On Call: A Doctor's Journey in Public Service

At the beginning of the Obama administration in 2009, Fauci hoped to resume his typical responsibilities at the NIH, focusing on HIV research, patient care, and overseeing NIAID’s extensive immunology and infectious disease programs. However, an unexpected outbreak of H1N1 influenza (also called the swine flu), originating near the US-Mexico border, demanded he shift his attention. As cases spread globally, Fauci and other health officials began strategizing a vaccine response. Facing the challenge of creating and distributing a vaccine within months, Fauci anticipated complications in the production timeline and worried about the readiness of the necessary doses by flu season. By mid-2009, public and congressional pressure mounted as US pharmaceutical companies, supported by federal contracts, worked to deliver millions of doses.

By June 2009, Fauci was summoned to the White House amid concerns about the impending H1N1 pandemic, reminiscent of the 1976 swine flu crisis that had led to flawed mass vaccinations. Officials in charge aimed to avoid past mistakes by focusing on timely vaccine availability. Fauci’s initial skepticism about the aggressive vaccine production timeline soon proved correct, as pharmaceutical companies faced delays due to virus growth issues and international shortages, while early H1N1 outbreaks in schools heightened demand. By October, only a fraction of promised doses had arrived, which led to public frustration and political criticism.