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Leading the Fight Against Disease

Mon, 11/21/2005 - 9:17am

Anthony Fauci, MD

Current Position
• Director of the National Institute of Allergyand Infectious Diseases of the National Institutesof Health, Bethesda, Md. (1984 to present)
• Chief of the Laboratory of Immunoregulation,Div. of Intramural Research
• Section Head, Immunopathenogenesis Section

Education and Honors
• MD, Cornell University Medical College, NewYork
• Internship/Residency, The New York Hospital/CornellMedical Center
• 13th Most Cited Scientist (1983 to 2002), Institutefor Scientific Information
• 9th Most Cited Scientist in Immunology (1993to 2003), Institute for Scientific Information
• 30 Honorary Doctorates
• Lifetime Achievement Award (2005), AmericanAssociation of Immunologists
• ‘Extraordinary Accomplishments’ Award(2004),New York Academy of Medicine
• Top 50 Scientific Leaders (2003), ScientificAmerican magazine
• 2003 Ellis Island Family Heritage Award forMedicine and Science
• 2002 Albany Medical Center Prize in
Medicine and Biomedical Research
• 2001 Frank Annunzio Award in the
Humanitarian Field from the Christopher Columbus FellowshipFoundation
• America’s Best in Science and
Medicine (2001), CNN/Time Magazine
• Frank Brown Berry Prize in Federal
Medicine (1999), U.S. Medical and
Delta Dental Plan of California
• Author, Coauthor, or Editor of
more than 1,000 scientific
publications

Current Memberships
• National Academy of Sciences
• American Academy of Arts and
Sciences
• Institute of Medicine (Council Member)
• American Philosophical Society
• Royal Danish Academy of Science and
Letters
• American College of Physicians
• American Society for Clinical Investigation
• Association of American Physicians
• Infectious Diseases Society of America
• American Association of Immunologists
• American Academy of Allergy Asthma and Immunology
• Editor, Harrison’s Principles of InternalMedicine

The world is faced with tremendous medical challengesthat now, all too often, have come to include the wordpandemic. Consider the fact that HIV/AIDS, malaria,and tuberculosis alone are directly responsible formore than 4 million deaths per year. That’s onedeath every eight seconds of every minute of everyday for just three diseases. TB, often thought of asa cured disease, will be responsible this year fortwo to three times the 220,000 people killed in lastyear’s Indian Ocean tsunami.

More than 2.5 million people will die of AIDS thisyear, many of them children—in Africa alone.And malaria, an ancient disease mostly preventablewith DDT sprayings, will still claim more than 1 millionlives this year.

And on the horizon is the threat of a pandemic influenzathat could rival the severity of the 1918 influenzapandemic, which killed between 20 and 40 million peopleworldwide in just one year. With all of these monstrouslylarge challenges to the world’s public health,the search for this year’s R&D Magazine Scientistof the Year was comparatively easy. The editors ofR&D are proud to award our 40th Annual Scientistof the Year to Anthony Fauci, MD, Director of the NationalInstitute of Allergy and Infectious Diseases (NIAID)at the U.S. National Institutes of Health (NIH) inBethesda, Md.

Fauci joins Steven Rosenberg, the Chief of Surgeryat the NIH’s National Cancer Institute and R&D’s1990 Scientist of the Year. Other life scientists thathave received this distinction include the Broad Institute’sEric Lander (2003), geneticist J. Craig Venter (1998),systems biologist Leroy Hood (1993), Nobel Prize winnerKary Mullis (1991), and more.

Fauci has been the Director of NIAID for the past 21years—the longest term of any NIAID Directorand second longest of any active NIH director. Butseniority, by no means, is indicative of Fauci’scontribution to medical science. Indeed, he has focuseda great deal of his research on the pathogenesis andtreatment of immune-mediated diseases. He pioneeredthe field of human immunoregulation by making a numberof basic scientific observations that now serve asthe basis for understanding the regulation of the humanimmune response.

Fauci also has made significant contributions to theunderstanding of how the AIDS virus destroys the body’sdefenses, which then leads to the body’s susceptibilityto often-fatal infections. And he also defined themechanisms of how HIV is transmitted throughout thebody. He continues to devote much of his personal researchtime to identifying the mechanisms of the HIV infectionand the scope of the body’s immune response tothe AIDS retrovirus.

Thirst for knowledge

Fauci traces his drive to succeed partly to the strictness of his Jesuit upbringing, first at Regis High School in New York City, and then at Holy Cross College in Worcester, Mass. “At Holy Cross I got a hybrid BA in Greek Classics and pre-med,” says Fauci. The Jesuits created an environment and a demand for excellence that “was profound,” according to Fauci. They also created an atmosphere and an environment to seek the truth, to obtain a command of the intellect in your specific area, and to seek public service.

Anthony Fauci accepts R&D' Magazine's 2005 Scientist of the Year award from Editor in Chief Tim Studt at the R&D Magazine/R&D 100 Awards banquet held in Chicago's Navy Pier on October 20th. Photo: Ali Ibrihim

These events just seemed to flow together, according to Fauci. “All of this was pivotal to where I am now,” he says. “There wasn’t any one defining moment that I said I want to be a doctor. I didn’t come from a family of doctors, it’s just that if you were a top student, you either picked law, medicine, science, or engineering, or you became a priest. It was just a confluence of things on top of which I got a heavy dose of having to do something good for society,” he says. So he became a doctor.

After Holy Cross, Fauci went to the Cornell Univ. Medical College in New York City for his MD, followed by a year of internship and residency at the New York Hospital-Cornell Medical Center. “The public service, the impact on people, all created an attitude of contributing to society,” says Fauci. “These were important driving forces to what I wanted to do with my life.”

Following his internship, Fauci joined the NIH in 1968 as a clinical associate in the Laboratory of Clinical Investigation (LCI) at the NIAID. In 1974, he was promoted to be Head of the Clinical Physiology Section of the LCI, and in 1980 was appointed Chief of the Laboratory of Immunoregulation, a position he still holds today.

In 1984, Fauci was appointed Director of the NIAID, one of 27 NIH Institutes that will command a total of more than $27 billion in federal R&D funds this year, second only to the Dept. of Defense. In the 21 years that Fauci has been Director, he has seen the NIAID grow from the sixth largest NIH Institute to the second largest (to the National Cancer Institute, and only by 8%) with an annual R&D budget of about $4.4 billion.

Managing by example

Front row (left to right):  Tae-wook Chun, Ph.D.; Audrey Kinter; Anthony S. Fauci, M.D.; James Arthos Ph.D.; Claudia Cicala, Ph.D. Second row (left to right):  Mark Dybul, M.D.; Susan Moir, Ph.D.; Domenico Mavilio, M.D.; Shyam Kottilil, M.D., Ph.D.; Angela Malaspina, Ph.D. Photo: NIAID
Identifying and Developing Cures

While R&D’s 2005 Scientist of the Year, Dr. Anthony Fauci has a full-time job in directing research at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID), he keeps active in the actual research of his institute by continuing to run one of its labs—that of the Laboratory of Immunoregulation, a position he has held for the past 25 years. He also is Section Head of the Immunopathogenesis Section of that lab.

There are two groups of labs within the NIAID—the Division of Intramural Research Labs (DIR) and the Vaccine Research Center (VRC) Labs. DIR labs conduct peer-reviewed laboratory and clinical research. These labs consist of two or more smaller labs (or sections) headed by tenured researchers.

The VRC, which is jointly funded by the NIAID, National Cancer Institute (NCI), and the National Institutes of Health Office of AIDS Research, encompasses all stages of vaccine development, including basic research, design and development of vaccine candidates, pre-clinical testing, production of vaccine candidates, human clinical trials, and efficacy testing. Its primary research focus is to conduct research to develop an effective AIDS vaccine.

Fauci is recognized for his driving demand for excellence, and noted for working 12 to 14 hours every day at his job. He’s motivated to work this hard by the enormous challenges of his job. The NIH is obviously a world leader in medicine. “We determine public health policies and I personally feel that I have an impact on the health of the country and the world. That’s my motivation.”

Fauci thrives on the excitement and the action of curing, or at the very least alleviating, serious, life-threatening diseases and never forgets the seriousness of the work that he’s involved in, and the fact that people’s lives hang in the balance. “We all have to make sacrifices, and sometimes it even gets to the point where we feel that sleep encroaches on that work. To manage the workload and to get the results we need, we have to be efficient and not waste time.”

Fauci motivates his NIAID staff similarly, ‘by example.’ “Organizations follow the leadership they’re given,” he says. “And our leadership demands nothing short of excellence. It permeates the Institute. It’s clear to me as a leader what has to be done, and we work to instill that attitude to the staff.”

And the challenges, for those at the NIAID, have profound consequences. “There are the constant challenges of emerging and re-emerging diseases,” says Fauci. “There’s HIV, West Nile virus, tuberculosis, pandemic flu, and SARS. For some diseases there are good therapies; but for other diseases, they’re raging out of control.

Fauci claims to have a low-grade sense of anxiety that acts as an energizing force that keeps driving him to each new scientific challenge. “We’ve accomplished a lot over the years, but in this position you never get the chance to become bored,” he says. “You’re constantly learning and you always have to put the challenges you face in their proper perspective.”

The 37 NIAID labs are comprised of:

DIR Labs
• Allergic Diseases
• Cellular and Molecular Immunology
• Clinical Infectious Diseases
• Host Defenses
• Human Bacterial Pathogenesis
• Immunogenetics
• Immunology
• Immunopathology
• Immunoregulation
• Infectious Diseases
• Intracellular Parasites
• Malaria and Vector Research
• Molecular Microbiology
• Parasitic Diseases
• Persistent Viral Disease
• Viral Disease
• Zoonotic Pathogens
• Bacterial Toxins and Therapeutics**
• Malaria Vaccine Development**
• Molecular and Cellular Immunogenetics**

VRC Labs
• Advanced Clinical Development
• Animal Medicine
• Biodefense Research
• BSL-3 Virology Core
• Cellular Immunology
• Clinical Trials Core
• Flow Cytometry Core
• Human Immunology
• Immunology
• Immunology Core
• ImmunoTechnology
• Structural Biology
• Structural Virology
• Vaccine Production Program
• Vector Core
• Viral Pathogenesis
• Virology

** — Individual lab sections not related to aDIR lab.

The biggest challenge Fauci and the NIAID face at the present time is the potential threat from pandemic flu. While NIH influenza vaccine and preparedness funding has more than quadrupled in the past two years, from $101 million in 2003 to $419 million in 2005, “we’re still racing against time.” The NIH will spend about $119 million on influenza research to study the pathogenicity of pandemic influenza viruses, the transmission of influenza viruses among different animal species, and the mechanisms of animal to human transmission.

The NIAID awarded contracts in 2004 to develop a vaccine against the H5N1 avian influenza as part of its preparedness program with safety/immunogenicity trials from the initial doses scheduled to begin this fall. Two million doses were ordered to “better prepare the nation for a pandemic.” The whole influenza vaccine enterprise is quite fragile, according to Fauci, with sole suppliers in some situations creating the possibility of shortages as what occurred in the winter of 2004-5 where the UK abruptly shut down a major supplier of flu vaccine to the U.S. “We continue to push the development of new tools, such as new delivery methods which could alleviate shortage issues when they occur.”

Rebuilding the infrastructure
Fauci also continues to fight the good fights outside of the technical area. “In the U.S., we’re at the cusp of losing a step in the quality of the life science graduates coming into the marketplace,” he says. “We’re not at the overwhelmingly better level that we used to be at, compared to the graduates and university systems in other countries. Our university system has not kept up with our leadership in the sciences. We need to push the sciences and educate our students better and to do that we have to start educating them at a much earlier level.”

In the relationships between government and industry in the life sciences, “there’s more of a dichotomy now than there used to be between the biomedical research being performed in government and industry,” says Fauci. “We need to translate our research into more meaningful products. There has to be a greater collaboration between government and academia, especially in the biomedical research arena.”

While continuing to support the development of U.S. academia and government-industry relationships, Fauci also finds himself more involved than ever before in the international aspect of medical research. His work in the HIV/AIDS area and the Bush Administration’s pledge of $15 billion in aid over five years to combat the global HIV/AIDS pandemic especially have pushed him in that direction.

While there are about 1 million people in North America living with HIV/AIDS, there are another 38.4 million people outside of North America with the disease that need to be treated. Fauci now finds himself traveling to Africa and other places in the world more often than he used to in the past. Even the international aspect of the influenza vaccine contracts that the NIH creates “has become a substantial part of what we do.” As has become readily apparent, infectious diseases don’t recognize international borders.

The future
So does Anthony Fauci believe that there will be an unforeseen life science problem or crisis within the next five to 10 years? “Unquestionably, yes, absolutely! We’ve had the AIDS situation now for 23 years and it’s only marginally stable in the U.S. and mostly out of control everywhere else,” he says. “We got lucky with SARS in that it was able to be identified and controlled relatively quickly and was medically manageable. We may not be so lucky with the next pandemic influenza.”

“ In this business, we’ve learned that we should never feel that we have enough safeguards, and that we cannot ever rest on our laurels,” he says. With a person of Fauci’s stature at the helm, we can be assured that we’ll always have as many safeguards against infectious diseases as are humanly possible, and that Fauci will always be pushing the system and himself for more.

— Tim Studt

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