Doctor Who

On December 23, 2020, when others were preparing for a different nativity, the mayor of Washington, D.C., announced that the following day, the great man’s eightieth birthday, would be known in her city as “Dr. Anthony S. Fauci Day.” It was an odd way to pay tribute to someone who had done so much to ruin other people’s Christmases. A week earlier, Fauci had discouraged Americans from traveling to visit family, calling it “just one of the things you’re going to have to accept as we go through this unprecedented challenging time.” In medieval Europe, even lepers were allowed to enter cities to beg alms at Christmas.

Who was this man whose birthday outranked Christmas Eve in the nation’s capital? Officially, he is the director of the National Institute of Allergies and Infectious Diseases, a post he has held for the last thirty-six years, during which time the N.I.A.I.D. has gone from the sixth-highest funded of the National Institutes of Health to the second. He is both a bureaucrat and a researcher, having rejected multiple offers to head the N.I.H. because the promotion would take him away from the lab bench. Sally Quinn, who has a nose for D.C. power if anyone does, met Fauci at a dinner party and he made such an impression that she decided to make him the hero of her next romance novel—“Dr. Michael Lanzer,” forbidden lover of the First Lady, whose “square jaw and high cheekbones” give him “almost oriental or Indian features which belied his coloring.”

Unofficially, Dr. Fauci has become the face of the liberal response to the coronavirus pandemic. Whatever charisma Sally Quinn sensed, the Resistance is feeling. There are Dr. Fauci bobbleheads, bumper stickers, and votive candles. Kim Kardashian invited him to address a private Zoom call of thirty-seven celebrity friends so they could ask him about quarantine measures (Mila Kunis wanted to know whether it was safe to eat takeout straight out of the container; Fauci said yes). When Saturday Night Live needed an actor to play Fauci in a sketch, they cast Brad Pitt, and when the sketch was over, Pitt removed his wig and said into the camera, “To the real Dr. Fauci, thank you for your calm and clarity in this unnerving time.”

The attraction for many is Fauci’s position as a man of science. When politicians grandstand, Fauci will stick to the facts. But it is something more than that. Other liberal heroes have come and gone in the last four years, most too quickly to be remembered. Who today could name the protagonists of the impeachment, the tubby colonel, the lady ambassador? Fauci is more beloved, because he fits the role the Democrats have been trying to cast since 2016. Like a good foil, he is his counterpart’s opposite in some ways and his twin in others. He is gentlemanly and restrained, but he also has the New York accent and no-nonsense manner, plus the evident happiness in front of a T.V. camera. He is—or at least his fans want desperately for him to be—the anti-Trump.

Anthony Stephen Fauci was born in 1940 in Bensonhurst, Brooklyn, and grew up above the family pharmacy at Thirteenth Avenue and Eighty-Third Street. Academically, he followed a Catholic pipeline that no longer exists: local parish school to the famed Regis High School to Holy Cross College in Massachusetts. Today, he would doubtless have attended Harvard or Yale. In those days, if a boy wanted to go to a non-Catholic university, the Jesuits at Regis would simply refuse to write him a recommendation letter.

After graduating first in his class from Cornell Medical School, Fauci arrived at the National Institutes of Health in 1968, a year when not even the N.I.H. campus in Bethesda was safe from anti-war protests. Remembering one that he watched out of curiosity, Fauci said, “I have a real problem with Jane Fonda. She was in many respects a demoralizing factor for the troops, particularly by going to North Vietnam and having her picture taken with the Viet Cong . . . She may be a great actress but she really pissed me off.” He was old-fashioned, so old-fashioned that in 1985 he did what every doctor used to do and married a nurse.

His choice of specialty, the most self-revealing decision a doctor makes, was infectious diseases. “I would rather be involved with patients who have fatal diseases than those with diseases that are just an annoyance,” he later explained. “I wanted something that could make you very sick and kill you unless I intervened. And if I intervene, you’re essentially cured.” This puts Fauci at the anti-social end of the medical spectrum, not quite a true lone-wolf specialty like surgery where you hardly interact with patients at all, but one in which you are unlikely to interact with the same patient for very long. Soon enough the fellow is either dead or cured, as Fauci put it, and either way out of his doctor’s jurisdiction.

Infectious disease should have spared Fauci the burden that chronic disease specialists must put up with, organized lobbies of patients and their families. That changed with A.I.D.S.

The idea that Fauci was “wrong” about A.I.D.S., which some of his contemporary opponents repeat, is unfair. His most notorious error was a paper in 1983 suggesting “routine close contact, as within a family household,” might spread the disease, but it was an understandable mistake given what was known at the time and he corrected it within a year, lightning speed by the standards of academic publishing. He behaved more responsibly than some of his peers when it came to speculating about a heterosexual A.I.D.S. epidemic around the corner. He was not one of the hysteria-mongers—though he did benefit from the hysteria when negotiating budgets with Congress.

The biggest mistake that Fauci made was the thing he is most often praised for: getting the patients involved. It certainly was magnanimous of Fauci to treat A.I.D.S. activists as well as he did after they burned him in effigy and accused him of genocide for such crimes as not letting a patient taking one experimental drug muddle the data by participating in trials for others. He could have told A.C.T.-U.P. to leave the science to the scientists, as many of his colleagues urged him to do, on the logic that giving in to tantrums only encourages more of them. Instead Fauci created the Patient Constituency Working Group and put laymen on the committees steering research priorities.

The problem with all of this consultation was that it was, essentially, fake. This was not Fauci’s fault. What was Gregg Gonsalves, a twenty-something college dropout, supposed to do on the F.D.A. advisory committee when it debated whether to commend drugs for approval based on their test results? Fauci once took a meeting with Garance Franke-Ruta, literally a teenager, about why so many jobs in the N.I.H.’s A.I.D.S. division remained unfilled. Have you considered, she suggested, commissioning a design firm to make more attention-grabbing ads? His experience must have taught Fauci that making medicine more democratic was mostly a matter of humoring people, propitiating the narcissistic with smiles and attention and honorary titles until they left you alone.

And when it was all over, the people’s activists that Fauci elevated became just as arrogant as the scientists they replaced. The same Gregg Gonsalves briefly became a Twitter sensation in December 2020 for a thread he wrote about the COVID crisis. Now armed with a Ph.D. in public health from Yale, after returning to school to get his B.A. at age forty-eight, Gonsalves mocked journalists such as Ross Douthat for weighing in without the proper expertise: “Dear Ross has no idea what people in public health do . . . From the politics that make us sick—we call them the social determinants of health (I just heard Ross faint) to the policies we have to fight for to keep people healthy, public health is intertwined with politics, as it is a public not private science.” All Douthat had said was that it seemed overly political to deprioritize the elderly in vaccine allocation in the name of racial equity because the old in America are more likely to be white. Gonsalves was telling Ross to leave it to the experts—meaning people like himself.

The experts bungled COVID-19 from the beginning, Fauci included. He told C.N.N.’s Jake Tapper last February that fifteen to twenty percent of those who contracted the disease would require hospitalization, a wild overestimate, as we now know. In March, he said: “There’s no reason to be walking around with a mask,” a position he later admitted was motivated by worries about supply shortages and wanting to “save the masks for the people who need them most.” After a vaccine was developed, he massaged his estimates of how many Americans it would take to achieve herd immunity, confessing to the New York Times: “When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take seventy to seventy-five percent. Then, when newer surveys said sixty percent or more would take it, I thought, I can nudge this up a bit, so I went to eighty, eighty-five.”

So Fauci lied. It is hard to blame him, since the official policy of public health experts in these situations is to lie. According to the Center for Disease Control’s public relations catechism, Crisis and Risk Communications, “Giving people meaningful things to do calms anxiety, helps restore order, and promotes a restored sense of control.” Whether the tasks do anything to halt the spread of disease is irrelevant. C.E.R.C. also recommends using a crisis to promote unrelated public health goals, which is how the federal task force that President Obama sent to Flint, Michigan, to fix its tainted water supply ended up building bike lanes and fiddling with the nutritional content of school lunches. Anything beneficial to the health of Flint residents fell within their remit, as they saw it.

Public health attracts a certain personality type, comparable to the nuclear theorists who gamed out doomsday scenarios at the RAND Corporation during the Cold War. The magnitude of the numbers involved constitutes a kind of trump card. How could tradeoffs matter, when success or failure is measured in megadeaths? Dr. Nicholas Christakis is a thoughtful public health expert whose COVID commentary avoided hysteria, but in his book about the crisis, Apollo’s Arrow, which was published in October, even he allowed himself to be intoxicated by large numbers. “If masks reduced the transmission rate of the virus by only ten percent,” he writes, “hundreds of thousands of deaths would be prevented around the world, creating trillions of dollars in economic value.” It’s the last six words that give away that he’s making it up.

Fauci doesn’t care whether masks reduce risk ten percent. “I want to make it be a symbol for people to see that that’s the kind of thing you should be doing,” he said at a press conference in May. “It’s sort of respect for another person, and have that person respect you.” Lots of things about the COVID response were symbolic like that. Obsessively wiping down countertops when surface transmission was never a factor, shuttering small businesses and leaving big chains open—logic was less important than seeming to do something. Some people even wore masks alone in their own cars, including one New Jersey driver who kept his mask on for so long that he passed out from the carbon dioxide and crashed into a tree. Which may have been symbolic in its own way.

To be fair, the megalomania that draws some people to public health was never a factor with Fauci. There is a saying in Hollywood that the best kind of famous is when everybody knows your name and nobody knows your face. In Washington, where the currency is power and not fame, that’s what Fauci had. He was a big deal to everyone who mattered in his world and nobody who didn’t. To suggest that he hyped up COVID to boost his own profile is to misread the man.

But after accumulating power for thirty-six years, when COVID struck, he didn’t make very good use of it. Governors were saying we’d have lockdowns until they invented a cure or a vaccine, and Fauci did not pipe up to inform them that this was idiotic. Democrats carved out an exception to draconian, church-shuttering lockdowns for protests, and Fauci equivocated. “It’s a delicate balance, because the reasons for demonstrating are valid,” he said. He told N.B.C. News that the preposterous fad of double-masking, wearing a cloth covering over a surgical mask, “just makes common sense.” He was the one man in America who could have insisted on sanity, but instead of telling off his fans in the Resistance, he treated them the way he learned to treat Larry Kramer and his friends in A.C.T.-U.P., as people to be placated, from whom rationality could not be expected. But the people who were pleading for sanity this time were not narcissists like Kramer. They didn’t want to be placated. They wanted to be left alone.

Today health care sits atop the American economy like Fuseli’s incubus. In 1990, manufacturing was the leading source of employment in most states. Thirty years later, in thirty-three states out of fifty, it is “health care and social assistance.” A country whose dominant industry produces nothing and hardly even creates value in the traditional sense is headed for trouble. The fact that its prices are centrally planned by a committee of doctors in the bowels of the Centers for Medicare and Medicaid Services, based on a “Resource-Based Relative Value Scale” that boffins at the Harvard School of Public Health came up with in 1988, is even more redolent of the late Soviet era.

Within the lifetimes of the oldest Americans, medicine had barely any drugs worth the name and couldn’t treat a simple infection (penicillin didn’t come into use until World War II). Today, medical trials have moved to Eastern Europe and Brazil because Americans no longer make suitable test subjects; everyone over forty is taking too many pills already. Young women are put on birth control to treat acne, nuking their natural hormones as casually as popping an aspirin. Half the prescription drugs in the world are consumed by Americans, and the most prescribed class, ahead of statins, is antidepressants.

Some people love America’s elevation of medicine to the queen of the sciences. It correlates with a certain personality type. The houses with “WEAR A MASK” signs in the fall were the same ones with “BLACK LIVES MATTER” signs in the summer. It was ever thus. The eighteenth century’s most vigorous proponent of inoculation, who sneered at anyone who hesitated to take the smallpox scab, was Voltaire. He would have loved the headline in the Atlantic that referred to Governor Brian Kemp’s loosening of lockdown rules as “Georgia’s Experiment in Human Sacrifice.” It was his sort of rhetoric, from his sort of person.

Of course, at the time Voltaire was writing, inoculation was not safe. This was before Jenner, when inoculation was done not with harmless cowpox but with smallpox itself, and one in a hundred of those who received it died. Mass inoculation was more likely to spread the disease than to restrict it, since very few patients were wealthy enough to isolate in quarantine hospitals for the post-inoculation interval when they were contagious. Voltaire’s sarcastic arrogance might have been justified a century later when vaccination was more advanced, but not in his lifetime. It was the pose, not the science, that mattered.

Making a hero of Dr. Fauci meant the opposite of what people thought it did. Instead of the triumph of facts, it signaled the triumph of a class. These are the people who made health care one-sixth of our economy, because they can think of no better use for the money than to avert death, their greatest fear. One-sixth of the economy is already more than a tithe. Looking at the bizarre fanaticism that Fauci presided over, it may be that they are willing to sacrifice more.

Helen Andrews is editor of the American Conservative and the author of Boomers: The Men and Women Who Promised Freedom and Delivered Disaster.