Diary Prequel Package — page 258

Nov. 2, 2011 - 7:30 AM Get call from Rick Klausner who is having breakfast with Raj Shah and Rick wants to set up teleconference with the 3 of us at 11:00 AM to discuss the above issues. On the call Raj dances around a bit, but what he really wants is a big initiative using PEPFAR money. He does not say so explicitly, but that is really what he wants. He does not want the efficiency money to pay for 6 million of TAP by 2013; he want 5.5 million for TAP and the rest for a full-court-press initiative to see in a selected 3 countries if maximizing both non-TAP and TAP prevention will actually end the pandemic. I explain that there is not enough money to do this, and besides, the expectation is to TAP, not do a study to prove that it could be done. He agrees with me that we should do both within the constraints of budget. He is sure that the POTUS will like this initiative since it is a scientifically-based approach (give me a break!!!). The big elephant in the room is that USAID has been wasting $100s of millions on prevention approaches (like behavior change) that do not work. They should use this $ to do their proof of concept full-court-press approach, not try to siphon off PEPFAR money (I did not say that, but this clearly was the elephant). Raj wants the have Eric, himself and I put together another proposal to this effect. After the call Rick e-mailed me and asked for a follow-up call. On that call Rick explained that what Raj really wants is to spend all of the efficiency money on the 3 country demonstration project and that this would be the POTUS initiative. They (Rick and Raj) just do not believe that PEPFAR/CDC model. Also, (amazingly), Raj admits to Rick that the USAID has been wasting $100s of millions, but he is not up to taking on the USAID bureaucracy. Rick is disappointed in him and thinks that he is being weak and has told him so. However, rick is in favor of the concept since he has issues with PEPFAR. Based on this, I arranged a teleconference with Tom Frieden (at Atlanta airport), Eric, Charles Holmes, and some PEPFAR people and CDC people to discuss all of this. Tom Frieden was furious at USAID. He says that they have been wasting $ for years and now they question what CDC proposes, when CDC has been saying for years that they should have been scaling up AMMC and PMTCT instead of wasting money on behavior. Clearly, Raj is a young, brilliant guy who is extremely ambitious (that is OK), but he wants control of PEPFAR resources. Frieden is dead against this PEPFAR is obviously against this. So am I. The original question was to use efficiencies to scale up TAP, not to try something that USAID should have been doing all along with their own $. The idea of nailing down whether we can end the pandemic with a full-court press (FCP) is a good one, but there are no resources available. I propose that we do both the PEPFAR plan and the FCP, the latter with $ that we get from additional sources. White House meeting scheduled for Nov. 9. Everyone wants me there, but HHS will have to decide who the "Plus one" is with Sebelius. Of note, I am scheduled to go to Seattle on Nov. 9 for a town hall meeting and a seminar sponsored by Lee Hood and the Institute for Systems Biology. Bill Gates is trying to undermine the initiative on upscaling TAP. See e-mail below from MSF to me sent on 11/02/11: Dr. Fauci,