Fauci and Birx worked together on AIDS. Now they are partners in the fight against the corona virus.

Apr 5, 2020 6:45 PM ET

After birth, she resumed research on the disease under Fauci’s guidance.

This disease would soon be known as HIV / AIDS. Birx and Fauci have worked together every year since then to successfully fight the disease and look for a cure and vaccine.

Now, 37 years after their first collaboration, the long-time allies often stand with President Trump in the White House to inform the nation about the corona virus as they band together privately to convince the President that economically more painful measures are needed, to stop the outbreak.

In doing so, they criticized a tightrope walk between their science-driven views and the president’s trust in gut feelings from left and right. The story of how they go this line is based on the way they have relied heavily on each other for decades and the lessons they have learned from fighting another disease that was initially untreated, both said in separate interviews with the Washington Post.

“Nobody will understand what it was like to be a fully trained doctor when you thought you were relatively knowledgeable and had patients dying and couldn’t stop them. And unable to know what it was, ”said Birx, 64, the United States’ global AIDS coordinator. “And I think that made both of us fight infectious diseases … because once you’ve had this devastating experience, you don’t want to live in an epidemic anymore.”

Fauci, 79, director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health (NIH), similarly recalled this.

“We have known each other for so long and have been through so much, the good times and the bad times, the successes, the failures,” he said. “So we’re like two veterans who went through a series of wars together.” When they realized that they were going to work together to advise the White House on how to fight the coronavirus, Fauci said they said, “Well, let’s get started, we’re together again.”

The two doctors and some of their staff said that while HIV / AIDS is a very different disease than Covid-19, the lessons from their previous work are clear. In both cases, there was early misunderstanding about the severity of the disease, the government was slow to respond, and the initial response was based on behavioral changes while a longer-term solution was sought.

Now it’s up to you to apply these lessons, but your efforts to work with Trump have led to some harrowing statements, and there have been some initial questions as to whether they were completely in sync. Fauci was both celebrated and denounced for overtly refuting some of Trump’s statements, such as when he told the science magazine, “I can’t jump into the microphone and push him down,” if the president makes a false statement.

Birx recently informed the Christian Broadcasting Network that the president “was so attentive to the details and data” and that he was “attentive to the scientific literature”.

Given Trump’s well-documented reluctance to review written information materials, her comment was ridiculed by President Clinton’s former spokesman Joe Lockhart she mocked on Twitter for “drinking the Kool Aid” and pushing to tell Trump the truth about the depth of the crisis.

Birx defended her comments and told The Post that her job as an officer was to make sure Trump understood the data, and she said he “asked the right questions.”

When Birx and Fauci informed Trump about what would happen if the social distancing guidelines were lifted prematurely, they presented such a unified voice that the president dropped his consent to end the restrictions in time for Easter Sunday and agreed that at least another 30 days were required.

Birx is in a more difficult position, according to Fauci, because she is a political candidate who can be fired at any time, while being relatively protected in his role as an administrator in the NIH system. While serving both presidents of both parties who have returned to the Reagan administration, he is used to speaking bluntly without fear of reprisals.

“She has to be a little more respectful because she is a political leader,” said Fauci. “But when it comes to presenting science, we are really like one, there is no separation at all between us.”

This has been the case since the first meeting of the two in 1983.

Birx was a colonel in the army and worked at the Walter Reed Army Medical Center in Maryland. Fauci worked at the National Institute of Allergy and Infectious Diseases, where he was to become director the following year.

After giving birth to her eldest daughter in 1983 and refusing a blood transfusion for safety reasons, Birx devoted herself to discovering a treatment for the disease that killed so many people around her. This work developed when she completed her scholarship in Fauci’s laboratory, and the two then worked together for several decades to find therapy or cure for HIV / AIDS.

“We were right in the middle of it,” said Fauci. “We both looked after HIV-infected people, me here at NIH, they across town with Walter Reed. And it was a dark year for both of us. We looked after patients and everyone died. “

Birx remembered that she would go round at the NIH clinical center and then return to her post at Walter Reed, where hundreds of soldiers in the twenties and thirties suffered from a poorly understood illness.

“You can’t imagine the devastation,” said Birx. “And I think that’s why when we see what is happening at the forefront with healthcare workers, we both do it [caring for coronavirus patients], that’s an experience we were both in. “

Soldiers in battle

Nelson Michael, who had worked with Fauci and Birx at the time, said the experience of seeing patients die was “no different from combat veterans” who killed soldiers in combat.

Michael, who is now director of the Center for Infectious Diseases Research at the Walter Reed Army Institute of Research, recently told Fauci that the current fight against coronavirus reminded him of the fight against HIV in the late 1980s and early 1990s, and he agreed . “For those of us who grew up and waged the HIV war and are still honestly waging it, this pandemic hits us hard,” said Michael.

After a decade of research, scientists funded by the Fauci Institute discovered that a combination of antiretroviral drugs can be used to treat but not cure the disease. “This success changed our lives at the same time,” said Fauci about himself and Birx. They revolved around how to help HIV patients around the world and find a cure.

Fauci and Birx soon pressed for one of the most difficult challenges in medicine: a vaccine to prevent HIV.

In contrast to a vaccine against infections such as the corona virus, which can theoretically be based on how a person’s immune system defends itself, an HIV vaccine would have to work differently and is considered to be far more difficult. Birx, as director of HIV Reed’s HIV research program, pushed for a vaccination attempt in Thailand and worked with the country’s military.

The idea was criticized by some scientists who doubted that the test could be successful and who believed that funds could be better spent on treating the disease. Birx was far from the funding needed. Then, in 2001, the Pentagon proposed to cut its budget to fight HIV / AIDS.

Fauci came to the rescue. After meeting Birx, he helped persuade the Pentagon to keep funding and then promised his institute’s money to top up the vaccine budget. It was a crucial moment in their relationship, he said.

“When I invested those tens of millions of dollars to support Deb’s process, people criticized me for it,” said Fauci. “People in the scientific community said,” You’re wasting money, you shouldn’t be spending money on a process that may not work. “But we have made progress.”

The study started in Thailand and resulted in a 31 percent effectiveness rate, which Fauci considered “one of the highlights of his partnership with Birx, a modest success that was good enough to lead to larger studies in South Africa.”

Birx was named US Ambassador for Global HIV / AIDS Efforts by President Obama in 2014 after serving as Director of the Department of Global HIV / AIDS Disease Control. At her swearing-in ceremony, she praised Obama for “his bold leadership” and praised her new chief, Secretary of State John F. Kerry, for his “amazing, long-standing and unyielding commitment” to fighting HIV / AIDS. She remains in her ambassadorial role during the Trump administration, making her an Obama leftover.

While she said that she and Fauci spend “every working hour” on infectious disease science, she said that they often crossed personally. She said that both have daughters who attended the same cross-country meetings, and she saw him “cheer on his daughter, I cheer on mine.” I saw him as a father. I saw him as a husband … We shared things on a scientific and personal level. He was just a fixed point in my life all the time. “

Because of their partnership, they were in countless panels together, including a December 2017 appearance at a Washington Post AIDS forum expressing optimism about vaccine trials in South Africa. In January it was announced that one of the attempts had failed, but Fauci said in the interview that others are continuing and keeping promises.

A new battle

Around this time, the severity of the coronavirus became apparent in the United States. In late February, when Birx attended an AIDS conference in Africa, Vice President Pence appointed her Coronavirus Response Coordinator at the White House. After a night flight from Africa, Birx met at the White House for a meeting of the Virus Task Force, where Fauci was already the government’s leading infectious disease specialist.

A key challenge for Fauci and Birx was to provide the public with realistic, scientifically sound assessments of the growing crisis, even if the president sometimes makes contradictory and false statements and advocates his own theories.

Myron Cohen, who has known Fauci and Birx since the 1980s, said the couple was too driven by science and data to face political pressure.

“They’re scientists and public health officials,” said Cohen, director of the Institute of Global Health and Infectious Diseases at the University of North Carolina Medical School. “You are not a politician. You present the facts. … This is a one-time thing and these are the right people.”

About a week ago, Fauci and Birx faced their greatest challenge in advising the President. Trump had said he wanted to end the social distancing requirements by April 12, which the two doctors said would result in a massive death toll. They traveled to the White House to convince Trump to drop his idea.

Data expert Birx brought a number of diagrams with him. Fauci, who excels in communicating complex ideas in lay terms, brought along his blunt style and supported Birx.

Fauci and Birx stood with their cards in the Oval Office, bent over the Resolute Desk and asked Trump to examine the data. The charts showed that more than two million people could die if Trump’s idea were followed. However, if the policy of social distancing and staying at home at the national level for 30 days would result in 100,000 to 240,000 deaths. “I think we have to do it,” said the President.

At a White House briefing on Tuesday, Trump essentially said he had entrusted the nation’s future to what he was told by the two doctors, whom he referred to as Tony and Deb. When a reporter asked Trump what he thought would be the number of fatalities if the public followed social distance restrictions, the President said, “I would rather have them say the numbers.”

As bad as the virus crisis was, Fauci said he and Birx were confident that this fight would be winning, also because a coronavirus vaccine can probably be developed using known scientific strategies that should pay off over the next 18 months, much faster than to continue efforts to eradicate HIV / AIDS.

“When you talk about how the experience we had back then informed what Deb and I are doing now, it’s like Deja Vu again,” said Fauci. “Here we are on stage in the press room of the White House. Turn the clock back 35 years and here we are talking about HIV. That’s what we mean when we look at each other and say softly, “Was there, did that.”

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