Anthony Fauci, who has served as the United States’ chief infectious disease adviser for nearly 40 years, announced on August 22 that he will step down from his leadership position in December. Although many scientists are saddened to lose his leadership, they understand his desire to step down. No other federal scientist held the top position as long as Fauci.

“Dr. Fauci is the most dedicated public servant I know,” said former US National Institutes of Health (NIH) Director Francis Collins, who worked closely with Fauci over the years. “His contribution has saved countless lives from HIV/AIDS, Ebola and SARS-CoV-2 and will be an extremely important gift to humanity.”

US President Joe Biden, who elevated Fauci to the role of his top medical adviser, echoed Collins’ sentiments. “His commitment to the job is unwavering, and he does it with unparalleled spirit, energy and scientific integrity,” Biden said. As vice president, Biden worked with Fauci on the U.S. response to the Zika and Ebola outbreaks.

Researchers who Nature spoke out to say that Fauci will be best remembered for his unwavering commitment to HIV research and treatment development, as well as his uncanny ability to communicate directly and clearly with the public. Whenever there was a particularly dangerous public health emergency, “the government used its best weapon — Tony Fauci,” says Jennifer Nuzzo, an epidemiologist at Brown University in Providence, Rhode Island. She joked with colleagues that whether a pathogen was worth worrying about was determined by the number of times Fauci appeared on television, calling the phenomenon the “Tony Fauci Index.”

“Determinate and aggressive” efforts

Fauci has headed the US National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, under seven US presidents, starting with Ronald Reagan in 1984. Most recently, he became the face of the US response to COVID -19 pandemic and a trusted voice around the world that helped millions make sense of the rapidly evolving threat. During his tenure, he transformed NIAID from a lesser-known NIH institute with an annual budget of $350 million to a global role model in infectious disease research with a budget of more than $6 billion annually.

Fauci is one of the most cited scientists of all time for his work on HIV immunology and has been well known in the infectious disease research community for decades. However, his role as a leading pundit has been turbulent at times. During the AIDS epidemic of the 1980s and early 1990s, activists believed that NIAID clinical trials were moving too slowly to help people with HIV access life-saving therapies that still are tested. They blamed Fauci for what they saw as unnecessary deaths and staged protests outside his office. Fauci began a dialogue with activists that, within years, led to the development of effective treatments to suppress the virus that would become the global standard of care. This type of community collaboration was unprecedented and has become a model for future health care leaders, says Steven Deeks, an HIV clinician at the University of California, San Francisco. “But Tony was the first,” he says.

Working with former President George W. Bush, Fauci also helped develop the US President’s Emergency Plan for AIDS Relief (PEPFAR), a global program launched in 2003 to provide treatment to people with HIV. PEPFAR, which is probably Fauci’s greatest and most impactful achievement, says Deeks, “has unequivocally saved millions of lives.” Bush awarded Fauci the Presidential Medal of Freedom in 2008 for his “resolute and aggressive efforts.”

In 2014, at a time when people were worried whether the Ebola outbreak in West Africa would turn into a pandemic, Fauci helped with treatment and notably hugged a nurse who was infected with the virus and hospitalized at the NIH. Fauci said later he did this to show his employees that he would not ask them to do anything he would not do himself. That “extraordinary level of empathy” will be hard to replace, Nuzzo says.

Fast-forward to 2020, and Fauci is under fire again—this time from the president he serves. Unsatisfied with Fauci’s guidance on limiting the spread of the SARS-CoV-2 coronavirus by implementing interventions such as mask wearing and social distancing, former President Donald Trump tried to silence Fauci by, at times, prevents him from speaking in public. Trump also hinted that he might fire Fauci (Fauci is a civil servant in the US government, not a political appointee, so it’s unclear how Trump might have done this). Fauci has received death threats and he has federal security to keep an eye on his safety.

“Because of the continued attacks on him and the failure of our political leaders to rebuke those attacks, his ability to communicate has been diminished,” Nuzzo says.

The next generation

Although Fauci did not elaborate on his future plans in announcing his departure, he was adamant that he would not be retiring. “I plan to pursue the next phase of my career while I still have as much energy and passion for my field,” he wrote. He indicated that whatever he does next will include advancing science and public health and mentoring the next generation of scientific leaders.

Fauci’s mentorship helped shape countless scientists—including Akiko Iwazaki, an immunologist at Yale University in New Haven, Connecticut—to be the scientists they are today. Although Iwasaki says she was just a “lowly postdoc” at the NIH in 1998, Fauci took time out of his schedule to meet with her several times. “He has this way of lifting up the scientists around him,” she says.

NIAID did not respond to an email asking when Fauci’s replacement might be named. But Deeks hopes the new director will have the same desire to continue trying to end the HIV epidemic. “Tony has carried this on his shoulders for 40 years,” he says.

This article is reproduced with permission and was first published on August 22, 2022

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