What’s next for Anthony Fauci, if the White House continues to sour on him?

WASHINGTON — The White House in recent days has accelerated an effort that President Trump began months ago: openly discrediting the guidance of Anthony Fauci, the country’s top infectious diseases researcher.

Trump accused Fauci of making “a lot of mistakes” since the onset of the Covid-19 pandemic in a recent interview, justifying his continued disagreements with the veteran scientist on issues as routine as the number of new coronavirus cases. He also said he disagreed with Fauci’s assessment that the U.S. was handling the crisis poorly compared to other nations — which, given the 60,000-plus Americans being diagnosed with the disease each day, is a simple reality. On Sunday, the Washington Post reported the White House had begun circulating a list of Fauci’s early predictions and guidance surrounding the Covid-19 pandemic that many, in hindsight, have labeled as overly optimistic, though several lacked context.

The latest broadsides have reignited fears that Trump could take far more drastic action to limit Fauci’s public health power and platform — or even remove him from his post, the way Trump has unceremoniously axed so many other federal officials.

Fauci’s future role in the U.S. government’s pandemic response will follow one of three paths. Though Trump can’t easily fire him, administration officials could remove him from his post leading the National Institute of Allergy and Infectious Diseases and reassign him elsewhere in government. Trump could also attempt to formally bar Fauci from conducting public briefings or interviews, effectively silencing one of the administration’s most recognizable public health experts.

Or Trump could continue to quietly diminish Fauci’s role and subtly limit his public platform — as he has for months.

Fauci’s role in public outreach has visibly diminished since spring, when he would regularly accompany Trump to daily White House coronavirus task force press briefings. His public role has since been reduced to sporadic appearances on podcasts, at scientific gatherings, or in print news stories. Fauci said recently he hasn’t briefed the president since June.

Even at the since-discontinued briefings, Trump would challenge Fauci, once admitting “we disagree a little bit” on lack of evidence surrounding hydroxychloroquine, the malaria drug, in preventing Covid-19, allowing that his view was “just a feeling.”

For now, however, the White House has insisted that Fauci remains in good standing and is not in jeopardy of losing his job. Trump even boasted of his “very good relationship” with Fauci on Monday.

Outside experts, however, feel that as long as Fauci continues to speak the truth on the realities of the pandemic, he’ll keep making enemies within the administration.

“If they do punish Fauci for telling the truth, then where are we?” said Elias Zerhouni, the former NIH director who famously testified to Congress that former president George W. Bush’s ban on scientific use of embryonic stem cells was stifling research. “You can ignore it, you can say I don’t take [your advice] into account, I changed my mind, I’m the policymaker. But don’t say you’re going to punish the messenger.”

Below, STAT walks through the possible futures for Fauci — and why some are likelier than others.

1. Trump moves to dismiss Fauci

The most dramatic — and least likely — move: Trump could try to fire Fauci.

But federal law prevents the president from firing most government employees without cause.

“Tony Fauci is not a presidential appointee,” Zerhouni said. “He’s a civil [servant] for 35, 40 years. So you can’t really fire him from the government — that’s not in the powers of the president.”

But if push came to shove, Trump could almost certainly order Fauci’s superiors — health secretary Alex Azar or NIH chief Francis Collins — to reassign him to a different role within the Department of Health and Human Services.

There’s precedent for such a move even during the Covid-19 pandemic. In late April, the Trump administration abruptly made a leadership change at BARDA, an agency explicitly tasked with keeping the nation prepared for a pandemic or bioterrorism.

The agency’s ousted leader, Rick Bright, was reassigned to a post at NIH focused on developing diagnostic tests. He soon claimed in a whistleblower lawsuit that his reassignment was retribution for his opposition to the president’s enthusiasm for hydroxychloroquine.

Zerhouni stressed that he does not believe Trump would move to reassign Fauci. But if he did, he said, it would put Azar and Collins in a difficult position.

It would be “like the Saturday Night Massacre, to be honest with you,” Zerhouni said, referencing the infamous 1973 night when former president Richard Nixon ordered his attorney general to fire a special prosecutor investigating the White House, only for the attorney general and his deputy to resign in protest instead of carrying out his order.

“If they do that, a lot of other people would resign,” he said.

2. Trump sidelines and bars Fauci from speaking

A slightly less severe, though no less noticeable, step: Trump could cut off Fauci from making any media appearances whatsoever.

Already in March, White House officials started requiring federal health experts to get their approval for any public speaking engagement. And Fauci’s seen his time limited as the pandemic has dragged on, especially after the administration’s Covid-19 task force stopped conducting daily briefings.

It’s not an out-of-the-ordinary arrangement; NIH leadership had to clear its media appearances with the White House in Zerhouni’s time too, the former NIH director said.

“You have to go by the rules of communication in the government,” he said. “It’s very typical.”

But Trump has, at least in one case, taken things much farther. In late February, Nancy Messonnier, a high-ranking Centers for Disease Control and Prevention official, delivered a stark warning in a press briefing: The agency expected the coronavirus would soon begin spreading through American communities, and the disruptions to daily life could be “severe.”

The remarks now seem prescient, even unreasonably calm. But when they were published, stock markets nosedived, and Trump was enraged, and reportedly advocated for firing Messonnier. The end result has been functionally similar, at least in terms of Messonnier’s public-facing role: She has not briefed reporters, or spoken publicly in any way, since.

That’s far more concerning, Zerhouni said.

“The fact that they don’t let you for a long time — that is something else. I never had that,” he said. “I always cleared it with the White House and HHS and it was usually OK, and I don’t recall an instance where I was censored to not talk.”

Even if the White House did bar Fauci from any future media appearances, he could still continue in arguably his most important function: helping to oversee the development of coronavirus vaccines and therapeutics. Messonnier, in fact, has presumably done much the same at CDC, returning to run an agency office focused on vaccines and respiratory diseases.

Attempting to silence Fauci from his role as a public health messenger, however, seems both difficult and unlikely: He is well-liked and trusted among Americans, effectively a household name.

3. Fauci stays in the background

Fauci, who has served six presidents and led the NIAID since 1984, isn’t necessarily the natural face of public health. His main job at NIAID is to oversee nearly $6 billion in grants and in-house research conducted into vaccines and medicines.

Fauci’s role, technically, is that of a researcher — not that of a public health adviser. It’s only after decades playing a leading role advising presidents like Ronald Reagan during the HIV epidemic and Barack Obama during the Ebola outbreak in Western Africa that the public has come to view him as a key part of any president’s public health apparatus — a role that could easily be filled by CDC or others within the federal health department.

But because Fauci’s role as a public spokesman is not a formal part of his job, it’s also easy for Trump and other federal officials to limit how much of that work falls to him.

Experts view this as the most likely scenario, in large part because it is the one that is currently happening. And despite the low-grade attacks, former NIH director Harold Varmus argued it’s a tolerable status quo — as long as decisions about what research the agency funds and conducts doesn’t become more politicized, too.

“So far, [criticism of Fauci] has not affected the way NIH conducts and supports scientific research, he said. “On the other hand, certainly, the government should have a representative who speaks the truth about what’s going on and no one is as well equipped as Tony Fauci to do that.”