Following an introduction by LitFest Director Jennifer Acker ’00, Cullen Murphy ’74 H’19 led a conversation with Dr. Anthony Fauci about his memoir, On Call: A Doctor’s Journey in Public Service, at Amherst College’s 10 Annual LitFest.
At 83, Dr. Anthony Fauci still speaks with the measured urgency of someone who knows exactly what’s at stake. The former director of the National Institute of Allergy and Infectious Diseases — a position he held for nearly four decades — sat down with Cullen Murphy, editor-at-large at The Atlantic, during Amherst College’s 10th Annual LitFest to discuss his memoir, On Call.
What followed was a wide-ranging conversation spanning nearly six decades of public service: from a Brooklyn childhood shaped by a pharmacist father who never turned away a patient who couldn’t pay, to navigating press conferences alongside four different presidents, to an assessment of where American public health stands today.
The conversation covers the early days of the AIDS crisis and how a Brooklyn kid who wanted to play college basketball ended up devoting his career to the sickest people in the world. It addresses PEPFAR — the program Fauci helped architect under President George W. Bush that has saved an estimated 25 million lives — and the threat its gutting now poses. It revisits the COVID-19 pandemic, the pain of publicly correcting a sitting president, and the torrent of threats and disinformation that followed.
It includes a warning, with historical context, of the inevitability of another pandemic. And it ends, perhaps surprisingly given everything, with a clear-eyed argument for why public service is still worth it.
You write in On Call that your upbringing was fundamental to who you became. Can you tell us about that?
My father was a pharmacist in Bensonhurst, Brooklyn — a working-class, almost entirely Italian-American neighborhood in the 1940s and ’50s. The pharmacy was the hub of everything: healthcare, neighborhood psychiatry, marriage counseling, you name it. And my father had a terrible business model. People would come in who couldn’t pay for their prescriptions, and he’d say, “Don’t worry, put it on the tab.” I once asked him why he didn’t just make them pay — we weren’t wealthy — and he said, “They’re struggling and we’re better off than they are.”
That was the beginning of my DNA around service. And then the Jesuit priests at Regis High School and at Holy Cross — the motto was “men for others.” It had a major impact on the arc of my career, though I didn’t fully realize it at the time.
Before medicine, you had athletic ambitions.
I was a genuinely good high school point guard — five-foot-seven, high scoring, captain of the varsity team at Regis. New York City high school basketball is competitive. I idolized college players and thought I might be one of them. Then my coach started having us scrimmage against freshman teams from St. John’s and Seton Hall. And I discovered that a five-foot-seven, very good-shooting point guard will always get destroyed by a six-foot-three, very good-shooting point guard. So I decided to go into science. The country can thank the St. John’s freshman team for that.
You joined NIH in the early 1970s. What was your career trajectory when AIDS arrived?
I’d had what I’d call a precociously successful nine years at NIH — I’d developed therapies for formerly fatal inflammatory diseases, and my career was on a very good arc. Then in the summer of 1981, the Morbidity and Mortality Weekly Report from the CDC landed on my desk, as it does every week. It reported five young gay men in Los Angeles with a strange pneumonia you only see in immunocompromised patients. I thought it was a fluke. One month later, another MMWR: 26 gay men, not just Los Angeles but San Francisco and New York, with the same strange pneumonia plus cancers you only see in immune-compromised people.
At that point I made a decision that every one of my mentors thought was foolish — I completely pivoted my career to study and treat these desperately ill young men. My mentor, Dr. Sheldon Wolff, literally said, “Tony, don’t give up your day job. This is gonna go away.” Obviously it didn’t go away. What drove me, I think, goes back to empathy. These men were already disenfranchised, already stigmatized, and now they were arriving at the hospital and dying seven, eight, nine months later. Every single patient.
That period also brought you into conflict with gay activists, particularly Larry Kramer.
Larry Kramer was an extraordinary playwright and a real firebrand. He and the activists had legitimate grievances: the clinical trial system was designed for diseases where you might have years to test a therapy. When you’re going to die in nine months, that doesn’t work. And the scientific community — and I say this with some indigestion — initially responded by withdrawing. Every time the activists did something provocative, the scientists became less amenable to listening.
And then Larry Kramer wrote an op-ed in the San Francisco Examiner: “I Call You a Murderer: An Open Letter to an Incompetent Idiot, Dr. Anthony Fauci.” He picked me because I was visible, I was the face of the federal government. And instead of running away, something made me say: let me listen to what they’re actually saying.
When I started to listen, what they were saying made perfect sense. I thought: if I were in their shoes, I would be doing exactly what they’re doing. So I started meeting with them. It took years of back and forth — it wasn’t like one meeting and suddenly we understood each other. But they became some of the most productive voices in how we redesigned clinical trials and the regulatory process. And Larry Kramer, my great nemesis, became one of my closest friends by the time he died. I eventually became his physician. The lesson is: listen to people who have a valid issue, even if they’re coming at you hard.
You’ve called PEPFAR one of the most important things you’ve ever worked on. Can you explain what it is and what’s happening to it now?
PEPFAR — the President’s Emergency Plan for AIDS Relief — was George W. Bush’s program, which I helped architect starting in 2002. When he proposed it in his State of the Union, he said something that has always stayed with me: “We as a rich nation have a moral responsibility to see that those people do not suffer from a preventable and treatable disease merely because of where they have been born.” We put together $15 billion over five years to prevent 7 million infections and treat 2 million people across 15 countries. Twenty years later, the numbers are $110 billion, 50 countries, and 25 to 26 million lives saved.
Right now, that program is being decimated. USAID — which implements most of PEPFAR — has been severely cut. There are people currently on lifesaving antiretroviral drugs who are facing interruptions in their supply. Pre-exposure prophylaxis therapy, which is 99% effective at preventing HIV acquisition, has been halted. If this continues, people are going to die who should not die. And to do this to a program that a conservative Republican president built — one of the most successful humanitarian programs in history — is, to me, unconscionable.
Everyone here remembers COVID. What was it like to publicly disagree with a president?
It was genuinely painful. I have a profound respect for the institution of the presidency — I’d advised seven presidents by that point. I wouldn’t proactively disagree with the president on policy issues that weren’t my domain. But when someone asked me, “Is the virus going to disappear like magic?” after the president had just said exactly that — I had to tell the truth. When someone asked, “Does hydroxychloroquine work?” — and we know it not only doesn’t work, it’s likely harmful — I had to say so.
To preserve my own personal integrity, and more importantly to fulfill my responsibility to the American public, I had to tell the truth. And that unleashed an extraordinary avalanche of vitriol that continues to this day. There are people who hate me, who threaten me. But if I had to do it over again, I would. That’s the world we’re living in, unfortunately.
You’re asked about disinformation a lot. Is there a way to fight it?
The challenge is that science is a process. It’s self-correcting by design. When I said early in COVID that we weren’t recommending universal masking, it wasn’t a lie — we genuinely didn’t have data yet on asymptomatic transmission. When that data came in, we updated guidance. That’s what science is supposed to do. But when the press reports it as, “You said one thing and now you’re saying another — he’s flip-flopping,” in an environment of profound societal divisiveness, anyone with an anti-science inclination uses that to say: you can’t trust scientists.
I probably would have done more to emphasize the caveats in real time — to say, “This is our guidance right now, but this could change as we learn more.” Whether it would have helped, I’m not sure.
How worried are you about the next pandemic?
Quite convinced there will be one. When you look historically — the plague of Athens in 400 BC, the bubonic plague that killed a third of Europe in the 14th century, the 1918 influenza pandemic that killed 50 million people in a world a third our current size, HIV, COVID — this is not a once-in-a-century phenomenon. It’s an ongoing feature of human existence. Almost all major outbreaks come from zoonotic pathogens — viruses that jump from animals to humans. And we’re less prepared for that now than we were a year ago.
You’ve seen the anxiety among young people about entering public service. What do you say to them?
I’m very aware of the hesitancy out there. But I take a clear-eyed look at the risk-benefit analysis. Despite everything — the threats, the vitriol, the difficulties that have beset me and many of my colleagues — the benefit and the feeling of accomplishment from serving others overwhelmingly outstrips the negative. That doesn’t mean it’s as easy as it was fifteen years ago. It might even get harder. But I don’t think there is any situation that would overcome the incredible feeling you get when you do something that actually helps somebody else.
And public service doesn’t mean government service. Teaching is public service. Medicine is public service. Journalism is public service. Just always check the box of the risk-benefit ratio. You’ll see very clearly that the benefit far outweighs the negative.
Dr. Fauci’s memoir, On Call: A Doctor’s Journey in Public Service, is available at Food for Thought Books in Amherst.
