Collins, Francis

Director of the NIH, 2009–2021/22; former leader of the Human Genome Project; author of The Language of God

Francis Collins: National Institutes of Health (NIH)

Lex Fridman Podcast · Nov 5, 2021

• Francis Collins
• NIH
• COVID-19 origins and lab leak question
• gain-of-function research oversight
• EcoHealth Alliance and Wuhan Institute of Virology
• Anthony Fauci defense
• vaccine hesitancy and mask guidance reversals
• ivermectin and Joe Rogan
• Human Genome Project
• science and Christian faith

Core ideas

Collins states he cannot exclude a lab leak but considers it "fairly unlikely," favoring a natural zoonotic origin (probably bat-to-intermediate-host-to-human, as with SARS and MERS, where identifying the intermediate host took years), while acknowledging investigation has been hampered by strained US-China relations and incomplete access to Chinese records. He devotes extensive effort to clarifying the term "gain-of-function," distinguishing everyday scientific usage (e.g., cancer immunotherapy that "gains" a patient's immune cells new capability) from the narrow, formally regulated category — "enhanced potential pandemic pathogen" (ePPP) research — that applies only to experiments enhancing transmissibility or virulence of already-known human pandemic pathogens. He argues the NIH-funded EcoHealth Alliance sub-award experiments at the Wuhan Institute of Virology (mixing bat coronavirus spike proteins to test ACE2 receptor binding) did not meet the ePPP threshold because the viruses studied were not established human pathogens and were roughly 80% genetically similar to SARS-CoV-2 — "decades" apart in evolutionary terms — making it, in his view, "demonstrably false" and "irresponsible" to claim this research produced SARS-CoV-2. He acknowledges a compliance failure: the grantee (EcoHealth) failed to promptly report an experimental result (a somewhat higher viral load from a chimeric bat virus) as required, but maintains this still didn't cross into ePPP territory. He defends continued (rare, ~3 approved cases in recent years) gain-of-function research on grounds that understanding potential pandemic pathogens in advance improves early detection and response, while conceding the field paused its own scheduled 2020 re-evaluation of the oversight framework due to COVID and states this review is now overdue and should happen transparently.

Collins strongly defends Anthony Fauci against calls for his firing, calling attacks on him politically motivated distraction from "failings of their own political party" and asserting there is "nothing in the ways Fauci has been targeted that is based upon truth." He argues Fauci's public health guidance changes (e.g., on masks) reflected legitimate updates to a rapidly evolving evidence base rather than dishonesty, though he agrees with Fridman's suggestion that more explicit humility in acknowledging early recommendations "were a mistake" (rather than solely reframing them as correct-given-available-data) might have won back some public trust, while doubting this would have stopped politically motivated attacks regardless. Discussing Joe Rogan specifically, Collins says his concern is less about Rogan's use of ivermectin after his own COVID infection than his broader public skepticism toward vaccination during a period when (Collins cites a Kaiser estimate) roughly 100,000 of ~700,000 US COVID deaths were preventable had those individuals been vaccinated; he cites an NIH-supported "ACTIV-6" randomized trial of ivermectin (with results expected within about a month of recording) as the rigorous way to resolve the open question, while noting most existing ivermectin evidence reviews suggest it "probably doesn't work." Pressed on why healthy, young, or physically fit people should still get vaccinated given their lower baseline risk, Collins argues risk is not zero for any group (citing roughly 700 pediatric COVID deaths at the time and recounting a professional wrestler's near-fatal case) and that vaccination meaningfully reduces risk across all risk tiers even if the absolute benefit is smaller for the young and healthy.

On vaccine hesitancy, Collins says he tries to approach it with empathy and active listening rather than assuming people's stated reasons, citing genuine uncertainty about long-term vaccine effects (which he says cannot be ruled out with absolute certainty, though there's no specific reason to expect it) as a legitimate underlying concern distinct from "demonstrably false" information being actively spread by some actors, which he calls "shameful" and says is "taking lives." He expresses deep concern about what he frames as a broader "epidemic" of eroding trust in objective truth as a shared basis for decision-making — extending the concern explicitly to disputes over the 2020 election's legitimacy — while agreeing with Fridman's suggestion that scientific communicators need to shift from an "authoritative" 20th-century tone toward more humble, listening-first communication to rebuild trust. On variants, Collins expresses concern about Delta's contagiousness and the possibility of future variants evading vaccine-induced immunity, crediting mRNA vaccine platforms' ability to be rapidly redesigned if needed, and frames reducing overall viral transmission (via vaccination, boosters, masking, and — his particular enthusiasm — cheap, widely available rapid at-home testing, which he says NIH's RADx program helped scale from near-zero to hundreds of millions of tests per month) as essential to limiting the emergence of new variants.

On animal research ethics, Collins discusses NIH's 2015 decision (which he championed, based on a National Academy of Sciences panel review) to end federal support for invasive chimpanzee biomedical research after concluding it no longer produced essential scientific value, while defending continued animal research more broadly (including dog studies for diseases like leishmaniasis and lymphatic filariasis, for which no other research model exists) as ethically justified when it offers realistic potential to save human lives, distancing NIH from a specific viral claim (that NIH funded controversial sedated-puppy sand fly research) which he says was a misattributed citation. Reflecting on his tenure (having served three presidents — Obama, Trump, and Biden — an unprecedented span for an NIH director), he highlights the Human Genome Project, the BRAIN Initiative, gene-editing therapies (citing sickle cell disease treatment), and public-private collaborative models he helped establish (the Accelerating Medicines Partnership, and later ACTIV, which coordinated COVID vaccine and therapeutic trials across ~100 people from industry, academia, and government) as major achievements, and explains his decision to step down as driven by a belief that scientific institutions benefit from leadership turnover after 12 years, not by any specific controversy.

The conversation closes on Collins's personal reflections on faith: describing his path from atheism (which he came to view as an unsupportable "assertion of a universal negative") through agnosticism to Christianity as a young medical student wrestling with questions science doesn't address, and his friendship with the atheist writer Christopher Hitchens (whom he assisted through his final cancer illness) as a model of respectful disagreement across a fundamental worldview divide. He states he draws on both scientific rigor and personal faith when facing difficult problems like vaccine hesitancy, and frames the meaning of life, drawing on the Sermon on the Mount, as striving toward altruism and love despite inevitable failure, within a belief that life is a brief span whose consequences extend beyond it in ways he doesn't fully understand.

Excerpts