A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
-
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.......
-
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".
-
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.
-
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
-
2011-10-25 00:00
Anthony S. Fauci
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.
-
Oct. 26, 2011 - Conference call with Eric, Ariel, me, Charles Holman and various people from USAID, PEPFAR, and CDC (Tom Frieden) trying to hash out the difference between Eric/me/Tom and USAID. It appears (maybe) that we have convinced Ariel that our model is valid. More to come.
-
Oct. 31, 2011 - Another WH (EEOB 430A) meeting regarding above topic. Chaired by Gayle Smith. Also there was Amy Batson (USAID), Lois Quam, and Tom Frieden by phone. Cold crisp day in DC. Fall is here! Again the tension between USAID goals and PEPFAR goals become clear. USAID is trying to enhance their own agenda, which in my opinion has failed with their spending millions on prevention messages that do not work. They are trying to derail the PEPFAR "scale up by efficiencies" initiative. Ariel is turning out to either be naïve or nefarious. I always heard that he was a good guy, but he and USAID team keep insisting that the efficiency money should go either to a broader GHI or to enhancing the non-treatment prevention agenda (PMTCT, AMMC, condoms, etc.). The PEPFAR/Fauci/CDC agenda is to use the efficiencies to scale up Tx from 4.2 million by 2013 to 6+ million by 2013. This should reach 8 million by 2015 without any additional funds. If you go to "blue Sky" of +$2.5 billion from 2013 to 2015, you will go from 8 million in 2013 to 10 million in 2015. The PEPFAR model also assumes and enacts a maxing out of the non-treatment prevention modalities. USAID disagrees and want to use efficiency money to favor non-treatment as Prevention. This is what Ariel is saying. After meeting with Eric Goosby, Ariel seems more convinced that the PEPFAR model may be OK. However, what does Raj Shah think????
-
Nov. 1, 2011 - Dinner with Rick Klausner at Matisse Restaurant on Wisconsin Avenue and Fessenden. Discuss the Qatar initiative, see above and below. But, conversation turned to Raj Shah and the PEPFAR/USAID story. Bottom line is that Raj has been talking with Rick and it appears from Rick and my prior conversation with Raj that Raj is not against treatment as prevention (TAP); however, he does not like the model and want to do it differently. (More on Qatar later - stick with USAID/PEPFAR for now)
-
Nov. 2, 2011 - 7:30 AM Get call from Rick Klausner who is having breakfast with Raj Shah and Rick wants to set up teleconference with the 3 of us at 11:00 AM to discuss the above issues. On the call Raj dances around a bit, but what he really wants is a big initiative using PEPFAR money. He does not say so explicitly, but that is really what he wants. He does not want the efficiency money to pay for 6 million of TAP by 2013; he want 5.5 million for TAP and the rest for a full-court-press initiative to see in a selected 3 countries if maximizing both non-TAP and TAP prevention will actually end the pandemic. I explain that there is not enough money to do this, and besides, the expectation is to TAP, not do a study to prove that it could be done. He agrees with me that we should do both within the constraints of budget. He is sure that the POTUS will like this initiative since it is a scientifically-based approach (give me a break!!!). The big elephant in the room is that USAID has been wasting $100s of millions on prevention approaches (like behavior change) that do not work. They should use this $ to do their proof of concept full-court-press approach, not try to siphon off PEPFAR money (I did not say that, but this clearly was the elephant). Raj wants the have Eric, himself and I put together another proposal to this effect. After the call Rick e-mailed me and asked for a follow-up call. On that call Rick explained that what Raj really wants is to spend all of the efficiency money on the 3 country demonstration project and that this would be the POTUS initiative. They (Rick and Raj) just do not believe that PEPFAR/CDC model. Also, (amazingly), Raj admits to Rick that the USAID has been wasting $100s of millions, but he is not up to taking on the USAID bureaucracy. Rick is disappointed in him and thinks that he is being weak and has told him so. However, rick is in favor of the concept since he has issues with PEPFAR. Based on this, I arranged a teleconference with Tom Frieden (at Atlanta airport), Eric, Charles Holmes, and some PEPFAR people and CDC people to discuss all of this. Tom Frieden was furious at USAID. He says that they have been wasting $ for years and now they question what CDC proposes, when CDC has been saying for years that they should have been scaling up AMMC and PMTCT instead of wasting money on behavior. Clearly, Raj is a young, brilliant guy who is extremely ambitious (that is OK), but he wants control of PEPFAR resources. Frieden is dead against this PEPFAR is obviously against this. So am I. The original question was to use efficiencies to scale up TAP, not to try something that USAID should have been doing all along with their own $. The idea of nailing down whether we can end the pandemic with a full-court press (FCP) is a good one, but there are no resources available. I propose that we do both the PEPFAR plan and the FCP, the latter with $ that we get from additional sources. White House meeting scheduled for Nov. 9. Everyone wants me there, but HHS will have to decide who the "Plus one" is with Sebelius. Of note, I am scheduled to go to Seattle on Nov. 9 for a town hall meeting and a seminar sponsored by Lee Hood and the Institute for Systems Biology. Bill Gates is trying to undermine the initiative on upscaling TAP. See e-mail below from MSF to me sent on 11/02/11: Dr. Fauci, Congratulations on getting NIH-supported HIV research the airing it deserves at the highest levels of government. We are all looking forward to Secretary Clinton's speech at the NIH next week. We are trying to use the USG momentum to leverage new commitments from the UK for World AIDS Day. So far DfID and other government actors are interested in a "step up" initiative that we have also been pitching to USG, South Africa, and Germany to pay for implementation of accelerated treatment. Today we had a bit of a minor set back: the Secretary for Development Andrew Mitchell just heard from Bill Gates at a Tory event "Friends of International Development" that HPTN 052 will not yield great effects and the role of ART in limiting incidence is more limited than what is being portrayed. It was unfortunate. It would help greatly if the policy makers in government could hear the science themselves. If the All-Party Parliamentary Group on AIDS invited you to give a briefing, and we arranged for high-level meetings, could you attend? Would an invitation by civil society and MSF suffice? And, hardest question of all-- do you have any free days where you could be in London in November? Thank you, Sharonann -- Sharonann Lynch HIV/AIDS Policy Advisor Access to Essential Medicines Campaign Médecins Sans Frontières (MSF) Tel: +1.646.824.3066 Email: sharonann.lynch@msf.org Also see below e-mail from Nov. 3 from Michael Iskowitz describing what the community actually is hearing about. It is amazing how things leak sinceI have told no one what I am doing regarding USAID, PEPFAR and the WH. Finally, tonight (11/02/11) went to Book Signing party at Hay-Adams Hotel for Chris Matthews on his new book "Jack Kennedy - Elusive Hero". Another example of the A group of Washington. It is clear that at age 70, being on the public/political/media scene for >30 years, I am extremely well-known and even friends with so many public figures, who merely on the basis of my being on TV/Radio/newspapers, etc. and the fact that we run into each other at so many of these functions have gotten to know me well. Just a sampling of people at event: Andrea Mitchell; Alan Greenspan; Sens. Chris Dodd, John Kerry; Rep. Ed Markey, Jim Moran; Howard Feinman; Murrey Jacobson; Luke Russert; Gloria Borger; Joe Scarborough; etc. Had animated conversation with my friend Ed Markey regarding the disgraceful conduct of the Banking Industry and Wall Street. The "Occupy Wall Street" movement is gaining momentum. The Republican scramble for the nomination is hot and heavy