Anthony S. Fauci, M.D. | Academy of Achievement

Let’s talk about your childhood and early years.  Where did you grow up and what was it like?

Anthony Fauci:  I was born and raised in Brooklyn, New York, in the Bensonhurst section of Brooklyn, at a time when there was a lot of community — I wouldn’t say segregation, but division — where the neighborhood of Bensonhurst was almost exclusively an Italian-American neighborhood: people who were either born in Italy, and moved to New York, who then had children who then had children.  So I was second generation.

My father was born in New York City — was actually born in Little Italy in Manhattan.  His father and mother came over from Italy at the turn of the century, in the very early 20th century.  They worked in New York City, moved to Brooklyn, which at the time was a move up, to go from the Little Italy section.  And that’s where my mother and father grew up.  My mother’s parents, very similar to my father’s parents, again, both were born in Italy and immigrated to the United States in the very early part of the 20th century, and again, settled in the Little Italy section.  My mother and father met in Brooklyn, literally in elementary school, got married right after high school. I was born and raised in that neighborhood, and I was in that neighborhood until I went off to college and then went off to medical school.

What did your father do? 


Anthony Fauci: My father was a pharmacist.  My mother went to Hunter College, but as soon as she had children — my sister, who’s three years older than I am — she then became a housewife-mother to the family.  My mother’s father and mother — my grandmother on my mother’s side — was a dressmaker and a homemaker. She took care of the children and worked and literally supported the family because her husband — my grandfather, my maternal grandfather — was an artist, somewhat of a bohemian kind of a person who used to hang out in Greenwich Village with his artist friends. He did some great painting, but he didn’t really make much money, so he was supported by my grandmother.

And on your father’s side, your paternal grandparents? What did they do?  


Anthony Fauci: My paternal grandfather, when he came over from Italy, members of his family had already been here and opened up some pretty substantial businesses, particularly a discipline called stevedore — namely, the people who unload and clean the ships in the New York Harbor.  He was a pretty bright guy, my paternal grandfather, so they made him the accountant and financial manager of this organization, which was called American Stevedores.  So he did pretty well. I would think that my father grew up in — even though it was an immigrant family — grew up reasonably comfortable, certainly not wealthy, by any means, but not street kid who had to go out and sell fruit on the street corner. He was in a reasonably well-established family.

Were you close to your grandparents?

Anthony Fauci: I was. I was very close to my grandfather on my father’s side. He was an amazing guy — a very strong personality but a very kind person who took a very special liking to me and would be the babysitter when my parents would go out to any social event. And at a time when my mother had chores and would have to leave, she would leave me with my grandfather.

It was a very interesting phenomenon because he spoke hardly any English at all.  He could understand English, but when he spoke and felt comfortable about speaking, he would speak in Italian.  It was an interesting circuitry of the brain because, from the time I was born until the time I went to elementary school in Brooklyn, when he was taking care of us, he would speak to me in Italian, and I would understand everything he was saying, but I couldn’t speak Italian back to him.  So I would speak English.

I still have some of those — deep down in the recesses of your brain — sometimes when I travel to give lectures or whatever — to go to Italy — and I hear people speaking, even though I cannot speak Italian, it’s kind of flashbacks of things that they were saying.  Anyway, it was a great relationship. He was a wonderful, wonderful man.

Your father owned a pharmacy?

Anthony Fauci: Right. My father went to Columbia University College of Pharmacy in New York City.  When he graduated and came out, he worked in various pharmacies. At a certain point in his life, his father, my grandfather  — who was, as I mentioned, from a financial standpoint, reasonably well — helped finance him buying a pharmacy, which he did, and he owned the drugstore where we lived.

It was kind of an interesting story — I think common among families like this — where he bought a drugstore on 83rd Street and 13th Avenue, and that’s when we moved from the Bensonhurst section to a little bit more of a highfalutin’ section, Dyker Heights, which was a little bit more financially prosperous than the Bensonhurst section.  He owned the drugstore, and my sister and I and my mother and father lived in the apartments above the drugstore.  So he owned the building, and we lived on the top of that. And that’s where I lived until I went away to college.

Did you work in the drugstore?

Anthony Fauci: I did.  It was a pharmacy that was right across the street from St. Bernadette’s Church.  What we used to do is that, when the masses would finish on a Sunday, there would be crowds and crowds of people that would come in for the pharmacy, and not only just for prescriptions but for cosmetics and things like that.  So from a very, very early age, I would help out behind the counter with the cash register and wrapping things.

But in the summers, and sometimes in the evenings, I would use my Schwinn bike with its little basket and deliver prescriptions to the neighborhood people.  Back then it was very common for calling up the pharmacy or getting a prescription done, and you would deliver it to the house.  That’s what I remember doing from the time I could ride my bicycle.

We understand your education, up until medical school, was entirely in Catholic schools.  You started out at Our Lady of Guadalupe Catholic Academy, and then you were picked for a very special private Jesuit-run high school. It was not in Brooklyn.  Tell us about Regis High School.

Anthony Fauci:  Regis High School is an all-scholarship high school, right in the middle of Manhattan.

Meaning it’s free?

Anthony Fauci: It’s free.  Everything is free in Regis High School.  At the time, it was a very unusual way that they would get people to — it still is, and was then, an all-boys school.  It was an endowed school, run by the Jesuit priests, and at the time, there were almost all Jesuit priests. And scholastics, who were priests-in-training before they become priests, were the ones that were teaching there.

What they would do is that every elementary school in the five boroughs, in addition to some in the Connecticut and New Jersey area — because we had kids in our class who were from Jersey City and places like that — the top person in the class that was picked by the nuns — who were usually nuns, sometimes brothers — from these elementary schools would go to a testing place in Manhattan. And they would give an exam, comprehensive exam, and they would pick the people who would be the incoming freshman class by going to the top X number of people on the exam.

So you had to have been put forth as the representative of your elementary school. You would take an exam, and then, depending upon where you ranked in the exam, you would get into Regis High School.  So academically, it was extraordinary.  New York City has some extraordinary schools.  The Bronx High School of Science is one of the elite science things, so I would say — you could say this, and it’s the truth — it was kind of the Bronx High School of Science for Catholic kids who went to elementary school.

It was really extraordinary because you had kids there from all over the city. It wasn’t like you have the school that people from the particular district — it was from all over: Manhattan, Bronx, Staten Island, Queens, Brooklyn, some from Connecticut, some as far away as New Jersey.  So it was a very, very good mixture of people from different backgrounds.

How long did it take to get there?  Did you travel by subway?

Anthony Fauci: Right. I became a real subway jockey from a very early age.  So I think of it now and it’s almost unbelievable. I would have to take a bus from my house to a local train that was then called the BMT, Brooklyn Manhattan Transit.  They have different names now in New York, and I don’t even know what they are.  I would take that local from a certain station to the express stop and switch to the BMT Express, which would go to 14th Street and Union Square in Manhattan, at which point I’d switch to the IRT — or Interborough Rapid Transit, it was called then — from 14th Street up to 86th Street and Lexington Avenue, get out and walk from 86th and Lex to 85th and Madison, where the school was.

How long did that take?  


Anthony Fauci: That would take about an hour — maybe a little bit more. I can’t remember the trains ever breaking down.  It was about an hour, an hour and 15 minutes sometimes. Coming home was interesting because I was captain of the basketball team and —

Wait a minute.  You were on the basketball team?  How tall are you now?  


Anthony Fauci: Well, I was five-seven. I’m probably five-six now at my age. I’ve shrunk a little.

So you were the captain? 


Anthony Fauci: I was the captain and high scorer of the basketball team, right.  That was the day of the two-handed jump shot and the fast break, and you didn’t have to be very good at a jump shot because we didn’t take jump shots then. It was mostly fast-break set shots and things like that.  I was very good at that at the time.  I really wanted to become a serious athlete in college — a very interesting story, but it was really one of those things in life where you’re convinced that this is not for you.

At a high school level, I was really quite good.  As we were getting ready — junior and senior year — our coach, who was a really great coach, would have the varsity, and I made the varsity in my sophomore year. So I went from freshman team right onto the varsity, so I was playing varsity for three years in high school. They would have the varsity from the high school — he would make a deal with the colleges in the New York area that their freshman team would scrimmage with us as the varsity high school.

So you had a freshman college team that would scrimmage with the varsity high school team.  And then I got to realize what really good basketball players were because I soon learned — and I tell a joke about this, but it’s true — I soon learned that a six-three, really fast point guard who can shoot will always destroy a five-seven, really good point guard who can shoot.  That was my realization:  “Okay, I think maybe there’s something else in my career besides basketball.”

So you had long days at Regis High School.  


Anthony Fauci: Oh, yeah. It was long days, and with basketball practice, particularly if you had to go up — which we did often — we used to go up and scrimmage in the Harlem Boys Club up on Lenox Avenue and 114th, 118th Street, go up to the Bronx and play.  By the time you finished school, went up, practiced basketball, came back down, you got home, it was clearly dark, even during the springtime.

And the rule then was very disciplined in study, so the Jesuits say, “I don’t care how you do it, but you’re going to study three hours a night because we’re going to give you enough work to study three hours a night.”  And the reason, I think — one of the reasons why I became very disciplined and could multitask a lot of the things that I do now is, you had to rigidly — even at age 14, 15, 16, 17 — rigidly organize what you’re going to do.

Like, ”You have this to do. You’re going to do this on the train. You’re going to do this on the way back. You’re going to get home, you’re going to eat, and you’re going to do this, and then you’re going to get up, and then you’re going to do the next thing.” You had to have a very organized life, which seems now, retrospectively, a little nuts for a young kid to have to do that, but it was great training.  It was great training.  The Jesuits have a very wonderful way of being highly academic and intellectual about things, always asking you to question things, and always consider what it means more globally than just for yourself.

Is it true you studied Greek and Latin?

Anthony Fauci: Yes.  In high school, as part of the required curriculum, was four years of Latin and three or four years of Greek, and three years of a Romance language — I picked French — as well as the other things that you do in high school.  You know, math, English, and I took some science courses, biology and things like that.  But it was very, very heavily weighted to the classics, and that continued over — it was something that I tell my children about and they shake their heads in disbelief.

When I graduated from Regis, the Jesuits would essentially tell you what college you’re going to be going to, that “You’re a really smart guy and you want to go into pre-med, so you’re going to go to Holy Cross.” And they wouldn’t write a recommendation for you if you decided you wanted to apply to Harvard or to Cornell or Columbia. My father went to Columbia, so I thought it may be a good idea to go to Columbia.

But the Jesuits wanted you to go to a Jesuit school.

Anthony Fauci: So I went to Holy Cross College, College of the Holy Cross in Worcester, Massachusetts, which was a very interesting place because it had a spectacularly good and highly rated pre-med program.  What I did when I went there — and retrospectively, it was a really good idea for what I do now in life and the kinds of things I have to deal with — it was a pre-med course which had this strange, almost oxymoronic name of “Bachelor of Arts Greek Classics — Pre-med.”

So you didn’t get a bachelor of science, you got a bachelor of arts. And I took over 25 credits of philosophy, as well as two years of Greek, two years of Latin, two years of French, and then enough of the sciences to get into medical school. But it was very heavily steeped in philosophy, and I was taking it. And you talk to people now: “Why would a pre-med want to do this?” — metaphysics, ethics, philosophical psychology, all those kinds of things that I still can’t remember at all what it was all about back then. But I did that.  So I graduated with very much of a humanitarian classics humanities background. I went to medical school, and that’s when I came back to New York City at Cornell University Medical Center, which is where I really wanted to go.

But you’ve said that in some ways, Regis High School was the defining academic experience of your life.  What do you mean by that?

Anthony Fauci: Well, it was more Regis High School together with what I learned. It was the atmosphere of having around you an extraordinarily diverse group of kids who were picked purely on their academic ability.  That’s it.  You don’t get in because you know somebody.  It’s purely on your academic ability. You had the Jesuit tradition, which taught you a couple of things — more than a couple of things.  But one of them was, you strive for excellence and nothing else.

Don’t go crazy about it if you don’t accomplish something, but at least you strive for excellence always.  And their motto is — it was only men then — it was “Men for others.” So what you do has to be guided by something that would be better for mankind.  It was, I wouldn’t say discouraged, but it never got into the dialogue of “I’m going to do this for self-advancement.”  It’s always “Do it.” Self-advancement would come, but the reason why you should be doing things is for others.

And that was kind of — you wouldn’t say drilled into you — it was, that’s the way it was.  When you went there and learned that, that became part of your personality, that you were striving for excellence always.  But the issue of service to others, one way or another — they didn’t say that everybody had to be a public servant or everybody had to be a doctor — you could go and be a Wall Street magnate if you wanted to, but you had to keep in mind that what you did had to have some aspect of it that would be good for other people. That was taught right from the minute you walked into the school.

Is it still that way?  Have you been back?

I went back there for one of their anniversaries and gave a couple of lectures.  It’s still the same.  Not as many priests. That’s the thing.  We had maybe 85 percent, 90 percent priests in scholastics, and the scholastics were young Jesuits-in-training and a few lay teachers.  I went back there now, and there may be three or four of five Jesuits and 100 lay teachers because very few people are going into the priesthood.

You went to medical school at Cornell, and then you were a resident at Cornell Medical Center.  That was a different environment. What was that like for you?

Anthony Fauci: People who hear stories about medical school would think I’m a little bit off-kilter by saying this, but I absolutely loved medical school.  I mean when I got to medical school, that was, I think, the real true birth of the Tony Fauci that I am today.  Medical school was absolutely made for me, and I was made for medical school.  I absolutely loved it.  I loved it because the curve of learning and then applying it to things that: a) are important, that you care about, and that are fulfilling that thing that has been subconsciously drilled into your midbrain, the idea about doing things for others. So I absolutely loved medical school. I loved my internship and my residency.

At the time, it was different than it is today.  I can’t make judgment better or worse, but now, you know, you’re on for a certain number of hours, and then you have to leave, and you can’t be tired. Back then — when I was an intern, and a couple of years of residency, and then a chief residency — we were on every other night and every other weekend.  And you never, ever left the hospital unless your patient was stable.  So you may be on every other night — and every other weekend — but there were days in a row when you just wouldn’t leave.  You’d take a catnap here and a catnap there, and you wouldn’t go.

Now, if you’re the kind of person that doesn’t function well under that, that’s dangerous, and that’s a good reason why there are restrictions now.  But if you happen to be somewhat of a type-one maniac, the way I am, that feeds right into the things you love. I mean just doing that, and doing all of those very important things, and realizing that sometimes when you’re really tired you can just pull yourself up and get it done. The terminology that my daughters use now was sort of born then, like “Suck it up and do it!” And that’s what we did.  So I really enjoyed that.  I really enjoyed that.

When you were coming up through medical school and internship and residency, were there any mistakes or failures you particularly remember that you learned from?

Anthony Fauci: I don’t really remember anything that I really screwed up badly to the point where it was like, “Oh my God, what did I do?”  When you’re in medicine, it’s always a learning experience, and that’s the reason why you’ve really got to take it very, very seriously.  I think maybe I’ve been fortunate. I’ve seen really, really good doctors get into situations where, through no fault of their own or something that was an accident, you slipped up and say, “Oh my God, what have I done?”  Fortunately, I’ve not had that happen. I’ve been in situations where people didn’t make it, that you always question, “Could I have done something differently?”  But you can’t second-guess yourself on that.

Do you remember any “light-bulb moments” in your training when you had a sudden insight into your career?

Anthony Fauci:  Taking care of someone who’s really sick surprised me because, depending upon what your fundamental nature is — and this isn’t good or bad or better, it’s just the way you are — is that for me, the sicker the patient, the better I function.  That’s why I went into infectious diseases, ultimately, because it’s such a dramatic aspect of medicine.  You die or you get better, that kind of thing.  But I loved every aspect of medicine.  Probably the most enjoyable part of my medical school was something I didn’t do ultimately, was OB-GYN, was just delivering babies.  I mean the phenomenon of delivering babies was amazing.

You’ve been in a position to advise Presidents Reagan, Clinton, two Bushes, and Obama.  And often, the news you bring is not the kind of news that presidents want to hear.  How do you deal with that?

Anthony Fauci: What has happened, that was a decision I made upon advice from an old friend who actually spent several years in the Nixon White House — and I would have hoped that I would have felt this way anyway — is that one of the things you have to do — and you really have almost a moral responsibility to do it because you’re dealing with the president, and you’re dealing with things that can affect the lives of many people — and that is, you have got to be totally honest and give advice and analysis that you’re asked to give that’s based on evidence.  And if the analysis that you come to comes to a conclusion that a president might not like to hear that, you can’t be afraid of saying, “Mr. President, with all due respect, this is the way I think the situation is.”

And what this person told me was that what you need to do is that, when you go to the White House, always say in the back of your mind that this may be the last time I’m going there because I might have to tell this president something he doesn’t like.  And sometimes people — not only presidents — you tell them something they don’t like, they don’t want to hear it, and they don’t want to ask you back again.  One of the first times that I had to do that was with Vice President Bush and then President Bush.

I developed a reputation in White House circles because the White House is an interesting place. Someone who is a junior staffer in this administration, and two administrations later is going to be the deputy chief of staff, that’s just the way it works.  So I developed, over the years, a reputation that I would speak the truth and give you advice and discussion based on evidence and not on my trying to ingratiate myself with you.  And the word got out. It got out from the Congress, and it got out among, not only presidents, but the people who staffed the White House because people who are staffers in the Senate become staffers in the White House, and it’s almost like a family of people that get to know each other.  What’s happened over the years is that I’ve been very honest.  I’ve given my best opinion based on the evidence, and people respect that.  So I’ve had to tell presidents sometimes things that they didn’t like.  But they keep asking me back because they know I’m going to give them an honest opinion.

And you’ve managed to do it without getting into trouble.  How do you account for that?

Anthony Fauci:  I’m not 100 percent sure, but I’m pretty sure I know why I didn’t get into trouble.  When Vice President George H. W. Bush was vice president, he was preparing to run for president, and he came and asked the NIH director — who was Jim Wyngaarden at the time — “I really want to learn a little bit about HIV. I hear there’s this guy Fauci out there that I see in the news” — and stuff like that.

This was in 1987, the beginning of 1988. He had already figured out he wanted to run for president.  So he came to the NIH, and he introduced himself to me, and I showed him my patients. I brought him into the room.  He came with Barbara.  Also in that entourage was a young man named George W. Bush, who was a staffer in the White House.  This was after (George H. W. Bush) became president; (George W. Bush) became a staffer.

But when he was vice president, and George W. Bush wasn’t quite there yet — he was still in Texas or wherever he was — he came to the NIH, and we developed a rapport and a friendship that I still to this day feel so blessed, having done that.  He all of a sudden started inviting me to the vice president’s mansion, to Christmas parties, to brunches and lunches over at his house.

And he would call me up, asking me advice about “What about this?” in medicine.  “What about this? What do you think about that?”  And then when he became the president of the United States was when this thing happened in San Francisco, and it’s a very interesting story, but it’s true — it’s really wonderful — is that we became, to the extent that you can do it, we became as friendly as you can be.  He was just a wonderful, wonderful human being.

The activists felt that he wasn’t doing enough for HIV, so they were getting pissed off at me because I was friends with the president.  So Larry Kramer’s famous thing is: “You need to chain yourself to the gate of the White House and demand that we have much more money.”  And I say, “Larry, I have a relationship with the president, and gradually, we’re getting a lot more money. If I chain myself to the White House fence, you will feel gratified. I’ll be a hero for 15 minutes, and that’ll be the end of our access to the White House.”

So anyway, I became very good friends with the then-president, and he would come to the NIH multiple times.  So when I wanted to come out, and when I went to San Francisco — and this guy told me, “The way you’re doing these protocols is ridiculous. You want me to either go blind or die” — Marty Delany, who brought me to San Francisco, arranged the town hall meeting.  And in the town hall meeting, as I was getting ready to go out, the press was really agitating. “What are you going to do about this inability to access clinical trials?”

There was a concept called “parallel track,” which Jim Eigo, who was an activist from ACT UP New York, and Marty Delany, who was an activist for Project Inform, were pushing for us.  The FDA career people were dead against it, understandably. In fact, I wasn’t harsh with them because they said, “That’s not the way you do it.  You can’t do it. You’ll violate the principles of the clinical trial.”  So as I was getting ready to go out on the stage, Marty, who I loved — I became his consulting physician with him when he ultimately died — and a great, a great man, he said, “Tony, please get out there and do it.”  And “do it” means, say, I come out that we have to change the way we do these clinical trials, and we have to have parallel approaches for people who can’t fit into a clinical trial to have access to the drugs without interfering with the scientific aspects of the trial.  It was referred to as “parallel track.”

So I went out there, and I got up on stage, and I said, “I had scripted remarks, but I’m going to throw them away.”  I said, “Let me just say that I’m convinced now, with this visit, that we really have to have a sea change in what we do.”  I didn’t clear it with the White House. I didn’t clear it with the FDA. I didn’t clear it with anybody.  Unbeknownst to me, right there, was Randy Shilts, the guy who wrote the book And the Band Played On, and he was a reporter at the time for the San Francisco Chronicle or whatever.  There was somebody from the Los Angeles Times.  And Gina Kolata from The New York Times heard about it.  So the next thing I knew, it was, like, front page of The New York Times: “Leading NIH Government Official Goes Against the FDA,” this or that, and I said, “Oh my God, I really didn’t think it was going to have that much.”

So I flew back — took the red-eye and flew back to the NIH.  And when I got there, much to my — I thought it was dismay — I get a phone call from John Sununu, and John says, “Tony, what happened out there?”  And I said, “John, it really needed to happen.”  I said, “The president just needs to get filled on this, what’s going on.”

John Sununu was the president’s chief of staff, right?

Anthony Fauci: Yes.  So I explained it to him, and I said, “This is really the right thing to do,” and the next thing he says is “Okay. I’ll tell the boss and we’ll see what happens.”  And then the next thing I knew, I was asked down to the White House for something else, and the president says, “You know, I think that was the right thing to do.”  Fast-forward X number of years, I was given the public-health-something distinguished award for doing this.  So I thought I was going to get fired for it and it turned out I got an award.

You had an interesting relationship with the first President Bush.

Anthony Fauci:  The relationship with George H. W. Bush was really an interesting relationship because he wanted very much for me to be the director of NIH, and it was kind of an interesting situation, where I didn’t want to do that because I didn’t want to get out of the AIDS business.  I said, “I know I can multitask,” but I really wanted to be the director of NIAID. I wanted to do infectious diseases, and I wanted to lead the AIDS effort.  So he asked me if I would be the NIH director, and he brought me down to the White House, and I said no, and I thought that would be the end of my relationship with him and that would be the end of my access.

As it turned out, he said something to me that made me realize what an amazing guy he is.  He looked me in the eye, and he said, “You know, I’ve always respected you a lot for all you’ve done, and are doing, and I respect you even more now.”  And I said, “Well, he’s just saying that and then he’s going to forget about me.”  About two weeks later, he invited me down to a lunch at the White House.  So it just was really an extraordinary experience.

In 2002, after the anthrax scare, Vice President Cheney was very hot to use the stock of live smallpox vaccine for a massive U.S. inoculation, for fear that there might be a terrorist attack.  Public health officials thought that was a dangerous idea.  Somehow you talked him out of it.  How did you do that?

Anthony Fauci:  Well, I first explained the pros and cons of that to Scooter Libby and Carol Kuntz, who was a woman who worked closely with the vice president, and then they said, “The vice president needs to hear this.”  So they brought me into the White House to explain it to the vice president.  The vice president wanted very much to take smallpox off the table.  In other words, he said that there are certain things that you just want to eliminate the possibility that they’ll be a real problem here.

So one of the things that was not very well articulated by some is that smallpox is an interesting disease. If you had smallpox, and I contracted it from you, I would have a grace period of a few days that you could actually vaccinate me even after I got exposed.  And that would protect me from getting smallpox.

Since smallpox, as effective a vaccine as it is, has some rare but nonetheless potentially very serious toxic side effects — if you’re immunosuppressed, it could be deadly, if you’re one of those people who have this strange myocarditis associated with it.  So if you’re in the middle of an outbreak of smallpox, and you want to vaccinate people — like you go back multiple decades and you’re in Africa — the risk of the toxicity is far less than the risk of the devastating effect of the disease.  So even though we accepted the toxicities of the smallpox vaccine back then, it was because there was active smallpox out there.  So what I explained to Carol and to Scooter and to the vice president is that we would have some time to vaccinate people.

If you all of a sudden vaccinated the whole country again, you would wind up — given the unlikelihood that you’re going to have a bioterror smallpox attack that would not allow you to then vaccinate around the people who were infected — I think the weight of the waiting, getting a stockpile, is infinitely better than just feeling better about vaccinating everybody.  And I presented it in a very articulate, simple way.  The vice president is a very smart guy, you know. He got it, and Scooter got it, and Carol got it.  So then we decided that we would not globally vaccinate the entire country.

And by the way, the country would not have accepted being vaccinated.  So we knew that; it was sort of like a failsafe, and I said, “Mr. Vice President, by the way, even when you’re offering it to the first responders, many of them didn’t want to take it.” So this idea about kind of saying everybody should take it, it didn’t make any sense.  So he listened to the data; he listened to the data.

During the Ebola crisis, you actually took care of patients. At that same time, Governor Christie in New Jersey wanted to quarantine health workers who were returning to the United States after having treated people.  It was a very heavy argument for a week or two. At some point, you must have persuaded him this was not a smart thing to do.

Anthony Fauci:  I didn’t directly, personally, persuade him.  But what was going on was something that — I would say dueling press appearances.  Not dueling directly against each other because I would be on many of the shows — Meet the Press, Face the Nation — talking about things, and then he would be saying certain things.  I made it a point — now maybe he heard it, maybe not — of saying, because some of the press and others were trying to dump all over Governor Christie. And I was saying, “I can understand” — and this is what I learned over years of being in Washington — “I can understand that the motivation of Governor Christie, of wanting to do that, was to protect the health of the people of his state.  So I don’t think he had nefarious motives at all.  However, what I want to make known to the people who are listening is that the evidence strongly points to the fact that that is not an appropriate response to someone coming back from an Ebola area with taking care of patients.”

Because Ebola is not spread by someone who was well and not coughing and bleeding and throwing up and having diarrhea.  If you’re well, you may be or not incubating Ebola, but you’re not going to spread it to someone else.  So that when someone came back, we had a very good protocol. They would take their temperature; they would know that if they got sick, they would go.  I did that when I was taking care of our Ebola patients for the few — that couple that we had, one was very, very sick — is that I took my temperature twice a day, every day, and reported it to someone to make sure that I wasn’t somehow accidentally incubating it.  But to say that anybody who takes care of an Ebola patient automatically is quarantined, nobody would ever want to take care of an Ebola patient, and you would immediately drain the people who would be brave enough to go and do that.

You have said that George W. Bush demonstrated real leadership in the creation of a big American AIDS treatment program for Africa. Could you tell us how that came to be?

Anthony Fauci:  Yeah. There had been a lot of activity around, after the drugs that, in combination, were proven to be totally lifesaving for people who had access to certain drugs.  It was called combination antiretroviral therapy — ART or HAART, standing for “highly active antiretroviral therapy.” The results in the developed world were stunning.

There was a lot of push around from some Christian groups and others about “What are we going to do for the developing world?”  So the president, in my discussions with him — because by that time, now, we had been through anthrax together, we had been through H5-N1.  We’d been through a lot together.

That the president trusted me, so he called me in and said, “I really want to do something that’s transforming in the field of AIDS, for the HIV-infected people in the developing world, particularly in Africa.  Not really quite sure what it is. The global fund is being formed at the UN level.”  He said, “I’m a little bit skeptical of that because, when you throw money into things, I don’t like these multi-multi-multilateral things. I want to do something that we have control of.”

And he said, “Let’s see if we can put something together because I firmly believe,” he said, “I, George W. Bush, firmly believe that, as a rich country, we have a moral obligation that when others throughout the world are suffering and dying, that when we have the capability of preventing that from happening, that we should do something about it.  So why don’t we do something?  I don’t know what it’s going to be. Why don’t you go to Africa, look around, talk to people, see what you can do, and then come back with a plan.”

We started off small because we first went down there, and it was right after the drug nevirapine was discovered that you give to a mother during pregnancy — and to the baby — that with a very small amount of money you can actually block mother-to-child transmission.

So when I went down there with Tommy Thompson, who was the Secretary of HHS at the time, we went around and we looked, and we said, “You know, you could probably do an incredible amount with 500 million dollars to prevent mother-to-child transmission.”  So I came back, and I presented it to the president.  He really liked it, but then, with a bunch of amazing people in the White House, particularly Josh Bolton; Gary Edson; Jay Lefkowitz; and a guy who was my assistant, who became indispensable, Mark Dybul, who then went on ultimately to be head of PEPFAR years later, we went back and said, “Okay, let’s go back and see if we can do a plan that’s much more transforming than just mother-to-child transmission, that actually prevents infections, cares for people, including orphans, and treats people with these lifesaving drugs.” And I said, “You know, Mr. President, that’s going to cost a lot of money.  And billions of dollars.” And he said, “Don’t worry about it.  Let me worry about it. This is something we really should do, and if it looks like it’s worth doing, we’re doing it.”  As it turned out, from the time I came back from Africa in 2002 — came back in April, presented to him then, throughout the whole summer until we got into the end of 2002 and 2003 — we were fine-tuning.  Mark Dybul and I and Josh Bolton were fine-tuning: how many people, how many countries, how much will it cost, etc., etc.

We kept on, through Josh Bolton, getting back to the president, never knowing whether he was going to accept it or not, except we knew he wanted to do it.  And then, towards the end of the years, we went into January, and he decided: “a) I’m going to do it, and b) I’m going to announce it in the January 28, 2003 State of the Union Address.”  And he did, and he did it unilaterally.  Surprised the hell out of a lot of people because they said, “My God, what is he really doing?”  But that was an example, in my mind, of amazing presidential leadership.

It’s very hard to get political leaders to plan for the future when they have pressing issues in the present, isn’t it?

Anthony Fauci:  Well, it is.  I think we’re doing better now. I think we’re starting to see that things are evolving at a global level, where you have the global health security agenda, where we get other countries to have enough surveillance and transparency and collaboration so that when there are outbreaks in different parts of the world, you don’t start from scratch.  You talk to each other.  Organizations are springing up, there are talks of emergency medical funds, infrastructure is being built in different places.

We’re doing better now than we were, but you’re absolutely correct.  It is very difficult, when resources are scarce and you have a lot of problems that are currently real problems, to get anyone — the Congress or the administration — to put in money for something that has not yet happened, that might not happen.  When there’s a lot of money around, you can say, “Okay, let’s put a little money there.”  But when you already have extraordinary budgetary constraints, that’s a real difficult thing to do, to convince somebody to put resources into something that might not ever happen.

What future prospects or threats keep you up at night?

The thing you get concerned about is an outbreak of an infectious disease that’s respiratory-borne, that has a high degree of morbidity and mortality, such as a pandemic influenza.  You know, in 1918, we had a devastating pandemic that, at the time, killed from 50 to 100 million people — which, in the population back in 1918, that would spell out into many, many, many more people. So that’s the reason why we’re doing things right now to try and develop more universal countermeasures against these things.  And that’s what we need resources for, which is the reason why it’s a shame when you have budgetary constraints.

One of those things is what’s called a universal influenza vaccine.  Namely, a vaccine that’s good against any strain of influenza: old strains, new strains, changing strains.  That’s something that we now have the scientific light at the end of the tunnel that we’ll be able to do that.  So yes, it keeps me up at night that one of these days that might happen, and you really want to be prepared for it, and one of the ways to be prepared is for an investment in basic and clinical and translational research.  That’s what I think we all need to understand.

What’s the difference between something like trying to find a cure for AIDS and what we call “basic research”?

Anthony Fauci: What people don’t understand is they think that these two things are disconnected — that there’s basic research and then there’s research for HIV drugs or what-have-you to treat AIDS.  So, give you an example: basic research is probing — it’s kind of like an incubator of new ideas for things in which you don’t quite yet know what the applicability is going to be.  But it’s probing the unknown, the unknown in biology.  For us in the medical sciences, that’s mostly the unknown in biology.  For a physicist who’s worrying about eclipses and things, that’s science that’s in the unknown of the physical scientist.  But I’ll give you a really cogent example of basic research that has ultimately transformed diseases.

Years and years ago, there were two investigators, Howard Temin and David Baltimore, who were working on trying to figure out how DNA — when you’re studying DNA codes for RNA — but what about if you have RNA, how does RNA reproduce itself?  Because DNA is the factory that makes the RNA that makes the protein.

So they were trying to figure out what this was, and they found out that there’s an enzyme that no one had ever identified before.  It’s called reverse transcriptase.  So it goes backwards.  Usually, it’s DNA — RNA — protein.  This is RNA into DNA; then the DNA then codes the RNA.  And like, “What are you talking about?”  There’s an enzyme called reverse transcriptase.

It so happens — fast-forward many years — reverse transcriptase is the enzyme that the HIV virus uses to get its HIV RNA to become DNA to get into your cell to start multiplying.  So if they had not been doing basic research, we would likely not have any of the drugs that we have now for HIV.  And I can guarantee you that when David Baltimore and Howard Temin were working on reverse transcriptase, they had no idea that we would have an HIV-AIDS epidemic many, many years later.  That’s the beauty of the discovery. You just don’t know, but if you shut off the basic research, then what you’ve done is you’ve shut off the incubator and you only deal with things that you already have about new things that’ll happen in the future.

Harold Varmus, when he was head of NIH, was quoted as saying that he didn’t worry about your division because you ruled it with an iron fist.  Your own wife has said that when she first got to NIH, you were away on a trip to China and she’d heard all these horrible stories about how strict you were.  How did you get this reputation?

Anthony Fauci:  I think that’s a little hyperbolic. That’s Harold’s subtle sense of humor saying “an iron fist.”  What Harold meant was that, as the leader of the institute, I expect everybody to put 100 percent in.  If you’re lazy, you’re sloppy, you don’t pull your weight, you’re going to have a problem with me.   If you work hard, you’re going to love me because I’ll give you a lot of responsibility. I will recognize you, and I will be very good to you.  We didn’t make any big-time mistakes when we were running that institute.

What my wife was saying was a different story.  Because, one, what Harold was talking about was running the institute, making sure that everything ran like a well-oiled machine. What my wife was talking about is that she came in to the NIH first as a nurse, and I was away giving some talks in China, and she had heard about — you know, on rounds, when you make rounds, I expect everybody to know everything about the patient, to be able to present it in a crisp, articulate way.  I need everybody knowing all the things that are going on because I think it’s a sacred privilege to be able to take care of the patient. Every once in a while, not always, you get somebody that’s sloppy.  You know they’re presenting the patient, they don’t know what the laboratory data is, and she had heard that when people are like that, I don’t suffer that very lightly.

If you’re going to take the responsibility of putting somebody’s life in your hands, you’d better know what’s going on with the patient.  And one of the things that I would not like at all when someone is presenting a patient to you, and they’re going through “and the patient has — let me see, what’s this?”  If you don’t know in your head what’s going on with your patient, you were going to have trouble with me.

So that’s why she thought I was this really bad guy, but I wasn’t because if you were really good, and you did your job well, we were great. I loved you, and you loved me, so there was no problem.  So she came in and heard from people who — you know, stories get magnified, legends get magnified.  So people were painting my demand for protection sometimes in a little bit hyperbolic way, and that’s what she heard when she came in.

Your wife, Christine, is now a Ph.D. She’s chair of bioethics at the institute, but how did you meet her?

Anthony Fauci:  I met her over the bed of a patient.  She had been at the NIH for a few weeks while I was away in China giving a lecture.  We had a patient who was from Brazil; he only spoke Portuguese.  Chris had just come back from two years in Project Hope in a small place in a northeastern part of Brazil called Maceió.  She ran a clinic there for two years.  She went from there and came to the NIH, so she was fluent in Portuguese.  When she came, she said, “Who runs the show? Who’s the boss here?” And they said, “It’s this guy Fauci.  Be careful because he’s very demanding.”  So she had heard that I was a very demanding person.

So when I went in to see this patient, he was a Brazilian senator, and he had one of the old diseases, the vasculitis, where he had ulcers on his leg, and I was making sure that we took care of him very well.  He needed to rest and elevate his legs so as to not have the breakdown of the skin.  So the last rounds before he was going to go home, I said, “I really want to give this guy instructions about what he needs to do when he goes home.”  I said, “Does anybody speak Portuguese?”  They said, “Oh, we have this new nurse, Christine Grady, who just came back from Brazil. She speaks Portuguese.”  So she came in, and I told the guy, in a very serious way, I say, “Mr. Such-and-such, I need you — when you go home, you need to rest.  You need to elevate your legs.”  You need to do this and you need to do that.  So she gets that, and she goes “blah, blah, blah” in Portuguese to the guy.  And he tells her in Portuguese, “This guy must be nuts. I’ve been sitting in this bed for weeks.  I’m going to go there. I’m going to go to the Copacabana.  I’m going to go to the beach. I’m going to dance. I’m going to drink caipirinhas.  So that’s what I’m going to do.”  She didn’t know what to do, so she gulped, and she turned around and instinctively said, ”He says, ‘Fine.’ He’ll agree with you.”  And I said, “Okay, fine.  That’s great.”

So I was struck by her beauty and her grace, and I said, “Nice-looking new nurse.”  So I went back, and about a week or so later, I decided, “Let me just take a chance and ask her out to dinner.”  So I told the head nurse on the ward, “Would you please have Christine Grady come to my office?”

My office at the time was right in the clinical center in building ten.  So when she heard that, she said, “Oh my goodness, somehow he found out that I lied to him. That’s the end of my career at NIH.”  So she came into my office, and she sat down very nervously, and I just looked at her, and I said, “How would you like to go out to dinner?”  And she just sort of — her mouth dropped for about five seconds, but she recovered very well, and she said, “Of course, I would love to.”  And then that was it.  That’s how we got to start going out.

You see patients, you run your own lab and do research, and you run a large institute, and you have a family. How do you organize your life? Do you have a system?

Anthony Fauci:  It’s a combination of prioritization, and when you get a certain amount of experience, you know what you really do have to spend time on and things that you can just blow off.  The other thing that I’ve done is that, in the operation at the institute, which, remember, is a five-billion-dollar institute, and we have a lot of responsibilities — malaria, tuberculosis, things like that — my style of leadership is that I set the fundamental principles of where I think we should be going.  I am very clear in what I expect, so the one thing that people will tell you in my institute: “There’s no ambiguity about where Tony wants to go with this.”

But balancing that, I surround myself with the very brightest people I could find because I don’t want to necessarily be the smartest person in the room all the time. I surround myself with the very brightest people, and I don’t micromanage them.  I say, “This is where we need to go.”  I don’t go off and never check what’s going on, and I say, “Let me know how I can help.  If you meet any trouble, we’ll do it.  But here’s where I want to go.”  When it comes to things like the development of AIDS drugs, I said, “Here’s what the goal is going to be.”  So there are certain things that I delegate, I don’t micromanage, and you pick the very best people.

There are certain things that you have to do.  Like when the Congress asks you to testify in the middle of a crisis, like Ebola or Zika or anthrax, that just consumes a lot of your time.  So if you didn’t have a good team to continue the good work that you’ve already — they know what you want.  When you’re a micromanager, or you don’t have a vision, and for some reason or other you get called away — you could get called away in a crisis or you can get called away because you’re sick or whatever it is, then the people back there, they don’t have any idea what they’re doing. But when you make it really clear that here’s where we’re going, then in the middle of the anthrax attacks — which, we didn’t know whether the next attack was going to be something that would wipe us out — I would say I spent more time in the White House in the Situation Room during that fall of 2001 because the anthrax came, remember, right after 9/11, that, those few months, that I literally lived in the White House and before congressional committees and on television, trying to calm the public.

Everything back home would have gone to pieces if I didn’t have a group that I trained, that I gave them the vision and that I didn’t micromanage them so that they knew how to take care of things when I wasn’t there.  I think that’s really one of the major secrets of delegate the things but don’t delegate in a completely open-ended way.  You say, “Here’s where we’re going. If you don’t agree with that direction, tell me, we’ll discuss it, and you might convince me that we want to go in a different direction.  But then I won’t micromanage you.”

Do you make it home for dinner?

Anthony Fauci:  I have a strange physiologic. I don’t want anybody who is listening to this to do that.  Usually, at times like that, I don’t even eat.  I don’t even leave work until — I mean during the crises of Ebola when Nina Pham and Amber Vinson got infected, and we were not sure whether it was going to be spread in this country, I was in my office until 11, 12 o’clock.  Maybe I would grab a sandwich and do it. I have a spectacular wife, who has been through all of these crises with me, who’s a professional in her own right, who has been amazingly supportive and understanding of that.  Sometimes you just can’t — “Let’s go home and have dinner!” type, it doesn’t work.  You don’t go home and have dinner when you’re in the middle of an anthrax crisis.

You and your wife have children.  How did you ever see them?

Anthony Fauci:  Actually, we had a deal when my girls were growing up.  Thanks to — what’s the right word? — the generosity, emotional generosity, of my wife — that we felt that we really needed to eat together.  They always tell you, “Don’t eat a meal before you go to bed.” Well, for many years, my daughters and my wife and I would eat a meal late.  Because I would stay at work until 8:30, quarter to nine, get home — I live in Northwest D.C., so it takes 15, 18 minutes to get to the NIH.  So I would come back home at nine o’clock, 9:15, and we would eat.  Now the kids, interestingly, they were all athletes and different things after school, so they would go to school, they would come back, they would go rowing or cross country, all the things they did.  They’d come back, they’d have a little snack, they’d do their homework, and then they’d come and we’d eat together.  So I would see them almost all the time, but it was a bizarre situation.

With the crisis situations that you handle, not to mention the regular duties of your day job, do you find time to sleep?  How much do you sleep?

Anthony Fauci:  On a regular night, I sleep about five hours — maybe a little — about five hours, five hours and ten minutes.  When we have crises, the adrenaline is so high that there were certain crisis components that it harkened back to my internship and residency days, where you had to do the things that you mentioned at my regular — quote  — “day job.”  You have to brief the president in the Situation Room. You get called down to the Congress by the leadership to brief them, sometimes individually, sometimes as a group.  And then you’ve got to go back down and be on Rachel Maddow late at night.

How do you relax? Do you listen to music when you work alone?

Anthony Fauci:  Sometimes I do, and there are certain things that I do that music is very distracting, and I can’t do it.  But there are other things that I do that music is really very soothing. I’m an inveterate Beatles fan, Eagles fan, America fan.  It just dates me, but I could listen to that and do certain things without being distracted.  When I’m trying to write a commencement address or write a paper, it’s impossible — it has to be completely quiet.  Any kind, even a soothing Mozart, doesn’t help me.

Do you enjoy reading or visiting museums?  Looking at painting or sculpture?

Anthony Fauci:  The museum that I really enjoy is the Air and Space Museum.  That’s great. I don’t have time to go to museums a lot, but I have this thing about history.  I really like the history of our country, particularly.  The books that I read — and I focus on a lot — and I’m just fascinated by what happened in the late ‘30s in Europe with World War II.  You can read multiple different versions of that.  I love Rick Atkinson’s books on war.  He’s a phenomenal writer, a Pulitzer Prize winner; he’s really fantastic.  So, that era of history fascinates me — how we could have gone so wrong.

If heaven exists, what would you like to hear God say when you arrive at the pearly gates?

Anthony Fauci:  That’s assuming I’m arriving at the pearly gates! “You did a good job, and I’m going to make you go back as Mickey Mantle.”

Do you ever think about retirement?

Anthony Fauci:  No.  No, I don’t.  I’m just going to keep working until I feel —and I think I have a pretty good radar screen for that — that I’m not at the top of my game, and right now, I think I’m even more than on the top of my game.  Because if you keep your energy up and you build on experience, that’s really the ticket.  I’m in a field where accumulation of knowledge and experience in difficult situations make you well suited to play a very special role.  If you don’t learn from experiences, then you can just burn out and run out of time, but I don’t really think about retiring.

Dr. Fauci, thank you so much for your time with us.

Anthony Fauci:  Good to be with you.  My pleasure.