How the Fight Against AIDS Can Inform the Fight Against Covid-19

Dr. Anthony S. Fauci grappled with another health crisis decades ago. What he told Retro Report about the effort against AIDS could apply to the battle against the coronavirus.
By Clyde Haberman

Dr. Anthony S. Fauci saw early on how the virus was killing people whose ability to fight disease had weakened disastrously. “I said, ‘Whoa, we really have an issue here,’ ” he said. “It seems to be spreading and spreading.”

Dr. Deborah L. Birx, his colleague in the current struggle to tame the novel coronavirus, recalled moments “when you not only couldn’t make a diagnosis, you didn’t know what the problem was, and you didn’t know how to treat it.”

“It was,” she said, “devastating.”

Neither of them had the coronavirus pandemic in mind when they made those comments. Instead, they were reflecting on a much earlier time in their public health careers — the 1980s and ’90s — when another plague raised discomfiting questions about how vigorously the United States dealt with ruinous infection. For both doctors, the enemy then was H.I.V., the human immunodeficiency virus, which at its direst led to the life-threatening acquired immune deficiency syndrome, best known as AIDS.

As shown in this latest offering from Retro Report, which uses video to cast a spotlight on past events and help illuminate the present, the AIDS epidemic of the ’80s resembled the coronavirus pandemic in a notable respect: It caught this country napping.

“The flags were going up, and the warning bells were rung,” said Allan M. Brandt, a historian of medicine in a remote interview with Retro Report. But “the United States was extremely poorly prepared to deal with H.I.V.,” Mr. Brandt said. “We didn’t have a recent history of massive infectious epidemic diseases. We didn’t have a preparedness apparatus.”

“One of the things about epidemics is that the clock is always moving, and that was really true with H.I.V.,” he continued. “Many people died because of the very slow and resistant and inadequate and inconsistent responses.”

Sounds familiar in the age of Covid-19, some would say.

AIDS has yet to be conquered, but medications have greatly subdued it in this country, to such an extent that Americans routinely forget the panic and pain of three decades ago as the virus’s spread reached crisis dimensions. In those years, the toll fell most heavily on gay men and on drug addicts using dirty needles. That made it easy for many people to shrug off AIDS as not their concern, just a disease confined to those living on society’s margins.

Government officials showed scant sense of urgency, and the same might be said about many news organizations. The intense media coverage in late May when the number of United States coronavirus deaths surpassed 100,000 contrasts sharply with what happened when the AIDS epidemic reached that same milestone in 1991. The New York Times, for example, took note of it with an Associated Press article at the bottom of Page A18.

Even Dr. Fauci came under withering attack back then from AIDS activists who accused him of moving too hesitantly to find a remedy. One of them, Larry Kramer, who died in May at 84, went so far as to call the doctor an “incompetent idiot” and “a murderer.” While he may not have appreciated the venom, Dr. Fauci came to agree that the federal bureaucracy had been overly cautious and needed to up its game. Over time, the two men bonded; in later years Mr. Kramer described Dr. Fauci as a “true and great hero” in the AIDS crisis.

Part of the problem in the 1980s was that the country had let its guard down. So many killer diseases had been vanquished — smallpox, polio, typhoid fever, diphtheria and more — that quarantines and other once-automatic protective measures faded into the dim recesses of collective memory. “By the early ’80s, when AIDS emerged,” Mr. Brandt said, “we had let our public health infrastructure deteriorate, and it was poorly funded — really poorly structured.”

Smugness had become a formidable enemy of its own. In a 1992 report, the nonprofit organization Institute of Medicine, now called the National Academy of Medicine, concluded that “complacency (i.e., the assumption that we have conquered a disease and can thus shift our concern to other pressing problems) can also constitute a major threat to health.”

Since then there have been plenty of warnings that health crises could descend like sudden rain on a clear day. Five years ago, Bill Gates cautioned that if millions were to die, the cause would most likely be “a highly infectious virus rather than a war.” Both Presidents George W. Bush and Barack Obama spoke of the need for clear policies and procedures to be firmly in place well ahead of disaster. “If we wait for a pandemic to appear,” Mr. Bush said in 2005, “it will be too late to prepare.”

President Trump’s attitude could not have been more different. As recently as late February, with the coronavirus whirling around the globe, he argued against the need for elaborate public-health systems to be kept on standby, ready to roll whenever disaster struck. “Rather than spending the money, and I am a businessperson, I don’t like having thousands of people around when you don’t need them,” he said. “When we need them, we can get them back very quickly.” That proved not to be the case. Stephen K. Bannon, Mr. Trump’s onetime chief strategist, has told The Times that the administration never took seriously the possibility of a calamity like this coronavirus.

Comparisons to the most catastrophic years of the AIDS crisis go further. Then as now, testing and contact tracing were essential, but many in the most vulnerable groups resisted. It was partly because they feared leaving themselves open to anti-gay discrimination; partly it reflected a mistrust of the government and the medical establishment. A similar lack of faith in authority is evident these days among Americans who refuse to wear masks or be tested for the coronavirus, and who insist they want nothing to do with any vaccine that may come along.

And then as now, there was Dr. Fauci in the eye of the storm. As director of the National Institute of Allergy and Infectious Diseases, he has been an adviser to six presidents, with a sense of mission that remains unchanged. What he told Retro Report about the effort against AIDS could readily apply now to the battle against Covid-19.

“I took very seriously to make sure that what I said was never sugarcoating,” he said. “Because when you’re dealing with any public health challenge, particularly a disease of the nature of H.I.V., communication with the public is as important as the science that we do.”

CLYDE HABERMAN, a regular contributor to Retro Report, has been a reporter, columnist and editorial writer for The New York Times, where he spent nearly 13 years based in Tokyo, Rome and Jerusalem. This article first appeared in Retro Report’s newsletter. Subscribe here and follow us on Twitter @RetroReport.