Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases and one of the nation’s most influential public health leaders, joins Stanford Department of Medicine’s The Future of Medicine for a conversation with Dr. Euan Ashley about science, service, public trust, and the future of public health.

In this episode, Dr. Fauci reflects on his early career as a physician-scientist, the first years of the HIV/AIDS epidemic, the creation of PEPFAR, the scientific foundation behind COVID-19 vaccines, and the challenge of communicating evidence in an era of misinformation.

Together, Dr. Fauci and Dr. Ashley discuss what it means to lead with integrity when the stakes are high, and why long-term investment in science remains essential for pandemic preparedness and medical progress.

The Transcript

Dr. Euan Ashley: Well, Tony, what a pleasure it is to welcome you to Stanford. First of all, is it okay if I call you Tony? 

Dr. Anthony Fauci: Of course. 

Dr. Ashley: You've been in my ears the last few days, because you wrote this amazing book, On Call, that talks about your own story, and I like to listen to audiobooks, which is how I ingest my books. You mentioned in the book that only two people ever actually called you Anthony, and one was the discipline master at your Jesuit school and the other was Donald Trump.

Dr. Fauci: No, actually it was different. Everybody was calling me Anthony when I was a child. I went to Regis High School, which is a Jesuit school in Manhattan. And believe it or not, they had the dean of admissions, the dean of studies — they had a dean of discipline in a Jesuit school. And I remember the first day, everybody would call me Anthony. We were being introduced to the dean of discipline, and everybody was afraid of the dean of discipline. And someone would go over and say, "What's your name?" He'd say, "My name is Francis." "Oh, Frank, welcome to Regis." And then they would go to a guy, his name is James. He said, "Oh, Jim, welcome to Regis." I said, "My name is Anthony." He says, "Well, Tony, welcome to Regis." I was so frightened. Ever since then, I was Tony. That's how I got Tony. 

Dr. Ashley: The dean of discipline made it so. Until this — one president also apparently on occasion would use your full name when he was angry, right? 

Dr. Fauci: Yeah, and I'm sure we'll get to that.

Dr. Ashley: Well, as you heard already in the intro, you grew up above your father's pharmacy Fauci's Pharmacy Days in Bensonhurst. Brooklyn boy, baseball fan, big Yogi Berra fan. Talk to us, first of all, about those origins. You've had this incredible, long and storied career. We'll come to talk about so many of your achievements in the next half hour or so. How were those things — a picture of Fauci Pharmacy right behind us — tell us how those formative years really impacted and led you to where you eventually went.

Dr. Fauci: Well, they definitely did. I get asked that question a fair amount. And the one thing that's apparent to me is that it had a major impact on me, but it was probably beneath my level of consciousness that it was having an influence on me, because when childhood experiences and youth experiences influence you, you don't psychoanalyze yourself when you're eight, nine, ten years old. But my father and mother, as you mentioned, ran a mom-and-pop pharmacy. And this is the 1940s and 1950s. I was born in 1940 — I'm pretty old, but I was, you know, seven, eight, nine, ten years old, working in the pharmacy, delivering. 

The thing about that atmosphere was that it was really the neighborhood service center for helping people. It was truly neighborhood service, unlike the industrial pharmacies of today, which are fine — Walgreens and CVS and others — but it was more of a business. So not only was he filling prescriptions, but he was the neighborhood marriage counselor, he was the neighborhood psychiatrist, he was the neighborhood physician for people who couldn't afford to go to physicians. So his entire mantra was service. So I got that instilled in me as a youngster, that service was really important. 

It was sort of ingrained in me, kind of in my DNA, and it was very much fortified by what you mentioned — going to a Jesuit high school and then ultimately a Jesuit college, because the theme of a Jesuit education — well, it was an all-boys school at the time, so it was "men for others"; it should be "people for others," but it's "men for others" — and that, I think, started off way back then, which I think is the motivating force of why I went into medicine. I had a circuitous route into medicine, because I took mostly classical Greek, Latin, French, with just enough science to get me into medical school. So it was more of a humanistic approach as opposed to a scientific approach. And only when I got into my fellowship did I really get deep into the science.

Dr. Ashley: And who knew at that time — you certainly didn't — that you would lean on all those learnings on many occasions through the following decades. When did you first become interested in science, if you had this humanistic early education?

Dr. Fauci: I was struggling, as all young people do, with what I wanted to do. I was very interested in people and very interested in doing things for people. I think the classic education was really important in fashioning me to be the kind of physician-scientist I ultimately became. So I was very fascinated with the history of civilization. That's why Greek was very exciting to me, Latin and ancient history, et cetera. But when I got into high school, I really liked the sciences. So I was trying to figure out the best way — I didn't know I was any good at it yet, because you're just taking courses in school. You like it, you get good marks, but you're not sure if that's something you really want. So I was trying to figure out the best way to fashion a career, at least as linear as I could get. So when I went to Holy Cross College — which was interesting, because the course at Holy Cross was almost oxymoronic in its title. I had a Bachelor of Arts, classics/philosophy/pre-med, which — 

Dr. Ashley: You may be the only person in history with that. 

Dr. Fauci: And what it did is it really was, at least in my own mind, emphasizing the patient and the person as much or more as the science associated. So I went to Cornell Medical School, New York Hospital–Cornell Medical Center, now Weill Cornell, and I literally had just enough science in college to get into medical school. And then only after that did I amplify on the scientific. But to me it was the right balance between my very strong propensity to want to be with people and do things for people, and science as a vehicle to do that — as opposed to the opposite. And there's nothing wrong with the opposite; I think it's great. That would be to be fundamentally a core scientist who maybe doesn't want to do it with people. So it was sort of the other way around. 

Dr. Ashley: And you had this moment where I think you either had an option of a chief residency or potentially to go to the NIH. 

Dr. Fauci: No, actually it was a little bit different. You got the right setting. I finished a few years of residency after medical school and I wanted to do a fellowship. I was talking to some of the Stanford students just a little while ago about the lack of linearity in career, because when I graduated medical school, did my residency, I wanted to subspecialize. I took a joint fellowship in infectious diseases and clinical immunology, with the full intention of going back to Cornell, becoming chief resident, and being on the clinical staff at the New York Hospital Medical Center. I was so differentiated, as I joke around — but it's true — not only did I want to go back to New York Hospital and practice medicine, I wanted to have my office on 71st Street and 1st Avenue. 

So I knew exactly what I wanted to do, to talk about the lack of linearity. But something happened on the way to the forum. I fell in love with science during my fellowship, and I had a very good mentor. I got on a good project and it was really quite successful. So I was left with a decision, because I had already committed to be chief resident in medicine back at Cornell. And my mentor — and this is to all the students in the audience, find yourself a generous mentor, it's really important — he said, "You're uncertain what you want to do. I'll make a deal with you. Go back to Cornell, be chief resident of medicine. If you decide you want to stay there and just practice medicine, we'll be friends forever. If you decide you want to come back, I have a tenure position for you at the NIH." So I had a phenomenal year. Back then it was every other night and every other week. So I was awash in clinical medicine. I really loved it. But I made the decision I wanted to go back to the NIH, and I did, and I was there for the subsequent 54 years.

Dr. Ashley: And you've been there for a few years now. Yeah. I think that many of us who know you in more recent times as a very public figure, someone who administers an important institute and has led many international groups — we maybe forget that your career as a scientist — I mean, you were, for 20 years, among the world's most cited researchers. So the early work from your lab was already making an impact. Tell us a bit about vasculitis, and in fact share something that we should know that you published from your lab that we don't.

Dr. Fauci: Well, it gets back to circumstances and the lack of linearity of career. So in my fellowship I got put on a project to study a disease which used to be called Wegener's granulomatosis. It's now granulomatosis with polyangiitis. It's uncommon, not rare, a deadly disease — 100% fatality, particularly if you get renal disease. My generous mentor said, "We have to figure out a way to do something. This is a completely fatal disease." So I was also getting my boards in infectious diseases. So at the same time as I was interested in the autoimmune aspects of this disease, I was clinically an ID doc. 

So we would get called up to the Cancer Institute — the old clinical center at the NIH was on the 11th floor, the Cancer Institute was on the 13th floor. So they were giving people chemotherapy, because they were developing at the time — this is 1968, '69, '71 — what turned out to be the cures for acute lymphoblastic leukemia and Hodgkin's disease, and they were putting them on blast COP — all of those, which included high-dose cyclophosphamide. So we got the idea that steroids was not working in GPA — again, it was called Wegener's then. So we decided, why not try a low dose of Cytoxan that you could titrate, instead of a gram per IV push? Give them like one to two milligrams per kilogram per day, and titrate, so you never let the absolute neutrophil count get below a certain level. 

So we avoided all the infections of cancer chemotherapy, but luckily it was just enough immunosuppression to completely shut off the disease. So what went from a 100% mortality — our first papers in the journal Medicine and the old journal Medicine and the New England Journal of Medicine — was a 93% remission rate, which blew apart the whole field of  autoimmunity, where you could actually give a cytotoxic drug. So I became, at a very young age, quite well known in immunological, rheumatological circles. Remember I said I came back to be chief resident in 1972, and from '72, '73, '74, '75, '76, '77 we made it better and better — the therapy has been somewhat replaced now with rituximab, which, if it isn't very severe — I would still use cyclophosphamide for overwhelming disease and consolidate with rituximab, but before, we just used cyclophosphamide. And that was going great, and I was on a real accelerated curve, getting into all the right societies and things. 

Then in 1981, everything changed for me, because I got the first reports of this unusual — it was one report from the MMWR. I was sitting in my office in the clinical center in June of 1981, and I got an MMWR with five cases of Pneumocystis pneumonia from Los Angeles, curiously all in young gay men. I said, "What is going on?" I thought, at the time, young men were taking poppers to enhance sexual satisfaction. I thought maybe that was immunosuppressing them, but poppers shouldn't be immunosuppressing. So I just put it aside to think about it. One month later, in July of 1981, the second MMWR came out. This time 26, amazingly all young gay men who were previously healthy, not only with Pneumocystis but with other OIs and with Kaposi's sarcoma. 

So I did something — that my wise mentor who helped me in my early career — I said, "I'm going to totally change the direction of my career. I'm going to take all of these protocols that we've developed, that by that time had gotten into the textbooks. I'm going to give it to my trainees, who are now senior investigators, because 10 years have gone by, and I'm going to devote all of my time clinically and in investigation on HIV." 

From the summer of 1981, which made me one of the first two or three people involved with HIV. And that was before it had a name. It was called GRID, and it didn't have an etiologic agent until 1983, with Luc Montagnier, who discovered it, and Bob Gallo proved it in '84. So I went for two to three years taking care of a deadly disease with no name until 1982, where all of my patients died. So I had this incredible shift of becoming this hero who was saving people with a deadly autoimmune disease with a therapy I developed, to all of a sudden all of my patients, with very few exceptions, were dying. So that was a really interesting transition, which started the 45-year journey that I've had with HIV, from no treatment to one pill a day and you get rid of everything. 

Dr. Ashley: An incredibly bold change for, at the time, a young investigator. And it sounds like your mentor had advised you otherwise. 

Dr. Fauci: Well, his words were, "Don't give up your day job." 

Dr. Ashley: Seemed fair. Seemed fair, turned out not to be, for the first time. You were probably right about what you saw coming.One of the things that struck me in listening to your book is just the extent to which you really have been the ultimate physician-scientist. So when you eventually, sometime after that, got offered the job as director of NIAID, you said there were two non-negotiable things — clinical medicine and science — that you would run the institute and do it well, but you didn't want to give up seeing patients, and you didn't want to give up your lab, as well as the 1,300 papers or whatever the current number is and all the citations. Starting from when — you just mentioned — you've also been, as many in the audience know, an editor for, I think, 36 years of Harrison's Principles of Internal Medicine. 

Dr. Fauci: 41 years. 

Dr. Ashley: 41 years. Okay, I didn't count that quite right. Pretty good — 41 years, 35 plus 6. And for many of those in the audience, this is how they first heard your name. Talk about being a physician-scientist and what that really means to you, and then let's go back to those dark days and the early days.

Dr. Fauci: Well, it depends on what you decide — well, you don't really decide, because it happens — what your identity is. So my primary identity is as a physician. My supplemental identity is as a physician-scientist who is doing studies to have an amplifying effect on what you know clinically. In 1984, I had been working on HIV, and it was interesting — we were working out the pathogenic mechanisms of the disease before we knew what the etiology was. So my first two or three papers in the New England Journal were describing things that I didn't even know what they meant, because we didn't know what the agent was. And the first paper that we did in the New England Journal in 1982–83 was looking at aberrant immune activation, paradoxically, in a disease characterized by immune suppression. So how does that happen? How do you get paradoxical immune activation? As it turns out, the immune activation that's triggered by the virus is the driving force for virus replication. So now everybody knows, you put the virus in culture and you activate it, and the virus just spreads. So I didn't even know it then. So I loved that. I didn't want to change it. But one thing was happening: we were not putting enough resources into HIV, or, I thought, even into the field of infectious diseases. When I became director, we were like the seventh out of 12 institutes. The budget when I became director was $320 million at NIAID. When I left, after being director for almost 40 years, it was $6.3 billion. I didn't even get a parachute bonus to leave. 

Dr. Ashley: How does that work out? 

Dr. Fauci: It didn't work out. 

Dr. Ashley: It didn't work out.

Dr. Fauci: But when I became director, apropos of your question, I absolutely did not want to leave my identity as a physician-scientist. Up to that point, no institute directors — this is 1984 now — had their own lab or saw patients. They were just in Building 31, administering. So I made a deal with the director of NIH at the time and with the Secretary of HHS, Jim Wyngaarden. Most people don't remember Jim Wyngaarden. He was a really distinguished physician. He used to be chairman of medicine at Duke. He wanted me very much to get the job, even though I was the youngest person ever to be an institute director, and I said, "But my condition is, I have to continue to see patients, and I'm going to keep my lab," because I was the lab chief at the time. And he said, "I've heard about you, I don't know you well, I trust you. As long as you remember that your primary responsibility is to direct the institute and your responsibility to grantees out on the outside." And I gave him my promise that I would do all three, and I would do it well. And he said, "Fine, I trust you." And that was the first time an institute director ever also had a lab. I felt that if I gave that up, I would be giving up my identity, and I didn't want to do that.

Dr. Ashley: I think that's a really good thing for all of us in the audience to hear. I think many of us feel that way. But to be able to say that to the head of the NIH as they're offering you a job is a whole other thing. 

Dr. Fauci: But he could have said no, and then I wouldn't have taken the job. 

Dr. Ashley: But I think this idea of telling truth to power is something we'll come back to. Because your own truth there, in your own identity, is a really important part of that answer. Take us back to those pretty dark days before there were treatments for HIV, because you were looking after those patients. 

Dr. Fauci: It was extraordinary, and I describe it in the book. It was a very unusual experience that is very unique in medicine, particularly in the very early years, when you didn't know what the etiology was, where the only thing you're doing is putting band-aids on hemorrhages. We didn't have any drugs, so you treat somebody's Pneumocystis and that goes away, and then they get CMV retinitis and you treat that, and then you get cryptococcal meningitis and you treat that, and then sooner or later they all die. Either that or with Kaposi's sarcoma. 

That was traumatic, and I refer to it in the memoir as really a post-traumatic stress that you still have. What it also does — two things — the bravery and the incredible character of the patients you're taking care of is very inspirational. But the other thing that is, retrospectively, the motivation and energy you get about doing something for it, is really profound, and that was one of the reasons why I decided to take the job as director. The last — if you would have asked Tony Fauci in 1981, '82, '83, "Would you want to be a science administrator?" I would tell you, "You're absolutely crazy. There's no way I want to do that." So I did it because I felt that we really needed to do something about that. 

So when I became director, during those early dark years — remember, we didn't get the first drug until 1987. AZT was approved. The second drug was two and a half years later, ddI and ddC. And then three or four years later, lamivudine. It wasn't until 1996 that we had triple combination that actually brought the level of virus to below detectable and durably kept it there. So during that period of time, it was a combination of trying to not have despair, working your butt off administratively and scientifically to try and develop drugs, and then all of a sudden seeing this ray of hope, going from absolutely nothing to becoming an outpatient disease that, in a proper healthcare setting — which, we can get into a discussion, which we don't have time for, of healthcare delivery in this country — no one should ever get sick from HIV, because if you treat someone soon enough, before their immune system tanks, the actuarial curves show that you could lead essentially a normal lifespan, minus maybe one or two years from the normal, all other things being equal. So the contrast from seeing patients in the '80s, where it was totally frustrating, to now, essentially just seeing patients on follow-up visits, checking things every — it's just extraordinary.

Dr. Ashley: One of my favorite stories in your book — we have a slide to go with this too — is, it ends with the line, "Dad, it's Bono at the door." And I wondered if you wanted to share that story.

Dr. Fauci: Well, the Bono story is really related intimately to the PEPFAR story. So let me give a brief discussion about PEPFAR, and then Bono goes in. From 1996 to the year 2000 or so, we were progressively, in the developed world — USA, Australia, Canada, UK, European Union — we had available drugs and accessible drugs. So all of a sudden the larger follow-up studies were showing the curves of people essentially leading normal lives. However, in Africa, where 67% of all the infections occurred, there was no availability of drugs. 

So I have, and still do, a lot of friends and colleagues in sub-Saharan Africa. So I would visit there, and it would be like a strange déjà vu, where I would be making rounds in Mulago Hospital in Uganda, or in South Africa, and my African colleagues were essentially a brown version of Tony Fauci in Bethesda in 1981, where all of their patients were dying, because they were doing what I was doing. They were putting band-aids on hemorrhages. They couldn't even afford treating people for OIs, much less for that. So I became agitated, or energized, that we really needed to do something about sub-Saharan Africa. 

So I started to talk about that in my talks. I would become almost a policy talk as opposed to a scientific talk. Fortunately for the world and Africa, George W. Bush felt the same way. So he called me into his office in the spring of 2002, and in his exact words, as I showed in the book — because I wrote it down, when the president tells you something you don't want to forget it, so you write it down. Well, some presidents. So he said, "I believe" — I being George Bush — "that we, as a wealthy nation, have a moral responsibility to not allow people to suffer and die from a preventable and treatable disease merely because of where they happen to have been born and lived. So what I want you to do is go back to Africa and see if it's feasible and accountable to do something transforming in Africa." 

Meanwhile, Bono was also agitating for people to be doing things in Africa, and he was drumming up a lot of support with the UN and with WHO. So I went to Africa, and I looked around, and I hooked up with some Africans who were using philanthropically donated drugs to give to people, because the thought in the United States was, "Africans will never be able to take drugs, and they may not even respond to the drugs the way we do in the developed world" — which is, holy mackerel, what a racist comment that is, but that's really what people were saying. 

So, to make a long story short, I got very convinced that we could do that. So I came back to the White House and I said, "We can do it." He says, "Okay, put together a program, but make sure it's accountable and it's transformative." He says, "But one condition: you can't tell anybody what you're doing. It's the truth," he says, "because if the Congress and other people find out about it, they're going to want to put their — I want to do it the right way." So literally, I was doing this for eight months, working with the White House staff, putting together this version — 15 countries, 12 countries, 10 countries, how much on condoms, how much on this, how much on drugs, how much on prevention — and somehow or other I didn't tell anybody, and it was really very stressful. He says, "You can't tell the Secretary of HHS, and you can't tell the director of NIH, you can tell nobody." So I said, "Well, you're the President of the United States. If you tell me I can't tell anybody, I'm not going to tell anybody." 

But somehow or other, in all things, something leaked out that I was working on something. So, apropos of your question — sorry for the long [story], but that was the intent — I get a phone call from Bobby Shriver, who is Sargent Shriver's son, the guy who developed the Peace Corps. He calls me up. He says, "I'm in Chicago with Bono and his team. We're doing a — he's doing a concert there. We would really like to talk to you about HIV in the developing world." I say, "Fine. Anytime you're in Washington, I'd be happy to chat with you." He says, "Well, how about  tonight? We have our plane. We'll fly in. Maybe we could meet at some restaurant." And I said, "We shouldn't meet at a restaurant. We'll never get a chance to talk. Everybody will see." Nobody knew I was — everybody will see Bono and they're all getting excited. He says, "No, but can we come to your house?" So my wife Christine, who's sitting in the audience, said, "Well, why don't you invite him on over? We'll cook an Italian meal for him." 

Dr. Ashley: So, no pressure. 

Dr. Fauci: No pressure. So he flew in. He came in. He stopped off at a wine store, bought some wine, and I decided I was going to play a joke. 

Dr. Ashley: What kind of wine does Bono bring? 

Dr. Fauci: More than I could afford. So I decided to play a little trick on my daughters, who were young — a teenager and lower. I knew he was going to come to the door. So I told my eldest daughter, Jen, I said, "I'm going to have some people coming over from the lab tonight. So when the doorbell rings, let them in, because I'm going to be inside the kitchen with mom." So the doorbell rings and she goes to the door. She opens the door, all of a sudden I hear a scream, and she said, "Dad, Bono's at the door." I said, "Well, let him in." 

So we had a phenomenal conversation. What's interesting is that I told Bono, "I am working on something, but I really can't tell you what it is." So, in his enormous generosity — what an amazing guy — he said, "Okay, tell me how I can help." And I said, "When it happens, we need your support, because since George W. Bush was a conservative Republican, we were concerned that the people who were leaning away from his ideology would not be in favor of it. You've got to gather support, because once we get it done, we're going to need congressional support to get it authorized and appropriated." 

And that's Bush — his genius of this — he kept it quiet literally until the night before the State of the Union address, on January 28th, 2003. And he called me and Mike Gerson — some of you know Mike Gerson was his speechwriter — he brought us down to the White House, and literally the evening before, we got on the phone calling up every major person in the Congress who we needed support from, saying, "By the way, you're going to have a surprise tomorrow at the State of the Union address," just to let them know, so they wouldn't be upset. And he made the announcement on January 28th, and then, bingo, that's what it was — $15 billion for five years.

Dr. Ashley: Just remarkable. And it's estimated — and you're correcting my numbers through our conversation today, so tell me if this is correct — 25 million lives saved.

Dr. Fauci: So it started off — my proposal was $15 billion over five years, to aim at treating two million people, preventing 7 million infections, and taking care of 10 million people, including AIDS orphans, which is what he accepted. You fast-forward 23 years from then, it now is over a hundred — a hundred billion dollars, $110 billion. It's in 50 countries, and it has saved 25, 26 million lives, which makes it the most successful life-saving public health program for a single disease in history. Now, having said that, it really shows you, quite frankly — and I don't mean this in a facetious way — what presidential leadership can do. He made me the vehicle for it, but it would never have happened if it wasn't for George W. Bush. 

Dr. Ashley: Well, that is actually my next question. Because you — and correct me here again — have worked with seven different presidents. 

Dr. Fauci: Yeah, seven administrations. 

Dr. Ashley: That gives you a really unique insight into that office. What can you tell us that we don't know?

Dr. Fauci: Well, again, as I described in the memoir, it really relates back to the first time I was called to talk to Ronald Reagan in the mid-1980s. As I was getting ready — Ronald Reagan did not mention [AIDS] until the second year of his second term, and he, I think, lost the opportunity to use the bully pulpit of the presidency to call attention to the things that we needed to do. Even though fundamentally I thought he was a good president, he missed that opportunity. So I wanted to talk to him about that. 

As I was getting ready to prepare, I called up a friend of mine who had spent six years in the Nixon White House, a very wise guy named Jim Dixon. And he told me, he says, "Let me give you a word of advice. This is the first time you're going into the White House. Whenever you go into the White House and you're getting ready to go under the awning of the lower level of the West Wing, which ends into the White House, whisper into your own ear that this may be the last time I'm going to come into this building, because I may have to tell the president an inconvenient truth that he might not like. I might be the messenger that gets shot, and I might not get asked back again." 

And then you may say, "Well, what's [the point] about getting asked back?" Let me tell you a not-secret about the White House. I've been to the White House now hundreds and hundreds and hundreds of times over the last years. Anytime you went to the White House, you have a pure feeling of awe. You walk in and you know, like, Lincoln was here, and Franklin Delano Roosevelt was here, and Harry Truman was here, and Eisenhower was there. So you have an instinctual, understandable, but dangerous feeling of, you needed to get asked back. And you might subconsciously, without even knowing it, tell the president something that isn't the absolute truth in order to ingratiate yourself with the president. 

Spoiler alert: that's going on. So I actually said, "Fine," and I have done that. Every single time. And his advice was, if you do that, people will understand that you represent science, evidence-based information, and integrity, and you will get asked back by people who respect you. And if they don't ask you back, at least you have your own integrity. So I did that literally with every single president, and it worked very well. Even when I had to tell presidents that maybe we should do things a little bit differently, they either listened and said, "That's a good idea," or they said, "I like you, Tony, but I can't do that right now." And it worked out very well, with the exception of when we had the clash of when the president was saying things that were not true, and I was put into a position, in front of cameras, of having to publicly disagree with the president. Hydroxychloroquine does not work. Ivermectin does not work. No, it's not going to disappear like magic. And that was very painful for me. The extremist theme is that I did it to undermine the president. I have a great deal of respect for the office of the presidency of the United States. I didn't want to undermine anybody. But there was no way, when a reporter asks you, "Is it going to disappear like magic?" and the answer is no, it's not. 

Dr. Ashley: And we all looked to you for that truth. Who was the funniest of the presidents? 

Dr. Fauci: The funniest, interestingly, was — well, I mean, the real outright humor jokester was George W. Bush. He's the biggest jokester of them all. But the subtle humor was Barack Obama. Really interesting.

Dr. Ashley: You've brought us up to date, so it's time for us to visit some more modern times. One of the ways I frame that time — I remembered this, and we have it on the slide — an article that was put together with one of those sliders from the New York Times, where you could estimate how long it would take for a vaccine for COVID. And if you left it at the default setting, you'll see — some of you might remember this — how long would it really take? Vaccine by November 2033. And you can move these sliders. If you go to the next slide, you'll see you could go do the trials at pandemic speed, and you could get that down to maybe 2025, and then, with everything going completely well, sometime late 2021. You brought together the forces that you'd been marshalling for decades to try to do that faster. On December the 20th, I think, 2020 — the same year that this began — the emergency use approval for the Pfizer vaccine was made. That's just the most remarkable feat of biomedical advance that we've ever experienced. And I think there is no one — there are many people who should and can take responsibility and credit for that, but there is no one more central to that effort than you. Take us into that.

Dr. Fauci: Well, one thing that is not fully appreciated, and is the reason why I get so anxious when I see what's happening today — of resources being pulled back from the NIH, of experienced investigators getting fired, of all the really unconscionable things that are going on right now at the CDC, at the NIH — is that that started years before. Because if you look at it, the success was three things, actually maybe four things. One was the science of the mRNA platform. The other was structure-based immunogen design, to get the right stable spike protein. The other was a clinical trials network that was ready to hit the ground running. And the other was a phenomenal amount of risk-reducing investment in the development and the testing of drugs. So very quickly, let's go through that. The platform for mRNA — that research started mRNA Platform 20-plus years ago. The defining paper by Drew Weissman was in 2004, in the journal Immunology, when he and Kati Karikó showed that when you modify the RNA molecule, it doesn't wind up not being able to be used as a vaccine. So that was years ago. 

Dr. Ashley: And you, by the way, were his postdoc mentor, right? 

Dr. Fauci: I was — he was — I claim credit for being his mentor for eight years when he was a postdoc. I claim no credit for his prize. None at all. He did that independent of me.The other thing was structure-based immunogen design. The people who were trying to develop an HIV vaccine were talking about the right conformation of the most immunogenic molecule for the HIV envelope. Forget about the spike protein. And really, really great scientists at NIH, at La Jolla, at Harvard, at Duke, here — people were working on it. And what they were doing was trying to figure out how you can stabilize the envelope in the right conformation, because it's kind of a floppy thing. So they came up with the right mutations to do that. 

The same people that did that, who were working on it for 25 years, were the same people who did it — Barney Graham and people like that, who were at the NIH — did the stabilized protein. Corbett — you talk about [it]. So now you have 20 years plus 20 years. We started the HIV clinical trials network that includes people here in San Francisco, New York, all over, which is a network of clinical trialists who knew how to do a 20,000-person clinical trial. They were already established. So that's already there. So then you say to yourself, now we have a deadly outbreak, and it usually takes several years to get a vaccine. How can we get a vaccine very quickly? What you need is billions of dollars in what we call Operation Warp Speed, which was an interesting thing that we did, because when you develop a vaccine and you leave it all to the pharmaceutical company, they have to be careful of risks. 

So first of all, they don't manufacture anything at scale until they get absolute proof that it's going to get approved if it works. So right away, you're talking years for that. You do a phase one study, and you usually don't prepare for a phase two or put everything into effect until you get results from the phase one. We didn't do that. We put all money into phase two, into phase three prep, so that we went seamlessly from phase one to phase two to phase three. So we got the sequence on the 10th of January of 2020. Five days later we had the vaccine movement going. 

I called Barney Graham into my office on the day that they published the sequence, and I said, "Let's go for it." He said, "We don't have enough money yet." I said, "We're going to get the money." So we had the first phase one trial: 69 days. Phase two trial: 198 days. Phase three trial: 200 days. 11 months later, in a 30,000-person trial, we had the vaccine that was 93 to 95% effective. And all that took was investment ahead of time, and then billions of dollars, that even if the vaccine failed, the only people that would have lost was the federal government, because the pharmaceutical companies put nothing into it — nothing — because they couldn't risk it. They didn't have the money to do it. 

So I think that can be done for any of a number of diseases if you want to put in the investment. But also, you can't forget that it was the years' worth of investment that antedated [it]. The reason I'm saying that right now is that some of you are aware that the new mantra at the NIH is, there's no such thing as pandemic preparedness. In fact, there was an article written in Nature, or in Nature Medicine, saying that we shouldn't prepare for a pandemic — that all you need to do is to lead a healthy life, drink raw milk, exercise, and nobody's going to get sick. And that, I think, is really not a good approach, given what's going on with Hunter and Ebola and everything else.

Dr. Ashley: You've been a bastion against misinformation for decades, but you've lived in the absolute spotlight doing that. You've already described having — I mean, you're on camera, on TV, literally in the Oval Office, trying to speak truth to power. What do you think of all that? It's changed your life in ways that are very favorable — you have a very high favorability rating among many — but in other ways that are less favorable. Do you have any regrets about any of those moments?

Dr. Fauci: If I had to do it over again — the idea of doing something that can wind up saving people's lives, there's no risk that you would avoid that to do that. There really is a downside, because the amount of misinformation and disinformation is really rather treacherous in this country. Social media is much more energetically driven by people who are spreading either mis- or deliberate disinformation. And if you want to counter [it], which we have been trying to do — and I think we have to rethink our strategy, because, as I always say, it appears that people who are spreading mis- and disinformation are so effective and energetic, it's almost as if they don't have a day job. So I assume that most everybody in this room has a day job. So you can't just spend all of your time putting out counter-information. We've got to figure out a way how to communicate better. And the thing that is the painful truth of our identities is that I will guarantee you that if you have a point you want to make about public health, somebody getting up quoting a Nature paper with 25 supplemental figures and a big methodology will always lose out to an influencer who says, "I tried this and it worked." And I guarantee you, your data is not going to go against it. It's got to be better communication. Absolutely.

Dr. Ashley: You still teach at Georgetown. You've co-edited a seminal textbook for 41 years. You've co-authored 1,300 citations. You've flown on Air Force One. You've worked with seven presidents. You've received the National Medal of Science, the Presidential Medal of Freedom. You have 45, if I'm correct, honorary degrees. 

Dr. Fauci: No, more — 64. 

Dr. Ashley: 64 degrees. You are, if I'm not mistaken, 85 years old. You don't need any of this. What gets you up in the morning? 

Dr. Fauci: My wife. 

Dr. Ashley: I can't think of a better place to end it. Family is such an important part of you. I get that from the book as well. You talk about your daughters and your wife in the most amazing way. I commend the book to you for sure. Please join me in thanking the legend, the man, Tony. Thank you.