On Call: A Doctor's Journey in Public Service

Fauci entered the field of infectious diseases in the 1960s and reached prominence as a public figure and director of the NIAID in the 1980s. During that time, the medical and scientific communities were still solidifying their approaches to outbreaks. Early in Fauci’s career, infectious diseases were often viewed as local issues, solvable within the confines of national borders. This mindset would soon be challenged, especially as the HIV/AIDS epidemic unfolded in the 1980s. Fauci’s work during this period highlights a critical moment in global health when the world first began to view disease as a borderless threat. As Fauci explains in his memoir, in the beginning, HIV/AIDS was stigmatized, and the government response was slow, partly due to anti-gay biases and misunderstandings surrounding the disease’s primary demographics. Over time, through advocacy, research, treatment, and a shift in global health dynamics, the scientific community acknowledged the need for public health to transcend political and social barriers, not only in relation to the HIV/AIDS pandemic but across the board.

Fauci’s work also puts into perspective the evolving role of research institutions and global cooperation. Over the decades, public health crises increasingly demanded rapid, data-driven responses, a trend that would peak during the COVID-19 pandemic. SARS, H1N1, Ebola, and Zika served as interim tests for this growing approach, which forced Fauci and his colleagues to find a balance between public alarm, governmental response, and scientific rigor. By 2020, this readiness was essential, though not perfect, in confronting COVID-19, illustrating the scientific community’s long journey from the tentative HIV/AIDS response to a comprehensive, if still flawed, pandemic preparedness infrastructure.

In On Call, Fauci writes about the importance of historical activists, such as Larry Kramer, an activist and outspoken critic of governmental inaction. While Fauci at times struggled with the intense criticism expressed by Kramer towards him, he also recognizes the importance of incorporating activist voices and the power of civic involvement in shaping policy. Over time, health activism has gained more prominence and activist initiatives have had to adapt to the shifting power dynamics of public health by adopting multi-level strategies, as Catherine Campbell argues in Public health activism in changing times: re-locating collective agency (2021).

However, Fauci’s narrative does not fully capture the deep societal scars left by the AIDS epidemic, which ravaged marginalized communities globally, from sub-Saharan Africa to the American LGBTQ+ population. Moreover, while On Call illustrates Anthony Fauci’s role in tackling various infectious disease crises, it misses an important opportunity to critically address the deep-seated inequalities in the US healthcare system, especially as they were laid bare during the COVID-19 pandemic. As Dayna Bowen Matthew discusses in Just Medicine, health crises like the pandemic emphasize the profound disparities in access to healthcare, where low-income and minority communities suffer disproportionately higher infection and mortality rates due to longstanding structural inequities. While it is a personal account, the book does engage with the history of the US medical system and, as a result, it inadvertently reinforces a narrow view of public health, one that overlooks the intersection of healthcare with broader social and economic, racial, and gender factors.