A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Sept. 8, 2014 - The situation is evolving rapidly where the Department of HHS is now telling us (NIH and others) that things are now going in the right direction and that we do not need to have daily phone calls anymore and could probably move them to every week or every other week. This is stunning to me since I do not see that anything has really changed and it appears to me that they are trying to paint a rosy a picture when things are actually getting worse. The reason for this is unclear. It could be that the White House has told them to tone down the rhetoric since they do not want to put pressure on the President. Also amazing is the fact that even Tom Frieden has told me on the phone that things seem to be going in the right direction now and they have work streams and points of contact and he is much more optimistic. I cannot believe that he has completely changed from the passionate person demanding an overwhelming amount of resources and beds to someone who now says everything seems to be going okay. There is something very fishy here. I suspect that HHS has promised him that resources are on the way and have told him to cool it. I will find out what is going on. Appeared on Diane Rehm show today with Sheri Fink from the New York Times as well as Sophie Delaunay from MSF and Mvemba Dizolele from the Democratic Republic of the Congo. Dvemba said that he has been reading about me since he was 16 years old and that I was his hero. He made me feel rather old despite the flattering comment (he is right about the age ). The host was Steve Roberts and we spoke about the drastic situation in West Africa. Also appeared on BBC radio. WTOP radio and Reuters TV. Although the President has said on Meet the Press that the military will now be involved, reports and news outlets such as Reuters quote officers at the level of Colonel saying that the military will deliver the 25 bed hospital to Liberia; however, there will not be "boots on the ground" of military personnel staffing the hospital. As far as I can see, this is no different than what was going on before the President's announcement. There were already plans to get a 25 bed hospital shipped by military aircraft to Liberia. I think this is a smoke and mirror game in which nothing will get done.
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Sept. 10, 2014 - The debate still continues as to whether or not we will have military assistance in dealing with the Ebola epidemic in West Africa. There is a disturbing lack of transparency between HHS and us here at NIH in that they are obviously negotiating at the level of the National Security Council and the Department of Defense about what to do in the epidemic without telling Francis Collins or me what is actually going on. In the meantime, Cliff Lane as a long-term member of the Medical Defense Board of the Department of Defense has met with Gen. Martin E. Dempsey, chairman of the Joint Chiefs of Staff today. Cliff relates to me that Gen. Dempsey seemed quite receptive to Cliff's pleading for a massive military logistic support for the Ebola situation in West Africa. Also at that meeting with the Joint Chiefs was Laurie Garrett, because of her prior experience with Ebola epidemics. According to Cliff, Laurie also pleaded for a massive military effort. It should be noted that today another important event occurred in which the President announced at a TV appearance that he will initiate a scaled up military attack on ISIS (he calls it ISIL) including their assets in Syria. He declared that ISIS is a threat to the Middle East, the surrounding regions, and the United States and Europe, largely due to the fact that they have publicly said that they will attack Western nations. This is a particularly important problem because many Westerners with Western passports and Visas including those from the United States have joined ISIS. The President stated that he would not include ground troops in this effort. However it is clear that Special Forces will be needed to guide the air attacks. The press is sharply criticizing the POTUS for having no plan, missing prior opportunities, and now doing too little, too late. More later. I bring this up because this is certainly a complicating issue when you are also asking the military to help with Ebola outbreak. Had a momentous evening today in that I gave a keynote lecture at the PhRMA Research and Hope Awards Gala at the Mellon Auditorium on Constitution Ave. It was particularly important because the other speaker was former Pres. George W. Bush. We resumed our warm personal relationship in that when he entered a small room of VIPs to shake hands and take pictures as soon as he walked into the room he caught my eye and said out loud for everyone to hear: "Hey, Tony it's great to see you". He gave me a big hug; we took pictures; chatted a bit and then when he was on the stage for his talk which was actually a conversation with a moderator, the first thing he said is that: "We have with us tonight my friend Tony Fauci. I gave Tony the Presidential Medal of Freedom several years ago. I did that because you should know that he is one of the most important American heroes of our time." It was extraordinarily flattering, but this is exactly the way he has been treating me for years. The talk that I gave was entitled ending the HIV-AIDS pandemic: a realistic goal. Overall the evening was very pleasant. I sat down next to my old friend form NIH director Elias Zerhouni and the evening was full of warm praise by many people for me and what I have been doing with HIV over the last many years.
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Sept. 14, 2014 - A lot has happened over the past few days. There has been a considerable amount of disorganization, diffusion, and lack of direction at the level of HHS as well as the rest of the USG (USAID, DoS, etc.). It has been announced that the President will visit the CDC on Tuesday, September 16. It is anticipated that he will announce that the United States military will get heavily involved in the response to Ebola by providing up to 1700 hospital beds as well as the logistics for transportation and provision of equipment. However, it is very clear that they will not provide medical personnel in the form of doctors and nurses. This might leave us with the situation in which we have equipment but the inability to implement it. HHS (Leslie Dach) is desperately trying to figure out ways to recruit and train medical personnel to man the hospitals. Of note, it might take up to 8 weeks to get these hospitals operational, if in fact, the US military decides to send them. The situation in the West African countries is still dire. I have been on the phone discussing this on multiple occasions over the past few days with Paul Farmer and Mike Gerson. Paul will be leaving tomorrow, September 15, for Liberia in order to set up hospitals under the auspices of Partners in Health, the organization that Paul and Jim Kim founded many years ago. Francis Collins, Cliff Lane, and I are still pushing HHS to suggest that there be a person in the White House who would be the overall Director and point person for the government's Ebola efforts. I have suggested to Francis and Francis has suggested to the secretary that that person either be someone like Gen. David Petraeus, Gen. Stanley McCrystal, or even former majority Senate leader Bill Frist. Again, I am concerned about the lack of organization, direction, and commitment on the part of the department as well as the White House. The President is having a very difficult time in that he is being pressured to respond firmly to the threat of ISIS in the Middle East. I feel that this pressure may make him and the administration less enthusiastic about getting heavily involved with the Ebola issue. Nicki Lurie, who is a good person and a friend, is making things more confusing by trying to suggest how to do clinical trials, train people and other tasks when she knows little about these issues. She is an Assistant Secretary and so officially she outranks us all (me, Peggy Hamburg, Francis Collins, Tom Frieden); yet, she gets in the way more often than not. Had a long conversation about this with Peggy Hamburg on the phone today. Paul Farmer is encouraging me to continue to push the envelope to get the USG to do more. Paul is showing an amazing amount of faith in me that I can fix this. He is basing this on his experience with me with PEPFAR. However, this is different since there are so many "cooks" in this process.
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Sept. 15, 2014 - Mike Gerson called me up again this AM wanted to find out if I knew anything more about the POTUS planned announcement at CDC tomorrow regarding increased resources (DoD) for Ebola. Mike is driven by his deep humanitarian values and wanting to nudge the administration to do more. Mike will speak with Lisa Monaco today about administration plans. I gave him a few questions to ask Lisa, i.e. who is in charge?
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2014-09-16 00:00
Anthony S. Fauci
Sept. 16, 2014 - I helped Mike gerson last night on certain elements of his column which appeared today in the Washington Post. Mike used several of my phrases and called for an escalated effort in various areas of need including US Military command-and-control, transportation, logistics, and supplies. Last night the White House sent out an embargoed fact sheet about what the President will announce today at the CDC. He will make the announcement at 4:45 PM. I will be testifying before the Senate HELP committee and the Senate Appropriations Subcommittee from 2:30 PM until about 4:30 PM. There are a large number of press including CNN with Wolf Blitzer,Hhardball with Chris Matthews, an MSNBC who want to speak to me about the President's announcement and the implications of the announcement. As usual the White House is very nervous about having anybody speaking to the press before or on the day that the president makes an announcement. Therefore I am getting a lot of grief from the communications people downtown and at the White House about all of the requests for me to appear on the media. By grief I mean that they are not clearing me nor are they refusing me. They are just keeping me hanging, which usually means that the requests will be withdrawn by the media people themselves and they will find someone else. This is typical stupidity on the part of the White House and HHS. With regard to the announcement of the President, he is proposing many of the things that I and several of my colleagues have been pushing for. This includes 3000 personnel, a command-and-control center in Monrovia, Liberia, a US Army general in charge of the process. The supply of 17 Ebola Treatment Units consisting of 100 beds per unit, much personal protective equipment, an education program, home health care kits, home test kits, among many other things that are much needed. Hopefully, this will turn around the trajectory of the epidemic. However it will depend on how quickly they get this material on the ground. I am off to the congressional committees. More later.
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Sept. 17, 2014 - Big day yesterday. POTUS announced military involvement in Ebola at CDC at the same time that I was testifying before a joint Senate Hearing of the HELP Committee and the Appropriations Committee. I testified with Beth Bell from CDC (Tom Frieden was at CDC with the POTUS visit), and Robin Robinson. I was questioned on the POTUS plan, the scope of the epidemic and the possibility of respiratory/aerosol spread of the virus. The latter was triggered by Mike Osterholm's (as usual provocative and attention-getting) statement that the virus could mutate and spread by respiratory and that would be the end of the world. Typical Mike Osterholm. I have been countering this with a reality check about likelihood versus hypothetical. Senators at the Hearing were Dems: Tom Harkin, Patty Murray, Dick Durbin, Jack Reed, Mark Pryor, Barbara Mikulski, Bob Casey, Al Franken, Sheldon Whitehouse, Tammy Baldwin, Chris Murphy and Elizabeth Warren and GOPs: Jerry Moran, Thad Cochran, Lamar Alexander, Richard Burr, Johnny Isaacson, John Boozman. Kent Brantley was witness on second panel. Another example of the WH and HHS press people messing up. They would not let me go on the many press requests (CNN, NBC, etc.) since they wanted Lisa Monaco (NSC) to go on. As it turned out, she was with the POTUS in his motorcade in Atlanta and so no one from USG went on and the media was saturated with the usual suspects (Laurie Garrett, Mike Osterholm, etc.) The WH and HHS press people are truly a bunch of idiot amateurs.
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Sept. 18, 2014 - Yesterday had Hearing before the House Subcommittee on Foreign Affairs (Africa) chaired by Chris Smith. On the GOP side were: Stockman, meadows, Burgess, Royce (Chair of Full Committee). On Dems side was: Bass, Cicilline, Engel, and McCollum. My co-witnesses were Nancy Lindborg (USAID), Luciana (Lu) Borio (FDA), Beth Bell (CDC). Recurring question was "Who is in charge?" Real answer is that multiple agencies/people are in charge depending whether it is health, infection control, logistics, etc. Kent Brantley again was on the second panel. Still much interest and interviews with written press and blogs over the ongoing "disagreement" between Osterholm and me on the issue of the virus mutating to respiratory spread. Ian Lipkin gave an interview on CNN agreeing with me and putting down Osterholm. Meanwhile, the House voted to give POTUS authority to arm the Syrian Free Army to fight ISIS. The situation continues to heat up with various mathematical models projecting anywhere from 20,000 to 100,000 to a soon to be published CDC model that would indicate if we do not have a highly effective control program, the number of cases could reach 500,000 within several months.
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September 19, 2014 - I continue to do small amount of press (as the press is getting some fatigue with the same story) with Swedish National TV interview as well as a FOX news appearance. Of note is the fact that the White House communications people are acting in a very bizarre way. During the past week I have been receiving requests for appearances on a variety of TV shows for the upcoming weekend including CNN and MSNBC on Saturday, September 20, as well as Face the Nation and Fox news on Sunday, September 21. The White House has refused to say yes or no to clearance and despite multiple requests on the part of our communications people, namely, Courtney Billet and Patty Conrad, we have not received a positive or negative reply for clearance. This has gone on into the late evening of Friday, September 19 despite the fact that the programmers were waiting for me to be on shows on Saturday. This is an absolute unacceptable disgrace. The White House because of their inability to decide what should go out on the weekends and their extraordinary and unexplainable need to control all messages is putting all of us in the embarrassing position of being unresponsive to legitimate media requests to discuss things that are not in conflict with anything else the administration is doing. This is unequivocally the worst administration I have ever dealt with when it comes to the need to control the media. This evening I had a very intense and somewhat poignant conversation with Tom Frieden at 9 PM to 10 PM concerning how we are going to approach the issue of vaccines. Tom still has considerable concern about a truly randomized controlled trial to determine the efficacy of the vaccine when the control is not one of the vaccines themselves. He continues to struggle with the fact that we are not going to be able to get efficacy data unless we do have a control arm which conflicts with the emotional need to get vaccine to everyone as soon as possible. The difficulty here is that we might in fact truly need an effective vaccine if the epidemic continues to expand and reaches the CDC projected model of 500,000 cases within the next several months. Under those circumstances we will absolutely need an effective vaccine and if we do not know if it is effective it will be very difficult to widely distribute it. This is a painful dilemma that hopefully we can work out. hether I have been discussing this by e-mail with Paul Farmer who is currently in Monrovia, Liberia. Paul is very sensitive to the fact that we need to do research to determine the efficacy of the vaccine and feels that we can pull this off in Liberia with a properly run trial. In this regard, the Minister of Health of Liberia has actually requested collaboration with the NIH in doing research on therapeutics and vaccines. It is going to be a difficult struggle to reconcile the emotional need of many people (in some respects including Tom Frieden) to distribute vaccine at the same time that we are not sure if it actually works or even paradoxically causes harm. I will continue to pursue discussions of clinical trial designs that might be able to get us where we need to be, i.e. proving efficacy at the same time as making vaccine available as quickly as possible.
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Sept. 20, 2014 - Went to reception tonight at the home of Hilary Rosen (Democratic pundit) at 4835 Hutchins Place, N.W. to welcome Megan Smith former VP at Google as the White House Chief Technology Officer. All the usual Washington glitterati were their (some examples: Judy Woodruff, Al Hunt, Andrea Mitchell, Bob Barnett, Tammy Haddad, Hunter and Kathleen Biden, etc. Megan is very impressive (MIT grad; Google exec) and we discussed the potential use of technology to address the Ebola epidemic - cell phone distribution, GPS tracking devices. Hopefully, she can help. Indeed, neither a yes or no from the WH and HHS regarding the requests for my appearances on TV over the weekend and so I did not appear. Instead, Face the Nation had Richard Schaffner from Vanderbilt and MNNBC had Laurie Garrett. This administration are a bunch of idiots.