Wednesday, June 19, 2002

Most extraordinary day!! The POTUS requested that I join him and Secs, Thompson, O’Neill, and Powell and Sen. Frist and Andrew Natsios at the Rose Garden Ceremony to announce the MCTC plan that Mark and I essentialy created. I met with the Pres for about 10-15 minutes in the Oval Office before the announcement. He was extremely gracious and complimentary. During the announcement, he specifically thanked me for all that I have done with the project. After the annoucnement, I went with Ari Fleischer and gave a press briefing in the WH press room on the program. Importantly, the Pres. asked Josh Bolten to meet with me and get my feel for the big picture of what the Adminsitration should be doing with AIDS (domestic and global). Present at the meeting were me, Josh, Margaret La Montagne Spellings, Robin Cleveland, Jay Lefkowitz, Gary Edson, Kristen Silverberg, Allen Gilbert. Josh asked whether we should do a Manhattan Project for a vaccine and not invest in international prevention and treatment. He said that I should assume that money was not an issues and I should tell them what is ”the right thing to do”. I gave details about the importance of building a sustainable (low tech) infrastructure of clinics and trained Africans. This infrastructure could then be used for HIV prevention and ulitmately treatment, but could also be used for approaching malaria, TBC, and other important diseases. I said that the USA needs to be the world leader in making international health a driving force in our foreign policy. If we lead, other countries will follow. Josh seemed genuinely moved and agreed with me. He even stated that it is his feeling that years from now, this Administration will be judged by how it handled the International HIV/AIDS Pandemic. He stated that the Pres. was very sympathetic to me and what he has heard me say on various occasions, but there is a skepticism that money will be wasted if there is no accountability. This is also fed by Paul O’Neill and Mitch Daniels. I said that I agree that we should not do it unless there was strict accountability. We need to have someone to run the program who could ”kick ass”. Josh and I resonated very well. I believe that the WH will be calling upon me soon to help with such a strategic plan. In fact, I am going to proceed to put one together and present to them pre-emptively. It was a great day!!! I may have accomplished more for global health on this day than on many, many others put together. July 7-12, 2002 – XIVth International AIDS conference in Barcelona. – Very important conference. The science was completely overshadowed by the policy, which in turn was dominated by the discussion of the incredible numbers and projections for the developing world. Latest figures are that approximately 40 million additional infections will occur worldwide by 2010 and up to 70 million dealths will occur by 2020 if serious intervention (prevention and therapy) are not implemented. I gave a highly scientific talk and used it to come to the conclusion that we must implement treatment and prevention for the North and the South. Please see records on my speeches for the full text of the talk. It was a Plenary Lecture on July 10. I spent much time with Secretary Thompson and his team (Terrell Halaska, Tony Jewell, Bill Steiger et al). There was an aggressive demonstration against Secretary Thompson during his address on Tuesday, July 9. I was with him and predicted to him exactly what would happen. I had heard from Gregg Gonsalves that ACTUP would demonstrate for awhile and then allow him to speak provided that he would meet with them afterwards. He agreed to meet, but they shouted him down and although (as per my suggestion) he calmly finished his speech, the audience could not hear what he said. This was unlike Secretary Sullivan in San Francisco when the TV and microphones allowed audiences (TV and present ) to at least here what he said. I helped Secretary Thompson with the Press (backstage)immediately after the shout-down. There was an issue that I handled. During the conference 2 days before the demonstration, at a Press Briefing during which I sat next to the President, the Press asked about needle exchange. Tommy G. Thompson (TGT) was not briefed on this issue and I told him briefly that we (Fauci, Jeff Koplan of CDC, David Satcher – Surgeon General, Alan Leschner – Director NIDA and others) had recommended to Donna Shalala upon review of the scientific data that the Clinton Adm. allow Federal funding of needle exchange. However, based on objections of Gen. McAffrie (Drug Czar) and certain Black leaders, Clinton would not allow it. (Of note Clinton was at the AIDS Conference in Barcelona and publicly stated that he regretted that decision and wished that he had allowed needle exchange). In essence, I told TGT that Clinton did not allow it and we (current administration) are not allowing it. This created a bit of a stir in the press since when asked at the press event (backstage) after the demonstration, he seemed confused about the dichotomy between scientific data and policy. I had to come in and explain the issue. I made it very clear that based on the scientific data, I had recommended that Clinton allow exchange. TGT said that he would ask Dr. Fauci to go over the data again, which the Press did not buy since they know the data are absolutely conclusive. It was a little awkward for TGT, but he is going to have to face the issue that the Bush Adminstration will likely do (and is doing) exactly what the Clinton Administration did and follow a policy that contradicts the scientific data. An important event at the meeting was a meeting that I arranged in my hotel (Fira de Palace) among myself, Mark Dybul, Cissy (?last name) and Peter Mugyenyi from Uganda. Peter is the Director of the Joint Clinical Research Center (JCRC) in Kampala. He is successfully treating many Ugandans with antiretroviral therapy (ART). We (Mark and I) want to use his model to try to implement the plan that Josh Bolten asked me about (see above and below). Peter showed us his plan of a main center with regional satelites and subgroups out of the satelites. These are low-tech clinics and each cost about $30,000.00 which is much less that the proposals that we have heard. I was very impressed with this and plan to use this as a model to put together a program to present to the WH (see below) It was a great meeting for me in that I became even closer (if that is possible) to TGT. He implicitly and explicitly trusts me and my opinion. I appeared on the Aaron Brown Show on CNN during the conference and this went extremely well.