Diary Prequel Package — page 253

Eric Goosby, Gayle Smith and David Lane, Jeff Crowley and Dana DeRuiter (White House); Lois Quam (USAID), Ariel Pablos-Mendez (USAID), Tom Frieden on the phone; Nils Daulaire and Howard Koh (DHHS) and others. Purpose of the meeting was to plan a strategy that the WH and the POTUS should take in addressing and utilizing the recent scientific advances associated with HIV prevention, particularly treatment as prevention (HPTN-052) in turning around the HIV pandemic. In essence it was a meeting to figure out how we can implement what I proposed in Rome at the IAS meeting in July, 2011. Eric Goosby and Gayle Smith want me to directly brief the POTUS on this. It remains to be seen whether this happens. Clearly, the activists want more money to go to PEPFAR for treatment and prevention. However, there are major budget constraints. The WH is afraid of demonstrations during the upcoming IAS meeting in Washington in the summer of 2012 - right before the election. They have to walk a fine line between promising more money, which will inflame the right and doing nothing, which will inflame the left. It seems that they are calling me in to help them with this. More later...... Sept. 13 -14, 2011 - Beautiful crisp sunny day in DC. Started 09/13/11 with breakfast at the Four Seasons in Georgetown at 7:00 Am with Bill Gates. Also present from the Bill and Melinda Gates Foundation (BMGF) was Stefano Bertozzi. The theme was that Bill is reluctant to fund (with NIAID) the proposed South Africa (RSA) and Thailand vaccine trial for licensure since he thinks that the companies are charging too much money for the protein (env - made by Novartis). In addition, he does not think that the results will lead to a marketable product. However, we need the private sector or else we will never get a vaccine made for HIV. The quid pro quo for us is that if we go with a regulatory (licensure) trial in RSA and Thailand, the companies (Sanofi-Pasteur and Novartis) will work with us on a research trial of comparing several products in RSA, which is what we really want. I convinced Bill that this was a necessary evil and that although it was an imperfect situation, it is still the only deal around since the product - Pox Vector + Protein boost was the one that gave the only positive result in a vaccine trial to this point (RV144 - conducted in Thailand 2 years ago). In addition, there are some possible correlates of immunity associated with RV144. We ended the breakfast with a mutual commitment to work together on this. Also, Bill had some interesting a bit "off the wall" ideas about making a universal virus vector into which you can insert genes of important neutralizing antibodies for different microbes that can be an instantaneous antibody factory for bioterror organisms as well as for HIV, merely by changing the insert. Also, Bill does not believe in treatment as prevention from a practical or logistic point of view. Went on to participate in a 2 day meeting run by the George W. Bush Presidential Center - "The Summit to Save Lives" held at the Mellon Auditorium on Constitution Avenue, N.W. I was on the panel to discuss the leveraging of PEPFAR resources and infrastructure to do screening and treatment of cervical cancer in Africa and Latin America. I studied up on HVP and cervical cancer and we the "scientific expert" on the panel that included Eric Goosby (PEPFAR), Grosbeck Parham (C0-Director of Cervical Cancer Prevention program, Zambia), Dr. Beatrice Wiaffe Addai - president of Breast Care International. Panel Chaired by Jennifer Griffin, National Security Correspondence,