A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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August 5, 2022 Met with Hans Kluge - WHO Regional Director for Europe. He is seeking my advice on multiple issues such as COVID, MPX, and vaccine related polio. He said the Europeans rely very heavily on my opinion: WHO/Europe @ @WHO_Europe Warm greetings as our Regional Director Dr @hans_kluge meets with Dr Anthony Fauci, = Chief Medical Advisor to @POTUS. Discussions include how Europe & the US can tackle #monkeypox, and prepare for a possible #COVID19 surge in the months ahead. #TransAtlanticHealthPartnership 3:13 PM: Aug 5, 2022 from Washington, DC - Twitter for iPhone Heard from Rochelle last night. Latest decision is that they wil hold off on the above announcement. Had meeting with Bruce Tromberg, Rochelle, Robbie Goldstein and CDC folks together with FDA folks (Rob Califf and team) and Steve Sha to try to get an agreement about guidelines for testing for isolation/quarantine when to stop isolation/masking, etc. We are coming to an agreement that is not perfect, but that is workable. Had another Zoom with the same team + Dawn O'Connell to explain to her our POTUS still positive on day 7 following rebound. ****Had a really major victory today resulting from a great collaboration between FDA, CDC, BARDA, me and John Beigel who was responsible for the design of a trial that would confirm that the study published in the journal Vaccine in 2015 by Frey et al and Bob Belshe showed that 1/5 the dose of the MVA monkey pox vaccine administered intradermally was as effective as a full dose of the subcutaneous administration. When we made this known to Bavarian Nordic (BN), lower level marketing people in the company objected strenuously, very likely because they saw this as a diminution in the need for full doses. Amazingly, they distorted the data and tried to marshal congressional support for blocking the use of the doses in the 1/5 dilution intradermally. This was an egregious attempt to interfere with the sound public health maneuver. To make a long story short when John Beigel showed all the data from the 2015 paper come it became clear that this was a very important way to expand the number of doses that were available. We finally got the leadership of BN to agree to continue to ship us the doses since their lower level people as indicated above were trying to block shipment in order to prevent us from distributing the vaccine in the 1/5 dilution. After much discussion with the FDA, we finally convinced them to issue an emergency use authorization (EUA) for the administration of the MVA vaccine in the1/5 intraderma; dilution. This is a major victory for the prevention of monkey pox because it turns 300,000 doses into 1.5 million doses and 1,000,000 doses into 5,000,000 doses. I consider this one of the major victories that I was a part of in trying to expedite the response to monkey pox. PRESS: WTOP Podcast with Luke Garrett & Megan Cloherty; CNN with Erica Hill; MSNBC with Andrea Mitchell;
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August 6, 2022 Continued drama now involving Larry Horowitz calling me up talking about how angry Ron Klain is at Rochelle for wanting to come out with a statement that the vaccines do not protect against infection at all. I have to look at the data but I think that although protection against true infection is low to modest at best, it is not zero and so I cannot figure out, and I am sure that this is what is bugging Ron, why the CDC needs to put that statement out now exactly at the time when we are pushing people to get the new BA.5 variant in early to mid-September.
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August 7, 2022 (Sunday) Long conversations with the CDC team (Sherri Berger; Rochelle), Steve Sha, Vivek, Kessler to get the wording correct on the condition to end isolation regarding testing and masking.
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August 8, 2022 For some time now the issue of "Long COVID" has been gaining momentum with much frustration in the community since recent studies showed that up to 20% of people develop more COVID following infection. Senator Tom Kaine (D-VA) has been a strong advocate for support since he is suffering for well over a year from long COVID characterized by dysesthesias. The NIH has been given $1.15 Billion to study long COVID. However, I have been very disappointed in the initiatives that have been brought forth under the leadership of NHLBI with Gary Gibbons and Amy Patterson as well as Walter Koroshetz. Rachel Levine is now been given the leadership for this at HHS. Recent description: Politico: Tim Kaine has long Covid. That's not moving Congress to act. While Kaine and other Democrats in the House and Senate are pushing for action, they have failed to gain meaningful momentum due to lack of GOP support. We had important conversations with activists James Krellenstein, Gregg Gonsalves, Peter Staley and Emily Bass regarding MPX vaccination. Peter alerted me today that James and other activists are concerned about misrepresenting the effective of the 1/5 approach to Jynneos (see above). I put together a hastily arranged Zoom at 12:45 PM to get us together and figure out what the problem is. The problem is that the activists are concerned that the data are not strong that 1/5 the dose of Jynneos intrasdermally (ID) will be protective. their argument is a bit inconsistent since the antibody titers induced by Jynneos ID are exactly equivalent to a full dose delivered subcutaneously (SC). The activists do not seem to be concerned about the efficacy of the SC dose, but they are concerned that we might be overselling the efficacy of the 1/5 dose. This may be an example of their making the perfect being the enemy of the good. It is much better to have some vaccine rather than no vaccine and so we needed to settle what their concern was since the FDA will be issuing tomorrow an EUA for the 1/5 ID dose. I got the activists on the zoom with Cliff, John Beigel, and me and we hashed it out. Peter Staley was agreeing with us and we finally got James and Gregg to come to the agreement that it is best to go ahead with the 1/5 ID program at the same time as trying to get data with a clinical trial that John will do as to the efficacy. That is better than having not enough doses and having a 5 minute notice getting the activist community together with my team to try and straighten out a potential disagreement. We had another zoom discussion with the HHS team led by Sherri Berger (CDC) to try to get the precise language for the CDC updating of their website discussion of the efficacy of the vaccine in preventing infection and transmission (see above). I believe that we got it right after a very good discussion among the group. The critical issue was to indicate that the vaccine protection against infection and transmission is only modest and diminishes with time. The concern was on the part of the White House that the CDC would say that it was zero. Now this is not really a consideration since the wording indicates in a positive way (by my suggestion) that although the protection against infection and transmission wanes overtime, that is a good reason why we encourage people to get the updated BA.5 bivalent boost. I believe we avoided a confrontation between the CDC and the White House which would have endangered Rochelle PRESS: Interview with Giuseppe Sarcina of Italian newspaper - Corrierre Della Sera;
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2022-08-09 00:00
Anthony S. Fauci
August 9-11, 2022 Global - 585,086,861/6,422,914; USA - 92,426,945/1,030,777 Cases and hospitalization plateauing but deaths still at ~300-400/day 1e CDC USA: 10,39 / Total confirmed monkeypox/orthopoxvirus cases Monkeypox: Daily confirmed cases req Today rong Breage ----, (cat -- mated: ci ieiped Stated Be) Paka) fan Seen ne Uniied Kingdom 1m Germany Cardeda cay Portugal Bethan len a -- = SS : : a ' Mae 12, PO Mary 30, POG?
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Aug 11, 2022 Source: Data produced by the "Global.health' team -- available at github.com/globaldothealth/monkeypax CC BY v>
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August 12, 2022 Deaths seem to be up a bit at around 400/day! yn data _and WY, some not available Cases ) hosp. admits Deaths iTs reported** st positivity** Total to date 92,426,945 5,121,355 1,030,777 935,100,009 9.4% Most recent 7-day daily Week-on-week day* average change 130,945 103,614 6,266 6,003 omitted due to 947,772"* +3.0%** reporting lag 16.8% -0.8 pct. pts.
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Aug 12, 2022 Source: Data produced by the 'Global.health' team -- available at github.com/globaldothealth/monkeypox CC BY 35,000 cases of MPX globally:
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August 13, 2022 More drama with regard to the CDC and Rochelle Walenski. After much going back and forth between the CDC and the other docs including me, Vivek, Steve Cha, and to some extent David Kessler, we thought we had gotten them pulled back from making the statement that the vaccines were not effective at all in preventing infection and transmission. The reason this is an issue is that if they came out with that statement, which in fact is not entirely true since there is some degree of modest but declining protection as you would expect, then this would conflict with the statement and effort of recommending that people get the updated bivalent BA.5 vaccine in September. In addition, it would undermine the DoJ's efforts at mandates for vaccines under certain circumstances. In any event, the CDC agreed to pull back on the statement of absolute lack of efficacy of vaccines against infections and transmission and take a more measured approach of saying that the vaccines provides only modest and waning efficacy against infection and transmission and that is why we should heed the advice of getting the updated booster in Sept. However, although they did this on their website, the MMWR that cam out yesterday had the same original damning language. When Larry Horowitz and Ashish noticed this, Larry went off the wall and in a somewhat agitated manner called me up this AM and said that this is the last straw and he was sure that when Ron Klain gets back from Spain this weekend he would fire Rochelle. Ashish was more measured and seems to have come to the conclusion that sooner or later (maybe not right now) Rochelle would have to go. Let us see what happens.....probably nothing