his instinctive fears and perceptions to guide what he does and recommends. For example, he has urged top government officials to prepare for the "obvious scenario" of terrorists putting anthrax or some other biological agent in the ventilation system of a subway or large building. "You have to use some common-sense rational reasoning," Fauci said. "If these evil perpetrators have enough of this material, what makes you think they're not going to try to disseminate it in a much more lethal way?"
Such a nightmare scenario could be contained, he said, by improving the public health network so diseases can be quickly diagnosed, antibiotics can be distributed widely, and vaccines are ready and can be rapidly distributed to everyone.
He also sees smallpox as a "logical major threat" and has focused much of his group's attention on the highly contagious disease. Fauci's office is conducting studies to determine whether the government's 15 million doses of smallpox vaccine can be diluted enough to produce up to 150 million doses that would be effective.
And his NIH scientists will work with soon-to-be-selected drug companies to produce the second-generation smallpox vaccine to supplement the existing supply, resulting in enough to inoculate every person in the country, if necessary, by the end of next year.
Thompson said Fauci has been his No. 1 adviser on whether the government should embark on mandatory smallpox vaccination once the 300 million doses are amassed.
Fauci, who was vaccinated as a child with 6 million other New Yorkers after a case of smallpox was diagnosed at Bellevue Hospital, suggests that the answer will depend on the perceived or real risk of a smallpox outbreak within two years. In the absence of multiple cases, which would make the case for mandatory vaccination, he said, he could envision assessing for the public the threat of a smallpox attack and the risks and benefits of the vaccine, then letting each person decide.
Fauci defends his colleagues at the Centers for Disease Control and Prevention, who were criticized for failing to recognize until after the deaths of two Washington postal employees that postal workers were at risk for anthrax.
"No one really fully appreciated the capability of that microbe of doing more damage to mail carriers than it did to the people who were objects of the letters," he said. "My feeling is, you've got to give them a break."
Though he said his work with AIDS helped prepare him for grappling with bioterrorism, he noted that the two foes are strikingly different in their effect on the nation.
With AIDS, Fauci said, it quickly became clear that if someone wanted to protect against HIV infection, "it was totally within their power to do that."
"The total difference with this," Fauci said, "is that it's a big unknown, and everybody feels helpless against it. You're minding your own business, picking up a piece of mail or going into the subway, and bingo! You find yourself possibly vulnerable."
A Brooklyn native who joined the NIH in 1968 after attending medical school at Cornell University, Fauci devoted himself to conquering AIDS after reading an article in 1981 about a strange disease affecting gay men. Fauci, who is considered the nation's lead scientist in battling AIDS and has received numerous awards and 22 honorary doctorates, and his colleagues were the first to recognize the relationship between HIV and the body's immune system.
As director of the allergy institute since 1984, he has developed therapies for AIDS patients, worked to make drugs more widely available and helped cut the death toll from that disease by two-thirds between 1995 and 1999.
A frequent target of AIDS activists in the early years when protesters accused the government of not doing enough to fight the disease, Fauci quickly brought those activists into the decision-making process - even inviting demonstrators into his office - and soon became a hero to the AIDS community.
"He's one of those rare scientists who can deal with advocates, with people under enormous stress," said Donna E. Shalala, who was Health and Human Services secretary in the Clinton administration. "He's a passionate human being, and they sense his humanness and that he genuinely cares."
His commitment to tackling the AIDS epidemic has been so strong that in 1989 he declined President George Bush's offer to become director of the entire National Institutes of Health.
He said he had no intention of leaving the AIDS field to become a full-time specialist in bioterrorism. After all, it is a subject he has become authoritative about only since Sept. 11. "Knowing what Bacillus anthracis is - that it's a gram-positive, nonmotile, spore-forming rod, I kind of learned that in medical school."
Now, having immersed himself in the subject for the past month, "it's second nature to me."