I think @SamAdlerBell in his quest to be the contrarian on …

First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/

I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/

I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/

Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/

I wrote to them privately and spoke publicly about the need to do more, but Sam misunderstands how long-time civil servants operate. The entire CDC staff could have resigned in protest, other agencies could have had everyone fall on their swords in protest as well. 6/

This isn't to excuse their behavior. It's just to say expecting people who have devoted their careers to places like CDC or NIH to resign in protest, speak out and get fired, is unrealistic. 7/

Lots can be said about the institutional failures--outside of Trump's influence--that happened last year. The testing debacle, the failure to real screen for new compounds against SARSCOV2 instead of just putting everything in the vaccine basket...8/

We were slow on masks. Yes. I agree. But there were also shortages of supplies even for healthcare settings in March. Remember the bandanas and panty-shields being worn by some on the wards, recycling N-95s? There was some worry about run on PPE by general public. 9/

Not an excuse, but context. The statement on herd immunity that Tony made. Dumb. Yeah. I get it. 10/

And Trump's obsession with loyalty twisted some of them to the breaking point. Redfield collapsed almost reflexively at the beginning. Birx thought she could control the situation. Tony though he could thread the needle, keep silent mostly, try to squeeze in some facts. 11/

No one came out of last year looking good and even if Fauci got accolades from some, those in public health saw what was happening. Shit was flying everywhere, everyone got soiled. 12/

But the biggest problem about @SamAdlerBell piece is not that it's slightly obsessive on Fauci (and I won't even start on the ACT UP sections, since I was there for many of these events), but gets the politics wrong in a big way. How so? 13/

At the end of the article Sam suggests that Tony should have resigned to lead the resistance. I mean, please. And then a bureaucrat arose to lead us. Really? The director of NIAID was going to be at the barricades? 14/

The big political question was NOT where was Dr. Fauci last year, but where were WE? Why didn't those not in government service rise up when the stakes were so much lower for resistance for us? Why didn't all the major non-governmental institutions mobilize on the pandemic? 15/

Many of us in public health were writing furiously about the failures of what was happening, as were others, but no one was doing the mobilization work to tip the scales from op-eds to direct action. 16/

Yes, those in government service do have to answer for their silence last year, but so do we. I am not holding up Fauci as a hero, but flipping him into the anti-hero of the story doesn't work either. 17/

I just posted a report from Brazil, about how Bolsanaro's policies drove the pandemic in Brazil. A fish rots from the head down. Trump and his circle hold the vast majority of blame for 2020 and our predicament today. It's just true. 18/

Bolsanaro's health ministers resigned and he just got other ones. This was also Trump's MO for 4 years, anyone who left, got replaced with people increasingly more loyal. The late arrival of Scott Atlas is a case in point here. 19/

So as a political history this piece fails. That's my main point. I've said terrible things about Fauci in the past in the press during the height of the AIDS epidemic, trashed Obama on global health/HIV in the 2000s. "Heroes" shouldn't be immune from criticism. 20/

Would it have been great if one by one federal scientists got to the mic and denounced Trump in 2020? Yeah, sure. And I want to be 35 again. Not gonna happen. 21/

The most startling thing to me and which no one has written about yet is why the rest of us were frozen like deer-in-the-headlights? 400,000 dead and "the resistance" to it all from outside the Administration was mostly in strongly worded op-eds. 22/

The press played the both sides game early on--kept saying "experts disagree" when Trump's policies were patently insane. This is the @NYTimes political desk's lingering shame, which they will never admit. 23/

Members of Congress sat on their hands. Mayors, governors just tried to keep their own cities and states from going under, but many aided and abetted the President. 24/

But political advocacy organizations, non-governmental actors could have mobilized. We did for the Women's March, after the Parkland shootings, for the March for Science. Yeah. big in-person events were a no-no, still are, but big not-in-person-events didn't happen either. 25/

In the aftermath of all of this, this is what's worry. Tony will retire soon. Take him off the playing field. Now what? We have to rebuild public health, not because of its failures last year, but because it was in shambles before 2020. 26/

We made our beds long before Trump. No national healthcare, a weak social safety net, a desperately under-funded and under-resourced public health infrastructure coast to coast under Republicans and Democrats. 27/

If Tony had spoken out all these structural issues would remain and frankly, it's the structures that outlast us, pave the way for crises out years into the future. 28/

And what are we going to do about that? end/

I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/

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