Drs. Deborah Birx and Anthony Fauci have garnered near-universal praise from the healthcare community for their leadership during the COVID-19 pandemic.
While both physicians have extensive track records of public service, they were relatively unknown to the public until bursting onto the national stage in March as America’s chief health science communicators, explaining the intricate details of previously arcane topics like disease transmission and vaccine development to an anxious and bewildered nation during their daily news briefings.
Their steady leadership during the crisis earned them the top spot on this year’s listing of the 50 Most Influential Clinical Executives.
“I just can’t imagine having better scientific leaders,” said former HHS Assistant Secretary Dr. Howard Koh, now a professor at Harvard University. “We all owe a debt of gratitude to them for their unbelievable public service during a time of crisis.”
Fauci, director of the National Institute of Allergy and Infectious Diseases, has been lauded for his level-headed, no-nonsense approach to describing what scientists do and don’t know about the virus. And unlike most politicians and public officials, Fauci freely weighs the costs and benefits of different response measures. He’s an unusual figure enmeshed in American politics because he confronts uncertainty. He acknowledges trade-offs. Backed by his magnetic personality and distinct New York accent, he tells the public what it needs to hear, even if it’s bad news.
“His insights represent the best science possible,” Koh said.
Though Birx, the White House coronavirus response coordinator, has not achieved the same level of acclaim, many people inside and outside the administration put her on equal footing with Fauci thanks to her tireless work coordinating the nation’s response to the pandemic. She’s largely responsible for arming senior administration officials with the information they need to respond to the crisis, spending hours each day poring over statistical models to better understand the spread of the virus and how to combat it.
The Trump administration did not make Birx or Fauci available for comment.
Despite the high praise from the healthcare community, both have come under largely political fire for their roles in the federal pandemic response.
In April, some Republican lawmakers and conservative activists called for Fauci’s firing after he said more lives could have been saved if the U.S. had implemented mitigation strategies like social distancing sooner. President Donald Trump even retweeted one such call for action.
Critics also attacked Fauci for his inability to predict the spread of the disease fully.
“Fauci told us there’s nothing to worry about. That’s his quote, ‘There’s nothing to worry about,’ “ former White House adviser Steve Bannon said during an April 14 interview on The John Fredericks Show, a conservative radio program. Bannon was referencing comments Fauci made in January in which he told Newsmax that COVID-19 was “not a major threat … right now,” but that the public officials should take it seriously.
They held him responsible for keeping the economy shut down, too. He became a political punching bag for a spell, despite his best efforts to sidestep politics and focus on science.
“I don’t give advice about economic things,” Fauci said during a May 12 Senate hearing. “I don’t give advice about anything other than public health.”
It was only a matter of time until he came under political pressure, having publicly contradicted the president on several occasions. Some people worry that could limit his influence inside the administration.
Birx hasn’t escaped criticism either. Some experts have chastised her for publicly kowtowing to Trump when he’s made unsubstantiated claims about the prevalence of the virus, death rates or the proven effectiveness of possible COVID-19 treatments like Gilead Sciences’ remdesivir.
But most people inside the industry agree that such criticisms about the nation’s most visible scientists are inaccurate or need to be put into context.
Both Birx and Fauci have challenging jobs because they’re responding in real-time to a global pandemic caused by a previously unknown virus. Unlike many earlier outbreaks, there’s no existing body of scientific research to fall back on.
This isn’t the first time they’ve been thrown into a politically charged public health crisis. Birx and Fauci cut their teeth responding to the HIV/AIDS crisis in the 1980s, a disease that was initially thought to only affect LGBTQ people, especially men. It was originally called gay-related immune deficiency, or GRID.
“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 devastating,” Birx said during an interview at the George W. Bush Presidential Center last September.
Now, once again, everyone is learning on the job. That includes federal agencies, states, providers, suppliers, public health experts and transportation professionals alike.
“The big problem that we have is that you can have the right science, but if you don’t have the right delivery mechanism, it all goes for naught,” said Dr. Rod Hochman, CEO of Providence health system, which cared for the first confirmed COVID-19 case in the U.S.
He said that if he were to level any criticism, he would direct it toward the Centers for Disease Control and Prevention for its slow initial response to the outbreak and vague guidelines.
Those documents “were watered down into these kinds of nonsensical, simplistic, one-page guidelines that really aren’t helping people,” Hochman said. “You have to provide guidance at the top, instead what we’ve got now is a potpourri.”
Both scientists are operating under tough political circumstances because the nature of the coronavirus can put the best available science at odds with politicians’ career interests and the nation's economic welfare—though the virus would hugely disrupt the economy regardless of what path the Trump administration chose.
They’ve been delivering clear messages to the public in lockstep with each other, but “the president steps all over those messages,” said former HHS Secretary Donna Shalala, now a Democratic member of the House representing Florida’s 27th District.
Birx is “not used to this daily kind of barrage or having someone that she works for that’s not a believer in science,” Shalala said.
It’s a challenge that many people will recognize in their own lives, Hochman said.
“We can all relate to it in our workplaces, where you’ve got to temper what your best opinion is by the environment that you work in,” he said. “I think that’s what both physicians are facing.”
Even so, experts agree that Birx and Fauci have performed admirably since neither of them has the power to marshal the full resources of the federal government. Much of the nation’s response to the pandemic is beyond their immediate control, although they certainly have influence.
That’s why both scientists need to stay in their roles, Hochman said.
Birx is known as a shrewd political operator inside the White House. In March, she reportedly managed to convince Trump to extend social-distancing guidelines by 30 days, despite his deep desire to reopen the economy.
“She’s a scientist who has to survive within the White House,” Shalala said. “I actually think she has the harder political job because Tony can go back to the NIH and testify and say anything he wants to say. Her job is a little more complicated than his.”