Via Financial Times

The image on the slide deck was stark — a chart in the form of a towering blue mountain that showed the US facing a potential 2.2m deaths from coronavirus, were certain measures not taken. But the voice delivering the message was calm, almost soothing.

“I know it’s a lot to ask because you’ve done it for 15 days,” Deborah Birx said, as she asked Americans to stay at home. “There’s no magic bullet. There’s no magic vaccine or therapy. It’s just behaviours.”

The co-ordinator of the White House’s coronavirus task force, Dr Birx, an immunologist and army colonel, has become a near-daily presence on US television these past few weeks.

She has appeared alongside Donald Trump, US president, in his daily briefings, standing poker-faced as he attacks his usual targets, ranging from certain US governors to the media.

As the crisis intensified, she has become a household name, along with Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, who has worked with Dr Birx since he was her mentor in the 1980s.

Yet the two have very different public profiles. Dr Fauci has been cheered by commentators on the left for his gentle corrections of the president’s public statements. This has made him an object of suspicion in some corners of the conspiracy-minded right. Dr Birx, on the other hand, has been criticised by the left for her public praise of the president.

It is an illustration of how views on coronavirus, like much else in America, have become divided along partisan lines. But it also points to the contrasting roles Dr Fauci and Dr Birx play in this crisis. 

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Dr Birx is a political appointee of Barack Obama who has held on to her role through the transition and now serves at the pleasure of Mr Trump. Dr Fauci, by contrast, is a civil servant.

“Debbi is the human side,” says Jose Esparza, a Venezuelan-American epidemiologist focusing on HIV-Aids who worked at the World Health Organization and knows Dr Birx. “She is compassionate. She connects with people. Tony is used to scientists. Debbi is on the ground.”

Paul Zeitz, an epidemiologist who worked with Dr Birx at the state department, says she was skilled at navigating competing partisan groups, inter-agency bureaucracy, red tape-laden procurement systems, and the other hazards that come with being one of the nation’s highest-ranking medical professionals.

“She knows how to walk that tightrope,” says Dr Zeitz. “Having her have a seat at the table and having her influence what is happening is much better than the counterfactual of having her not be there.”

A prim figure known for her trademark silk scarves, Dr Birx, who turned 64 on Saturday, studied chemistry at university and then went to medical school. She followed her then-husband into the military, joining the army, where she rose to the rank of colonel.

After a notable career as a leading HIV researcher, in 2014 she was appointed by Mr Obama to head the $85bn President’s Emergency Plan for Aids Relief, or Pepfar, one of the top public health jobs in the country. Colleagues said she got the job because of strong bipartisan relationships on Capitol Hill, as well as powerful allies, including past presidents.

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Under the new administration, she established a relationship with vice-president Mike Pence who asked her to lead the coronavirus task force in late February.

While allies cheered her appointment, some have expressed concern about her praise of the president. She was criticised for claiming at a briefing last month that there was no “evidence” yet of a shortage of ventilators, despite media reports to the contrary, and for not correcting some of the false statements made by the president about the crisis.

In an interview with the Christian Broadcasting Network she praised Mr Trump as being “so attentive to the scientific literature and the details and the data. I think his ability to analyse and integrate data that comes out of his long history in business has really been a real benefit,” she added.

In late March, when Mr Trump announced that he wanted the country to reopen for business by Easter, Dr Birx did not disagree with him, instead telling NBC that Mr Trump was “very focused on what the American people need, both economically and public-health-wise”.

By contrast, the 79-year-old Mr Fauci has been more blunt in his disagreements with the president, noting to Science Magazine that he could not “jump in front of the microphone and push [Trump] down” when the president made a false statement.

Dr Zeitz noted that Dr Birx and Dr Fauci had very different relationships with the president. “She’s not leaving the building. Tony is going back and forth to NIH and doing vaccine research. She’s there 24-7.”

“Clearly she was trying to ingratiate herself with the leadership. Everyone knows that’s what you have to do with this president.”

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This strategy, he noted, appears to have paid off — at least for now. Last week, Dr Birx and Dr Fauci presented Mr Trump with their projection models in the Oval Office, which showed a clear acceleration of Covid-19 infections and projected fatalities were social distancing guidelines to be lifted prematurely. 

“He looked at [the models], he understood them, and he shook his head and said, ‘I guess we go to do it,’” Dr Fauci told CNN.

It is too early to know whether Dr Birx will be remembered for these interventions or for her praise of the president — a concern among those in the medical world who admire her work.

“Her reputation will undoubtedly take hits,” said Mitchell Warren, executive director of Avac, the aids prevention group, who has known Dr Birx for almost 20 years.

Yet for Dr Birx that was probably a risk worth taking, he added. “I do actually believe at the end of the day that Dr Birx and Dr Fauci are willing to sacrifice their reputation if they do believe that public health will be protected and win out. ”