Dec. 26, 2002 --

In context

A single line often inverts meaning once you see what it answers, so neighbouring messages are always shown.

1. 2002-12-18 00:00 Anthony S. Fauci open
   Dec. 18, 2002 - Another exciting day at the White House. Clearly, Scooter Libby and the VP are in favor of pushing for the Vaccine Trust Fund. OMB and the WH economic advisors have a problem with the concept of a trust fund. As usual, Carol Kuntz has been very supportive. Was called down to a meeting at the WH with OMB people (Jim Capretta), the VP staff (Carol K., Seth Carus, Noreen Hynes), DHS people (Richard Falkenrath, et al), Kristen Silverberg, Ken Bernard, Stew Simonson, Phil Russell, Bill Raub. We had to discuss the vaccine research plan. Again, must concern as to why we need a trust fund instead of an appropriation. I explained that one (the fund) is mandatory and the other (appropriation) is discretionary. Jim Capretta came up with the idea of a "Permanent and Definite Appropriation" that would be mandatory and multiyear. In the middle of the meeting, Scooter Libby called me on my cell phone and said that he was going into a meeting with the VP and the President at 1:00 PM (it was now 11:30 AM) and he needed for me to write a 1⁄2 pager on the concept of a mandatory fund for vaccine (he said trust fund, but we subsequently hashed out a Perm. And Def. Appr. He also wanted a microbe by microbe breakdown with time-lines and costs - all by 12:55 PM. In addition, he wanted me to meet with the CEOs of "Big Pharma" to determine if they would support this. I rushed to the DHHS with Stew, Kerry Weems, Phil Russell and Bill Raub and put together a great package to e-mail and FAX to the VP's office (Carol K.) arriving a few minutes before 1:00 PM. They loved it. We will wait to see what happens.
2. 2002-12-19 00:00 Anthony S. Fauci open
   Dec. 19-22, 2002 - Still much activity with the VP continuing to push to help us get a Permanent and Definite Appropriation for purchase of countermeasures, particularly, but not exclusively for vaccines. There is much concern about botulism and acquiring botulism anti-toxin. Many phone calls and meeting with Stewart Simonson with whom I now speak with and/or meet at least several times per day. Carol Kuntz and Noreen Hynes are trying to help us. They asked us to put together a programatic assessment of our procurement needs for countermeasures without consideration of budget constraints. We had previously put together a $4.2 billion package concentrated mostly on MVA and rPA (anthrax) with only about $450 million over 10 years for other countermeasures. We presented this several days ago to OMB people in the presence of Kristen Silverberg (see above). OMB was miffed that they had not seen these numbers before, when in fact the numbers were contained in our budget submission for '04, but were not specifically designated as purchase. Clearly OMB is resisting the VP's attempts to get this fund through. The new "no budget constraint" package that we put together was approximately $15.0 billion over 3 years (FY04 - 06) with considerable amount now to other countermeasures such as botulism, plague, Ebola, tularemia, Rift Valley Fever, EEE/VEE/WEE, Staph. Enterotoxin, antibiotic resistance, pandemic flu, WNV, etc. Even though this was put together by Phil Russell with help from DMID, the VP wants me to defend it to OMB since they are cashing in on my reputation and scientific credibility. The VP has set up a meeting for Dec. 23 at the WH with himself and Scooter Libby teleconferenced from Jackson Hole and me, Mitch Daniels, Nancy Dorm (OMB Deputy Director), Tommy Thompson, the VP's staff, etc. (see below).
3. 2002-12-23 00:00 Anthony S. Fauci open
   Dec. 23, 2002 - Critical meeting at the White House (see above). Attending were VP Cheney and Scooter Libby by teleconference from Jackson Hole; Stewart Simonson, Phil Russell, Kerry Weems (Budget, DHHS), Carol Kuntz, Noreen Hynes, Seth Carus, Nancy Dorm (Deputy Director OMB), Tom Reilly and Jim Capretta (OMB). Issue was that Scooter and the VP had asked Carol Kuntz a couple of days ago to put together a threat related proposal for a wide range of microbes with no concern for budget to be used for procurement of products. It should be program and need driven. Carol tasked me to do this with Phil Russell. I worked until late through the night of Dec. 22 fine-tuning this and learning it cold. The proposal went beyond MVA, rPA, and included botulism, plague, tularemia, Ebola and other hemorrhagic fevers, pandemic flu, West Nile. Etc. The proposal came to $15 billion from FY'04 - '06. The OMB had agreed several days ago to creating a "Permanent and Indefinite (first it was definite) appropriations authority to purchase vaccines for BioT for a total of $4.2 billion. In typical OMB fashion, they were against any new spending. The intense interest of the VP was the reason why we were being listened to. Importantly, Carol Kuntz called OMB people to the meeting (Mitch Daniels was supposed to be there, but he was out of town) but did not warn them that they would be faced with a $15 billion exercise in front of the VP. I convinced Carol to let them know at least a few minutes before the meeting started. They were mortified and enraged that they were not warned in advance. As Nancy Dorm said, every time she sees me, it costs her billions of dollars. The VP called upon me to present the proposal. Nancy did not get it. She was tied down in process. She insisted that the original agreement was for vaccines only and not what she called "countermeasures" such as botulism antitoxin and Cidofovir, which were on the list. She did not understand that "Countermeasures" is the big umbrella under which are vaccines, antitoxins, etc. Also, she argued that we she not include in the purchasing authority anything that was not licensed. I proposed that we should include anything that was "licensable", i.e. on the way to license by the FDA, but perhaps months away because of the FDA process. The VP very clearly was on my side and did not hide it. He even said to Nancy " Do you expect me to go to the President and the American people and say that we cannot provide countermeasures against threats that we either know or strongly suspect that Iraq has because we do not want to broaden authorities and because the "process" will not allow it?" She then said that she would work with us to get something out. The VP was spectacular! It was a classic example of OMB not being able to get beyond process and missing the entire point of the concept. Amazingly, Nancy said that "look what happened with the smallpox vaccine. We bought it and now we are not even going to use it widely". She considers the smallpox vaccine situation, which was one of the great successes of the year to be a failure since many Americans would opt not to take it. She does not understand that the fact that we have it is critical. Amazing! The meeting ended with the VP clearly in my corner. My relationship with him, Scooter and the whole staff, particularly Carol is getting very strong.
4. 2002-12-24 00:00 Anthony S. Fauci open
   Dec. 24, 2002 - Nice surprise today. At 1:00 PM, I received a call in my office. I answered the phone since everyone else had left for the 1⁄2 day Christmas eve. On the other end someone sang the full verse of "Happy Birthday". It was Secretary Thompson calling from Wisconsin on a cell phone from a shopping center.
5. 2002-12-26 00:00 Anthony S. Fauci
   Dec. 26, 2002 --
6. 2002-12-30 00:00 Anthony S. Fauci open
   Dec. 30, 2002 -- Another meeting at the White House with OMB people. They are still trying to resist the Pemanent and Indefinite Appropriations, particularly for pandemic flu. Attending meeting were me, Stewart Simonson, Seth Carus, Carol Kuntz, Barry Glendennin, Tom Reilly, Bill Raub, Phil Russell. We went back and forth and it was clear that Secretary Thompson and VP Cheney want this, but OMB does not. Again, the VP and DHHS are relying on my reputation to drive this through.
7. 2003-01-03 00:00 Anthony S. Fauci open
   Jan. 3, 2003 - Another meeting at the White House with Carol Kuntz, Seth Carus, Noreen Hynes, and Stewart Simonson on the pending Project Bioshield Legislation. VP Cheney is still trying to get this into the State of the Union address. I am still counseling Carol regarding her CML. Jan. 4 -- Jan 9, 2003 -- Continual back and forth about the language for my new authorities and for the permanent and indefinite appropriations authority for procurement of countermeasures. Much opposition from OMB. Scenario is Stewart Simonson, Carol Kuntz, Scooter Libby and the VP against OMB. Trying to keep NIH Director Elias Zerhouni in the loop. He is somewhat (not a lot) concerned that I am in the driver's seat here, but in all, he has been quite good about it. VP's people keep asking me to provide materials for them to strengthen our arguments. This has become almost a full-time job. Also, I have had a URI with sinusitis for at least 6 weeks and this has made 19 hour days difficult. We (NIAID) had to move our Winter Program Retreat from Shepherdstown, W.Va. to Bethesda since Stewart and others felt that I like would be needed on the phone or to go to WH during the 2 days of the retreat (Jan. 9-10).
8. 2003-01-10 00:00 Anthony S. Fauci open
   Jan. 10, 2003 -- Meeting at the White House with Kristen Silverberg, Carol Kuntz, Noreen Hynes, Seth Carus, Richard Falkenrath, Ken Bernard, Stewart Simonson, WH speechwriters Amy Jensen and Gordon Johndroe. Purpose of meeting was to prepare for the possibility that the President will announce Project Bioshield at the State-of-theUnion Address in a couple of weeks. I had to present to the group the background and. rational for the special authorities for the NLAID director as well as the Permanent and indefinite appropriations authorities to purchase countermeasures. In addition, we explained the special use licensure of countermeasures by the FDA. For the latter part of the meeting, Mark McClellan (FDA Commissioner) joined us by phone. We will have follow-up meeting next week.
9. 2003-01-11 00:00 Anthony S. Fauci open
   Jan. 11, 2003 -- Had an all day meeting of virtually all the players in biodefense organized by Richard Danzig (former Secretary of the Navy) at Strategic Analysis, Inc. in Arlington, VA. We did case studies of possible catastrophic bioterror events and discussed the need to establish a BAT team or biological anti-terrorist team to be available to the President for advice and service in the event of a catastrophic attack. Present was among many others: Julie Gerberding, David Franz, Lisa Gordon-Hagerty, Josh Lederberg, Richard Danzig, Bill Patrick. Entire attendee list is in my files. Jan. 13 or 14, 2003 - Meeting in the West Wing (Ward Room) of the White House with Kristen Silverberg, Ken Bernard, Carol Kuntz, Amy Jensen, Sally Canfield (DHS), Jim Capretta, Tom Reilly, Richard Falkenrath, Stewart Simonson and others from WH communications to continue to fashion the precise language of the Project Bioshield (authorities, Procurement, FDA regs) in preparation for getting this into the President's State of the Union (SOTU) address . We wrangled a bit about the precise language. We will meet again in 2 days to finalize it.

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