NIH Director Francis Collins on Tony Fauci, the WHO, and running a $39 billion research agency from home
ASHINGTON — Francis Collins hasn’t set foot on the National Institutes of Health’s campus in Bethesda, Md., for the last month.
But the NIH director says he’s working harder than he has in his nearly five decades in science — never rising later than 5 a.m. and rarely stopping work before 10 p.m. to make sure the $39 billion biomedical research agency continues to function during the coronavirus pandemic.
Collins’ agency has already assumed a central role in the federal government’s coronavirus response. Tony Fauci, who leads the NIH’s infectious disease research institute, has become a household name across America. President Trump visited the NIH for the first time during his presidency last month. And last week, the NIH announced a public-private partnership with 16 pharmaceutical companies called Accelerating Covid-19 Therapeutic Interventions and Vaccines, or ACTIV, meant to speed the development of therapeutics and vaccines to treat and prevent the coronavirus.
STAT spoke with Collins by phone last week to discuss that public-private partnership, as well as Trump’s recent tweet suggesting he might consider firing Fauci, the president’s controversial decision to defund the World Health Organization, and, of course, what the future holds for the de facto NIH house band in which Collins serves as frontman, known as “The Affordable Rock and Roll Act.”
The following conversation has been lightly edited for length and clarity.
STAT: Tony Fauci has always had a flair for elaborate slide presentations, talking to reporters, and testifying before Congress. Now he’s also a household name. What do you make of the referee-like role he’s had in determinations about continued social distancing and President Trump’s enthusiastic touting of certain untested treatments for Covid-19?
Collins: Tony is a complete model of what you want to see in a public servant. He is dedicated, he’s incredibly smart and knowledgeable. He is both a fantastic scientist and a very experienced physician who personally took care of Ebola patients when we had them in our hospital just four or five years ago.
And he is incapable of actually doing anything except speaking truth. He has a lot of truth to offer, and he speaks it in a careful, diplomatic way. He’s also not somebody who will slip into demonizing anybody, or throwing mud back at people who are throwing mud at him, he’s just gonna be what you want to have in the room when an important decision is being made, who can tell you: Here are the facts, here are the consequences if you do A or you do B.
I consider it a great privilege indeed to have him as a friend, as a colleague, as a remarkable leader of infectious disease at NIH, probably the most highly respected infectious disease researcher in the world.
There are only two people in the federal government who technically have the authority to fire Dr. Fauci as director of the National Institute of Allergy and Infectious Diseases. Last week, when the president retweeted a post that included the “Fire Fauci” hashtag, were you worried you’d have an impossible decision on your hands?
I didn’t actually think that was likely to happen, so no I don’t think I was worried. And certainly nobody reached out to me at that point.
I figured as much, and I don’t take you for someone who spends much of his day scrolling Twitter.
No, you’re quite right about that. Tony and I have a phone conversation every evening, sometime between 8 and 10 p.m., just to be sure that we’re completely in lockstep about all the things we’re trying to do with research. I don’t think we ever talked about that tweet.
What can you say about the state of NIH more broadly, especially research taking place on the Bethesda campus? How many investigators have had their work disrupted?
I can certainly say it’s had a huge effect. We did insist that people shift into telework, unless they were in special categories where coming to campus was still justified. One of those are the patient care providers, because we do run a hospital called the Clinical Center, where every patient is on a clinical trial. We stopped doing all elective admissions and all outpatient elective visits, but that still means there’s plenty to do there, and so all of those staff are coming.
All the people taking care of animals are coming to take care of the animals, and then people working directly on Covid-19 research are coming, like our Vaccine Research Center, which we are counting on to be a major component of how we ultimately see ourselves out of this difficult situation.
There are about 50 investigators, though, who weren’t working on coronavirus or Covid-19, who came up with a research project that they thought would potentially be contributory. They had to propose that to an oversight group, to be sure that it was justified then to have them come back to campus, and for most of them, it made a lot of sense, so those folks are also at work. That means most of the scientific workforce is not there. They’re like me, they’re hanging out.
In these days, where a lot of biomedical research is also computational, there are things that people have been able to do quite well while at home. In my own research lab, I would say a couple I have a couple people in the lab who are really frustrated because they primarily work at the bench. But the rest of my lab is like, ‘OK, finally I get a chance to write that paper that I have been putting off,” or “Oh, this is that data analysis thing that I really needed to get focused on, and not get distracted, and now I can do it.” So research is going on, but certainly not going on the way you’d want it to be.
NIH has a number of existing partnerships with the World Health Organization. What does President Trump’s pledge to halt U.S. funding for the WHO mean for NIH and for existing research and public health partnerships between WHO and the federal government?
We have had research partnerships with WHO going back many years. I couldn’t tell you at the moment exactly the nature of those collaborations, but obviously, as the organization is supposed to be watching over public health for the whole world, it would be odd if we didn’t work with them on shared areas of interest.
When you go back and look at what happened with Ebola, you will certainly see NIH and WHO working side by side to try and tackle what was a devastating situation in West Africa. So yeah, we work with them, absolutely.
Is that a concern? Do you hope that the NIH has the continued freedom to fund and partner with WHO on research and public health projects?
We are certainly deeply invested in the support of global health because diseases don’t really pay much attention to country boundaries. An awful lot of the things that we need to worry about in our own country are also affecting other parts of the world. Given the WHO is a major player in that global health arena, we’d hope to be able to continue to work with them in some productive way.
The country seems to have done a fairly good job buying into social distancing measures to slow the spread of coronavirus, but some people — Trump, in particular — have argued that there’s a real health cost to keeping people cooped up inside for this long. What’s your view?
I think we do have to take that seriously. In fact, we set up a series of 10 significant trans-NIH research initiatives, bringing together all of the best and brightest leaders that we have around us — virtually, of course — to try to address things that we would all want to know about the consequences of this as well as ways that we can help end it.
Obviously that includes things like vaccines and therapeutics, but one of those initiatives is very much about the mental health consequences of what this has done, socially, by asking people to stay at home for long periods of time, losing those face-to-face personal connections.
It is interesting that if you look back over history, when we have had other times of major national stress, it looks as if, for the most part, actually, illnesses, and even mortality, seems to actually not be as bad during those situations. But that’s not true of specific areas, and particularly with suicide, one worries about the people who already are struggling with depression, and then are put in a circumstance of being isolated from others. That’s exactly the wrong thing.
So that’s one more reason why we need to figure out in a safe way, and an evidence-based way how we can get ourselves back out there again, because people are suffering with this.
A lot of lawmakers and advocacy groups have pushed for affordability guarantees for any new vaccines or therapeutics that come to market, since much of the research is taxpayer funded and the drugs will largely be purchased using public funds as well. Has NIH considered using the “reasonable pricing” language within Bayh-Dole to exact any guarantees on price?
I’m sure there will be some interest in that, based on past history, and that’s an area where NIH involvement doesn’t generally seem to help very much. So we will count on others to raise that if it needs to be raised.
Beyond the serious stuff, can you tell us what your life has been like this past month? How are you doing, on a personal level?
I have a rather modest, small home office, and that’s where I’m anchored and have been now for four weeks. I have not been on the NIH campus, I’m doing my thing for social distancing. If you saw my desk, you would go, “You need somebody to help you file stuff,” because it’s building up in a lot of piles.
I don’t think I can remember ever working more hours than I have the last four weeks, and I’m usually a pretty hard worker as it is. I can’t quite keep straight whether I’m in a weekday or a weekend, because they all seem to be about the same. And I’m up sometimes at 4 a.m., never later than 5, and I’m rarely turning in until 10 or 11 p.m. Gosh, I realized this week I hadn’t even gone outside for four days in a row, just because there wasn’t enough time to take a walk or a bike ride or anything.
It’s the life we’re leading. I’m fortunate to have a wonderfully supportive wife who understands why this all has to be this way. And it’s just her and me in this house, and she sneaks out to get groceries from time to time.
OK, a lighter note: What’s the latest with your band, the Affordable Rock and Roll Act?
[Sighs] The band, like everything else, is hibernating. All of the gigs that we have lined up got canceled — there weren’t that many, mind you. So there are occasional wistful emails sent by band members saying, ‘Oh, maybe we could try to get together and rehearse six feet apart.’ But nobody has a basement that’s big enough. So we’re completely on hiatus, which is very sad.
What do you want people to know about this pandemic, in general? What do you think is being missed?
I hope people who are finding this to be a particularly stressful circumstance, do see that public servants, like Dr. Fauci and also the millions of other people who work in this country on biomedical research, are rising to the occasion, trying to bring all the tools that they can to come up with answers.
It’s a tough problem. I think we’ve never had, in the lifetime of those of us who are around right now, an epidemic that came this fast and was this infectious and spread across the globe this quickly. That is certainly stressing all of the research capabilities that we need to bring to it. I’m hopeful that this new partnership, called ACTIV is the best chance we’ve got against this virus, to bring it to its knees in a shorter period of time than would otherwise happen. I hope people do understand that that means a lot of sacrifices being made, a lot of components of this biomedical research ecosystem that have decided to work together without worrying too much about who gets the credit or who makes the money.
Basically, it’s the right thing to do. And I think that’s a good thing for people to see. This is a noble enterprise populated by people who work — whether they’re at NIH, or whether they’re in a company somewhere — trying to find answers for disease, because that’s what they want to do, that’s what they believe in. I hope people see that.
In the current climate where everything is polarized, people are quickly able to get a bit cynical, to maybe not notice just what a dedicated team of experts exist in these various places. And now we’re all a team together, and we aim to do what we can to try to save lives as fast as we can.