On the morning of President Trump’s inauguration, former NIAID Director Anthony Fauci received a blanket pardon from outgoing President Joe Biden, covering any crime he may have committed in the course of his official duties and extending back to 2014. That was the year that Fauci allocated grant funding to the creation of mutant lab engineered SARS-related coronaviruses in work done at the Wuhan Institute of Virology.
Anthony Fauci is best known as the public face of the COVID-19 pandemic response, exhorting, mocking, and denouncing Americans who challenged his policy prescriptions. Fauci enjoyed robust support from the mainstream media and politicians and used his power to silence his critics. He left his post at the end of 2022, but his biggest collaborator remains at the NIH: his wife, chief bioethicist Dr. Christine Grady.
Fauci notoriously claimed that attacks on him were ‘attacks on science’. If Fauci is “the science,” Grady is “the ethics.” She received several awards in 2021 and 2022 for her work during the pandemic, but little is understood by the public about what her job entails, its consequences, or her positions on various pandemic policies. A survey of her public statements, though, reveals an authoritarian streak in her philosophy that supported Fauci’s policies, raising questions about her suitability as America’s chief bioethicist.
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Grady has led the Bioethics Department of the NIH since 2012. Her own research focuses on ethics in clinical research design, particularly surrounding informed consent and clinical trial recruitment. She practiced as a nurse before receiving her PhD and also writes about ethical issues pertaining to that profession (a recent paper is titled “The Value of Nurse Bioethicists”). She is also a part of the Bioethics Consultation Service; a group of ethicists that help medical workers make decisions about patient care and runs a fellowship program for recent college graduates involved in ethical consultations whose alumni often go on to elite PhD programs or medical schools.
Grady’s official job description emphasizes that all her work functions “have an influence on ethical science and research, clinical practice, and health policy.” Arguably the principal vector of influence is her husband. Fauci and Grady have been married for four decades and frequently credit each other for inspiring their work in interviews, writings, and public speaking engagements.
During the COVID response, Grady influenced Fauci to push for extreme government overreach. As she explained in one co-interview with her husband: “We’ve had conversations about the sort of consequences of telling people to stay home and what it would do for the economy… And I remember having this conversation, I don’t know if you remember it? Where I said that one of the messages should be: how many lives are you willing to sacrifice? And so we’ve had that kind of conversation over dinner more than once, actually.” Fauci acknowledged that these conversations “sharpened [his] resolve to push forward” with lockdown policies.
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Open the Books systematically analyzed Christine Grady’s public statements and publications during the COVID-19 pandemic to understand her role in the national policy conversation from 2020-2022. Fundamentally, Grady prioritized “public health” over individual freedom. Wearing a mask whenever you go outside, social distancing, getting a vaccine—to her these were simple things to do for the good of the “community” rather than questions of individual autonomy.
In a November 2021 interview, Grady outlined her philosophy: “What’s striking to me is that the kinds of burdens that we’ve asked people to undertake, like putting on a mask, don’t really infringe on one’s freedoms very much. They’re low burden and they have an effect. They do protect the person who’s wearing the mask, as well as the people that are around them.”
Yet wearing a mask at all times is not a small thing. And people were being told to do more than that by November 2021. But this posture anchors all of Christine Grady’s pandemic policies, which became more authoritarian over time.
By April 2022 Grady published a co-edited book that advocated turning bioethics on its head through the adoption of a collectivist ‘solidarity model’. She wrote: “Bioethics tends to emphasize the ethical principle of respect for persons and the right of individuals to make decisions in accordance with their interests. We should recognize that there are times when solidarity takes precedence over individual liberties.”
During an April 2020 Q&A, Grady claimed: “Unfortunately, because of visiting policies and fear of contagion sometimes when somebody is really sick their family cannot visit them, they can’t see them, but people are being creative with devices and other things where they can talk to each other… but to the questioner’s point, the stress and the sadness and the isolation on families is and is going to be great.” Two years later, her position was changed. Her co-edited April 2022 book included an essay which stated: “the solidarity model may apply to restricted family visitation, which generated moral distress for nurses, particularly when patients died without loved ones present… Designing visitation policies using a solidarity lens means considering the well-being of patients, families, and health-care professionals, and community transmission risk.”
How did Grady’s philosophy impact the Clinical Center, the on-site medical facility where she gives “bioethics consultations,” during COVID-19? We filed a FOIA request in January 2023 and have yet to receive a response.
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Grady’s position on mandates changed radically from 2020 to 2022. At first, she dismissed the idea of an “immunity passport” as a form of discrimination; because of her role as a “nurse bioethicist,” she was particularly concerned about mandates in healthcare settings. Then in early 2021, she stated vaccination should be a free choice for healthcare workers. But by November she decided the choice should be between vaccination and their jobs.
Ironically, early in the pandemic, Grady released a paper on how to respond to patients’ advance directives (written statements describing the care they wish to receive if they can no longer communicate) during COVID-19. She wrote, “Respect for persons and in particular respecting patients’ wishes regarding their medical treatment remain paramount… Not inflicting patients with invasive treatments that they do not want must remain a high priority.” Evidently, this philosophy did not survive the release of the vaccines developed by her agency and pushed by her husband. The choice between a salary and bodily integrity, for many Americans facing financial difficulties, is no choice at all.
Grady was also a strong proponent of vaccinating children, which she claimed would protect their teachers and their families. One of her major research papers from this time described the ethics and urgency of testing COVID-19 vaccines on children; despite admitting that children were at extremely low risk of serious harm from the disease. In the paper, and also in subsequent interviews, Grady listed the mental health harms inflicted on children from school closures. COVID-19 itself, rather than policy choices, was blamed for these deleterious impacts.
Although Grady does not seem to have conducted research in resource allocation directly, she often discussed frameworks developed by bodies including the CDC’s advisory committee and the World Health Organization (WHO), and emphasized that these guidelines put patient-facing healthcare workers first in line for vaccines, and nursing home patients second. Grady also spoke approvingly of race-based allocation of vaccines and other resources to address what she saw as social “inequities.”
Grady is committed to the ideology of ‘antiracism’. She participated in a Bioethics “Anti-Racism Working Group” in 2020 that sought to “develop concrete anti-racist actions that the Department can take as a whole.” During a 2021 conference held for her Bioethics fellows, participants discussed creating a “justice-oriented bioethics” in “service of social change.”
At the WHO “Ethics to Policy Summit” in December 2021, Grady argued that ethicists like herself should be involved in top-level policy discussions in order to mitigate “nationalism.” Greater international coordination and guidance from ethicists, she claimed, is needed to limit local and state “autonomous discretion” in health care decisions including decisions concerning resource allocation. Fauci, who was also at the summit, concurred: “Nationalism is a strong pull, and politicians and people are very nationalistic. To try to get them to think about global equity, and how it affects them, is an important step, but it’s not always going to win.”
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Grady has repeatedly stated that the role of the ethicist is to “ask questions” in order to illuminate new areas of consideration in medical or policy decisions. But questions she asked during COVID were consistently leading in order to put the collective ahead of individual rights.
Where does this leave bioethics at the NIH? With respect to the question of cost-cutting via DOGE, it is unclear how much funding the Bioethics Department requires. The department belongs to the NIH Clinical Center, which is itself under the Intramural Research Program at NIH. The IRP gets about $120 million a year, but the NIH Clinical Centre doesn’t show up individually in federal budget justification documents. Open the Books asked for the Bioethics budget over a year ago and has yet to receive a response.
But even if the cost were merely Grady’s own $243,749 salary, it’s too much for the American people to bear. COVID was a test of leadership, morals, and ethics, and Grady failed it. If she cannot be fired, the department under her leadership must be radically downsized, and its influence diminished. In particular, the fellowship program that sends young people radicalized by her tutelage into elite graduate programs must be disbanded.
This is not to say there is no use for formal ethical considerations in the government. Grady, for instance, was a member of the Presidential Commission for the Study of Bioethical Issues, which was created by executive order in 2009 and expired in 2017. Commission members were selected by the president and advised on bioethical issues related to science and technology. The Commission also produced reports on a variety of bioethical issues.
President Trump could establish his own Bioethics Commission examining COVID policies like vaccine mandates, social distancing, masking, and patient isolation. Its members could lay down philosophical arguments that favor liberty and targeted interventions to protect the highly vulnerable. Before his nomination to NIH Director, Jay Bhattacharya served on the editorial board of Collateral Global. The nonprofit researches the effects of these policies and would be a good place to start looking for Commission members.
Between Grady and Fauci, COVID-19 demonstrated that ethics claims can determine policy response in disastrous ways. Although Fauci has now retired, his self-defined ethical compass and sounding board remains at NIH with a much lower profile. There’s little reason to believe the casual authoritarianism that buttressed his recommendations has changed. Fauci has gone, but Faucism has not. The Trump administration must roll it back and return public health policy to principles that safeguard individual liberty and bodily autonomy before another contagious disease licenses the administrative state to roll out a disastrous response again.
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