「他拯救了無數人的生命」：關於美國科學家佛奇的離開 NIH 的角色

從 AIDS 流行到 COVID-19 大流行，這位標誌性的醫療負責人就為七位總統多次提供了爆發流行上的建議。

資料來源：新聞 / 2022 年 8 月 22 日 / 自然 / 財團法人台灣紅絲帶基金會編譯

在 COVID-19 大流行期間，美國首席醫療顧問安東尼·佛奇曾多次在國會作證。圖片來源：Chip Somodevilla/Getty

擔任美國首席傳染病顧問近 40 年的安東尼·佛奇（Anthony Fauci）於 8 月 22 日宣布，他將於 12 月辭去領導職務。儘管許多科學家對失去他的指導感到難過，但他們理解他下台的願望。沒有其他聯邦科學家像佛奇那樣曾擔任最高職位如此地久。

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「佛奇博士是我所認識的最敬業的公務員」，多年來與佛奇密切合作的美國國家衛生研究院 (NIH) 前院長弗朗西斯·柯林斯說。「他的貢獻挽救了無數生命免受愛滋病毒/愛滋病、伊波拉病毒和 SARS-CoV-2 感染，並將成為對人類意義重大的禮物」。

美國總統喬·拜登（Joe Biden）將佛奇提升為他的最高醫療顧問，他與柯林斯的觀點相呼應。拜登說：「他對這項工作的承諾堅定不移，他以無與倫比的精神、精力和科學誠信來做這件事」。當作為副總統時，拜登與佛奇合作，共同應對美國對玆卡病毒和伊波拉病毒爆發的反應。

與《自然》雜誌交談的研究人員表示，佛奇將因為他堅定不移地致力於研究和開發愛滋病毒治療方法，以及他與公眾直接、清晰地交流的不可思議的能力而被人們銘記。羅德島州普羅維登斯布朗大學的流行病學家詹妮弗·努佐說，每當出現特別令人擔憂的公共衛生緊急情況時，「政府都會拿出他們最好的武器——東尼·佛奇」。她與同事開玩笑說，從佛奇出現在電視上的次數就可以清楚地看出一種病原體是否值得擔心，並將這種現象稱為「東尼·佛奇指數」。

「堅定而積極」的努力

從 1984 年的羅納德·雷根 (Ronald Reagan) 開始，福奇一直在馬里蘭州貝塞斯達的美國國家過敏和傳染病研究所 (NIAID) 掌舵，歷任七任美國總統。最近，他成為美國應對 COVID-19大流行的代言人和全球值得信賴的聲音，幫助數百萬人了解迅速發展的威脅。在他任職期間，他將 NIAID 從一個鮮為人知的 NIH底下所屬之研究所（年預算為 3.5 億美元）轉變為全球傳染病研究的榜樣，年預算超過 60 億美元。

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由於他在 HIV 免疫學方面的工作和幾十年來一直在傳染病研究界享有盛譽，佛奇是有史以來被引用次數最多的科學家之一。然而，他作為領先專家的角色有時是動蕩的。在 1980 年代和 1990 年代愛滋病流行的初期，此期間活動人士認為 NIAID 的臨床試驗進展太慢，無法幫助 HIV 感染者獲得仍在測試中的挽救生命的療法。他們指責佛奇造成了他們認為不必要的死亡，並在他的辦公室前舉行了抗議活動。佛奇開始與活動人士進行對話，在幾年內導致開發出有效的治療方法來抑制病毒，這亦成為全球照護標準。加州大學舊金山分校的 HIV 臨床醫生 Steven Deeks 說，這種與社區的合作是前所未有的，並成為未來醫療照護領導者的典範。「但東尼是第一個」，他說。

與前總統喬治·W·布希合作，佛奇還幫助設計了美國總統愛滋病緊急救援計劃 (PEPFAR)，這是一項於 2003 年啟動的全球計劃，旨在為愛滋病毒感染者提供治療。迪克斯說，PEPFAR 可能是佛奇最偉大和最有影響力的成就，「明確地挽救了數百萬人的生命」。 2008 年，布希授予佛奇總統自由勳章，以表彰他「堅定而積極的努力」。

2014 年，當人們擔心西非伊波拉疫情是否會成為大流行病時，彿奇幫助治療並特別擁抱了一名感染病毒並在 NIH 住院的護士。佛奇後來說，他這樣做是為了向他的員工表明，他不會要求他們做任何他自己不會做的事情。 Nuzzo 說，這種「非凡的同理心」將難以取代。

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快速進展到 2020 年，佛奇再次受到抨擊——這次來自他所服務的總統。前總統唐納德·川普對佛奇透過實施戴口罩和保持社交距離等介入措施遏制 SARS-CoV-2 冠狀病毒傳播的指導感到不滿，他試圖讓福奇閉嘴，有時阻止他公開講話。川普還暗示他可能會解僱福奇（福奇是美國政府的公務員，不是政治任命的，所以不清楚川普可能是要如何做到）。佛奇收到了死亡威脅，並曾有聯邦警衛監督他的安全。

「由於對他的持續攻擊以及我們的政治領導人未能譴責這些攻擊，他的溝通能力被削弱了」，努佐說。

下一代

儘管在宣布離職時，佛奇沒有詳細說明他的未來計劃，但他很清楚自己不會退休。「我計劃在我仍然對我的領域充滿活力和熱情的情況下追求我職業生涯的下一階段」，他寫道。他表示，無論他接下來做什麼，都將涉及推進科學和公共衛生，以及指導下一代科學領袖。

福奇的指導幫助塑造了無數科學家——包括康乃狄克州紐黑文耶魯大學的免疫學家 Akiko Iwasaki——成為今天的科學家。雖然岩崎明子說她在 1998 年只是 NIH 的一名「低層級的博士後研究員」，但福奇還是抽出時間與她多次會面。「他用這種方式來提升他周圍的科學家」她說。

NIAID 沒有回復詢問何時可能會任命佛奇的替代者的電子郵件。但迪克斯希望新任主任也有同樣的願望，繼續努力結束愛滋病毒的流行。「東尼肩負這個使命已經 40 年了」，他說。

doi：https://doi.org/10.1038/d41586-022-02301-x

‘He has saved countless lives’: US scientists on Fauci leaving NIH role

From the AIDS epidemic to the COVID-19 pandemic, the iconic medical chief has advised seven presidents on numerous outbreaks.

NEWS / 22 August 2022 / Nature

Chief US medical adviser Anthony Fauci has testified before Congress numerous times throughout the COVID-19 pandemic.Credit: Chip Somodevilla/Getty

Anthony Fauci, who has been the top infectious-diseases adviser in the United States for almost 40 years, announced on 22 August that he would resign from his leadership roles in December. Although many scientists are saddened to be losing his guidance, they understand his desire to step down. No other federal scientist has held a top position for as long as Fauci.

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“Dr Fauci is the most dedicated public servant I have ever known,” says former US National Institutes of Health (NIH) director Francis Collins, who has worked closely with Fauci over the years. “His contributions have saved countless lives from HIV/AIDS, Ebola and SARS-CoV-2, and will stand as profoundly significant gifts to humanity.”

US President Joe Biden, who elevated Fauci to the role of his top medical adviser, echoed Collins’s sentiments. “His commitment to the work is unwavering, and he does it with an unparalleled spirit, energy, and scientific integrity,” Biden said. As vice-president, Biden worked with Fauci on the US response to outbreaks of the Zika and Ebola viruses.

Researchers who Nature spoke to say that Fauci will be best remembered for his unwavering dedication to research and the development of treatments for HIV, as well as for his uncanny ability to communicate directly and clearly to the public. Whenever there was a particularly concerning public-health emergency, “the government would trot out their best weapon — Tony Fauci”, says Jennifer Nuzzo, an epidemiologist at Brown University in Providence, Rhode Island. She joked with colleagues that whether a pathogen was worth worrying about was clear from the number of times Fauci appeared on television, nicknaming the phenomenon the ‘Tony Fauci index’.

‘Determined and aggressive’ efforts

Fauci has been at the helm of the US National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, under seven US presidents, starting with Ronald Reagan in 1984. Most recently, he became the face of the US response to the COVID-19 pandemic and a trusted voice worldwide who helped millions to make sense of a rapidly evolving threat. During his tenure, he transformed the NIAID from a lesser-known NIH institute with an annual budget of US$350 million to a global role model in infectious-diseases research with a budget exceeding $6 billion a year.

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Fauci is one of the most highly cited scientists of all time on account of his work on HIV immunology and has been well known in the infectious-diseases research community for decades. However, his role as a leading expert has, at times, been tumultuous. During the AIDS epidemic in the 1980s and early 1990s, activists felt that the NIAID’s clinical trials were moving too slowly to help people with HIV gain access to life-saving therapies that were still being tested. They blamed Fauci for what they saw as unnecessary deaths, and staged protests in front of his office. Fauci began a dialogue with the activists that led, within years, to the development of effective treatments to suppress the virus that would become the global standard of care. This type of collaboration with the community was unprecedented and became a model for future health-care leaders, says Steven Deeks, an HIV clinician at the University of California, San Francisco. “But Tony was the first,” he says.

Working with former president George W. Bush, Fauci also helped to design the US President’s Emergency Plan for AIDS Relief (PEPFAR), a global programme launched in 2003 to provide treatment for people with HIV. PEPFAR, which is probably Fauci’s greatest and most impactful accomplishment, Deeks says, has “unequivocally saved millions of lives”. Bush awarded Fauci the Presidential Medal of Freedom in 2008 for his “determined and aggressive efforts”.

In 2014, at a time when people were worried about whether the Ebola outbreak in West Africa would become a pandemic, Fauci helped treat and notably hugged a nurse who had been infected with the virus and hospitalized at the NIH. Fauci later said he did this to show his staff that he wouldn’t ask them to do anything that he wouldn’t do himself. That “extraordinary level of empathy” will be difficult to replace, Nuzzo says.

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Fast forward to 2020, and Fauci once again came under fire — this time from the president whom he was serving. Dissatisfied with Fauci’s guidance to curb the SARS-CoV-2 coronavirus’s spread by implementing interventions such as mask wearing and social distancing, former president Donald Trump attempted to silence Fauci by, at times, preventing him from speaking publicly. Trump also hinted that he might fire Fauci (Fauci is a civil servant in the US government, not a political appointee, so it is not clear how Trump might have done this). Fauci has received death threats and has had federal guards overseeing his safety.

“Because of the sustained attacks on him and failure of our political leaders to rebuke those attacks, his ability to communicate was lessened,” Nuzzo says.

The next generation

Although in announcing his departure Fauci did not detail his future plans, he was clear that he would not be retiring. “I plan to pursue the next phase of my career while I still have so much energy and passion for my field,” he wrote. He indicated that whatever he does next, it will involve advancing science and public health, and mentoring the next generation of science leaders.

Fauci’s mentorship has helped to shape countless scientists — including Akiko Iwasaki, an immunologist at Yale University in New Haven, Connecticut — to be the scientists they are today. Although Iwasaki says she was just a “lowly postdoc” at the NIH in 1998, Fauci took time out of his schedule to meet with her on several occasions. “He has this way of elevating scientists around him,” she says.

The NIAID did not respond to an e-mail enquiring about when Fauci’s replacement might be named. But Deeks hopes the new director will have the same desire to continue trying to end the HIV epidemic. “Tony has carried this on his shoulders for 40 years,” he says.

doi: https://doi.org/10.1038/d41586-022-02301-x