A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Sept. 22, 2011 --I received the C. Everett Koop AIDS Public Health Leadership Award at the Dirksen Senate Building. Presented to me by Chick Koop and Rep. Henry Waxman. Extraordinary ceremony that was a "Tribute to Dr. Fauci". I was somewhat embarrassed in that so many people said some many flattering things about me at the symposium (where I gave the Keynote) and at the reception thereafter held at the Capitol Visitors Center. Secretary Sebelius and Deputy Secretary Bill Corr came to the reception and praised me as did several IC Directors (Nora Volkow, Griff Rogers, Susan Shurin); also Jean-Francois Delfraissy (Head of INRS) flew in from Paris to honor me.
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Sept. 23, 2011 -- Took Amtrak to NYC for the Lasker Awards since the NIH Clinical Center won the Bloomberg-Lasker Public Service Award. I got caught in a downpour without any taxis in sight and so had to run to Penn Station in the rain (40 blocks) to catch the train back to DC.
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Sept. 24, 2011 -- Went to 95 Birthday Party for Chick Koop at the Koshland Museum of the NAS. I gave a laudation. Chick had insisted that I be there to give the laudation. Of note, I did the same thing at his 80, 85, and 90% birthdays.
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Sept. 30, 2011 -I appeared on The NewsHour that same night to discuss unplications of Nobel Prize in Physiology or medicine to Bruce Beutler, Jules Hoffman and Ralph Steinman for innate (TLR) and adaptive (Dendritic cells) immunity.
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2011-10-13 00:00
Anthony S. Fauci
Oct. 13, 2011 - Over the past week or so, I have been going back and forth with Gayle Smith (National Security Staff at White House), Lois Quam from State and Eric Goosby (PEPFAR) and Hillary Clinton's (HRC) speechwriter (Josh Daniels) to put a speech together for HRC on the same subject that I spoke on in Rome - "The Science has now shown that we can end the AIDS pandemic - we need to implement" Only difference is that she will say that we can do it by increasing efficiencies PLUS having other partners (donors and host countries) put in a greater share. I said that we should put in more resources. The speech spins off the document mentioned above that we were asked to put together following the Sept. 9 meeting (see above). The main issue is that we will raise our goal of 4 million on treatment through PEPFAR by 2013 to 6 million by 2013. With much input from me and CDC, Eric Goosby put together a nice document explaining the importance of increasing this goal and having certain host countries such as South Africa and Rwanda assume more of the cost of treatment so that we can concentrate on countries with less resources such as DRC, Cameroon, Malawi, Zimbabwe. Also, we can use more bulk purchases etc. TODAY - (10/13/11) we had an important meeting in the Situation Room of the White House from 4:00 to 5:30 PM. Gayle Smith instigated the meeting. It was a Deputies Meeting chaired by Denis McDonough (Deputy National Security Advisor - Deputy to Thomas Donilon). He was very good and sympathetic to our goal. Also there were: Cheryl Mills, Eric Goosby, Tom Frieden, Steve Kosiak from OMB, Ariel Pablos-Mendez Nancy-Ann deParle, Dana DeRuiter from NSS, Samantha Power (NSS), Charles Hohman (OGAC). They called upon me to explain the scientific basis for our pushing to do more to turn around the trajectory of the Pandemic. I explained the details of HPTN-052. Great meeting - this may lead to an acceleration of our efforts. Also, Denis McDonough asked us to put together a "Blue Sky" proposal that would ask for more resources in addition to the increased efficiencies that we are already planning. We may not get more money, but we can probably show the leadership to inspire others to invest more, i.e. other rich countries. More later.......
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Oct. 17-19, 2011 Eric and I among others worked on a paper that gave 2 options: Scenario 1 - increase efficiencies and have host countries take more responsibility and thus shift PEPFAR money to treatment as prevention. This ill raise the bar for goals to 6 million people on PEPFAR-paid Tx by 2013 and 8 million by 2015. Scenario 2 - get $2.5 billion more money from 2013-2015 and raise goal to 8 million on treatment by 2013 and 10 million by 2015. Mathematically modeled (done by CDC), this would "tip" the curve (of incidence) of the pandemic more sharply downward and would also have many secondary benefits of saving lives and hospitalization. Denis McDonough now refers to this as the "Fauci curve".
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Oct. 20, 2011 - Met again in WH Situation Room with Denis McDonough chairing and the same people there with Tom Frieden by videoconference. Continued discussion about "Blue Sky". I again vigorously defended the concept of our golden opportunity at this point. Problem is that OMB feels that we will never get new money passed through Congress and State might have to "eat" the $2.5 billion if we actually pursue Blue Sky. I suggested getting group of CEOs involved (as per my upcoming WSJ - CEO Council meeting that I will chair on Nov. 15). Denis thought that it was a great idea and will bring it to the POTUS. Again, budget problems may stand in the way of a visionary breakthrough of "tipping" the pandemic.
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Oct. 24, 2011 - Met again at the WH (EEOB 439) with the usual cast of characters. Gayle Smith chaired the meeting. Denis McDonough not there. Main issues again is the reluctance of USAID (Ariel) to buy into the idea of expanding treatment as a way to "tip the curve". He suggested moving the money from the efficiencies of PEPFAR treatment (see above) to non-treatment prevention modalities. Eric Goosby tried to explain that the non-treatment prevention modalities (PMTCT, AMMC - adult medical male circumcision) are already maxing out and any increasing or not are due to other issues besides resources. I arguing strongly against Ariel and reminded people that this was a POTUS initiative to increase Tx. Below is an e-mail that I sent to Gayle Smith after the meeting clarifying my stance on this. Gayle: Thanks for running an important and sometimes contentious meeting today. You do it masterfully. Please read my comments below and then you can either accept them or throw them out if you wish and I will still be your friend. Here goes... Eric, Ariel, and I, and hopefully Tom Frieden will get together by phone tomorrow to try and hash out and hopefully resolve the issues that were brought up today regarding standard prevention versus treatment as prevention. It appears that Ariel and USAID feel that in an arena of a flat budget, the money saved by efficiencies in treatment should be turned over to standard prevention modalities as opposed to expanding the number of people on treatment (which is also prevention). As Eric will explain to Ariel tomorrow on our phone call, the model that has been developed takes all of these issues into account and the standard prevention modalities such as adult male circumcision and PMTCT to which Ariel is referring can be maximized in a number of ways without significant increases in resources, whereas putting more people on treatment clearly requires more money. You can treat the same number of people with less money by efficiencies, but the only way to get more people on treatment with a flat budget is to use the savings from efficiencies. As we have been discussing, this will have the effect of preventing more infections at the same time as saving the lives of the infected people who would now be receiving treatment. This also results in other economic and social benefits. Although you are trying to be fair to all points of view, in my humble opinion, if we go to the Principals giving them a choice of the two approaches, we will confuse them. I believe that they need to look at a single proposal that we have already agreed upon in our discussions and decide if they are comfortable with it. Another point that seems to have gotten lost by some in today's discussion in the fact that, as I mentioned at the end, we are talking about a potential game changing initiative by the POTUS that could be a legacy. We are not talking about competition for limited money that might go to other areas. Another issue is that the activist community would support the POTUS in an initiative with no new money, but that includes a plan to increase the numbers of people on treatment by the mechanisms that we had discussed with you and Denis. If he comes out with a plan to divert savings from treatment efficiencies to non-treatment programs, the constituencies will be infuriated. Sorry for taking your time with this e-mail. I just felt that I needed to express my thoughts to you. Talk to you soon. Best regards, Tony ple
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Oct. 25, 2011 - Raj Shah (Administrator of USAID) called me at 1:30 PM to get a better feel of my position on treatment as prevention. I thought that he would have a problem with it, but he was really asking if it was better to target people with very early infection since they are most likely to spread infection. I explained to him that although this was the case, they represent a relatively small fraction of infected people and they are very difficult to identify at this early stage. I found out later in the day from Cheryl Mills (Chief-of -Staff to Hillary Clinton) that Bill Gates had told Hillary that treatment as prevention was a waste of money and would not work. Hillery (HRC) heard from Eric that Bill Gates is probably the only person in the world who felt this way and that is exactly what I told Cheryl (see my breakfast with Bill Gates above). It seems that HRC is to meet with Raj today to get his opinion and so that is why Raj called me. Also, HRC will come to NIH on my suggestion to give speech on this subject on Nov. 8. I helped drafting her speech.