The National Institutes of Health announced last week that Jeanne Marrazzo, a leading researcher of sexually transmitted infections (STIs), will replace Anthony Fauci as head of the National Institute of Allergy and Infectious Diseases (NIAID), raising the possibility of a meaningful response to recent crisis-level STI transmission trends in the US.
Marrazzo's career has been devoted to finding new ways to test for, prevent, and treat infections spread through sex. And her appointment comes as sexually transmitted infection rates — especially syphilis and gonorrhea — are screeching upward at an alarming pace, while funding to address them is being slashed at the federal level following contentious debt limit deal negotiations. Her appointment has led to a rare moment of hope, and even jubilation, among experts in the field.
"For STIs, we need better therapeutics, vaccines, and point-of-care diagnostics," said David Harvey, director of the National Coalition of STD Directors. "These are all things that Dr. Marrazzo happens to be an absolute expert at, and we're very excited and hopeful that more resources will be put into these priorities."
Although Marrazzo's new role will give her a lot of power over the scientific community's research priorities, it will also require her to tangle with political decision-makers who've often been overtly hostile to science. But even here there's a sense that her forthright and sensitive communication style will be a strength, given her track record as a public commentator on a range of public health issues.
As the head of NIAID, Marrazzo will lead decisions on which scientific priorities deserve backing from the agency's multi-billion dollar budget — and will be responsible for convincing Congress she's made the right choices. And if Fauci's precedent stands, she may also play an important role helping the public navigate confusing moments in public health (and I'm sorry to say this, the next pandemic).
Marrazzo brings lots of skills to this job, and she's going to need all of them
Since she led her first NIH-funded research project on chlamydia testing in 1997, Marrazzo's career has focused on preventing, diagnosing, and treating conditions of the female reproductive tract.
Some of her most influential work has been in the area of STI prevention in women: She led an important 2015 study among African women that showed how strongly stigma could interfere with HIV prevention efforts. Marrazzo has also conducted a lot of research on gonorrhea and a non-sexually transmitted but extremely common condition, bacterial vaginosis.
Her background in STIs is particularly well-suited to this moment in public health. The Centers for Disease Control and Prevention reports that over the five years between 2017 and 2021, the US has seen a 28 percent increase in gonorrhea, which is fast becoming an antimicrobial-resistant infection. Meanwhile, syphilis rates have increased by 75 percent, many of them among women. The shift has led to a threefold increase in congenital syphilis cases, which can portend death among newborns.
Meanwhile, STI funding has dropped 40 percent since 2003, and capacity to combat surging infections decreased further when the CDC was forced to slash STI contact tracing funding by $400 million after funding cuts were written into the latest budget.
Marrazzo is an out lesbian, and as a researcher, educator, and speaker, she has advocated tirelessly for LGBTQ health equity. In a statement, HIV prevention advocacy organization Prep4All said, "At a time where infectious disease threats are on the rise globally and preventive and sexual health has come under attack for women and LGBTQ communities around the world, Dr. Marrazzo's demonstrated commitment to addressing HIV and STIs in marginalized populations will be of enormous value in ensuring that the research needs of vulnerable communities are met."
She is also, critically, a respected health communicator. Currently the director of the infectious diseases division at the University of Alabama at Birmingham, she was a fixture of local and national news outlets during the Covid-19 pandemic, and became known for her unshakeable and forthright demeanor.
All of that will serve her well as the director of an often embattled government agency, said Harvey. NIAID frequently faced heated criticism from many directions during Fauci's tenure, beginning with ACT UP's antagonism over the agency's slow response to the HIV/AIDS epidemic, and ending with GOP criticism of Fauci's legitimacy and calls to eliminate the agency altogether in the wake of its Covid-19 response.
Although Harvey expects she will face some tough questions from Congress, "she is a force to reckon with in her own right," he said, and "one of the best communicators I've ever seen. In this area, she is like Fauci — she can take complex clinical issues and translate them for a lay audience, as we saw her do day after day in Covid."
Marrazzo will need all of those skills in the role to respond to tough congressional inquiry and combat misinformation, said Carlos del Rio, president of the Infectious Diseases Society of America, the professional society that represents scientists and clinicians working in the infectious diseases field.
"When Rand Paul says we need to break up the institute into three institutes, we need to decrease your budget," del Rio said, "the NIAID director has a very important role." Whether the country is in the middle of a pandemic or merely between emergencies, it will be up to Marrazzo to help Congress understand why the NIH and NIAID budget are important.
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