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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. With us now, with his memoir out now, Dr. Anthony Fauci. It's easy to forget that his job title all these years was not COVID Lightning Rod, but rather Director of the National Institute of Allergy and Infectious Diseases, which he held from 1984 to 2022. Now retired at 83 years old. His book is not just about Trump and the pandemic, but that and a whole lot more about public health in his life and times. The book is titled On Call: A Doctor's Journey in Public Service. Dr. Fauci, thanks for coming onto this. Welcome back to WNYC.

Dr. Anthony Fauci: Thank you very much. It's good to be with you.

Brian Lehrer: I see it's not a public health official's journey, it's a doctor's journey. Is that how you identify?

Dr. Anthony Fauci: Oh, absolutely. As I point out in the book very clearly that my primary identity is as a physician and I tell the story about how I got to that particular point in life and everything else is derivative of that; a scientist, a public health official, and a public servant. That's the reason why I talk about that in the context of my primary identity being a physician, which it still is, actually.

Brian Lehrer: Before we get into politics or public health, let's just cover a little of your childhood because it was here in New York, in Brooklyn. I think some of our listeners might find it interesting and it'll probably be the most fun part of the segment. Where exactly did you grow up and can you describe your block or your immediate neighborhood?

Dr. Anthony Fauci: Sure. Yes. I was born in the Bensonhurst section of Brooklyn on 79th Street and New Utrecht Avenue right across the street from the New Utrecht High School, the high school that my mother and father both went to and got married immediately after graduation from high school. They got married when they were 18 and 19 years old.

I moved when I was a young boy around eight or nine years old to Dyker Heights on 13th and 83rd Street when my father opened a pharmacy, a drug store, which is where I got my first look at the whole concept of community service. The pharmacy back then- this was the 1940s and '50s when this happened- was really the hub of the neighborhood. You could be the neighborhood psychiatrist, marriage counselor, as well as the pharmacist who distributes medications to people who need them. I got that concept of serving the community literally from the time I was a child, eight, nine years old when I was delivering prescriptions on my Schwinn bike in the various streets up and down around that neighborhood.

Brian Lehrer: Do you have memories of your father talking about advances in medication or risks of certain medications for that matter? Customer's good or bad experiences or anything like that as a pharmacy back in the day?

Dr. Anthony Fauci: Well, no, I don't think it was that explicit. What I did get an introduction to though, was the whole idea of people who have illnesses who might actually be unable to afford the medications that were necessary to treat their illness. That's one of the things I point out in the memoir, that my father, a wonderful human being that he was and was really admired and respected in the neighborhood, he wasn't a very good businessman because he had such empathy for people who could not afford the medications that he would often give it to them on a tab, which not infrequently they could not pay.

When my sister and I asked him about that, he, without missing a beat, said, "Well these people are struggling, so we have the capability of helping them. I think it's almost our responsibility to do so." I've carried that mantra throughout my training in school, and then in medical school and my advanced medical training, and even up to this day, and it's punctuated throughout the book of hearkening back to that attitude that was formulated for me literally in my childhood.

Brian Lehrer: Gee, I thought the first thing you learn in pharmacist school is how to say, "Show me your insurance card."

Dr. Anthony Fauci: [laughs] Well, that's pharmacy of today, and that's the point that I made in the book, and I would hope the readers would enjoy that, of how things have changed over so many decades where the pharmacy was a haven for people who needed help and I mean anything. As I mentioned, you have a delinquent child, what should I do about it? I'm having trouble with my marriage, I can't quit smoking, or something like that. The pharmacy who was referred to as "Doc" in the neighborhood would be the person that would sit down with you and talk to you about that. That is very different from the industrial-size pharmacies that we deal with today.

Brian Lehrer: People don't say they want to grow up to run the National Institute of Allergy and Infectious Diseases. What led you to go from Anthony Fauci MD to get on that public health and policy track?

Dr. Anthony Fauci: Well, it's, again, one of the themes of the book, that life and one's career and one's life direction is very often not linear. There are unexpected opportunities that fall in front of you that if you are prepared and trained, you can actually essentially go after that opportunity and achieve something that you hadn't originally planned. My plan when I went to medical school, and again, I went to medical school and did my internship and residency training in New York City at the New York Hospital Cornell Medical Center, which is now Weill Cornell on 69th Street and York Avenue.

My goal was to finish my residency training, get a few years of fellowship in infectious diseases and immunology at the NIH in Bethesda Maryland, and come back and practice medicine right there in Midtown, East Side, New York City. That's what I really wanted to do.

Something changed on the way to that, in that when I went down to the NIH in Bethesda to my fellowship, I got introduced into the world of biomedical research where not only can you take care of an individual patient, but that you might do an experiment, the clinical trial, a study that would provide information that others could use, and you publish it in the medical literature, ultimately would get into a textbook.

Instead of just impacting a single patient that you're taking care of one at a time, you have a multiplier effect. I became a researcher down there.

What evolved over the next few years, particularly triggered by my introduction into the arena of HIV/AIDS, which began in 1981 and all of its implications for global health and the terrible tragedy it imposed upon certain segments of our society, I felt I wanted it to do more than just do research and take care of patients. I didn't give that up. I continued to do it, but I wanted to have a greater impact on the field of infectious diseases. That's why at a very early young age, I accepted the position that was offered to me as essentially the youngest director of an institute at the NIH in its history.

That's how I got involved in running a large biomedical research institute in infectious diseases and immunology because I really wanted to have much more of an impact on the broad field of infectious diseases, particularly in the context of the outbreak that we were facing with HIV/AIDS.

Brian Lehrer: Listeners, we can take a few questions via phone or text for Dr. Fauci whose memoir is On Call: A Doctor's Journey in Public Service. We don't have too much time for calls. We have a lot of breaking Supreme Court news that we're going to get to with Professor Aziz Huq coming up for a long segment at the end of the show, but we can take a few. If there's anything you really always wanted to ask Dr. Fauci but didn't have him over for dinner, 212-433-WNYC, 212-433-9692, call or text.

You brought up HIV and 35 years before Donald Trump, you had your very first or your first very high-profile political adversary in Larry Kramer, a founder of Act Up. For listeners who don't know, I'll tell them you later became close and even traded I love yous near the end of Larry's life. You and I have talked about this before, but recall for us, if you would, why was he so upset with you at the time, and did you come to believe he was right to be?

Dr. Anthony Fauci: Well, the answer to your last question is that he and the young activists, particularly in Act Up New York actually were right, and let me explain to the listeners what I mean by that. Back in the early days when we were doing clinical trials, the scientific community and the regulatory community in the form of the FDA were understandably rigid in the entry and exclusion criteria for clinical trials and the availability of drugs on a compassionate basis outside of the clinical trials. The FDA was quite rigid and took a long time to get their drugs approved, which worked well for other diseases because it provided a real good cushion of safety together with the proof of efficacy.

For a brand new disease that was like no other disease in the sense that it was essentially killing all of these young, mostly gay men who had been previously healthy, they didn't have time to wait. They wanted to be part of the agenda. They wanted to have input into how the research was done and to get their side of the picture sitting at the table with the scientists and the regulators, of course, the scientific and regulatory community who felt understandably but inappropriately that they knew more and better what was the best for the patient or the people at risk for the disease. They wouldn't listen to what they had to say, which triggered a degree of pushback, iconoclastic behavior, theatrical behavior, and confrontation, which was led in many respects by the firebrand, Larry Kramer, who was a well-known author and playwright.

He had been nominated for an Academy Award for Women in Love as the screenwriter for that. He got my attention. One of the best things that I've done in my career was when they started pushing back, the rest of the scientific community, essentially dissociated themselves even further from the activist community. I decided to listen to what they were saying because I felt a great degree of empathy for the fact of what they were going through, the pain and the suffering and the fear. When I started to listen to what they were saying, they made absolutely perfect sense.

I said to myself, if I were in their shoes, I would be doing exactly what they were doing. I would be pushing the envelope. It was sort of a reminding one of what John Lewis, the great iconic civil rights person who said, when you make trouble, make good trouble. What the activists were doing, they were making good trouble to gain our attention. When they did, we started to interact with them. After a while, I went from adversary, to collaborator, to colleague, to very good friends. To this day, 40-plus years later, some of these individuals are my best friends.

Brian Lehrer: We have a caller who remembers being critical and maybe is, to this day, critical of another aspect of what was going on with you and HIV in the early days. I'm going to take that call. Shayla in Montclair, you're on WNYC with Dr. Anthony Fauci. Hi, Shayla.

Shayla: Hello. Hello, Dr. Fauci.

Dr. Anthony Fauci: Hello.

Shayla: Hello. As a Haitian person, there's a big thing in our community, as you are seen as the person who had a very big impact, your speech about Haitians and HIV. We regard you as, I don't want to say a problem, but as a person who caused us a lot of problem in the '80s due to the AIDS epidemic. I'd like to be enlightened about that because I would like to hear it from your mouth and not from hearsay about what did you do during the AIDS epidemic to help the Haitian community?

Brian Lehrer: Shayla, thank you very much. I'll just give a little more context for listeners who may not know it, and Dr. Fauci or Shayla, correct me if you think I'm getting this wrong. In the very early days of HIV, when they were just figuring out how it was transmitted through semen and blood mostly, there was this term out there that it was the four Hs who were the big risk groups, homosexuals, hemophiliacs because of blood transfusions, heroin users because of shared needles putting somebody's blood into somebody else's body and Haitians, who for a short time were incorrectly thought to be an independent risk group. Were you part of that?

Dr. Anthony Fauci: Well, I don't know what you mean by being part of that. We didn't know what was going on at the time. First of all, this was mostly CDC and not me, because the epidemiology, I was doing the research to try and understand the disease and to develop drugs. I'm not trying to push it off on the CDC, but it was the CDC that created that four Hs. What it was that we were unclear as to why Haitians seemed to be getting infected, and they were heterosexual, not just gay men, Haitians. That was the first clue that the disease in the developing world, particularly in Sub-Saharan Africa, was predominantly a disease of heterosexuals where the one-to-one man-to-woman ratio was very clear while in the United States, it was fundamentally among gay men and injection drug users.

When we started to see Haitians who were infected, but many of whom were heterosexual, it was the first clue of what was actually going on in Africa. It was the relationship and the exchange of people back and forth between Haiti and Africa that introduced the virus into Haiti. There was nothing that was discriminatory against Haitians. It was a big clue as to the fact that it wasn't just among gay men, that heterosexuals could definitely transmit the virus. In fact, in Africa, it's almost exclusively a heterosexually transmitted disease. Transmission among gay men is only a secondary phenomenon, whereas in the United States, it's still the primary phenomenon.

Brian Lehrer: Does that mean that in some places female to male transmission is easier than in other places?

Dr. Anthony Fauci: Well, it depends on a number of factors. If a man has an underlying sexually transmitted disease and has mucosal erosions from any of a number of infections, syphilis, gonorrhea, other genital diseases, it would be easier for a woman to transmit it to men. In general, with HIV, historically, it is much easier for a man to transmit it to a woman than it is for a woman to transmit it to a man.

Brian Lehrer: Shayla, what'd you think of the answer you got?

Shayla: Well, I think there's a little bit of disregard for what we went through. I was in my 20s when that happened. I was living in Montreal I remember the day the news came out, how the whole Haitian community was, some people lost their jobs, some people lost some relationships as they were dating people from other communities. They would for the longest time were not allowed to give blood. Some people were embarrassed to say they were Haitian. I wish Dr. Fauci would show a little bit of compassion about what happened.

Dr. Anthony Fauci: Yes. I think to be honest with you, I'd like to shake my head and say yes, but I think you're misrepresenting what I was saying and doing back then. With all due respect to you, I think you're misrepresenting. I had a phenomenal amount of compassion and empathy for any person with HIV because I took care of personally hundreds and hundreds and hundreds of patients. To say that you think I should have shown more compassion, I think reflects that you don't know anything about me.

Brian Lehrer: Shayla, thank you very much for your call. We don't have that much time. I want to go on to you and Donald Trump, which is probably what most of the interviews have dwelled almost entirely on. I wanted to do these other pieces too like a bit about your childhood and definitely some things about HIV. Dr. Anthony Fauci memoir is called On Call: A Doctor's Journey in Public Service.

I actually want to ask you something about something in the news today, and I don't even know if you're going to have an answer to this yet. Trump, regardless of what you and he went through during COVID, wants to dismantle much of the administrative state. Today's Supreme Court ruling that we're going to talk about with our next guest is going to make it easier for him to do that, it looks like,` if he's reelected as president and he is running on that. Is there anything specifically related to public health that you're concerned that he might weaken or destroy?

Dr. Anthony Fauci: Well, one of the things that has been said that he wants to do is to essentially dismantle a considerable part of the civil service and make it all essentially reporting directly to a political person. I think, and most scientists and others in the public health arena, feel that that is a really bad idea. Once you have a political influence on important public health decisions, that is a recipe for things going wrong because you don't want to have a situation where a physician, a scientist, or a regulator, would be afraid to tell the truth about something because if the political person who has complete power over them doesn't like it, they could just remove them out of hand without any excuses. That would be a state that I think would diminish our capability of being a very effective scientific and public health community.

Brian Lehrer: Do you think there's a quantifiable Trump COVID death toll, like an estimate of excess deaths because of remedies or protections that he delayed, or people he convinced not to take it seriously enough, or to not get vaccinated for?

Dr. Anthony Fauci: I don't want to go there because first of all, that immediately becomes a soundbite. I'm not really into that. I'm not trying to play the blame game with anyone. I just don't really want to answer that question.

Brian Lehrer: Do you have an opinion on this debate in New York State right now over banning masks on the subways and in other public places? I know plenty of people who, let's say older people and immunocompromised people who have not stopped wearing masks on the subways that they started wearing during COVID.

Dr. Anthony Fauci: No. I don't understand the basis for that. I hesitate to comment on an answer to a question when I'm not really sure exactly what's going on, but if there's banning of mask, I don't understand why that's the case. If a person is vulnerable, an elderly person, a person with an underlying condition, a person whose immune compromised for chemotherapy for an autoimmune disease or cancer, wants to wear a mask, I don't understand why you'd want to ban someone from making their own individual decision to protect themselves.

Brian Lehrer: Oh, it's because some people have been wearing masks as they commit hate crimes, so they can't be identified.

Dr. Anthony Fauci: Well, I don't know. I think you have to do a risk-benefit ratio about that about the protection that some people need. That's a local issue. Again, I stay in my own lane. I'm just giving you my feeling of why it would be good if a person who really is at risk, has the opportunity to wear a mask.

Brian Lehrer: On risk-benefit and COVID, do you have any regrets or do you second guess some of the policies like the extent of the lockdowns because as a public health official, maybe some people were only looking at COVID prevention and COVID death and hospitalization prevention and didn't take into account as much the risks of delayed other health care that would ultimately result in death or mental health crises?

Dr. Anthony Fauci: Yes, of course. Whenever you have gone through such a terrible experience that we have, where we have 1.2 million deaths in the United States, essentially more on a per capita basis than virtually any other country with few exceptions, you look at what has happened and what you've done, and the decisions that you've made not only the initial decision but how long you carried out the implementation of that decision.

Certainly not everything was done perfectly, we're or absolutely certain. I think you have to turn the clock back and look at what was happening when the decision was made by the Coronavirus Task Force about the 15-day close-down. It wasn't an absolute shutdown, but it was certainly was a physical separation in trying to flatten the curve with the extension over 30 days.

At that point in time, we were faced with a tsunami of hospitalizations and deaths. In our own New York City, there were freezer trucks parked in front of several of the hospitals because there was so many bodies, they couldn't fit them in the morgue. That was a desperate situation. When you have a desperate situation, you have to do unusual things. Shutting down initially was the right choice.

What we need to examine and look at the cost-benefit ratio is the duration of that shutdown, the duration of schools closing in different parts of the country in different regions of the country. That's when you have to carefully look at was the collateral damage in a very long shutdown worse than some of the medical issues and we need to examine that. We need to examine that in an open-minded way.

Brian Lehrer: Do you have a preliminary answer today?

Dr. Anthony Fauci: No, we don't. I think it really requires us taking a look at the numbers and the number of lives that were saved by that versus the negative impact on children, which really occurred. If you go back and take a look click into YouTube and look at what I was saying, soon after the closure when we got to the spring and the summer and the fall, that we should do whatever we canto, as quickly and safely as possible, reopen the schools, because I, among others felt that a prolonged closing of the school would have a detrimental effect. I was feeling that way back then. I think what we need to do now is to take a look in an unbiased way, and examine those kinds of decisions about the length of time that things were shut down, particularly the schools.

Brian Lehrer: Dr. Anthony Fauci's new memoir is called On Call: A Doctor’s Journey in Public Service. I appreciate that you've come on the show a number of times during the pandemic, and now for the book. Thank you for your service in that field, and thank you for talking to us.

Dr. Anthony Fauci: Thank you for having me. I really appreciate it. Thank you.

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