A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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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 They are just keeping me hanging, which usually means that the requests will be withdrawn by the media people themselves and they will find someone else.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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2014-09-20 00:00
Anthony S. Fauci
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.
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Sept. 21, 2014 - Had call at home from Leslie Dach wanting my opinion about a "dispute' between USAID and Tom Frieden about home care versus community based care of people with Ebola or suspected of Ebola in situations where the ETUs are full. I backed Tom who feels that doing it at home would be counter-productive. Leslie now relying on me as "the adult in the room" according to Peggy Hamburg.
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Sept. 22, 2014 - Tait Sye from HHS not giving me clearance to appear on CNN-Wolf Blitzer because "CDC will be putting out an MMWR today". What morons!! I just cannot believe this administration. I must write about this in my book. They so inappropriately try to control "messages" that they are laughable. POTUS decides to bomb ISIS in Syria. Ebola numbers expanding. Had another night time call with Tom Frieden trying to iron out the RCT issue. Also, Tom is very frustrated with Nicki Lurie, saying that having her around and involved in conversations is always counter-productive. Also, he is frustrated with Sec. Burwell, feeling that she seems only to want to "check the boxes" instead of getting involved in important decisions.
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Sept. 23, 2014 - Still working with Tom Frieden in trying to get agreement on whether to conduct an RCT of the vaccine. Tom remains concerned about a true control (placebo) arm and wants to do a Stepped-Wedge trial of sequentially vaccinated different cohorts without the simultaneous double blind control group. This evening went to the Annual Friends of cancer Research Awards Ceremony on the roof of the Hay-Adams Hotel. Gov. Deval Patrick of Massachusetts and Gov. Bobby Jindal of Louisiana received awards. Had good conversation with Gov. Patrick.
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Sept. 24, 2014 - On the last Secretary's call, Burwell tasked me to get the HHS team together and fashion out a consensus about the way forward following ending of phase 1 vaccine trial at NIH. I had long conversation with Tom Frieden this AM and he is starting to come around. Seems he will be OK with an RCT simultaneously done with a Stepped-Wedge Trial. I arranged a conference call at 5:30 PM with me, Tom, Nicki Lurie, Peggy Hamburg, Lu Borio, and Anne Schuchat. We came to agreement that we will do the two trials (RCT + Stepped Wedge) simultaneously. CDC (Anne and Tom) feel that the RCT may be so difficult to implement that the Stepped-Wedge approach might give us some information, while the RCT could fail. Cliff and I feel just the opposite. However, in order to get things moving, we came to a compromise. I will report this to the HHS Secretary's call tomorrow. Continue to have press interest: Bloomberg News TV; WTOP Radio; pre-show interview with CBS 60 Minutes for future show.