Dr. Anthony S. Fauci is the director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health. Fauci has advised seven United States Presidents on infectious disease and public health matters, including HIV/AIDS, respiratory infections, diarrheal diseases, tuberculosis, malaria, Ebola, Zika, and most prominently, COVID-19. Today, he serves as the Chief Medical Advisor to President Joe Biden.
This interview has been edited for length and clarity.
Harvard Political Review: These past few years, we’ve seen both the coordination and fragmentation in the ways that the national and state governments and local governments have been responding to the COVID-19 pandemic. How have you seen the United States’ federalist system interact with the public health response to COVID-19? Do you think it’s been a boon or a hindrance?
Anthony Fauci: It’s been complicated, but I think for the most part, and again, I don’t want to seem judgmental on it, but on the balance of it, I think it has been more detrimental than it has been positive. Now, obviously, when you talk about the federalist system and states’ rights, and the idea that states can and should do things differently, in the big picture of why that was originally established in our government, it makes sense in many respects, because we have such a large, diverse country. Not only ethnically diverse, but geographically diverse, economically diverse, climatically diverse — it’s really quite a diverse country. So you want to respect differences in the 50 states and territories that we have.
However, when you have a situation where you can have individual components of a country that is trying as a nation to address the historic pandemic, the likes of which we haven’t seen in over 100 years, which has already killed 1 million Americans, you really have to have at least somewhat of a unified response that’s based on data, evidence, and science. If you happen to have at the local level a governor or a mayor who decides, “No, I don’t think you should get vaccinated,” because of the political influence, people in that particular region don’t get vaccinated, or don’t want to wear a mask in an indoor congregate setting where there are 50 people in a room. Then, all of a sudden, you’re getting the danger to health that is really unacceptable when you’re in the middle of a situation where it’s very clear [that] there are some core fundamental principles of public health that have to be adhered to.
Although there are still many, many good things about the state’s prerogative to do what they want to do, I think it has been counterproductive to some extent when it comes to COVID.
HPR: Do you think that the risk of this fragmentation is greater than the risk of centralization in the federal government but then potentially having a figure who would undermine the response? With Trump, for example, you have given him credit for his vaccine efforts, but his misinformation has derailed the public response to the pandemic — do you think those two risks are equal, or that one is greater?
AF: No, I wouldn’t conflate them at all. Because, you know, I’ve had the personal experience of having to deal with him. It’s the public health principles that are key. Even though he was the president of the United States, he wasn’t espousing public health principles. So what I’m talking about, the general community of public health people agree 98% that you should be doing something. That’s what I mean by something that’s universally consistent in the country. No, I’m not talking about a dictator that says, “Take off your mask, everybody.” That’s a different story.
HPR: A big focus for you over the course of the pandemic has been increasing vaccination rates. And to this end, we saw the Biden administration send vaccines directly to local primary care providers. These physicians found themselves increasingly in the position of navigating ideological differences with patients. Do you see frontline responders taking an increasingly “political” role in the eyes of the public, and how should they navigate ideological rifts with their patients?
AF: Yeah, I think you should, as best as you possibly can, keep anything ideological out of what you do when it comes to the delivery of healthcare. That, to me, again is one of the issues that has been, in my mind, so destructive in our public health response to COVID, has been the divisiveness in our country along ideological lines that has really had a profound impact on life and death of people.
For example, there is absolutely no justification of having an acceptance of a life-saving intervention like a vaccine be very poorly accepted in a red state and well accepted in a blue state when there’s nothing political about that. It is scientifically proven to be life saving. And yet, when you look at the data, there are more Republicans dying from a from COVID than there are Democrats with all other demographic issues being equal.
There’s an incredible figure that came out a few weeks ago that showed the deaths due to COVID prior to vaccination was about equal between Democrats and Republicans. As soon as vaccines became available, because of the acceptance of vaccines predominantly by blue states and the rejection of vaccines predominantly by red states, the deaths among Republicans was up here and the deaths among Democrats was down here. That is unconscionable from a public health standpoint, that you should have an ideological difference impact whether or not you get seriously ill or die from an infection. So I feel very strongly about that: that ideological considerations should not influence fundamental core public health principles.
HPR: What would you say to a primary care physician whose patient refuses to take the vaccine for an ideological reason?
AF: I would try. Obviously, you can’t force someone to do something. But I would try to reason with the person, not by ideologically sparring with them, but by saying put ideology aside for a moment, and let’s look at the data together. That’s the thing. Now, there are people, even when you show them the data, they can tell you, “I don’t believe it.” Well, then there’s nothing you can do about that. But if that’s the category of people that no matter how hard you try, the people that say, but these are the facts then say, “Well, there are alternative facts.” Well, there are no alternative facts. There are facts and then there’s fiction.
That’s the point, but there are people who say they don’t want to get vaccinated because they don’t like the fact that Joe Biden is saying get vaccinated or Tony Fauci is saying get vaccinated. Okay, fine, but let’s unpack that for a minute and say, “Is it because you don’t like them? Or is it because you really believe that what they’re saying is wrong? And if they say, “I really believe that what they’re saying is wrong,” that’s when you come back with the facts. And you say, “Okay, let’s take a look at the facts,” and I think you’re gonna get a certain proportion of the people that will adhere to the facts.
