Fauci Leaves a Broken Agency for his Successor

Fauci’s agency failed to conduct definitive research quickly during Covid. The result was a pandemic marred by controversy.

By Marty Makary M.D., M.P.H.

After 54 years at the NIH, today marks Dr. Anthony Fauci's last day in office as director of the National Institute of Allergy and Infectious Diseases (NIAID). While many were angered by his changing and conflicting recommendations, I am not. They are mere symptoms of a much larger and deeper problem. Dr. Fauci's agency failed to promptly fund key research during the pandemic. That research would have abruptly ended many of the COVID controversies that divided our country.

In a study of NIH funding published in The BMJ, my Johns Hopkins colleagues and I found that in the first year of the pandemic, it took the NIH an average of five months to give money to researchers after they were awarded a COVID grant. This should be unacceptable during a health emergency.

Consider the question of how COVID spread—was it airborne or spread on surfaces? (Remember all those people wiping down their groceries?) It lingered as an open question without good research for months, as Fauci spent hundreds of hours on television opining on the matter. Finally, on August 17, 2021—a year and a half after COVID lockdowns began—Dr. Fauci's agency released results of a study showing the disease was airborne. Thanks for that. The announcement on the NIAID website, titled "NIH Hamster Study Evaluates Airborne and Fomite Transmission of SARS-CoV-2" came 18 months too late.

Imagine if, in February 2020, Dr. Fauci had marshaled his $6 billion budget, vast laboratory facilities, and teams of experts to conduct a definitive lab experiment to establish that COVID was airborne. On this question and many others throughout the pandemic, our problem was not that the science changed—it's that it wasn't done.

NIH funding for COVID research was also erratic. The NIH spent almost $1.2 billion on long COVID research, but virtually nothing on masks, natural immunity, COVID in children, or vaccine complications. Ironically, the NIH spent more than twice as much on aging research as it did on COVID research in the first year of the pandemic, according to my team's analysis. I'm all for aging research, but not when a novel virus is killing thousands of Americans per day.

A randomized controlled trial is the gold-standard method to establish a drug's effectiveness. Yet remarkably, for COVID, we still don't have randomized trials for so many drug recommendations, including the new bivalent vaccine, COVID vaccine boosters in young people, the optimal vaccine dosing interval, and even the antiviral drug Paxlovid in vaccinated people. More disturbing, our country has been deeply divided for years about whether to mask children. The partisan arguing and harm to children could have been avoided if a proper study settled the science early.

Because the NIH moved at glacial speed, most of our COVID knowledge came from overseas. The critical discovery that steroids reduce COVID mortality by one-third came only after European researchers did a randomized trial that Fauci's agency should have commissioned quickly. Similarly, a conclusive study showing that Vitamin D reduces COVID mortality, published last month, arrived two years too late.

The official government job description for Dr. Fauci's role states that the director must "respond rapidly to emerging and re-emerging infectious diseases." Dr. Fauci didn't do that during the coronavirus pandemic. In order for the U.S. to respond better to the next pandemic, we will need our nation's infectious diseases research agency, and its top doctor, to act with a sense of urgency.

The NIH's disheveled COVID response is a window into a bureaucracy that has underperformed for decades. With obvious biases and blind spots, our nation's top research institution has long hindered research progress in important topics, from food as medicine to the role of general body inflammation in disease. The 'H' in NIH stands for health, and health means much more than laboratory medicine

 That means it should fund proper studies on environmental exposures that cause cancer, not just chemotherapies to treat it. The NIH's legacy system of having the oldest scientists in the room determine what research is worthy of investigation crowds out the study of fresh new ideas.

The Journal of the American Medical Association (JAMA), the most widely circulated medical journal, recently reported its most-discussed articles of 2022. The top three articles were on the discovery of mRNA vaccine particles in breast milk, myocarditis after COVID vaccination, and a study I led at Johns Hopkins on the durability of natural immunity. None of the three were funded by the NIH—all were topics downplayed by Dr. Fauci and other public health officials. What does it say that the 3 JAMA research studies that generated the most interest among doctors and the public were on Covid topics of no interest to Dr. Fauci and the NIAID?

On a personal level, many infectious disease doctors and academic physicians have told me privately they were afraid to disagree with Dr. Fauci because their entire career is dependent on NIH funding. We are now learning—through the Twitter files—that U.S. health agencies pushed for the censorship of opposing opinions from top scientists at top institutions. Health officials could have spent that time and energy conducting much-needed scientifically sound research.

If Dr. Fauci wants to forever improve the agency he is now departing, he should speak out against medical censorship and publicly call for the immediate discontinuation of a White House internal policy that the thousands of doctors and scientists at the NIH, FDA, and CDC are not allowed to speak to the media. Medical discussion should not be a privilege hoarded by a select few agency leaders.

Dr. Fauci made helpful contributions during the pandemic, urging people to take COVID seriously and encouraging high-risk Americans to get vaccinated. But at a desperate time when the country needed the NIAID to work, it didn't. Fauci's agency failed to pivot its mammoth research infrastructure to give doctors and policymakers the medical evidence they needed at a critical time. In the absence of evidence, dogma ruled the day. The result has been the most politicized pandemic in history and a loss of public trust. Rebuilding that trust and a broken agency will be the charge of Dr. Fauci's successor.

Marty Makary MD, MPH is a professor at the Johns Hopkins University School of Medicine and author of the New York Times bestsellers Unaccountable and The Price We Pay.

This article was first published in Newsweek