Power Broker

By Leon Jaroff Reported By Anne Moffett/Washington

The year was 1988, and the U.S. AIDS epidemic was in full bloom. Angry homosexual groups were blaming the National Institute of Allergy and Infectious Diseases (NIAID) for the glacial pace of government research, drug testing and drug approval. Dr. Anthony Fauci, director of the agency since 1984, was singled out for attack, branded a "Nazi" and a "murderer," and hanged in effigy.

Other government officials might have hunkered down. But Fauci decided to hear his critics out. Meeting with AIDS activists in San Francisco, he was introduced to a 34-year-old schoolteacher who explained that a maze of outdated government regulations was preventing his use of a drug that could save his eyesight, failing because of an AIDS-related infection.

"Here was this guy who wasn't confrontational, who didn't shove a banner in my face, but had this terrible dilemma," Fauci told the San Francisco Chronicle. "You can't be a human being without having that move you."

The day marked something of an epiphany for Fauci. Returning to Washington, he set out to mobilize the government against the disease. He successfully lobbied the Food and Drug Administration to make AIDS drugs more widely available. He set up speedier protocols for testing new AIDS drugs. He invited AIDS patients to participate in the NIAID advisory process. Practically overnight, he became one of the leading advocates of AIDS causes and a hero to the gay community.

Indeed, when former President George Bush in 1989 asked Fauci to become director of the entire National Institutes of Health, he turned down the prestigious job primarily because, as director of NIAID, he was too involved--professionally and personally--in tackling the AIDS epidemic.

In the years since, Fauci has set a frenetic pace, often working an 80-hour week. He runs NIAID with a hands-on style and, as former NIH director Harold Varmus once commented, "an iron fist." With Fauci at the helm, NIAID's annual budget soared from $320 million in 1984 to $2.4 billion this year. He has already won over new Health and Human Services Secretary Tommy Thompson, who calls Fauci "one of the most passionate HIV/AIDS researchers in the world today."

Far more than an excellent administrator, Fauci modestly admits to "wearing several hats." He helps design and oversees large clinical trials of experimental AIDS drugs, conducts research in his own institute laboratory, publishes reams of scientific papers, makes weekly rounds of AIDS patients at an NIH clinical center and travels the world to spread the gospel of AIDS prevention and treatment. "It's almost as if I were trained for this epidemic," says Fauci, who earned a medical degree from Cornell and has specialized in infectious diseases and immunology.

Thanks in no small part to Fauci's prodigious efforts, AIDS deaths in the U.S. have dropped from 50,610 in 1995 to 16,273 in 1999. But the situation is still critical. Forty thousand new AIDS cases are reported annually in the U.S., and new findings at NIAID have shown that even after extended treatment with the strongest antiviral drugs, infected patients still harbor reservoirs where the AIDS virus replicates persistently.

It's for this reason, Fauci concludes, that the best hope for preventing the further spread of AIDS lies in the development of a safe and effective vaccine--a goal that remains stubbornly elusive after 15 years of research. That leaves Fauci with his greatest concern, "the impending catastrophe internationally, which is beyond our imagination." He points to the staggering number of people infected with HIV--36 million around the world, 26 million of them in sub-Saharan Africa alone.

Still, having attended the U.N. AIDS conference in June, Fauci sees reason for hope. "Only recently," he says, "have world leaders recognized the enormity and complexity of the global nature of the AIDS epidemic." That sets the stage, he believes, for a worldwide assault on AIDS. Guess who will be leading the charge.

--Reported by Anne Moffett/Washington