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Long Before COVID-19, Dr. Anthony Fauci 'Changed Medicine In America Forever'

President Trump's daily briefings on the COVID-19 pandemic have introduced millions of Americans to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. At times, the specialist in infectious diseases has differed with the president during the briefings, correcting him on the seriousness of the virus or on the timeline for developing a vaccine. That's fueled speculation that Fauci's tenure might be cut short.

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DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies in today for Terry Gross. One consequence of President Trump's daily briefings on the coronavirus pandemic is that millions of Americans have gotten to know and admire Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Fauci has, at times, differed with Trump in the briefings, correcting him on the timeline for developing a vaccine, on the value of an anti-malarial drug in treating COVID-19 and other points.

Last weekend Fauci acknowledged in a TV interview that lives could've been saved if social distancing restrictions had been imposed earlier in the outbreak. Trump then retweeted a message from a Republican congressional candidate that included the phrase, time to fire Fauci. Despite reports that Trump has been unhappy with Fauci, the president insists he has no plans to dismiss him, and Fauci has continued to participate in the briefings.

Our guest today, science and technology writer Michael Specter, has known Fauci and covered his work for decades. He has an article in the April 20 edition of The New Yorker titled "How Anthony Fauci Became America's Doctor." Michael Specter has been a staff writer at The New Yorker since 1998. He's also an adjunct professor of bioengineering at Stanford University. Before joining The New Yorker, he was a foreign correspondent for The New York Times and The Washington Post's national science reporter. I spoke to Specter Tuesday from my home in Philadelphia. He was at Stanford University.

Michael Specter, welcome back to FRESH AIR.

MICHAEL SPECTER: Thank you.

DAVIES: People have gotten to know Dr. Fauci in recent weeks because he's appeared with President Trump in these daily briefings. You know, they've made Dr. Fauci one of the most trusted people in America now. Polls show that. You have known him, covered him for decades. Does anything about his role in the briefings or his handling of the questions surprise you? Is this the guy you've always known?

SPECTER: Yeah. He's been a remarkably consistent person since the day I met him, which was 35 or 36 years ago. He does his job. He tells the truth such as he knows it. He's not a political fellow, though he's had a political job. And he just sort of sees his job as marshalling evidence and presenting it to the people who need to know what he is talking about.

DAVIES: Does he have guidelines you've become aware of for dealing with political minefields, which he must sometimes, you know, walk through?

SPECTER: Well, he has his own guidelines. And he long ago said to me, you know, he goes to his favorite book of political philosophy, "The Godfather," and says it's basically just business, not personal. And I think his bottom line is you have to deal with the people that you're dealing with because if you say you are a childish fool, they are going to dismiss you or at the very least dismiss what you're saying, and you're not going to make a difference. And he wants to make a difference.

DAVIES: Let's talk a little bit about who Fauci is in the public health infrastructure. You know, there are all these institutions that we have heard about - the National Institutes of Health. There's the CDC in Atlanta. There's the Department of Health and Human Services. I mean, there really isn't a clear structure for handling a public health crisis, is there, with decision-making and lines of authority?

SPECTER: Well, there isn't at the moment. When AIDS started, I think CDC, the Centers for Disease Control, did that and did it very well. They haven't been as good at that in the last couple decades. Fauci runs an institute devoted to doing basic research on allergy and infectious diseases and immunology. But ever since the AIDS epidemic, he has filled the vacuum. He speaks clearly, he speaks honestly, and people have learned to listen to him. It isn't necessarily his job to do this. It isn't necessarily even something that he sought. But there is no one else doing it.

So we don't have an actual leader, so Fauci is the closest thing. And he does a good job. But he runs one institute at a very large organization, and it isn't even the organization that one would think would be focused on telling the American people what to do about disease control. That's why we have a Center for Disease Control.

DAVIES: Right. He has, for 36 years, headed the National Institute of Allergy and Infectious Diseases, which is one of the National Institutes of Health, right? They're actually government employees. They're part of the Department of Health and Human Services. Is he a presidential appointee?

SPECTER: No, he isn't. So the whole firing Fauci thing is - Trump can't fire him. He can kick him off the coronavirus task force. And I think Fauci's view is he wants to be up there to tell people what the truth is. So if the president of the United States wants to get rid of him by functionally dismissing him from that group, he can. But he can't fire him from his job. Fauci's 79 years old and has been doing this for 36 year. I don't think he gets up every morning and wonders whether his job is secure.

DAVIES: So tell us about Anthony Fauci's background, where he grew up, what his parents did.

SPECTER: His dad was a pharmacist. His mother was a well-educated woman who raised him and his sister. They grew up in Bensonhurst, Brooklyn, which was, in the '50s, pretty heavily Italian and Jewish in different parts of the neighborhood. He was in the Italian part. Very Catholic family - he went to Catholic grammar schools. He went to Regis, which is often considered the best private Catholic high school for men in America. And he went to Holy Cross after that because he was told by the Jesuits at Regis that that's where he would be going. That's how it worked in those days.

DAVIES: (Laughter).

SPECTER: But interesting to me - and, I mean, I guess I sort of knew this but hadn't remembered it. Fauci spent a lot of his life studying Latin and Greek and Romance languages and philosophy. He was very deeply concerned with the humanities. He wasn't a guy just saying, what are the English courses I need to take to graduate so I can go to medical school? It was pretty much the inverse. He was saying, what are the science courses I need to take to go? Because these other things are also very important.

DAVIES: Yeah. Do you think that informed his understanding of infectious diseases as his career unfolded?

SPECTER: I have to think it did because infectious diseases are diseases that spread among people, and that is a discipline that requires a sort of social interaction. This isn't - there are some medical disciplines where you can go in and do your job. You know, if you're a surgeon, you'll take things out. And maybe you have good bedside manner, and maybe you don't. But what we really care about is, are you good with your hands?

That's not as true with the type of doctor that Fauci is, and I think this played a role. He certainly has said and said to me that the combination of the humanities and science seemed to push him towards being a certain type of physician because physicians are people who interpret science and deliver it to people, but they need to do it in a human way. They need to do it in a way that people understand, and I think we all know that is sometimes in short supply.

DAVIES: Yeah. And sometimes you have to look at a problem from an unfamiliar angle, be creative in a way that might not be so easy with a science background.

SPECTER: I agree. And I have to say, just as a reporter who has known him for very long, he's always taken an open-minded approach to the problems that he's faced. He's not one - he's never been one, even in the early days, to say, this is how we do it, and we're never going to do it a different way. With AIDS, he started off saying, well, you know, there's a certain way we do clinical trials of new drugs. But he was persuaded by facts. He's always been able to be persuaded by facts. And I'm sorry to say that that is a vanishing art in this country.

DAVIES: After medical school, he had to either join the military or the Public Health Service. So he gets into the Public Health Service and then gets into Allergy and Infectious Diseases. And you write that he had early succession with a condition called vasculitis.

SPECTER: Yeah.

DAVIES: What was it? What insight did he have that made a difference?

SPECTER: It's kind of interesting. I mean, vasculitis is a very rare inflammatory disease where your blood cells attack your blood vessels and your organs shut down. And until Fauci and his mentor, Sheldon Wolf, came along, it was almost uniformly fatal. But when Fauci started working on it, he was also called to consult for cancer chemotherapy patients at the National Cancer Institute just on their treatment, because they get very powerful toxins and it suppresses their immune system. So doctors like Fauci were experts on the immune system. And when he saw a bunch of that, a weird thing occurred to him, which is the vasculitis patients have overactive immune systems. Maybe if we gave them these toxic drugs, but in a much lower dose, it would lower the overreaction without killing them. And, in fact, it not only did that, it cured the disease. He and his colleagues, principally Sheldon Wolf, helped cure a disease that, as he has said, it's not a disease that zillions of people have, but people died from it, and they don't die from it now. It went from sort of 98% died to 1% to 2% die.

DAVIES: Yeah. So it was a matter of taking one treatment for a disease and then thinking creatively, making the connection that might not have been...

SPECTER: Yeah. I mean, it was just an...

DAVIES: Yeah.

SPECTER: It was an interesting insight that you could take - you know, in cancer chemotherapy, you're basically trying to poison all the bad cells and hope that you do that before you poison all the good cells, too. And in watching this, he somehow felt like there is a way to harness this type of energy. We can do something with this that might be useful. It was a gamble. It might not have worked. He did it in very few patients at first. But it did work. And it was a kind of insight that not that many doctors, researchers or intellectuals even have.

DAVIES: Michael Specter is a staff writer for The New Yorker. His article "How Anthony Fauci Became America's Doctor" appears in the April 20 edition of the magazine. We'll continue our conversation in just a moment. This is FRESH AIR.

(SOUNDBITE OF AARON PARKS' "SMALL PLANET")

DAVIES: This is FRESH AIR, and we're speaking with Michael Specter, a staff writer for The New Yorker. He's written an article for the magazine's April 20 edition about Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who's become well known in the - President Trump's daily briefings on the coronavirus pandemic. Michael Specter's article is "How Anthony Fauci Became America's Doctor."

Anthony Fauci was onto the threat of HIV/AIDS early on when it appeared in the '80s - the early '80s. He was then, I guess, in infectious diseases but not yet head of the National Institute. What captured his interest about HIV?

SPECTER: Well, there was this - so the MMWR, the mortality - Morbidity and Mortality Weekly Report is something that is issued by the Centers for Disease Control. And it's sort of a bible of infectious diseases that people like Fauci and many, many others in that field study every week. I mean, it's very important. In one week in 1981, there was this strange report of five men who had a type of pneumonia called pneumocystis that you do not get unless you have very compromised immune systems. And they happened to be five gay men, which was unusual. The whole thing was unusual. And he thought, whoa, this is weird. But because it was five gay men and it was so offbeat, he thought, well, maybe they took some drugs to suppress their immune system and this happened. But he did pay attention.

And then a month later, there was another report, and it was a more significant number of people. And it was clearly not just, you know, a fluke. And he said, this is going to be big. This is going to be a huge problem. We have an infectious disease that we don't know what the agent is at that point. We don't know what's causing it. And furthermore, the fact that it's attacking gay men is - I mean, it matters. But there's no virus in the history of the world that decides on your sexual orientation whether to attack you or not. So this isn't a one-off thing.

He went to his colleagues and bosses, and they all said, what is wrong with you? You've got a career doing - you just cured a disease. Your career is shooting off. And he felt very strongly that he needed to detour into this. He wrote a piece for the New England Journal of Medicine saying, hey, this is important. And don't - first of all, gay men need our help. And secondly, why would you think this will stop there? And the New England Journal, which is a very prestigious publication, rejected it and said - and one of the reviewers told him he was just being alarmist. So he sent it to the Annals of Internal Medicine, another good publication, and they did publish it the next year. But at that point, he just felt like, I am going to switch my career and focus on this from now on. And he did. And that is - you know, as they say, the rest is history.

DAVIES: Yeah. Well, it's a very interesting history. In 1984, he becomes the head of the National Institute of Allergy and Infectious Diseases, then only in his - what? - mid-40s. He was young, you know?

SPECTER: Yeah.

DAVIES: Ronald Reagan was president. And AIDS activists began to really press for more research, for faster approval of drugs. How did they regard Fauci?

SPECTER: They hated him. I started writing about this stuff for The Washington Post right about when Fauci became the head of that institute. And he was the physical embodiment of everything they hated - a slow government that didn't care about the people it was serving, that it had a system of studying drugs and it really didn't matter whether people were dropping dead in front of them. They were just going to get their answers. And the protests were vicious and prolonged and personal.

DAVIES: Yeah. I mean, Larry Kramer, who was one of the lead activists - he called him a murderer, essentially, right?

SPECTER: Yeah. I mean, I've known - to be honest, Larry also called me a murderer because he didn't think my reporting was good enough. He was pretty easy with that term. But I've known Larry a long time. And he was a very influential man, and he cared deeply. And he just attacked Fauci relentlessly because Fauci was the guy that he saw who could pull some strings. And it was vicious.

DAVIES: And what was the problem? I mean, Fauci didn't control the Food and Drug Administration. I mean, what were the hang-ups? What were the bottlenecks...

SPECTER: Well...

DAVIES: ...That they wanted action on?

SPECTER: So basically, drug trials, for a long time, have undergone a particular system where you try a drug over a period of time in a small group of people who are healthy to see if it's safe, if it has side effects, if it would harm you. Once that's done - and it can take a while - you then move to another level of testing called phase two, where you test a small group of people to see if it's effective. Like, does it change the course of your disease? Are there markers in the blood system that show that it's taking effect? That takes a while. And then if it's safe and seems to be effective, you do a much longer and bigger trial to make sure it works and that there aren't some adverse reactions that people hadn't counted on. This can take years.

Meanwhile, these guys had nothing. They had no hope of any treatment or cure. They were dying by the hundreds, then the thousands, then the tens of thousands. And they were listening to organizations not only say, well, wait a few years, but they had rules like if you were on one experimental drug, you couldn't take another one in a trial. So that disease Pneumocystis pneumonia that I mentioned, there was a treatment for that. It was an anti-microbial drug called Pentamidine. If you took it, it was very effective. So thousands of men were taking it. But if you took that drug, you could not enter any other clinical trial that NIH had for AIDS. So you could be OK with the Pneumocystis. You would just die of something else.

And these were absurd and outdated rules, and Fauci was the person that they knew who they could attack. It didn't matter whether he was in charge. He was the face of AIDS for the U.S. government.

DAVIES: He made a difference, though, and it involved a change of his own thinking. Tell us about that.

SPECTER: Well, I mean, after a certain number of protests, he looked out at NIH one day as they were - as ACT UP and other protesters were storming the gates. And he thought, you know, these guys, they dress crazy and they say terrible things, but they're mostly from New York like I am. And let me think about this for a minute. If I had a disease in which the result was that I would die no matter what and the government was telling me you can't try anything that might work under any circumstances, I'd be ramming down the doors, too.

So at that point, he decided to talk to these leaders more frequently, to go up to New York and meet with them, to go to San Francisco. And he came to realize that, A, they had a point, and even more importantly, they had some people who understood the system way better than anyone who worked for him.

DAVIES: Michael Specter is a staff writer for The New Yorker. His article "How Anthony Fauci Became America’s Doctor" appears in the April 20 edition of the magazine. He'll be back to talk more about Dr. Fauci and fighting viral outbreaks after we take a short break. I'm Dave Davies, and this is FRESH AIR.

(SOUNDBITE OF MILES DAVIS' "ALL BLUES")

DAVIES: This is FRESH AIR. I'm Dave Davies in for Terry Gross. We're speaking with New Yorker staff writer Michael Specter about Dr. Anthony Fauci, now a well-known participant in President Trump's daily briefings on the coronavirus. Specter has an article in the April 20 edition of the magazine titled "How Anthony Fauci Became America's Doctor." When we left off, he was explaining that in the 1980s Fauci faced intense criticism from AIDS activists who were furious at their lack of access to experimental drugs. Specter says Fauci concluded they had a point and changed his approach.

So what were the changes that he made?

SPECTER: Over time, at the urging of activists - particularly a man named Mark Harrington, who is an ACT UP activist and a very brilliant man - Harrington said, listen. Let's look at this testing regime, and let's give people who are dying a chance to take drugs that may or may not work after we know they're safe, not just throw them at them. But after the first phase is done, let's give them some opportunity to try these drugs. And we will continue with the other trials anyway so we can get to the bottom. We need to do that. But we can't deprive everyone of any hope whatsoever.

And Fauci - once he understood that the activists weren't saying, let's get rid of the whole system but let's open it up a bit so that we can have some relief while we press on to get the ultimate answer, he said that makes perfect sense. And he proposed something called parallel track, which was these sort of two systems - the old system and the new - melded. And it worked.

DAVIES: Did it have a far-reaching impact on the FDA's drug approval process more broadly?

SPECTER: Well, I think it changed medicine in America forever because, you know, AIDS activists - people like Larry Kramer, Mark Harrington - and this new system basically forced people to realize that you can't run drug trials and decide what to do with patients without ever consulting patients. And now we have a system where you don't approve drugs in America if you're the FDA without ever having talked to people who have the disease or are representatives of groups who have the disease. That just isn't done anymore. And, you know, I'm not saying the FDA doesn't have problems anymore. They have plenty. But that's one they have overcome now. And I think it's to everyone's benefit that that happened.

DAVIES: How did Larry Kramer and these other activists come to regard Fauci?

SPECTER: (Laughter) Kramer loves Fauci. Kramer went from wanting him dead to never being in the same city without having dinner with him. I think he, in my piece, said that Anthony Fauci was the one true hero of the AIDS epidemic. Larry's hyperbolic, but the truth is that the AIDS activist Mark Harrington, who is not hyperbolic, felt that Fauci could be worked with. And Fauci listened to reason, and Fauci responded to data and analysis. And if you gave him the right facts, he'd make the right decision. So, you know, that was all they ever wanted. And Fauci, all he ever did was look at the information before him and make his decisions based on what he thought the data said. And that turned out to be enough.

DAVIES: So did Fauci's work on HIV/AIDS - I mean, it obviously was recognized by AIDS activists as having made a difference. What did it do to his stature within the public health community?

SPECTER: Huge. I mean, he went from - you know, in 1988 during a debate between Michael Dukakis and George Bush, someone asked Bush who his heroes were. And he said, oh, there's this guy Dr. Fauci at NIH. None of you have ever heard of him. But he's working hard and brilliantly to solve AIDS.

Fauci has been offered the head job to be the director of the National Institutes of Health - I've lost track. I think it's three times. He always turns it down. He turns it down for a couple reasons. He has a lab, and he cares about keeping his lab. He cares about seeing patients and even now still does. But I think more importantly, he's figured out that you can be more persuasive sometimes without having the top job. You have more room to maneuver. I think what he values is his ability to get his point across. And sometimes when you run an organization like that, the administration is just very, very burdensome.

DAVIES: You know, now he's become a celebrity of sorts. I mean, if people were on the streets, I'm sure he would get recognized all the time. Has that changed, do you think - his approach or the way he can be effective now that he is so well-known?

SPECTER: Well, I can only tell you what I think because I have not physically been in his presence. I wanted to go down to Washington to work on this story, and he kindly suggested that he didn't want to be responsible for having me get infected with the virus. So we did not do it that way. I don't think he's going to change the way he is. He's lived a certain way for a long time. His wife is an important NIH researcher. She runs the bioethics division. They care about their family and their work, and I don't see that changing. I think it'd be very disappointing to him if it did change in any fundamental way.

DAVIES: You mentioned that he didn't want you to come to Washington because, you know, he didn't want to, you know, risk spreading the virus.

SPECTER: Right.

DAVIES: Did you talk to him for this story?

SPECTER: I began to try to talk to him at the beginning of the story. I mean, we have been in touch over the years quite a bit. But really, very early on he sent me an email saying that it was - he had been discouraged from participating in any personal profiles. He had been talking to everyone. You know, you can't hardly turn on the TV or the radio without seeing him on the news, which is great. You know, he even talked to Steph Curry, which is also great because some people listen to Steph Curry who don't watch the news.

But when it came to a story that was specifically about Fauci, the White House made it very clear that that wasn't going to happen. And Fauci wasn't going to defy them because he wants to do his job. He wants to be able to get up there every day and tell people that, in fact, we won't have a vaccine tomorrow and, in fact, the drug the president of the United States is telling you to take may kill you. And so if not doing a personal profile meant that he could still do that, that was probably a pretty easy choice for him to make.

DAVIES: Michael Specter is a staff writer for The New Yorker. His article "How Anthony Fauci Became America’s Doctor" appears in the April 20 edition of the magazine. We'll talk more after a short break. This is FRESH AIR.

(SOUNDBITE OF BEN SAMUEL'S "TOSCANA")

DAVIES: This is FRESH AIR, and we're speaking with Michael Specter, a staff writer for The New Yorker. He's written an article for the magazine's April 20 edition about Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who's become a well-known participant in President Trump's daily briefings on the coronavirus. Michael Specter's article is titled "How Anthony Fauci Became Americas Doctor."

You write about Fauci's perspective and goals for dealing with viral outbreaks, generally. And you note that these have been with us throughout human history. You say every virologist that you know believes further viral pandemics are coming. You say for a deadly virus to flourish, it must meet three critical conditions. What are they?

SPECTER: Well, the first one is that it has to arise from a place, usually an animal reservoir - a bat or something like that - where we have no antibodies. The reason that it's dangerous is because there are no humans who have antibodies. Antibodies are what the body makes to defend against viral invaders. But there's no human on Earth who is protected against this virus. So that's very dangerous because it means we can't defend ourselves. The second thing is it has to be harmful. There are literally billions, possibly more, viruses out there. The vast, vast majority of them do not harm us. And the third thing is that it has to be contagious. You know, you can have a very harmful virus, but if I have it and I'm sitting next to you and I can't spread it, it's not that - it's not as big a deal. I mean, Ebola is something that people are petrified by, and rightfully so. It kills the people it infects. But you can sit on the subway in New York City next to someone who has Ebola, and if that person doesn't sneeze right in your face or exchange bodily fluids with you, you're going to be fine. That isn't true of things like influenza or these respiratory viruses. So those are the things we worry about the most, the things that are deadly and easily spread.

DAVIES: And is coronavirus - I mean, we've seen several viral outbreaks, you know, since the early 2000s. Is the coronavirus the most problematic in that it is both spread easily and harmful?

SPECTER: The most problematic is a philosophical question. It's very problematic. It's not as deadly as it could be. In fact, H5N1, which was usually referred to as avian influenza, was truly deadly. And if that virus had spread the way this one spread, we'd be talking - millions of people died. And in 2009, we had a pandemic of influenza. H1N1 was the designation, and a lot of people called it the swine flu. One-quarter of the population of Earth was infected with that virus - 1.47 billion people at the time - before any vaccine got anywhere. So that happened to be way less virulent than is usual for influenza. But had it been super bad, 10 million, 20 million, 30 million people could have easily died - easily.

And yet, these things come up every few years, and an endless number of reports are issued saying we have to do more. Fauci has been screaming this song since - I don't know. I've talked to him about it at least 10 times in the last 15 or 20 years. And he's not the only one. There are many, many people, there are so many reports, and they are constantly ignored. And, you know, we spend hundreds of billions of dollars in missile defenses in the United States. That's something that it's not even clear it works. And we don't spend pennies on the dollar to do the same thing with viral defenses.

DAVIES: So is a structural change in the government needed - I mean, a cabinet-level position, you know, so you don't have to invent a task force every time a problem arises?

SPECTER: Well, I think a lot of things have to happen, and that is one of them. There has to be someone with authority. Fauci is a guy who is a good spokesman, and he can marshal facts. But he doesn't go to his office every day and plan the biological future of this nation.

You know, the fact that we are surprised by biology is a tremendous failing given what we do and what we know. And teaching at Stanford in bioengineering, that's one of the things we're trying to focus on, which is to make sure that bioengineers, and also people in this country, understand that we don't have to be surprised by biology in the future. We can plan for it. And we can even create what we want to create.

And I'm hoping that maybe this pandemic, which is so ruinous, will at least make people realize that an investment - a few hundred billions of dollars, which sounds like a lot of money but it's a drop in the bucket of what's happening now - will pay tremendous dividends in terms of the safety of humanity because this is going to happen again. There isn't any way that it won't.

DAVIES: And certainly, this has gotten literally everybody's attention in a way that maybe some of the others haven't. You know...

SPECTER: Well, yeah. I mean, this does have everyone's attention, but so have other viruses - not quite as much as this. But I am deeply concerned - and I'm not the only one - that what will happen is we'll get over this, and some money will be appropriated, and some commissions will be formed, and some words will be said, and over time, people will start to stop thinking about it. And we can't do that. We can't allow ourselves to do that because, honestly, as bad as this one is, the next one could be worse. And also, it would be irresponsible of me not to point out that the next one might not come from a bat. It may come from a crazy person who has the ability to make a virus and disseminate it because we are in a world where that is possible.

DAVIES: Gene editing, you mean.

SPECTER: Well, gene editing and creating synthetic genes. Many of the tools are wonderful, and we can see that it could cure diseases. It could help the environment. You know, we can really sit down - and again, at Stanford, we're trying to get bioengineering students to do this, think about what they want in the future and make it happen.

But as I said in this piece and I've said before - and I'm not the only one - if you can do something like edit the genes of a mosquito so that it doesn't transmit malaria, which researchers are doing and may well succeed and would be remarkably wonderful, it also means that somebody could edit the genes of a mosquito to do something really bad to people. And we have to be aware of both sides of this coin.

DAVIES: You know, you wrote that Fauci told you four years ago that we need a major paradigm shift with influenza vaccines. What was he talking about?

SPECTER: Well, so influenza is the thing that we usually worry the most about because it's extremely contagious and can be quite deadly. In most years, 50 to 75,000 Americans die. One of the ludicrous things the president said early on was, gee, nobody ever knew that many people died of influenza. In fact, anyone who has a thing called Google could know that.

But the fact of the matter is flu comes every year. It comes in different strains. A flu virus has eight genes, and it looks kind of roughly like a stalk of broccoli. And the thing that keeps happening is the head of the broccoli changes every year, mutates. And epidemiologists and virologists try to figure out what the strains are that are the worst each year, and then a vaccine is made based on that. It's been very hard to figure out ways to attack the thing that stays the same, which is the stalk of that virus, the equivalent of the stalk of the broccoli.

And now there's a lot of promising research. It's - there are - a group - several groups of people have pretty much figured out ways where - to make that work. And if you can get the stalk, if you can get the thing that's in every flu virus and make a vaccine, you could have a universal vaccine. And you could vaccinate everyone. But it would cost - we aren't there yet. It will cost a lot of money. It will take a tremendous commitment and for a lot of political and financial reasons and emotional ones because we feel like we have a flu vaccine, so why bother? No one is focusing on that. But if you get a influenza virus that's lethal and as contagious as the one that we're seeing now, it's going to make this particular pandemic look meek. And we can stop that. We can prevent that. But we need some political will and some financial commitment, and we don't have either.

DAVIES: You know, you make an interesting point in the piece that there's an example of real political commitment getting behind a public health goal, and that was when George W. Bush decided that fighting HIV in the developing world was something he wanted to pursue.

SPECTER: Yeah. It's interesting because George Bush does not get high grades for how he dealt with public health in the United States, and I am one of those people who has written quite harshly about him. But he created something called PEPFAR, the President's Emergency Plan for AIDS Relief. And he basically asked Fauci one day what was going on with AIDS, and Fauci said, in this country, we have gotten to the point where we can treat it. We can treat it somewhat inexpensively. And people who get HIV don't need to die from it, and they don't even need to have their lives shortened. But in the developing world, they all die. It's just like it used to be in the '80s in America. There's no money. There's hardly money for measles vaccines. So it's not reasonable to expect that those people would be able to pay for these medications.

And Bush said to him, that's just wrong. Figure out a way. We shouldn't let people die of a disease that we can get rid of just by writing a prescription just because we're rich. And he asked Fauci to go look into it, and Fauci and others created PEPFAR at Bush's instigation. And it has been, without any question, the most successful public health endeavor that any government has ever embarked upon. It has saved tens of millions of lives. It has probably saved the economy of a whole bunch of African countries. So you can do good if you care.

DAVIES: Michael Specter is a staff writer for The New Yorker. His article "How Anthony Fauci Became America's Doctor" appears in the April 20 edition of the magazine. We'll talk more after a short break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: This is FRESH AIR, and we're speaking with Michael Specter. He's a staff writer for The New Yorker. He's written an article for the magazine's April 20 edition about Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who's become such a well-known participant in President Trump's daily briefings. Michael Specter's article is titled "How Anthony Fauci Became America's Doctor."

Tell us a little more about what you can do with bioengineering, what we should be doing that will make a difference. I mean, you're an adjunct professor at Stanford on this.

SPECTER: Look. When we talk about bioengineering, we're talking about engineering living matter. We are getting increasingly able to do that - to build things out of biology - and that means make drugs, cure diseases. But it also means address some of the problems we have in the environment. We can use our ability to alter genes and rewrite biology to do that, and we don't have to wait anymore for bad things to happen to us. We should sit down and say, what are the things we want to prevent, and figure out ways to prevent them.

It won't be perfect. It won't be 100%. There are lots of questions about how we want to deploy such powerful tools. But we have those tools. We have the ability not to be shocked by biology in the future. We should be using biology, not be afraid of it. That is what progress in science has always been. And we've moved very far and very fast.

So one of the things we're doing here and one of the things I think is very important for this country, and I have for a while, is - we need some sort of biological leadership initiatives. We need strategic planning to see how we're going to do those things, how we're going to do them safely, how we are going to engage the population because it can't be a bunch of scientists who make decisions about how to rewrite genes. It has to be this country. It has to be the world. These are very fundamental decisions. But I don't see how we can't make them because if we don't make them, some individual people will make them for us.

DAVIES: The science here is way beyond my understanding here. Can you give us an example of using this technology? You say anticipating what might come and preparing for it. Can you think of an example of that?

SPECTER: Well, let's look at the virus that we're dealing with now. We know that it is a coronavirus that came from a bat. We know that it hooks onto a particular receptor in the respiratory system of humans. It's the same receptor that SARS hooked onto. And I'm not saying it wouldn't be hard, but it's entirely feasible to figure out a way to make it so that it cannot interrupt - cannot dock onto our respiratory system.

The same is true with things like HIV. There are ways to go in and either alter human cells or alter HIV so that it can't lock into our cells and enter them. We know enough to do that, and we know enough when it comes to how to deal with genetics to save a lot of species that are disappearing. And that's important, too - or make things like biofuels not out of things - you know, we shouldn't be digging in the ground to make these things anymore. We can manufacture them safely. We can make drugs in vats. We don't have to cut down the Amazon forest to do it. I mean, these are things that have been possible for a while, and they're getting much more so. And we don't do a lot of them because we don't have the money and we don't have the will.

DAVIES: What kind of advocacy would make a difference? This gets beyond your area, I know. But, I mean, it just seems like, with these remarkable possibilities, there ought to be a constituency that could make some noise about it.

SPECTER: Well, I think one thing that helps to happen is for people to understand what the possibilities are better. I think there is always a sort of fear of, are we messing with nature? And I understand that fear, and it's real. But nature is messing with us, and we've been dealing with nature ever since we threw a road down somewhere. So I think we need to get better educated about what kind of intervention we're comfortable with.

And then we need leadership. I can't say this enough. We need leaders, people who can appropriate money and decide what the priorities are for this nation. The next president should have a very significant human being attached - and I will say him because that's the way that's looking right now - to him that can advise him on how to go in some of these directions. And that person needs to listen, and that just really has not happened yet. And it's - I hope people will realize, as we're losing thousands of lives every day and untold billions of dollars, that these things matter. And the idea that we could prevent some of it - even some of it - and we're not doing so is just absolutely disgraceful.

DAVIES: Well, Michael Specter, thanks so much for speaking with us again.

SPECTER: My pleasure.

DAVIES: Michael Specter is a staff writer for The New Yorker. His article "How Anthony Fauci Became America's Doctor" appears in the April 20 edition of the magazine.

If you'd like to catch up on interviews you missed, like our interview with journalist Nelson Schwartz about the growth of special services for the super-rich and how it's dividing America or with actor Jason Bateman, who stars in the Netflix series "Ozark," or with journalist David Rohde about how Trump is creating a deep state of his own while complaining there's another deep state out to get him, check out our podcast. You'll find lots of FRESH AIR interviews.

We'll end today's show with music from bassist Andy Gonzalez, a mainstay of Latin music, having anchored bands with Tito Puente, Eddie Palmieri, Dizzy Gillespie, Conjunto Libre and the Fort Apache band, which he formed with his late brother, the trumpeter Jerry Gonzalez. Andy Gonzalez died last Thursday from pneumonia and complications of diabetes. He was 69 years old.

(SOUNDBITE OF JERRY GONZALEZ'S "NUTTY")

DAVIES: FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Mooj Zadie, Thea Chaloner and Seth Kelley. Our associate producer for digital media is Molly Seavy-Nesper. Roberta Shorrock directs the show. For Terry Gross, I'm Dave Davies.

(SOUNDBITE OF JERRY GONZALEZ'S "NUTTY") Transcript provided by NPR, Copyright NPR.

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