Nobody has ever played the game of insider/outsider politics quite the way Dr. Anthony Fauci did with his public foe and private friend Larry Kramer, the late playwright and cofounder of ACT UP. In 1988, Kramer wrote an open letter, published in the San Francisco Examiner, which started with a bang: “Anthony Fauci, you are a murderer and should not be the guest of honor at any event that reflects on the past decade of the AIDS crisis. Your refusal to hear the screams of AIDS activists early in the crisis resulted in the deaths of thousands of Queers.”

Fauci was the director of the National Institute of Allergy and Infectious Diseases (NIAID), a post he took in 1984 and holds to this day. This made him the public face of the Reagan administration’s shameful AIDS policy, a refusal to take any action commensurate with the scale of the epidemic, born of a mixture of homophobia and a desire to placate the religious right. After reading Kramer’s letter, Fauci did something unusual for someone just accused of being a murderer: He contacted Kramer and recruited him as an informal adviser.

“It was an extraordinary 33-year relationship,” Fauci recalled after Kramer died earlier this year. “We loved each other. We would have dinner. I would go see him in the West Village, he would come down to Washington.” In the years that followed, the two men stayed true to their public personae: Fauci the consummate Washington bureaucrat, Kramer the firebrand dissident. But behind the scenes, they worked together in a way that transformed the federal response to AIDS.

In a Washington Post profile of Fauci, Molly Roberts reports that the physician’s relationship with ACT UP activists changed his approach to the epidemic: “Soon enough, Fauci was convinced that the people dying of AIDS should have a role in the process designed to make the dying stop—meaning they ought to participate in agenda-setting committees at NIAID.”

Fauci was able to introduce this radical measure because of the relationships he had built up with public figures very different from Larry Kramer, most importantly George H.W. Bush. The senior Bush was trying to carve out an identity as a kinder, gentler conservative that would distinguish him from Reagan’s callousness. Fauci, with his prestige as a scientist, gave Bush the cover needed for spending more money on AIDS.

Very few people could count both Larry Kramer and George H.W. Bush as friends. Fauci’s ability to cultivate a relationship with both is crucial to understanding his success as a medical politician. Social networking, done not in an opportunistic way but for the promotion of genuine public goods, is the hallmark of Fauci’s career.

Molly Roberts calls it “the Fauci protocol.” For Roberts, the protocol is to “argue the science for science’s sake, and ignore the rest.” But another way to phrase this is that the protocol consists of using social networks and the prestige of science to overcome partisan gridlock.

This protocol had served both Fauci and America well from the late 1980s until the Covid crisis. It enabled Fauci to convince Republicans like George H.W. Bush and George W. Bush to ramp up spending on AIDS both domestically and abroad. It informed Fauci’s friendships across the political spectrum and enabled him to grapple with diseases ranging from malaria to tuberculosis to Ebola.

But with Trump and Covid-19, the Fauci protocol has met its match. To be sure, Fauci has had some notable successes on Covid-19. Notably, the day after Chinese government made the genetic code of the virus public on January 10, Fauci pushed for a crash program to develop a vaccine and smooth the way for fast-track testing on the model of AIDS treatments. If there is an early effective vaccine, Fauci is likely to get much of the credit for it.

But the vaccine is still in the future. In the meantime, millions of Americans are coming down with Covid-19 and hundreds of thousands will die from it or suffer chronic health problems. The broader federal response to Covid-19 has been a disaster of mixed messaging and denial of reality.

The Fauci protocol doesn’t really work with a president like Trump, who is unwilling to listen to expert advice, especially if it goes against his instincts. On Covid-19, Trump’s gut-level response has been denial of the medical emergency and cheerleading a desired economic recovery.

The current surge in Covid-19 cases can be traced back to Trump’s decision in early April to push for a quick reopening of the economy and offload all responsibility for the pandemic on the governors. This move already seems a world-historical failure. It’s one of the worst decisions made by a modern American president, ranking with Herbert Hoover’s failed response to the Great Depression, Lyndon Johnson’s escalation of the Vietnam War, and the younger Bush’s decision to invade Iraq.

As The New York Times reports, starting in mid-April the Trump’s administration’s “ultimate goal was to shift responsibility for leading the fight against the pandemic from the White House to the states. They referred to this as ‘state authority handoff,’ and it was at the heart of what would become at once a catastrophic policy blunder and an attempt to escape blame for a crisis that had engulfed the country—perhaps one of the greatest failures of presidential leadership in generations.”

Fauci stood in opposition to this shift. In doing so, he was transformed from being a Nestor, a sage whose counsel was sought, to being a Cassandra, a prophet of doom whose warnings were ignored. In Fauci’s own words, his pessimistic forecasts made him the “skunk at the garden party.” Trump’s people haven’t just shut their ears to their Cassandra: They’ve also tried to discredit him.

For the last two weeks, Fauci has been the target of a remarkable opposition research campaign coming from the Trump administration. “The White House continues its attacks, subtly on some days, not so subtly on others,” Molly Roberts noted. “This week began with an anonymous dump of quotes from the administration to the media designed to show the doctor being ‘wrong.’” The Washington Post reporter further observed, “Peak absurdity of the colleague-on-colleague pile-on arrived when deputy chief of staff for communications Dan Scavino shared a cartoon of Fauci as a faucet dumping cold water on the economy to send it spinning down the drain.”

Fauci’s current dilemma is in some ways a reprise of the political problems of the early AIDS epidemic. Like Reagan, Trump is allergic to bad news and prefers to talk about victories. The big difference between now and the 1980s is that Fauci doesn’t have the outside allies he found in Larry Kramer and ACT UP. Absent a mass mobilization, it’s unclear what pressures could be put on Trump to change course on the pandemic.

There is a slim possibility that Fauci might be able to gather up the allies he still has in Washington, which includes members of both parties. Some Republicans are finally starting to break ranks with the president.

On Sunday, The New York Times reported, “In recent days, some of the most prominent figures in the G.O.P. outside the White House have broken with Mr. Trump over issues like the value of wearing a mask in public and heeding the advice of health experts like Dr. Anthony S. Fauci, whom the president and other hard-right figures within the administration have subjected to caustic personal criticism.”

Yet this Republican revolt, based on the evidence the newspaper presented, seems like too little too late. It’s mostly governors and senators offering muted or private rebukes. There’s no plausible scenario whereby this could cause Trump to change directions.

If the Fauci protocol has failed with Trump, the problem is that it was predicated on having politicians who respected science and saw an advantage in allying themselves with expertise. The Fauci protocol also relied on mobilized public pressure to deal with medical problems.

America needs both its Anthony Faucis and its Larry Kramers. But right now, Fauci is politically weak, and there is no Larry Kramer in sight.