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When the urgent phone call came last month, respected HIV researcher Deborah Birx was meeting with African officials and activists from around the world at a Johannesburg conference to help determine how U.S. AIDS relief funding would be doled out.
It was the White House calling.
Birx was on the next flight out, headed home to Washington to become coordinator of the Trump administration’s new corornavirus task force.
Ever since, the tough-minded, data-driven scientist has become one of the administration's key messengers assuring anxious Americans, and one of the daily public faces on television — often framed by colorful scarves — standing behind Trump and speaking at the lectern.
She and her mentor, Dr. Anthony Fauci, head of infectious disease at the National Institutes of Health, have become crucial voices of science and caution, at times contrasting sharply with Trump and other administration officials eager to downplay the risks.
Supporters say she has brought a cool head and credibility to news briefings often muddled with misinformation and contradictions from the politicians.
"It is probably really tough," said Jen Kates, senior vice president and director of global health and HIV for the Kaiser Family Foundation. "You're dealing with an emergency like we have never faced — and having to navigate the politics."
An immunologist, world-renowned global health expert and U.S. Army colonel, Birx is a rare holdover from the Obama administration. Birx also serves as the State Department’s ambassador-at-large for global health and heads the world’s single largest AIDS program, the $85-billion President's Emergency Plan for AIDS Relief, or PEPFAR, created in 2003 by President George W. Bush.
Those who know her said she managed to establish and maintain good relations with Vice President Mike Pence, who said she was his first call when Trump asked him to lead the government's coronavirus response. He has called her his "right arm."
Along with most others who have appeared at the White House lectern with Trump, Birx has heaped praise on the president and rarely contradicted him in public, even when some of his statements seem at odds with hers. That has led to some backlash on social media among those who say she's undermining her own message and risking her reputation.
Birx's aides said she was not available to comment for this article.
Her supporters say that she is a seasoned political operative with the diplomatic skills to handle Trump while also bringing serious technical and medical expertise to a crisis that is unprecedented.
“She is very focused on the mission, driven to get the job done, whatever it takes," Kates said. "And it’s a level of rigor that she demands from everyone around her."
But at times, finding that balance has been challenging. Last week, for example, Birx was one of the first U.S. officials to raise alarm flags that younger Americans were not taking the threat seriously, noting that growing evidence abroad suggested that young people were in fact becoming infected and suffering serious health problems.
This week, she seemed to undercut that warning by suddenly emphasizing that the mortality among young people is very low, a position seemingly more in line with the administration.
On Tuesday, she struggled to reconcile Trump's aim to reopen the country by Easter with the warnings of the scientific community that social distancing and similar prophylactic measures would need to stay in place longer to be effective.
"We have to be willing to adjust our plans as we see impact," she said on NBC.
Asked whether she thought Trump would heed advice from her and other medical experts if they believed a full lockdown were necessary to save lives, she also hedged.
"I am confident that the president has listened to and seen all of our data as it evolves," Birx said. "You can see that in the past few weeks he has been very focused on what the American people need, both economically and public-health-wise."
Birx is very skillful in managing people, both those who work for her and those above her, said Robert Hecht, founder and president of Pharos Global Health Advisors, a Boston-based nonprofit organization that advises on world health policies.
"My hope is she will find a way to navigate" alongside Trump, Hecht said. "You have to take the hand of cards you're dealt."
He and others said Birx wins high marks for her ability to work across political party lines and to deal easily with numerous groups, from adolescent girls exposed to HIV, to presidents and prime ministers of Africa, Asia and elsewhere.
"Her ability to see short-term reality and long-term needs is a defining characteristic of her leadership," said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, a New York-based group promoting HIV prevention.
Data is Birx's essence, as she intimates in her public appearances. She famously shows up at meetings with a bundle of slides under her arm, ready to show the latest PowerPoint with graphs and charts on disease, treatment and the social context of epidemics. Establishing the connection of disease to its environment — poverty, inequality, violence against women or girls, patriarchal discrimination — underlies much of her work, associates say.
Birx, 63, is married to a fellow doctor, has spoken of her two millennial-aged daughters and is also a grandmother. A local newspaper said she channels the “the government’s collective maternal instinct” in her briefing appearances. But those who know her see more military than motherly.
Birx started working on AIDS before much of the world knew what AIDS was. After working her way through medical school and specializing in immunodeficiency disease, she joined the Army to follow her husband and was stationed at Walter Reed National Military Medical Center. It was the early 1980s, and mysterious cases of young soldiers dying from an unknown infection began arriving on her ward.
"We tried to save these soldiers and we couldn’t," Birx said last fall on the "Strategerist," a podcast for the Bush presidential center. "We didn't know what the problem was and we didn’t know how to treat it. It was devastating."
Birx credited the Walter Reed experience for her discipline and leadership skills.
"You had to be able to lead troops," she said.
Birx went on to conduct research at the Centers for Disease Control and Prevention and NIH. From 2003-10, she was one of the forces behind a massive and controversial AIDS vaccine trial in Thailand. It involved thousands of people and millions of dollars. Numerous U.S. scientists opposed it, saying the trial was wasting money and had little chance for success. Birx, backed by Fauci, insisted it go ahead. Ultimately, the trial, while not stopping infection, reduced it substantially and is held up today as the most successful vaccine experimentation so far.
She showed she could lead a massive program "with courage," said Chris Collins, president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria. "The issue is, is she going to be given the authority to bring those strengths to this crisis?"
Birx has also attracted notice for her bright silk scarves, which stand out in contrast to the dark men's suits and military uniforms that usually surround her. She told the podcast that they became a habit in her constant travel, when her personal rule was to pack nothing more than a small carry-on bag. "I learned from men," she said. They have one suit but many ties; she said she packs a couple of dresses and all the scarves.
President Obama appointed her to head PEPFAR in 2014, and she has stayed on through the arrival of Trump, when she was faced with drastic cuts in her budget. In briefings with State Department reporters, she defended the cuts, saying with increased efficiency she could focus money in countries most in need, primarily Africa. Some members of Congress, however, as well as a report from the inspector general last year, called into question how the funds were being allocated.
If Birx is reluctant to directly criticize Trump in public, she didn't hesitate to sharply scold Sen. Rand Paul (R-Ky.), who disclosed recently that he tested positive for COVID-19. Paul criticized testing guidelines that say no test is needed for people without symptoms, adding that if he had followed them, he would have continued exposing people without his knowledge.
Birx shot back that Paul should have been following social-distancing guidelines in the first place, rather than going to the Capitol gym and sitting next to other senators at lunch.
"If he had been following these guidelines, he wouldn't have been infecting others," she said this week, noting she had skipped briefings over the weekend after registering a mild fever. (She said she tested negative for the virus.)
"Each person has to be responsible," Birx said. "All of us have made sacrifices.... [People] have really made those personal sacrifices. What we're asking every American to do is to make those personal sacrifices for these next weeks."