Olivia: I have a confession. Before reading this book, I thought I knew the story of Dr. Fauci. The COVID guy, right? Jackson: The face on TV, for sure. The calm, sometimes exasperated, voice of science during those daily briefings. Olivia: Exactly. But here’s a number that blew my mind: 330,000. That’s the estimated number of preventable deaths in South Africa because their president embraced HIV denialism. And Fauci was in the thick of that fight, decades before COVID. Jackson: Wow. Okay, so this is a much bigger story than I realized. Olivia: It's a massive story. Today we’re diving into On Call: A Doctor's Journey in Public Service by Anthony S. Fauci. Jackson: And what's wild is that he wasn't just reacting to events. The book reveals he'd been taking notes for this memoir since the Clinton administration, knowing he was living through history. Olivia: Right. He wanted to document his journey for future public servants. And that journey put him at the center of literally every major public health crisis for the last 40 years. It all started with a choice that his colleagues thought was career suicide.

Olivia: Picture it: it's 1981. Dr. Fauci is a highly successful immunologist at the NIH. He's got a great career path, studying how the human immune system is regulated. Then, a strange little report from the CDC crosses his desk. It’s titled "Pneumocystis Pneumonia—Los Angeles." Jackson: That sounds incredibly obscure. Not exactly a headline-grabber. Olivia: Not at all. It described five young, otherwise healthy gay men who had developed this incredibly rare pneumonia, something you’d only see in cancer patients with destroyed immune systems. He said he initially dismissed it as a medical curiosity. But then a month later, another report. This time, 26 gay men in New York and California with the same pneumonia, plus a rare skin cancer called Kaposi's sarcoma. Jackson: Okay, now that's a pattern. That’s not a coincidence. Olivia: That was his "game changer" moment. He describes sitting in his office on a quiet Saturday, reading that second report, and feeling a chill. He knew, instinctively, this wasn't a curiosity. This was a new disease. And in what he calls a career-defining decision, he decides to pivot his entire lab, his entire research focus, to this mysterious new illness. Jackson: Hold on. So he's at the top of his field, and he decides to throw away a successful, prestigious research line to chase a complete mystery disease that, at the time, was seen as a fringe, 'gay plague'? That's a huge risk. His colleagues must have thought he was crazy. Olivia: They did! His own mentor, Shelly Wolff, a man he deeply respected, took him aside and said, "Anthony, I love you, but please don’t give up your day job yet. This might all go away." But Fauci felt, in his words, that it was his "destiny" to get involved. He was an immunologist, and this was a disease that was destroying the immune system. Jackson: So he dives in. What did that look like in the beginning? It's not like they had a cure. Olivia: It was brutal. He calls the period from 1982 to the late 80s the "dark years" of his medical career. He and his small team started admitting these desperately ill young men to the NIH Clinical Center. But there was nothing they could do. They were just watching them die. He tells this one heartbreaking story about a patient named Ronald Rinaldi. Jackson: What happened to him? Olivia: Rinaldi was young, and his immune system was collapsing. He developed an opportunistic infection called CMV, which started attacking his eyes. Fauci and his team tried everything, but they were powerless. He describes being in the room one evening when Rinaldi suddenly went completely blind. Just like that. Fauci writes, "It felt as if we were putting Band-Aids on a hemorrhage." They were treating the infections, but they couldn't stop the underlying virus from destroying the body. Jackson: Wow, the emotional toll of that... watching young men just waste away and being able to do nothing. I can see why he describes having symptoms of post-traumatic stress from that period. Olivia: Absolutely. And it’s this trial by fire that really forges the public figure we know. He’s not just a lab scientist anymore. He’s on the front lines, facing death, and also facing a community of activists who are terrified, angry, and demanding action. He had to learn to communicate, to lead, and to fight—not just the virus, but the political indifference surrounding it. Jackson: That makes so much sense. That experience of fighting for a marginalized, dying community must have prepared him for the political battles to come. It's one thing to fight a virus, but it's another to fight a president.

Olivia: Exactly. And that brings us to the second major theme of his career: the high-wire act of speaking truth to power. He served seven presidents, from Reagan to Biden. And he shares this incredible piece of advice he got from a mentor early on. The mentor told him, "When you walk into the White House, be prepared that it might be the last time. If you base your advice on truth and science, you will eventually tell a powerful person something they don't want to hear. Don't fall into the trap of pleasing rather than informing." Jackson: That is a tough rule to live by in Washington. So how did that play out in reality? Olivia: You see it in stark contrast with different presidents. Let's take two examples: George H.W. Bush and Donald Trump. With Bush, it was a relationship built on respect and curiosity. In 1987, then-Vice President Bush visited the NIH. He wasn't just there for a photo-op; he asked deep, probing questions about AIDS. He was genuinely trying to understand. Jackson: That's a different picture than the Reagan administration's public silence on the issue. Olivia: Completely different. Bush invited Fauci and his wife to social functions. He would call him for medical advice. This built a foundation of trust. Later, as president, Bush visited an AIDS patient support group at the NIH. The book describes him going around the room, talking to each patient, listening to their stories, even hugging them. This was at a time when stigma was still rampant. And that personal connection translated into policy. The NIH AIDS budget more than doubled during his administration. Jackson: So with Bush, it was about building a relationship of trust behind the scenes. With Trump, it was... public combat. Olivia: Public combat is a good way to put it. The book details the now-infamous hydroxychloroquine controversy. President Trump, looking for a "magic bullet" for COVID, started touting this anti-malarial drug at daily press briefings, based on anecdotal reports. Jackson: I remember that. It was everywhere. Olivia: And Fauci knew the clinical data wasn't there. He describes this moment of decision. He could stay silent, or he could publicly contradict the President of the United States. He chose to speak. He went to the press and said, simply and directly, "Hydroxychloroquine doesn’t work." He knew it would infuriate the president, but he felt his duty was to the American public, whom he considered his patient. Jackson: That takes guts. What does the book say about the personal cost of being the guy who has to say 'no' to the President on live TV? Olivia: It was immense. He talks about the threats to him and his family, the need for a security detail. But he also reveals this fascinating, bizarre dynamic with Trump. Even after their public clashes, Trump would call him. In one instance, after a particularly heated briefing, Trump called him and was ecstatic about the TV ratings. "Our ratings are amazing! We’ve got to keep doing this!" Jackson: It's like he saw it as a TV show, and Fauci was his sparring partner. That's a really strange relationship. It's like he had to become two different kinds of advisors for two different presidents. Olivia: And that public combat with Trump brings us to the final, and perhaps most challenging, battle of his career: COVID-19. Because this time, the enemy wasn't just a virus.

Jackson: What do you mean by that? The enemy was SARS-CoV-2, right? Olivia: On one level, yes. But the book frames the COVID-19 pandemic as something more: a crisis of truth. The fight wasn't just against a pathogen; it was against a tidal wave of misinformation, political polarization, and the deliberate erosion of public trust in science. Jackson: The "Disinfectant Debacle" comes to mind. Olivia: A perfect, and terrifying, example. Olivia recounts how President Trump, after a briefing on how disinfectants kill the virus on surfaces, mused aloud at a press conference about injecting disinfectant into the body as a "cleaning." Fauci was watching from home, horrified. He knew he and the entire public health community would have to spend the next 24 hours frantically telling people not to drink bleach. Jackson: It’s absurd, but also incredibly dangerous. And it wasn't a one-off event. The politicization of masks, the downplaying of the virus... Olivia: Exactly. And Fauci traces the origin of the global catastrophe back to a similar crisis of truth. He describes the first weeks of January 2020. The official numbers coming out of China were low—a few hundred cases. But he was getting unsettling back-channel information from colleagues that things were much worse. The turning point for him, the "full code red" moment, was when he saw a newspaper photo of the Chinese government building a thousand-bed prefabricated hospital in Wuhan in just a few days. Jackson: You don't build a thousand-bed hospital for a minor outbreak. Olivia: Precisely. He knew in that moment that the official data was a lie and that the world was facing an unprecedented disaster. He was seeing the physical evidence of a truth that was being suppressed. Jackson: This is where the book gets polarizing, right? The reception has been mixed. Critics say he doesn't fully reckon with the negative impacts of the policies he championed, like lockdowns, or fully address the lab-leak controversy. Does he grapple with that criticism? Olivia: He addresses it, but from his perspective. He doesn't apologize for his advice, because he sees his role as being the consistent, unwavering voice for science-based public health measures in a storm of political chaos. He views the attacks on him not as legitimate scientific debate, but as part of the broader "crisis of truth." He became a lightning rod because he was a convenient symbol for a reality that many people, including the president, didn't want to accept. Jackson: So he sees himself as a truth-teller, even if the truth was painful or politically inconvenient. Olivia: That's the core of it. He felt his ultimate responsibility was to the public's health, and that required him to be brutally honest about the science, no matter the political fallout.

Jackson: So after all these wars—AIDS, Ebola, COVID—what's the ultimate legacy? What's the one big idea he leaves us with in this book? Olivia: It's not just about 'expecting the unexpected,' though that's a big part of it. The book's epilogue is a powerful and frankly chilling warning. He says the greatest threat we face now isn't a new virus. It's the 'crisis of truth.' Jackson: What does he mean by that, exactly? Olivia: He argues that when we, as a society, normalize lies and allow people to invent their own set of facts, we lose the ability to solve any major problem. Think about it. If we can't agree on the basic reality of a virus, how can we possibly come together to fight it? He sees this divisiveness, amplified by social media and political opportunism, as a more dangerous long-term threat than any single pathogen. Jackson: That's a heavy thought. It reframes his entire career. The fight against AIDS was also a fight against stigma and denial. The fight against COVID was a fight against misinformation. The virus changes, but the human challenge remains the same. Olivia: Exactly. The real plague is divisiveness. He ends on a hopeful but cautious note, expressing his wish that civility and a shared respect for facts can prevail. Jackson: It makes you wonder, in our current climate, could we even handle another crisis of that magnitude? It leaves you with a pretty urgent question about how we, as a society, begin to restore that basic trust in facts. Olivia: A question for all of us to ponder. This is Aibrary, signing off.