Jeanne Marrazzo Chosen to Succeed Fauci as NIAID Director

Jeanne Marrazzo, MD, will be the next director of the National Institute of Allergy and Infectious Diseases (NIAID), NIH Acting Director Lawrence Tabak, DDS, PhD, announced on Wednesday.

"Dr. Marrazzo brings a wealth of leadership experience from leading international clinical trials and translational research, managing a complex organizational budget that includes research funding and mentoring trainees in all stages of professional development," Tabak said in a press release. "I look forward to welcoming Dr. Marrazzo to the NIH leadership team."

Marrazzo is currently the director of the infectious diseases division at the University of Alabama at Birmingham. She succeeds Hugh Auchincloss, Jr., MD, who served as acting director of NIAID following the resignation of Anthony Fauci, MD, who stepped down in December 2022. Marrazzo will oversee a budget of $6.3 billion, which supports research to advance the understanding, diagnosis, and treatment of infectious, immunologic, and allergic diseases. She is expected to begin her role as NIAID director in the fall, the press release said.

Marrazzo's selection was greeted with widespread praise. "I can't think of a better pick to be Fauci's successor," said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition (AVAC). "One of Fauci's great successes is communicating complex science to a range of audiences. I think we've all wondered who could fill those shoes and more importantly, who could fill the microphone explaining complex science to policymakers and to politicians and to communities and to the media. That's Jeanne Marrazzo."

Warren worked with Marrazzo while she was at the University of Washington in Seattle, where she led the Microbicide Trials Network, an NIAID-funded effort to develop products for women at risk of vaginal exposure to HIV and for women and men engaging in anal intercourse. During that time, Warren said, she oversaw the Vaginal and Oral Interventions to Control the Epidemic (VOICE) study for AIDS prevention, which took place in eastern and southern Africa.

"This was back to the early days of PrEP [pre-exposure prophylaxis], there was a lot of research looking at oral PrEP," he said. "This was one of those studies. But this study looked at both oral PrEP and the topical gel tenofovir for women to use. So it's a very complicated study because you had people in multiple arms getting two different formulations of PrEP, and then another arm getting the gel version."

In addition, "the VOICE study was one of the first studies that really embedded what were good practice guidelines and the engagement of communities within the research process," said Warren. "The amount of engagement was unprecedented, really, in a biomedical trial."

Unfortunately, the study showed no statistically significant effect from any of the products, largely because of low adherence to the required daily use, he continued. However, Warren said he found it heartening that despite the negative result, study participants "didn't say, 'Researchers lied to us and it was a waste of time.' They understood that this was a process, and that a successful trial can have disappointing results."

The Infectious Diseases Society of America (IDSA) also applauded Marrazzo's selection. "IDSA and its members have experienced firsthand Dr. Marrazzo's effective, engaging and visionary leadership through her many years of service on the board of directors," IDSA President Carlos del Rio, MD, said in a statement. "We look forward to working with her in her capacity as NIAID director to strengthen the pipeline of infectious disease researchers and physician-scientists and advance groundbreaking science that will improve outbreak and pandemic preparedness, combat antimicrobial resistance, and end HIV as an epidemic."

But Marrazzo will have many challenges ahead of her, Warren said. He noted that when Fauci -- who as President Biden's chief medical advisor was the subject of much hostile criticism for his handling of the COVID-19 pandemic -- came to meet with the AVAC team a few months ago, "he came with seven security guards. That's really no way to live."

"So the fact that she said 'Yes' I think shows great courage and bravery, and shows a great commitment to wanting to advance the science and work through those policies," he said. "It is not going to be easy. To watch the politicization, to see members of Congress attack Dr. Fauci -- that's the reality she's walking into ... I think this says a great deal about her integrity of wanting to be a voice of reason, to be a voice of science, to be a voice of public trust and confidence."

Warren listed several priorities he hoped Marrazzo would work on in her new position, including a bigger focus on social and behavioral science as it relates to implementing cures and treatments, and a research agenda for HIV that includes not only vaccines and injectables, but also shorter-acting solutions.

"There are a lot of individuals who would say, 'Yes, I want an injectable. Yes, I want a vaccine. Yes, I want an antibody,'" Warren said. "But there are also many people who say, 'You know what? I also want a short-acting method that I can control, whether that's a vaginal ring, whether that's a film, or a vaginal or rectal insert. So it's a user-controlled method ... We need a research agenda that also listens to end users."

Marrazzo is a fellow of the American College of Physicians and of IDSA, and is board-certified in infectious disease. She earned her bachelor's in biology from Harvard University in Cambridge, Massachusetts, her MD degree from Thomas Jefferson University in Philadelphia, and a Masters of Public Health in epidemiology from the University of Washington. Marrazzo also has chaired the American Board of Internal Medicine (ABIM) Council, and the ABIM Infectious Disease Specialty Board.

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