Government Protects Public Health: When you Allow It

 Where is Tony Fauci now that the impossible has happened?

Dr. Fauci

AIDS was first reported 44 years ago, and the virus which causes it, HIV, was identified within two years later, a remarkable scientific achievement. 

The virus itself clearly spilled over from monkey to man years before AIDS was identified in  a group of men in Los Angeles, published in the CDC's Morbidity and Mortality Reports, (a publication Trump and his toadies have abolished) and then quickly identified in reports from New York Hospital (Henry Masur) and from San Francisco shortly thereafter published in the New England Journal of Medicine.

Tony Fauci, down in Bethesda, Maryland at the National Institutes of Health (NIH), quickly organized a task force to respond to HIV, recruiting Masur down to the NIH along with Cliff Lane and others. 

Robert Gallo

Identifying the causative agent of any infectious disease is the sine qua non of any effort to control or cure it. That was done by Drs. Luc Montagnier and Robert Gallo. 

Alexandre Yersin: Discoverer of Plague bacillus

The alacrity with which the medical establishment was able to come to grips with the basics raised hopes the scourge could be halted the way polio once had been, or small pox.

Couldn't scientists do just about anything?

Right from the get go, politics entered the fray: ACT UP, a group advocating for a government effort to thwart AIDS vilified Fauci for not doing enough fast enough. Fauci did something government folks rarely do: He invited the protestors picketing outside his building on the NIH campus into a conference room and offered to show them the ICU where AIDS patients were being cared for and the labs where research was going forward. They became among his most ardent fans.

George F. Will

From the other side, George F. Will dismissed AIDS as nothing to worry about, in an piece in the Washington Post, he posited that it was a "gay disease" which would only ever be a problem in that community, owing to the peculiar practice of anal intercourse, which disrupted the anal mucosa, exposing the tissues below with their blood supply and allowing the virus to enter. But AIDS would never infect the innocent heterosexual population Will averred. (Sound familiar? Oh, measles! We get measles outbreaks all the time. Nothing to worry about!)

That elicited a quick letter to the editor from a local doctor who pretty well destroyed Will's hypothesis, along with his credibility in scientific areas, which was important because Ronald Reagan had bought into that whole trope.

So, for those who think Robert F. Kennedy is the first ignoramus to gain currency in the response to infectious disease and the first clown to try to grab the controls of the airplane when he has no pilot training: he's not.

"As for George Will's rectal mucosa theory of AIDS {op-ed, June 7}: it is appalling to see a columnist's speculations elevated to the realm of fact, especially when there is at least as much evidence against his contention that there is something so special about the actual practices of homosexuality as to ensure that the predominant reservoir of the disease will remain with homosexuals. Mr. Will's column does a disservice in two major (and I'm sure, many minor) ways:

1) The implication is that heterosexuals may heave a collective sigh of relief and pursue their sexual activities with somewhat less trepidation.

2) There is now the likelihood that the heterosexual majority will be less keen to support research for a disease that is confined to a rather unpopular minority.

Reports from Africa suggest that AIDS has already become a heterosexual disease of frightening proportions. Physicians like myself realize we function in an area of impressive ignorance. We can only advise what seems prudent, realizing our advice may change as research provides more answers.

Mr. Will risks moving from a position of renowned conservatism to one of medieval reaction by suggesting, however obliquely, that this plague has been visited upon those who in some way deserve it. There will always be ''innocent'' victims of disease. And I would argue that patients should always be considered ''innocent'' and treated with compassion

What the world needs now is a biologist who can provide the kind of relief Jonas Salk provided from polio. Perhaps his name will be Anthony Fauci, perhaps we have not yet heard his name. But I very much doubt that relief will come from the speculations of George Will.

So, even at that early stage, physicians were looking to Dr. Fauci to be the central figure to bring the HIV era to a close. 

But Dr. Fauci insisted that a successful vaccine against HIV would be so unlikely it was not likely to ever be the solution. 

Within 6 years, the first effective, if cumbersome drug protocols emerged, and ultimately, by the late 1990's HIV was no longer a death sentence which got executed within months, and HIV became a chronic disease.

And still, at every appearance, Dr. Fauci was asked about the prospects for a preventative vaccine and he would always shake his head, dolefully, and say the problem with this virus is that it attacks the very cells, the T cells, which were essential to mounting an immune response to any virus, and it mutates so effectively, catching up to it with a vaccine seemed unlikely--so he despaired of a vaccine ever being successful. 

Then we got  a report (November 2024) in the New England Journal of Medicine about Lenacapavir, which may actually work to prevent HIV, not that it's a vaccine, but, in practice, offers much the same protection a vaccine would.  Of 3265 men in the trial cohort, only 2 got HIV infected during the trial, an astounding result. It has to be injected every 6 months, but it works in men. It was known to work in women, but apparently men are different in some way. Maybe they are more sexually active, and less likely to take precautions. Or maybe Will's notion that anal intercourse is different plays a role. Who knows? But now we've got a prophylactic anti viral which might protect as well as a vaccine.

Dr. Fauci is now 84, and he's kept a low profile since retiring.  He was the object of death threats for his role in guiding the country through COVID, and then he was out in his own backyard in Washington, D.C. and got bitten by a mosquito and got West Nile Virus, of all things, which nearly killed him. Of course, infectious disease experts have died from the diseases they studied, and Fauci admitted he had nightmares of getting AIDS, but he got West Nile virus in Washington, D.C.

Go figure.

At least it wasn't COVID.

But I'd sure like to hear what he thinks about the future of AIDS prevention. Lenacapavir is not a vaccine. It's a drug, a selective poison, but it's worlds better than where we have been, and it might even, some day, help slow or halt the spread of AIDS.