A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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June 13 - 18, 2002 - Extremely busy with putting the finishing touches on the MTCT proposal that the Pres. is planning to annouce soon. I am trying and succeeding (I believe) in having them do it correctly, i.e. this is not a substitute for the Global Trust Fund, but as a comlement to it. Have been working very hard with Terrell Halaska and Mark Dybul in getting the Pres. speech written and his talking points arranged for the announcement. Simultaneously with this going on, I have been working with Stewart Simonson in trying to get the correct authorization language written for the proposed bill for the new Department of Homeland Security (DHS). The WH wants me to be comfortable with it; however, they seem inflexible in that they clearly want the $1.748 billion of NIH money to go to the new DHS and they want the perogative to set the research agenda. Richard Falkenrath of DHS assures me that despite this, they want me to run the program from NIH.
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June 19, 2002 - Most extraordinary day!! The POTUS requested that I join him and Secs, Thompson, O'Neill, and Powell and Sen. Frist and Andrew Natsios at the Rose Garden Ceremony to announce the MCTC plan that Mark and I essentialy created. I met with the Pres for about 10-15 minutes in the Oval Office before the announcement. He was extremely gracious and complimentary. During the announcement, he specifically thanked me for all that I have done with the project. After the annoucnement, I went with Ari Fleischer and gave a press briefing in the WH press room on the program. Importantly, the Pres. asked Josh Bolten to meet with me and get my feel for the big picture of what the Adminsitration should be doing with AIDS (domestic and global). Present at the meeting were me, Josh, Margaret La Montagne Spellings, Robin Cleveland, Jay Lefkowitz, Gary Edson, Kristen Silverberg, Allen Gilbert. Josh asked whether we should do a Manhattan Project for a vaccine and not invest in international prevention and treatment. He said that I should assume that money was not an issues and I should tell them what is "the right thing to do". I gave details about the importance of building a sustainable (low tech) infrastructure of clinics and trained Africans. This infrastructure could then be used for HIV prevention and ulitmately treatment, but could also be used for approaching malaria, TBC, and other important diseases. I said that the USA needs to be the world leader in making international health a driving force in our foreign policy. If we lead, other countries will follow. Josh seemed genuinely moved and agreed with me. He even stated that it is his feeling that years from now, this Administration will be judged by how it handled the International HIV/AIDS Pandemic. He stated that the Pres. was very sympathetic to me and what he has heard me say on various occasions, but there is a skepticism that money will be wasted if there is no accountability. This is also fed by Paul O'Neill and Mitch Daniels. I said that I agree that we should not do it unless there was strict accountability. We need to have someone to run the program who could "kick ass". Josh and I resonated very well. I believe that the WH will be calling upon me soon to help with such a strategic plan. In fact, I am going to proceed to put one together and present to them pre-emptively. It was a great day!!! I may have accomplished more for global health on this day than on many, many others put together.
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July 7-12, 2002 - XIVth International AIDS conference in Barcelona. - Very important conference. The science was completely overshadowed by the policy, which in turn was dominated by the discussion of the incredible numbers and projections for the developing world. Latest figures are that approximately 40 million additional infections will occur worldwide by 2010 and up to 70 million dealths will occur by 2020 if serious intervention (prevention and therapy) are not implemented. I gave a highly scientific talk and used it to come to the conclusion that we must implement treatment and prevention for the North and the South. Please see records on my speeches for the full text of the talk. It was a Plenary Lecture on July 10. I spent much time with Secretary Thompson and his team (Terrell Halaska, Tony Jewell, Bill Steiger et al). There was an aggressive demonstration against Secretary Thompson during his address on Tuesday, July 9. I was with him and predicted to him exactly what would happen. I had heard from Gregg Gonsalves that ACTUP would demonstrate for awhile and then allow him to speak provided that he would meet with them afterwards. He agreed to meet, but they shouted him down and although (as per my suggestion) he calmly finished his speech, the audience could not hear what he said. This was unlike Secretary Sullivan in San Francisco when the TV and microphones allowed audiences (TV and present ) to at least here what he said. I helped Secretary Thompson with the Press (backstage)immediately after the shout-down. There was an issue that I handled. During the conference 2 days before the demonstration, at a Press Briefing during which I sat next to the President, the Press asked about needle exchange. Tommy G. Thompson (TGT) was not briefed on this issue and I told him briefly that we (Fauci, Jeff Koplan of CDC, David Satcher - Surgeon General, Alan Leschner - Director NIDA and others) had recommended to Donna Shalala upon review of the scientific data that the Clinton Adm. allow Federal funding of needle exchange. However, based on objections of Gen. McAffrie (Drug Czar) and certain Black leaders, Clinton would not allow it. (Of note Clinton was at the AIDS Conference in Barcelona and publicly stated that he regretted that decision and wished that he had allowed needle exchange). In essence, I told TGT that Clinton did not allow it and we (current administration) are not allowing it. This created a bit of a stir in the press since when asked at the press event (backstage) after the demonstration, he seemed confused about the dichotomy between scientific data and policy. I had to come in and explain the issue. I made it very clear that based on the scientific data, I had recommended that Clinton allow exchange. TGT said that he would ask Dr. Fauci to go over the data again, which the Press did not buy since they know the data are absolutely conclusive. It was a little awkward for TGT, but he is going to have to face the issue that the Bush Adminstration will likely do (and is doing) exactly what the Clinton Administration did and follow a policy that contradicts the scientific data. An important event at the meeting was a meeting that I arranged in my hotel (Fira de Palace) among myself, Mark Dybul, Cissy (?last name) and Peter Mugyenyi from Uganda. Peter is the Director of the Joint Clinical Research Center (JCRC) in Kampala. He is successfully treating many Ugandans with antiretroviral therapy (ART). We (Mark and I) want to use his model to try to implement the plan that Josh Bolten asked me about (see above and below). Peter showed us his plan of a main center with regional satelites and subgroups out of the satelites. These are low-tech clinics and each cost about $30,000.00 which is much less that the proposals that we have heard. I was very impressed with this and plan to use this as a model to put together a program to present to the WH (see below) It was a great meeting for me in that I became even closer (if that is possible) to TGT. He implicitly and explicitly trusts me and my opinion. I appeared on the Aaron Brown Show on CNN during the conference and this went extremely well.
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July 14, 2002 - C-SPAN's Washington Journal - I appeared for 45 minutes on the show the morning after returning from the AIDS conference. I had spent July 7-10 at the conference and July 11-12 in Genoa as Chair of the International Scientific Committee that is reviewing the Gaslini Institute for Lorenzo Moretta (its Scientific Director)
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2002-07-16 00:00
Anthony S. Fauci
July 16, 2002 - Diane Rehm Show - Spent a terrific 1 hour alone on the show with Diane. I went over the AIDS Conference highlights. I explained about and defended Secretary Thomspon vis-a-vis the demonstration against him. Also, I defended the Administration in that I related that they actually are willing to greatly support international AIDS efforts, but that they require developing nations and others involved to put forth a strategic plan with accountability, endpoints, projected deliverables, etc. I received excellent reviews for the show. I have it on tape as a reference.
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July 17, 2002 - Meeting at the White House with Gary Edson and Jay Lefkowitz. We discussed the details and implementation of the MTCT project. Obviously, there will be difficulties with USAID. They are resentful that DHHS is getting involved in international AIDS issues. Anne Peterson was at today's meeting. I have no confidence that she or her staff are capable of successfully pulling off this program. Mark Dybul alone can do better than their whole group. Sorry for being so direct, but it is true. Of note is that I brought up to Gary Edson and Jay Lefkowitz the issue that I had discussed with Josh Bolten regarding the more Global plan of therapy, prevention for HIV and other diseases in a "low-tech" manner. I discussed my meeting with Peter Mugyenyi and Cissy (?last name) from Uganda (see above). I told Jay and Gary that I believe that we could pull off a program based on the "Mugyenyi model". He told me to put together a proposal in a very short time frame (before the WH leaves for August break ( i.e. <2 weeks). They want to determine if the POTUS could bring this initiative with him on his upcoming trip to Africa in January, 2003. I will work with Mark Dybul to do this.
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July 21, 2002 - Over the past few weeks important issues have evolved regarding Biodefense. There is a major struggle going on in the Congress about the formation of the new Department of Homeland Security (DHS). At issue (among other important issues) is whether the $1.748 billion that is in the President's budget for FY2003 will be transferred over to the new DHS and who will actually be responsible for the strategic plan and prioritization for biodefense. DHS people (Gov. Ridge and Richard Falkenrath) clearly state that they want the money and the responsibility, but that they will work very closely with me. The Congress and all of the scientific Societies (FASEB. ASM. Etc.) say that they want the money and prioritization with me. As usual, I must publicly defend the President's position, but I work behind the scenes with people like Sens. Lieberman, Kennedy, and Frist to get language in the new authorizing Bill that will not transfer the money or responsibility (let us see what actually happens). Meanwhile, VP Dick Cheney is pushing for a Manhattan Project approach to Biodefense. He mentioned this at his visit to CDC and told Julie Gerberding that he would mention this to me also. Of note, I was quite influential in supporting Julie for the CDC job. We have CIA intelligence that Iraq has smallpox and everyone in DHHS and the WH are scrambling to get together an immunization plan that will go well beyond what the ACIP is recommending (i.e. pre-emptively vaccinate only about 10,000 - 20,000 health workers and rely on ring vaccination in the event of an attack). Cheney is pushing for a much wider vaccine plan. TGT will present our plan to Cheney within a few days, which recommends a staged (1,2,3) process that vaccinates about 500,000 health workers from Oct. 02, to December 02 and then from Jan. 03 through the end of 03 vaccinate up to 10 million responders (phsyicians, nurses, police, firefighters, EM people, primary care personnel). After that and depending on the adverse event rate and the perception of threat, we will make vaccine available for the entire USA population on a voluntary basis. One of the reasons for the push by Cheney is that he knows that Iraq has smallpox and he is planning to push out Sadam Hussein either by direct invasion of Iraq or by funding the opposition. He is afraid that Sadam will strike Israel or even us if his back is against the wall. There will be very intense discussions over the next couple of weeks with the WH and DHHS that involve me regarding smallpox vaccine policy. Things are obviously very busy with my being involved simultaneously with Biodefense and International response to HIV/AIDS. Both of these involve my direct interaction with the White House.
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July 22-24, 2002 - Went to the beach (Beach Haven) to link up with family. In the car on the way up and while I was there, I spent considerable time on the phone trying to work out with Sen. Spector's staff (Bettylou Taylor et al) language in the Lieberman Bill on authorization of DHS that Spector could support. They want to make sure that I am comfortable with the language. I am trying to get language that give DHS ultimate lead in the overall prioritization of the research on biodefense, but the money stays in DHHS and the research is executed by NIH, but the development of the research agenda in done by DHHS in consultation with DHS. Finally we had a conference call (I took it in the kitchen of the beach house) among me, the White House (Richard Falkenrath) and the Senate staff that are marking up the bill. Richard and I agreed upon what I listed above. Hopefully, the bill will get through with that language. It was important to have the WH on the phone since I was getting concerned that they might think that I was undermining their efforts to get the DHS going. By hashing it out with them, we are doing it up front and honestly.
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July 25, 2002 - Had top secret conference call with Jerry Hauer (HHS), Phil Russell (HHS), Stewart Simonson (HHS), and Lester Crawford (FDA). Subject - VP Cheney has indicated that we will hit Iraq soon and we expect retaliation with a smallpox attack on us or on Israel. Cheney wants us to greatly accelerate the process of getting vaccine available to vaccinate everyone if necessary. I offered to accelerate studies to determine if we can dilute the Dryvax even more than 1:5 and whether we can also dilute the 77 million doses of Aventis Pasteur WetVax. Stay tuned. The House and the Senate Committees have adapted the language that I had suggested to Richard Falkenrath. Therefore, at this time it appears that the money will go to DHHS, the overall prioritization will rest with DHS, the strategic plan and specific priorities will be the responsibility of DHHS in consultation with DHS and the research will be executed by and through the NIH. If this holds, I will have won a big victory.