July 20, 2022 I just had an important conversation with Rochelle in which I related to her the conversation that I had last night with Carlos Del Rio in which Carlos articulated that there's a great deal of concern and agitation in the gay community, which I already am aware of, regarding the difficulty in getting TPOXX for the treatment of monkey pox. I decided to call Rachel and give her a heads up that the community is really starting to get very agitated to the point that they may be attacking the administration and her and the FDA and all of us in the press if we don't do something soon to cut down the difficulty in getting TPOXX to those in need. I suggested to her that she and the FDA think in terms of doing something akin to the parallel track approach that I initiated decades ago during the HIV pandemic. She will look into this with her people. I had a great meeting today in building 31 with Dr. Karl Lauterbach, the Minister of Health of Germany. He relied heavily very heavily on my advice about how to handle the decision about and distribution of booster shots for COVID in Germany. He is having some of nice laudation of me today: the same problems as we are having here in trying to decide what the correct booster should be in the fall. He has already ordered millions of doses of Moderna bivalent which is an omicron plus ancestral as well as Pfizer which is a BA.4/5 bivalent plus ancestral. Moderna is obviously pushing their product, but Karl was very interested in what my opinion was. I told him that on the advice of me and others, the FDA has already authorized the bivalent of BA.4/5 and ancestral for the full dose. It is now up to the CDC and teir ACIp to make a recommendation f who "should" versus "may" receive the dose. We also spoke about the tension regarding vaccinating people now who are at risk of severe complications given that there is a wave of infections in Germany as well as in the United States versus waiting until a more variant-specific boost is available in the fall. Germany is facing the same dilemma as we are in that some people in Germany are arguing in a very similar way to Paul Offit who is saying that we should not be vaccinating people now. Paul is smart and a good friend but he is a victim of what I consider making the perfect the enemy of the good. From a purely immunological standpoint it is obviously not optimal to have a boost now (ancestral) and require an even better boost (bivalend BA.4/5 + ancestral) just a couple of months down the pike. However, you have to balance the public health benefit of getting some form of vaccine to people who are at risk for infection and severe disease now compared to the relatively minor negative effects of giving a vaccine shot now followed in 2 to 3 months by a vaccine shot with a better boost. I was surprised that bloggers such as Paul Offit have a major impact globally. Karl mentioned to me that he and his colleagues listen very carefully to what I say and it would be very helpful to them to hear what I am telling him today and that I agree completely with him since he is absolutely in the same lane as I as well as many of my NIH colleagues including Rick Koup and others. It was a very stimulating conversation and I was on my A game. We then went on to discuss the issue of monkeypox. According to Karl monkey pox is out of control in Germany and similar to what we are seeing in the United States the gay community is very frustrated with the lack of as many vaccines as they need as well as the lack of easy access to antivirals. They seem to be having no trouble with diagnostics which are plentiful. I explain to him that our situation is very similar here in the United States. The conversation ended with him wanting to take a picture with me since his daughter who is 15 years old apparently is a great fan of mine. We exchanged cell phone numbers and he promised me that he would be calling me frequently. John Laureman (Bloomberg) wrote a very nice laudation of me today: An Early Farewell to America's Top Pandemic Expert July 21, 222 Harassment from the far right continues: ¥ Fauci: If Rand Paul Sends Message To Fauci: You'll Have To Testify Under Oath If GOP Wins. Fox News (7/20, 23.99M) reports, "Sen. Rand Paul, R-Ky., issued a warning to Dr. Anthony Fauci: If the GOP takes back Congress in the midterms, be prepared to testify under oath regarding the coronavirus pandemic." On Wednesday, he argued on "America Reports" that "the American people deserve the truth and answers on whether there was a cover-up for a lab leak in China." President Biden tested positive today (Thursday)! Tested negative on Tuesday, went to Boston on Wednesday; had mild sxs this AM and tested positive. https://www.whitehouse.gov/wp-content/uploads/2022/07/Letter-7.21.pdf Obvious media storm. He has mild sxs. I mentioned this to a sheesh during a briefing called this evening since we are all going on television tomorrow. Couple of interesting things related to the infection of the president. 1) I called up Kevin O'Connor who is the physician to the president and got a briefing from him for the simple reason then when I go out on TV and I'm asked whether or not I have been consulted with it would be rather embarrassing to say that they did not call the so-called most famous infectious diseases expert in the world, who happens to also be the chief medical advisor to the president. I explained to Kevin my concern about the anticoagulation. He understood my concern and said that he has started the president on low dose aspirin which is a good thing. Kevin explained that the president was negative for an antigen test on Tuesday, did not sleep well on Wednesday evening, and woke up on Thursday predominantly with fatigue. Tested himself on a routine basis which for him is 2 to three times per week. The test came back positive, confirmed by a PCR. Throughout the day he then began to get sniffles, at first a dry cough and then a loose cough. His temperature rose to 99.4 F, which came back to normal with tylenol. His oxygen saturation was 97 to 98%. He was resting reasonably comfortably when Kevin left him tonight. 2) We had a meeting with the comms people and Ashish Jha this late afternoon in preparation for media requests tomorrow. I was under the impression that they were going to spread out the request for morning shows between Ashish and me. I found out later in the evening that all the morning shows will go to Ashish and they will give me regional meeting in the afternoon. As mentioned several times above it is very clear that Ashish is trying to dominate the media scene with regard to COVID-19 and is telling his staff to lead me out of the major media hits. Again, he does a good job but it is a bit of Bush league to do that. I have asked Courtney to in Post article: communicate with the White House calms people and two in a very nice way ask them just what is going on here. Monkeypox continues to spread throughout the world. 15,000 cases worldwide in 70 countries; >2000 in USA: Monkeypox Virus Infection in Humans across 16 Countries -- April-June 2022 J.P. Thornhill, S. Barkati, S. Walmsley, J. Rockstroh, A. Antinori, L.B. Harrison, R. Palich, A. Nori, I. Reeves, M.S. Habibi, V. Apea, C. Boesecke, L. Vandekerckhove, M. Yakubovsky, E. Sendagorta, J.L. Blanco, E. Florence, D. Moschese, F.M. Maltez, A. Goorhuis, V. Pourcher, P. Migaud, S. Noe, C. Pintado, F. Maggi, A.-B.E. Hansen, C. Hoffmann, J.I. Lezama, C. Mussini, A.M. Cattelan, K. Makofane, D. Tan, S. Nozza, J. Nemeth, M.B. Klein, and C.M. Orkin, for the SHARE-net Clinical Group* The activist community is very angry. See Washington Post article: