By Rick Valachovic, DMD, MPH, Clinical Professor and Executive Director of the NYU Dentistry Center for Oral Health Policy and Management

It is a suspenseful time for anyone concerned about public health. In a matter of days or weeks, new leaders will arrive in Washington and Atlanta to lead the nation’s three-letter health agencies. Within the FDA, CDC, CMS, and NIH, people are bracing for change, while nongovernmental stakeholders publicly speculate about how the likely new secretary of health and human services — an attorney known for his unorthodox views on public health — might reshape the research and regulatory environment over the next four years.

Those seeking inspiration or guidance on navigating a changing federal landscape might want to read Anthony Fauci’s 2024 memoir “On Call.” In addition to his widely reported observations on the federal government’s handling of the COVID-19 pandemic, the book describes the forces that shaped this exceptionally talented physician and researcher, including his earlier years in medicine, research, and public health.

Fauci began his professional journey at the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), which he was tapped to direct in 1984. Over the course of a multi-decade career, he responded to a series of public health challenges, including HIV/AIDS, bird flu, Ebola, Zika, and the post-9/11 anthrax scare. In the process, he became an adept influencer of U.S. health policy under seven U.S. presidents, starting with Ronald Reagan.

Both praised and vilified during his time in the spotlight, Fauci remained in public service until the age of eighty-two, concluding a professional journey that offers lessons in leadership we can use today. Here are a few from his early career that resonated with me and offer guidance as we prepare for whatever comes next.

Lesson 1: Build connections with individuals who have the influence to drive change.

Fauci made the fateful decision early in his career to focus his research on the care of patients with HIV/AIDS. At the time, the disease was poorly understood, highly stigmatized, and almost universally fatal. As gay men started dying of AIDS in large numbers, an activist movement arose to pressure the NIH to devote more resources to studying the disease.

The movement’s strident criticism of the government’s response drew widespread attention, elevating Fauci’s public profile and immersing him in controversy. He rose to the challenge, cultivating relationships with both vocal gay rights activists and the powerful government officials they criticized. He proved skilled at helping these adversaries appreciate each other’s perspectives and at communicating with political leaders in ways that would eventually spur action. “I addressed public policy only when it related to my scientific expertise, and I left politics to others, a practice I tried hard to adhere to for the rest of my career,” he wrote. “[I]t was crucial to be truthful and consistent in providing information based purely on scientific evidence and best judgment, and nothing else.” This approach won him the respect of George H.W. Bush and each of the presidents who followed.

In my own work, I have also found that successful advocacy requires what I call “RiP SAw” — shorthand for “the relentless pursuit of strategic alliances.” While I was at the American Dental Education Association (ADEA), we forged strong ties both inter- and intra-professionally; across education, practice, and research; with dental professionals on other continents; and with lawmakers in the executive branch and on Capitol Hill. These relationships were integral to our ability to achieve changes in dental licensure, the formation of the Interprofessional Education Collaborative, the sharing of evidence-based curricula throughout the globe, and policy advancements such as the inclusion of a children’s dental benefit in Medicaid and the Children’s Health Insurance Program.

One of our earliest successes dates to the period when Fauci was focused on increasing federal funding for HIV/AIDS research. ADEA partnered with others to secure the inclusion of dental and dental hygiene services in the Ryan White CARE Act, which reimburses providers for uncompensated care of people living with HIV and AIDS.

Lesson 2: Always be looking around the corner.

In the mid-1980s, people with HIV were dying at an alarming rate and trying all sorts of untested remedies on their own in hopes of suppressing the virus. Fauci responded by accelerating NIAID’s work to discover drugs that could be effective in treating HIV/AIDS. He established the Division of AIDS within NIAID and facilitated partnerships between academic institutions and pharmaceutical companies to spur drug development.

“Not everyone at the NIH or in research institutions throughout the country was excited about spending the money to create such a network, especially when we did not have any drugs yet to test in these units. Some scientists were even saying that we were ‘throwing money away,'” Fauci writes. Despite the criticism, he stayed the course, and the network soon proved its value.

This commitment to “looking around the corner,” as I like to say, is an essential leadership skill. The political and institutional pressures to prioritize immediate needs can be overwhelming. Leaders who can also cast their gaze outward, gauge future needs, and invest their resources for the long term are essential to achieving the kind of progress that yields significant impact down the line.

Lesson 3:  Health care is an art as well as a science.

Despite his strong interest in research, Fauci learned this lesson early on. “I was dealing with a human being who needed care, compassion, and comfort in addition to the correct description of her heart murmurs,” he writes of a woman he treated while a medical student. “Right from the get-go I felt the importance of this combination of the art and the science of medicine.”

This realization served Fauci well while caring for patients with HIV/AIDS at NIAID. A particularly poignant event occurred one evening as he made rounds. A favorite patient, with whom he chatted daily, was unable to recognize him. In the intervening hours, an opportunistic infection had rendered him blind. “It was as if someone had stuck a spike in my chest,” Fauci recalls.

I also retain vivid memories of some of my early experiences treating people with HIV/AIDS. They regularly came through our doors when I was dean for clinical affairs at the Harvard School of Dental Medicine in the late 1980s. At the time, few private practice dentists were willing to treat these patients, and dental schools stepped up to provide access to care. In Boston, we became known as a place that welcomed these patients.

One day I was called on to consult on the oral complications of a patient with AIDS at the Brigham and Women’s Hospital. The 25-year-old man was unable to eat or drink because of fungal infections in his mouth. He was in an isolation room, and when I entered — fully gloved and gowned with a mask and a face shield — he began to weep. My attire telegraphed the gravity of his health situation, which he had not disclosed to his parents. He told me they did not even know he was gay.

The encounter taught me a lesson in empathy and was instrumental in shaping my future interactions with patients with HIV/AIDS. I found ways to interject humor in patient encounters and, most importantly, looked for ways to give them hope.

Final Reflection: The enduring power of hope.

Providing hope is woven throughout “On Call.” It is easy to look around at everything that is wrong in the world and get discouraged, but the book reminds us that behind the scenes, people of goodwill are making progress every day. The pace of change may be incremental, but the small gains of clinicians, researchers, and others can accrue in ways that change the lives of millions, especially when changes occur at the policy level. Health scientists willing to serve as honest brokers and do the hard work of informing politicians and the public are urgently needed today. Dr. Fauci led through six decades of often dark and frightening times—we can and will step in as he steps back. Let us hope the qualities that Fauci exemplifies continue to have currency in the years ahead.