Why Anthony Fauci approaches every trip to the White House as if it's his last

For much of the past four years, Dr. Anthony Fauci has been the public face of the government's response to the COVID-19 pandemic — a status that garnered him gratitude from some, and condemnation from others.

For Fauci, speaking what he calls the “inconvenient truth” is part of the job. He spent 38 years heading up the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, during which time he advised seven presidents on various diseases, including AIDS, Ebola, SARS and COVID-19.

Fauci still recalls the advice he received when he first went to the White House to meet President Reagan: A colleague told him to pretend each visit to the West Wing would be his last.

“And what he meant is, you should say to yourself that I might have to say something either to the president or to the president's advisers … they may not like to hear,” Fauci explains. “And then that might lead to your not getting asked back again. But that's OK, because you've got to stick with always telling the truth to the best of your capability.”

During the COVID-19 pandemic, Fauci clashed repeatedly with President Trump. "He really wanted, understandably, the outbreak to essentially go away," Fauci says of Trump. "So he started to say things that were just not true."

Fauci says Trump downplayed the seriousness of the virus, refused to wear a mask and claimed (falsely) that hydroxychloroquineoffered protection against COVID-19. "And [that] was the beginning of a situation that put me at odds, not only with the president, but more intensively with his staff," Fauci says. "But ... there was no turning back. I could not give false information or sanction false information for the American public."

Fauci retired from the NIH in 2022. In his new memoir, On Call: A Doctor’s Journey in Public Service, he looks back on the COVID-19 pandemic and reflects on decades of managing public health crises.

Interview highlights

On appearing before the House Select Subcommittee on the Coronavirus Pandemic to answer questions about the pandemic response

If you look at the hearing itself it, unfortunately, is a very compelling reflection of the divisiveness in our country. I mean, the purpose of hearings, or at least the proposed purpose of the hearing, was to figure out how we can do better to help prepare us and respond to the inevitability of another pandemic, which almost certainly will occur. But if you listened in to that hearing … on the Republican side was a vitriolic ad hominem and a distortion of facts, quite frankly. As opposed to trying to really get down to how we can do better in the future. It was just attacks about things that were not founded in reality.  

On his interactions with President Trump concerning COVID-19

He is a very complicated figure. We had a very interesting relationship. ... I don't know whether it was the fact that he recognized me as kind of a fellow New Yorker, but he always felt that he wanted to maintain a good relationship with me. And even when he would come in and start saying, "Why are you saying these things? You got to be more positive. You got to be more positive." And he would get angry with me. But then at the end of it, he would always say, "We're OK, aren't we? I mean, we're good. Things are OK," because he didn't want to leave the conversation thinking that we were at odds with each other, even though many in his staff at the time were overtly at odds with me, particularly the communication people. ... So it was a complicated issue. There were times when you think he was very favorably disposed, and then he would get angry at some of the things that I was saying, even though they were absolutely the truth.

On reading reports of a mysterious illness afflicting gay men in 1981 (which later became known as AIDS)

I knew I was dealing with a brand new disease. ... The thing that got me goosebumps is that this was totally brand new and it was deadly, because the young men we were seeing, they were so far advanced in their disease before they came to the attention of the medical care system, that the mortality looked like it was approaching 100%. So that, you know, spurred me on to ... totally change the direction of my career, to devote myself to the study of what was, at the time, almost exclusively young gay men with this devastating, mysterious and deadly disease, which we ultimately, a year or so later, gave the name of AIDS to.

On the trauma of caring for patients with AIDS in the early years of the epidemic

All of a sudden I was taking care of people who were desperately ill, mostly young gay men who I had a great deal of empathy for. And what we were doing was metaphorically like putting Band-Aids on hemorrhages, because we didn't know what the etiology was until three years later. We had no therapy until several, several years later. And although we were trained to be healers in medicine, we were healing no one and virtually all of our patients were dying. …

Many of my colleagues who were really in the trenches back then, before we had therapy, really have some degree of post-traumatic stress. I describe in the memoir some very, very devastating experiences that you have with patients that you become attached to who you try your very, very best to help them. ... It was a very painful experience.

On working with President George W. Bush on the President's Emergency Plan for AIDS Relief (PEPFAR), which aimed to combat the global HIV/AIDS crisis

The president, to his great credit, called me into the Oval Office and said we have a moral obligation to not allow people to die of a preventable and treatable disease merely because of the fact [of] where they were born, in a poor country, and that was at a time when we had now developed drugs that were absolutely saving the lives of persons with HIV, having them go on to essentially a normal lifespan here in the United States, in the developed world. So he sent me to Africa to try and figure out the feasibility and accountability and the possibility of getting a program that could prevent and treat and care for people with HIV. And I worked for months and months on it after coming back from Africa, because I was convinced it could be done, because I felt very strongly that this disparity of accessibility of drugs between the developed and developing world was just unconscionable. Luckily, the president of the United States, in the form of George W. Bush, felt that way. And we put together the PEPFAR program. ... We spent $100 billion in 50 countries and it has saved 25 million lives, which I think is an amazing example of what presidential leadership can do.

On personally treating two patients with Ebola during the 2014 outbreak

The fundamental reason why I wanted to be directly involved in taking care of the two Ebola patients that came to the NIH is that if you look at what was going on in West Africa at the time — and this was during the West African outbreak of Ebola — is that health care providers were the ones at high risk of getting infected, and hundreds of them had already died in the field taking care of people in Africa — physicians, nurses and other health-care providers. So even though we had very good conditions here, in the intensive care setting, of wearing these spacesuits that would protect you, these highly specialized personal protective equipment, I felt that if I was going to ask my staff to put themselves at risk in taking care of people ... I wanted to do it myself. I just felt I had to do that.

We took care of one patient who was mildly ill, who we did well with. But then the second patient was desperately ill. We did have contact with him, and we did get these virus-containing bodily fluids — everything from urine to feces to blood to respiratory secretions — we got it all over our personal protective equipment. And that was one of the reasons why you had to very meticulously take off your personal protective equipment so as not to get any of this virus on any part of your body. So the protocols for taking care of persons with Ebola in that intensive care setting were very, very strict protocols, which we adhered to very, very carefully. But it was a very tense experience, trying to save someone's life who was desperately ill at the same time as making sure that you and your colleagues don't get infected in the process.

Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz and Meghan Sullivan adapted it for the web.