A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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April 20, 2001 - Last day of meeting and my day of departure. Discussions continued and we all realized how difficult it would be to accomplish this lofty goal of providing antiretroviral therapy for Africans. There was good news during the meeting that the consortium of drug companies had withdrawn their ill-advised lawsuit against South Africa for trying to distribute drugs outside of patent restrictions. Now the South African government (which has been extremely problematic at best with President Mabeki showing bizarre behavior regarding whether HIV causes AIDS) would have to move to start treating their people since the drug companies could no longer be considered the obstacles. Lincoln Chen of the Rockefeller Foundation gave a very nice summary of the meeting as the last speaker and used many of my direct quotes from my talk and my discussions to make important points. One in particular was my warning to beware of the "ethical police" who would only want us to do studies in Africa that would be acceptable and relevant in the USA. This centers around the issue of the Declaration of Helsinki which states that the control arm of any trial in a developed country (or anywhere) would have to be the best possible therapy for the disorder. By "best possible therapy", they mean best anywhere. This would make research to answer questions that are relevant to Africa virtually impossible. We all agree that high ethical standards are necessary; but to demand the best therapy anywhere as the control arm in a nation where there is virtually no health care and which would not be relevant to Africa is unrealistic. Everyone in the audience agreed and gave me a long applause. After the meeting, we drove to the Uganda Virus Institute in Entebbe on the way to the airport to visit Dr. Sylester Sempala, a well known Ugandan virologist whom I had met previously at a meeting in Naples, and Mary Meehan. It was a nice facility (by African standards) and the view was magnificent. It was perched overlooking the shores of Lake Victoria. This was an extremely important trip for me in that it gave me a first-hand appreciation of the dire situation in Africa, not only with regard to HIV/AIDS, but also with regard to heath care in Africa in general. I believe that this trip will change me dramatically towards a direction that I have already been heading for the past couple of years. This direction is towards a greater effort and interest on my part in global health.
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April 24, 2001 - Spent 30 minutes on the phone with Secretary Tommy Thompson briefing him on my trip to Uganda. Thompson is getting ready to brief the Cabinet and convince them that the USA should take a leadership role in the AIDS in Africa initiative. He mentioned that he will rely very heavily on me to help him accomplish this important goal.
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May 5, 2001 - Important conference call with DHHS. On call was Art Lawrence (Acting ASH), Eric Goosby, Helene Gayle, ASH-Designate Claude Allen, Jeff Copeland, Terrell Halaska, Bill Steiger. We (Me, Jeff Copeland, Terrell Halaska, Bill Steiger) had been working for weeks on putting together a position paper for Secretary Thompson on the response to the challenge of AIDS in Africa. UN Secretary General Kofi Annan will come out with a proposal for a Global Trust Fund for AIDS in Africa in June at a Special Session of the UN General Assembly. The White House used our White paper as background to get out front on the issue and announce that the USA would contribute to the Global Trust Fund. We were told on the call that the Cabinet Council met with Pres. Bush. The Cabinet Council consisted of Secr. Thompson, Secretary Colin Powell, Carl Rove, OMB Director Mitch Daniels, Domestic Policy Council Margaret La Montagne, Pres. Counsel Rodriguez and members of VP Cheney's office. The decision was made for Pres. Bush to announce on May 9, 2001 that the USA would contribute in FY 2002 $200 million to the Trust Fund. However, of great relevance to me and NIH, there would be no new money. It would all be budgetary offsets. Of the $200 million, HHS would give $100 million, Dept. of State would give $60 million and $40 million would come from the existing AIDS trust fund. Of the $100 million from HHS $95 million would come from NIH as a transfer. $65 million would come from B & F, $25 million from NIAID, $5 million from NIH OD and $5 million from cyber security. Of considerable note is that Bill Steiger mentioned on the call that he was very "grateful for the generosity of Tony Fauci who has offered to provide the $25 million from his FY 2002 appropriation. Since NIAID will get a 14.2% increase, when you subtract the $25 million, this means we would still get a $260 million increase in our >$2 billion budget. It would not be taken out of the base, but would be a one time transfer.". The fact is that I had offered to help a few weeks earlier in my conversation with Terrell Halsaka. By "help" I was not referring to the Trust fund; I was referring to putting more research money into the AIDS effort in Africa. There was no way that I offered $25 million for the trust fund. However, I did not object over the phone since it was obviously a done deal and the President was going to announce it. It would look very bad if I objected. There was nothing that I could do but turn this "challenge" into an "opportunity". In the end, it really is the right thing to do since it shows leadership in an important cause and our base was not impacted. I will probably take some heat from our constituencies. However, who can cogently argue against my doing something for dying Africa babies? At the end of the day, I am not unhappy at the outcome since we need to get the ball rolling on the African AIDS issue and Tommy Thompson and J are leading the way.
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May 10, 2001 -- Met with Ambassador-Designate to the UN John Negroponte at the State Department. Also at the meeting was his aide Joe Marty. Secretary Thompson had suggested to him that I brief him on the international AIDS crises in preparation for his assuming the position as US Ambassador to the UN. It was a good meeting and John recalled with pleasure that I had briefed him on AIDS in 1985 (more than 15 years ago). I mentioned to him that the situation in Africa is much more of a health care infrastructure/nation building problem than it is a scientific problem. We renewed friendship and promised to work closely together.
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2001-05-11 00:00
Anthony S. Fauci
May 11, 2001 -- HVIN in Crystal city in the AM of Friday 5/11/01; but then went to Atlanta on Sunday to deliver Commencement Address at Emory Medical School. I know.... I am nuts!
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May 18, 2001 -- Had important meeting with Adel Mahmoud in my Conference room regarding future collaborations with Merck on an HIV Vaccine. Present -- Jack Killen, John La Montagne, Peggy Johnston, Gary Nabel. Meeting triggered by my concern that Merck was leading Gary Nabel on regarding collaborations with NIH (in the form of Emilio Emini), but really did not want to collaborate for obvious and understandable reasons. Ed Scolnick and I spoke by phone and decided that we needed to get Adel M. involved. My feeling is that although the parties are friends (me, Adel Mahmoud, Ed Scolnick), Merck does not feel that it is in their best interest to get seriously involved in a collaboration with the US government (i.e. NIH) for the obvious reason that they want control given they have invested so much and are aimed directly at approval of product. I believe that they are acting like they want to collaborate for public relations purposes. I actually do not blame them since I would probably do the same thing if I were in private industry.
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May 21, 2001 -- Had dinner at home of William Haseltine (CEO of Human Genome Sciences). Bill is an old and good friend who frequently includes me in social events. The event was the meeting of the Board of Trustees of the Brookings Institution. Bill is a Board member. It was a politically star-studded gust list including most of the Trustees. Present were James Johnson (Chair), Larry Summers (former Secr. of Treasury and recently appointed President of Harvard), Dennis Ross (Middle East peace negotiator who gave a great after dinner talk on Middle East conflict), Joan Spero (DDCF), Donna Shalala, Leonard Shaeffer. Michael Armacost (President of The Brookings), Lee Hamilton (former Congressman and President of the Woodrow Wilson Institute), Zoe Baird, etc. etc. Excellent conversation at dinner regarding a wide range of world and. domestic topics.
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May 24, 2001 -- Went with Christine to the Sons of Italy dinner at the National Building Museum. Met and had warm conversations with old friends Sam Donaldson (MC for the event), Tony Lo Bianco, Connie Stevens, John Podesta, etc. Seated at my table was Connie and Tony Morella, and Geraldine Ferraro.
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May 25, 2001 -- Briefed the Staff of Sen. Thomas Daschle on global health down at the Senator's office. Main person was Dennis McDonough. It was coincidental that Sen. Jim Jeffords had just turned from Republican to Independent and will vote with the Democrats and so Daschle will be the new Senate Majority Leader. Big excitement about this in Washington.