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Guest Essay
Anthony Fauci: A Mosquito in My Backyard Made Me the Sickest I’ve Ever Been
Dr. Fauci is the former director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
After I spent more than 50 years chasing and fighting viruses, one fought back and nearly took me down. I speak of the West Nile virus, delivered by the deadliest animal on the planet — the mosquito.
I didn’t get infected during any of my international trips over the years, but most likely while I was outside my home in Washington, D.C. In mid-August I was feeling weak and exhausted, but attributed it to a recent bout with Covid-19. Though I had tested positive for Covid over a month prior, I had experienced a rebound of symptoms after taking the treatment Paxlovid. Perhaps I was still experiencing lingering symptoms that would eventually resolve.
Not so. Instead, I began to experience unexplained, severe fatigue and exhaustion culminating in my admission to a hospital on Aug. 16, delirious and incoherent with a temperature of 103 degrees. I remember little of the five and a half days that I spent in the hospital except that I had never felt so ill in my life. My physicians assumed that I had sepsis and treated me with antibiotics. After several days, my fever subsided, and I was discharged on antibiotics without a clear diagnosis. That changed the next day when blood tests revealed that I had West Nile virus.
There is no treatment for West Nile virus disease, and I was left to deal with its toll on my body. It was terrifying. I could not swing my legs over the side of the bed to sit up without help from my wife and three daughters. I could not stand up without assistance and certainly could not walk. A very scary part of the ordeal was the effect on my cognition. I was disoriented, unable to remember certain words, asking questions of my family that I should have known the answers to. I was afraid that I would never recover and return to normal.
Fortunately, over a period of a few weeks slow improvement began. I was able to walk with a walker and then without any assistance. Now I can walk a few miles per day with only minimal fatigue, and my cognitive issues have completely resolved. I am on my way to a total recovery, but it has been a harrowing experience.
I tell my story because West Nile virus is a disease that, for many people, can have devastating and permanent consequences. At my age of 83, I was at risk of permanent neurological impairment and even death. Yet the public may be unaware of the danger of this disease and that it continues to spread across the United States; it has been identified in 46 states this year. Unfortunately, very little is being done about it from scientific and public awareness perspectives.
West Nile virus belongs to the family of flaviviruses that also includes yellow fever and dengue viruses. It was first detected in the United States in the New York City area in 1999, most likely introduced from the Middle East or parts of Africa where it is prevalent. Mosquitoes get the virus from infected birds, and then pass the virus on to humans by a bite. West Nile virus infection is by far the most common mosquito-borne disease in the United States: Since 1999, about 60,000 cases have been reported. The actual number of infections is surely higher, no doubt in the millions, since many cases are not reported because infections are often asymptomatic or are confused with other common maladies such as flu. Among the reported cases in the United States, more than 30,000 have had neurological symptoms like mine, resulting in about 23,000 hospitalizations and close to 3,000 deaths.
As climate change makes it easier for mosquitoes to proliferate in many places, West Nile virus disease as well as other mosquito-borne illnesses are emerging as greater threats in this country and elsewhere. Yet, efforts to develop a vaccine or treatment for this illness are modest compared with those for other diseases of public health importance.
I understand the challenges for research, having been director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health from 1984 through 2022. When West Nile virus was first identified in the United States, we began efforts to develop a vaccine. However, we never could move the vaccine trials beyond early testing, in part because the number of cases varied greatly from year to year. For example, about 700 cases were reported in 2011 and more than 5,600 cases were reported a year later in 2012. Such fluctuations make it almost impossible to have a consistent-enough number of cases to show that a vaccine was effective at preventing infection. The same frustration applies to the development of antiviral drugs. Because the patient numbers are so inconsistent, pharmaceutical companies lack the financial incentive to make major investments in drug and vaccine development for West Nile.
So, how do we address this emerging public health threat? Vaccine development must go forward; however, to be successful, clinical trials must be international and include countries with a consistent and large number of cases each year. The pathway to a vaccine cannot be in the United States alone. Global public-private partnerships between the N.I.H. and the drug industry have historically proved successful in the development of a number of important vaccines such as those against hepatitis B and Covid. There is no reason this shouldn’t also be the case for a West Nile virus vaccine.
The same holds true for the development of antiviral drugs. There is no insurmountable scientific obstacle to developing safe and effective antiviral drugs for West Nile virus infection. The pharmaceutical industry in collaboration with the N.I.H. and other partners had remarkable success in developing effective drugs for other emerging viral infections. Examples include lifesaving drugs for H.I.V. infection, therapies for hepatitis C infection and useful drugs for Covid-19 and influenza. With international research partnerships and political will spurred by an engaged activist community such as we have seen with H.I.V. and now long Covid, West Nile virus treatments and prevention tools should be within our grasp.
When I returned from the hospital and lay in bed, disoriented and unable to sit up, there was little to offer me except the much-appreciated support and love of my family. Was I going to be one of the lucky ones who recovered completely, or would I be permanently impaired? There are many people who have not been as lucky as I have been in my recovery. Considerably more resources must be put into addressing this threat now, not when the threat becomes an even greater crisis. As a society, we cannot accept this as the status quo.
Anthony Fauci is a professor at Georgetown University School of Medicine and the university’s McCourt School of Public Policy.
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