On Call: A Doctor's Journey in Public Service

Dr. C. Everett Koop (1916—2013) was US Surgeon General from 1982 to 1989, appointed by President Ronald Reagan. Before serving as Surgeon General, he was a renowned pediatric surgeon. Koop is widely recognized for his work in public health, particularly in areas of smoking cessation, HIV/AIDS awareness, and infant health. He advocated for broad-based public health initiatives and was notable for his willingness to tackle controversial health issues with a focus on evidence-based practices, often against significant political pressure. Koop had a conservative outlook, noted for his pro-life stance against abortion, which was informed by his Christian evangelical background. Widely criticized by pro-choice, democratic groups, Koop maintained his position against abortion throughout his public career.

Despite his conservative background, Koop gained a reputation for prioritizing scientific integrity and the welfare of the public, becoming a progressive voice on issues such as anti-tobacco and AIDS. His work on HIV/AIDS, for example, pushed against stigma and advocated for widespread education about the disease at a time when much of society preferred silence on the matter. In On Call, Fauci recounts Koop as a transformative figure who influenced public health policy during the HIV/AIDS crisis, a time that intersected with the beginning of Fauci’s career at the National Institute of Allergy and Infectious Diseases (NIAID). Fauci describes Koop as an important ally in public health, particularly when political resistance hindered proactive response efforts.

Dr. James Carroll Hill (1941—1997), whom Fauci calls “Jim” in his book, was a microbiologist and a close professional companion to Dr. Anthony Fauci. Graduating from the University of Arkansas, Hill’s career was dedicated to advancing immunology and infectious disease research. He thus played an instrumental role during important moments in the US healthcare response to various health crises. Hill was the deputy director of the NIAID until 1995, two years before his death.

In On Call, Fauci highlights Hill’s influence on his career, praising the way in which Hill’s mentorship and friendship helped shape his approach to medical challenges when he was a director at the NIAID. The memoir describes their professional relationship as mutually reinforcing, marked by shared dedication and a sense of duty toward public health. Moreover, the two professionals became close friends, with Hill playing the role of godfather for two of Fauci’s daughters—a role of great importance for Fauci’s Italian-American heritage.

Hill was openly homosexual and understood from a personal perspective the struggles of the LGBTQIA+ community during the AIDS crisis in the US. Thus, his insights were deeply valuable for Fauci’s and NIAID’s work during this crisis. Hill’s death as a result of a medical incident during his liver surgery profoundly impacts Fauci and his work.

Larry Kramer (1935—2020) was a playwright, producer, and activist whose advocacy for people with HIV/AIDS during the 1980s and 1990s made him one of the era’s most influential voices for healthcare reform and social justice. He is known for his intense, confrontational voice, often considered “the most annoying and abrasive man in America.” Kramer believed that the government and broader society were largely indifferent to the suffering of the LGBTQIA+ community—a group that endured considerable discrimination at the time and continues to battle for their right to medical care. Kramer co-founded the Gay Men’s Health Crisis (GMHC) and later the AIDS Coalition to Unleash Power (ACT UP).

In On Call, Fauci reflects on his complex relationship with Larry Kramer, acknowledging Kramer’s pivotal influence on his approach to the AIDS pandemic and public health activism more broadly. Initially, Fauci and Kramer stood on opposite sides of a contentious battle: Kramer often criticized Fauci and the National Institutes of Health (NIH) for what he perceived as bureaucratic inaction and insufficient urgency in responding to the AIDS crisis. However, Fauci eventually came to appreciate Kramer’s impassioned advocacy, recognizing that Kramer’s persistence was rooted in a profound concern for the lives of those impacted by the disease. Fauci describes how Kramer’s activism, although initially challenging, pushed him to rethink the ways in which public health institutions could engage with patient advocacy and more rapidly address urgent medical needs, underscoring the text’s thematic engagement with The Challenge of Maintaining Emotional Composure in Medical Practice.

President George W. Bush (born in 1946) was the president of the United States from 2001 to 2009. As Fauci’s book illustrates, George Bush was a significant figure in public health history for his involvement in the AIDS crisis, the large-scale preparation to potential bioterrorism, the establishment of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, and other such initiatives. PEPFAR sought to provide antiretroviral treatment, care, and support to millions of people living with HIV/AIDS. This ambitious program marked a turning point in global health policy, making Bush a notable figure in the fight against HIV/AIDS.

President Bush’s relationship with Fauci, who was then the director of the National Institute of Allergy and Infectious Diseases (NIAID), was central in the implementation and success of PEPFAR. Fauci’s expertise in infectious diseases and his longstanding commitment to HIV/AIDS research and treatment made him an ideal advisor for shaping PEPFAR’s medical and logistical strategies. In On Call, Fauci notes that Bush’s dedication to public health was driven by his compassion and empathy.

Barack Obama (born in 1961) served as President of the US from 2009 until 2017. His administration prioritized expanding healthcare access, most notably through the Affordable Care Act (ACA), which restructured US healthcare policy to improve accessibility, affordability, and insurance coverage. Obama’s administration marked a new chapter in public health efforts by addressing domestic healthcare reform and by recognizing the significance of infectious disease threats in an increasingly interconnected world, highlighting The Intertwined Realities of Public Health and National Security.

Obama’s influence on Fauci’s role was especially notable during the Ebola outbreak of 2014-2016, as Fauci notes in On Call. Faced with an unprecedented public health emergency that threatened to reach US soil, Obama prioritized a coordinated response, tasking Fauci and other leading health experts to develop protocols and communicate effectively with the public. As a result, Fauci’s public presence increased during the Obama administration. In On Call, Fauci discusses how Obama’s focus on informed leadership and reliance on scientific guidance shaped his handling of the outbreak. Fauci also reflects on Obama’s commitment to addressing long-term global health security, a priority that mirrored Fauci’s own focus on pandemic preparedness and infectious disease control.

Donald Trump (born in 1946) served as President of the US from 2017 until 2021. He has a background as a businessman and reality television personality. From the point of view of public health policy, Trump’s administration faced significant challenges when COVID-19 emerged as a global threat. Trump’s handling of the pandemic, marked by combative interactions with scientists and public health officials, became a defining aspect of his presidency and, by extension, his relationship with Dr. Anthony Fauci.

In On Call, Fauci details his experiences working with the Trump administration as he navigated the tense dynamics between science and politics. Fauci describes how Trump’s initial public response to the virus often conflicted with scientific evidence, such as downplaying the virus’s severity and promoting unproven treatments. These actions, Fauci notes, influenced public perceptions and behaviors surrounding COVID-19, complicating the work of health officials seeking to control the virus’s spread. The tension between Fauci’s advocacy for evidence-based responses and Trump’s more politically driven messaging is one of the main themes of Part 5, illustrating the challenges Fauci faced as he attempted to balance transparency with the necessity of working within the administration.