A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Oct. 10, 2002 - Had 2 important meetings at the White House today: First - meeting with Gary Edson, Jay Lefkowitz and Robin Cleveland about the comprehensive AIDS implementation plan for prevention, treatment, and care for developing nations for possible consideration by the President. This was in response to a call from Jay about 1 week ago asking to spread out the plan from 5 years to 7 years and to calculate how much money would be spent for each prevention intervention, i.e. condom distribution versus sex worker education versus needle exchange versus family counseling. The point is that they feel that the request might be too much for the 5 years (Total = $9.987 billion over 5 years, including up to $1.0 billion for the Global Fund). They want us to spread it out so that the early years will be less. Also, they want us to assume that countries other than Russia, China, and India (which will contribute 50%) would be contributing some proportion. We figured Botswana and South Africa could contribute 30% each Namibia and Guyana 20% and Uganda 10%. Furthermore, they anticipate that the President is going to ask just what the money is going for and if it is for Condoms, sex workers and IV drug users, he should at least know that. Obviously, the right wing in the WH would be against this. We crunched the number and I presented this. Right off Robin mentioned that Jim Capretta (OMB PAD) had mentioned to Mitch Daniels that something was cooking vis-à-vis international AIDS and that this would require new money. Mitch immediately said no chance and that no matter what we give, we will be criticized. Robin then left for another meeting. I suggested to Jay and Gary that another alternative would be to do this through the Global fund with the stipulation that they work from our plan with suggestions from them. My reason was as follows. The WHO group just met in Geneva with Bernard Schwartlander to try to galvanize a plan and support for a global program. Mark Dybul went to that meeting. It appears that they will ask for a 3 year plan to treat 3 million people at a cost of $10-15 billion with $4.6 billion from USA. They want to announce this on World AIDS Day (Dec. 1). This could pre-empt the President. In other words, we will be pressured to give $4.6 billion to do someone else's plan. This would be less that our 5 year and 7 year plan. Why not announce that we will give $4.6 million to the global fund if they coordinate their activities through our plan? The President could announce this and get credit for leadership as well as for contributing to the Global AIDS Fund. Also, it would avoid the impression that we Americans are going off on our own. Gary and Jay liked the plan very much and asked me to put together a 3-pager for Josh Bolten. They made me swear to tell no one about this, not even Mark, Terrell or TGT. I finally convinced them that I really needed to tell Mark since he is necessary to put these things together. I am very uncomfortable about not telling Terrell. Second meeting was a briefing of Vice President Cheney's Staff on the NIAID efforts on biodefense, i.e. what is our "vision" for spending the $1.75 billion as well as our longterm vision. At the meeting were Carol Kuntz, Seth Carus and Noreen Hynes (all from Cheney's senior staff) and Jerry Hauer (from the DHHS). The meeting went extremely well. I wowed them with a passionately delivered presentation. I told them that we at NIAID could transform the way the country deals with bioterrorism threat from a 1 document (see yer who has already research and public health standpoint. They loved it and asked what powers I needed that I do not have to execute this. I mentioned that we should have a fund to purchase vaccines and drugs so that the pharmaceutical industry would have an incentive to get involved. Also, I said the FDA needed to be more flexible.
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Oct. 17, 2002 - Sent down the 3-pager that Jay and Gary wanted (see above). It calls for the USG taking the lead and committing a considerable amount of money THROUGH the Global Trust Fund, but under the stipulation that other countries join us and implement our plan. The plan would cost approximately $18.8 billion of new money over 5 years. In the covering memo to Jay and Gary, I mentioned that I was uncomfortable about not telling Terrell what we are doing since I am supposed to me representing her and TGT at these meetings. Of note, Gary and Jay usually respond almost immediately to me when I send material such as this. However, over the subsequent 2 days (Oct 18,19), I have heard nothing from them. I suspect that they are put aback by my mentioned my discomfort about not telling Terrell about this. We shall see what happens. Also, received a call from Stewart Simonson who said that Vice-President Cheney wants a meeting with me about my Biodefence Research Vision on Wednesday, Oct . 23. The White House has set up the meeting.
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Oct. 20, 2002 - Gary Edson contacted me and likes very much the revised document (see above). We are closing in on it and he will soon show it to Josh Bolten.
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Oct. 22, 2002 - Had a terrific visit and briefing of Vice President Cheney in the West Wing of the WH. Present were the VP, "Scooter" Libby, Carol Kuntz, Noreen Hynes, Seth Carus, (Gen.) Phil Russell, and Stewart Simonson. I went over our NIAID Research Agenda and Strategic plan for biodefense. As I did in my briefing of Carol Kuntz (see above), I stressed that we can and will do the job. I stressed that we needed help in getting greater regulatory flexibility, having the power to sole source contracts, and we need to provide major incentives for industry. We must work more closely with industry the same way that the automobile industry made our planes and tanks during World War II. It was a very easy and enjoyable interaction with the VP. Of note, when we discussed briefly the policy for smallpox vaccination, it was clear that Libby is the driving force for mass vaccination sooner rather than later. The VP seemed rather measured on the subject. On the way out of the WH, I ran into Gary Edson in Josh Bolten's office (Josh's assistant had seen me walking by and asked me to come in to say hello to Josh). Josh and Gary were actually working on the plan that Mark and I had just sent to them. They like it very much and I think that something is going to happen with it.
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2002-10-23 00:00
Anthony S. Fauci
Oct. 23, 2002 - Met with Bono again at the Jefferson Hotel for breakfast. Also present were Jamie Drummond, Lucy Matthew, Katrina and Erin Chapman. We spent almost 2 hours going over options for how we can drive the agenda for universal care, prevention that Victoria and treatment for HIV infected people worldwide. I emphasized the importance of engaging Russia, India, and China because of the large populations in these countries in which a mere increase in prevalence from 1% to 2% in countries like India and China (I billion people in each country) could quickly create a pool of infected people that would equal all of Africa. He will be meeting with Condolezza Rice this afternoon to push for the USA getting involved in a major way with money (billions) and leadership. I am impressed with Bono's good intentions and his intelligence and energy. I am disappointed that I cannot tell him about the program that Mark Dybul and I have been working on for the "comprehensive implementation" plan. Hopefully, we can make this public soon so that we can engage Bono's assistance with his bully pulpit.
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Oct. 29, 2002 - Received today the written version of the oral history that Victoria Harden collected from me a few months ago. See attached document. Fauci on biodefense 8-9-02.doc Oct. 30 - Nov. 1 - Multiple conversations and e-mail exchanges with Gary Edson regarding the AIDS Project (see above). I believe that finally we are getting this straight. Historically (see above), every time that we try to calculate the needed resources for a comprehensive program, Robin Cleveland (OMB) or someone else says that it will not fly (see note of Oct. 10, 2002). Now Gary calls me and says that our most recent package might be low-balling it since he recently read an article by Jeff Sachs in The Economist that we need $25 billion per year. I finally told Gary that I had had enough. The world is calling for $10 billion per year for 5 years with an increase to $15 billion per year by 2007. They all say that the USA commitment should be 35% of this or $3.5 billion per years for 5 years. I told Gary that this is what we should propose as the President's initiative provided that the other countries put in the remaining 65% and that they use our implementation plan. I told Gary that he and Robin need to figure out how much of $3.5 billion per year we (USA) will have already been spending in order to determine the amount (% of $3.5 billion) that really would have to be new money. Finally, he agreed and now we can stop all of this ridiculous back and forth with Robin and him. We may be getting close to presenting this to the President. We just need to convince Josh Bolten
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Nov. 1, 2002 - Had a great meeting with Carol Kuntz, Noreen Hynes, and Seth Carus regarding the request of the Vice President for me to list what added powers that I would need to make the BioD program work at NIAID. Stewart Simonson and Phil Russell also present I listed a group of these and Carol et al liked and agreed with them. They were mostly sole source contracting authority, rapid grants, DARPA-like powers, etc. Next step is arranging a meeting with me, TGT, and Cheney.
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Nov. 12, 2002 - See note of Oct. 30 - Nov. 1 above. Gary Edson called me last week and said that they were on the verge of making the decision regarding whether we will go for the major implementation plan. However, there is skepticism on the part of OMB (and likely others that he did not mention) concerning whether this can be done. They need to do due diligence and get some outside opinions and so they Gary has asked me to gather for a meeting at the WH a group of people who have actually done developing country implementation. They want to speak with these people without my being there, i.e. to check up on me. I suggested and they agreed to bring in the following: Peter Mugyenyi (Uganda), Jean (Bill) Pape (Haiti), Paul Farmer (Harvard-Haiti), Eric Goosby (Pangea Foundation and Rwanda). Gary asked me on a Friday and I needed to contact these people who were scattered all over the world to come to DC to see me and then have a visit to the WH. Gary insisted that I not reveal the plan to them and so I had to convince them to travel within a 72 hours period merely on faith as a favor to me. They all agreed and came: Mugyenyi from Uganda, Goosby from Rwanda, Farmer from Germany, and Pape from Haiti. Still Gary insists (despite my asking him again and again) that I cannot tell Terrell Halaska about any of this. I pushed Gary and he checked with Josh Bolten who said that this week we indeed will be able to tell Secretary Thompson. On another issue, things are heating up regarding possible war with Iraq. This makes compelling the imminent decision of policy regarding smallpox vaccination of civilians. The Pentagon will imminently announce that 250,000 to 500,000 troops will be vaccination with vaccinia (Dryvax). The question of the availability and recommendations for civilians remains. I am pushing for "recommending" that the 500,000 and then the up to 10,000,000 health workers and first responders get vaccinating. However, I feel that although we should make available the vaccine for the general public, given that the threat assessment is very soft, we should recommend that they not take the vaccine unless they feel very strongly that they do not want to take any chances. This is different from the situation with the anthrax vaccine where the DHHS said that had no recommendation either way; they just made the vaccine available if people wanted it. Went down to the White House to pre-brief Gary Edson and Jay Lefkowitz on Mugyenyi, Goosby, Pape, and Farmer. They both inquired as to what pretense I used to get these people to come to the USA. I said that I asked them to come and advise me about clinical trials in developing nations. Had dinner at the Trattoria Sorrento in Bethesda (Cordell Street) with the 4 visitors and told them exactly why I called them in and explained what type of questions would be asked of them at the WH. They look upon me as a hero for what I am doing.
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Nov. 13, 2002 - Multiple meetings in the DHHS to plan roll out of smallpox vaccination plan. It is imminent. The President is planning on having to start bombing Iraq in the 2nd week of January and wants to start vaccinating the 500,000 people smallpox response teams by December 1 and the 10,000,000 first responders by January in order to prepare for a release of smallpox by Iraq. Much discussion about timing the announcement of vaccinating the military with the announcement about the general population. Concern is that if we do not link the 2, the people will react to vaccinating the military by saying "what about us?" It looked like we were going to make the announcement on Friday, Nov. 16. However, at the WH, the President told the cabinet (including TGT) that he now wants to wait until he comes back from a foreign trip (Nov. 27) since Osama bin Laden just released a tape yesterday indicating that he is still alive and threatened the USA, UK, and Russia. Bush does not want it to appear that we are panicking in response to the tape. I am relieved that we decided to wait since I would have had to cancel my going to Los Angeles to receive the RAND Prize ($10,000.00) in order to remain in DC for the Press. Heard that the WH meeting with the 4 visitors on the global AIDS plan went extremely well. I believe that we are convincing the skeptics that we can effectively treat HIV in developing nations. Of note, Robin Cleveland asked to have Nils Daulaire there for his opinion. It is my impressions that she is resentful of the NIH and me. This is likely due to the fact that her OMB account for which she is responsible includes USAID and there is obviously some competition in her mind given that NIH always does so well with the budget.