Read Tony's Diary: The Prequel (Part 5 of 8)

Wisconsin Avenue
and Fessenden.   Discuss the Qatar initiative, see above and below.  But, conversation
turned to Raj Shah and the PEPFAR/USAID story.  Bottom line is that Raj has been
talking with Rick and it appears from Rick and my prior conversation with Raj that Raj is
not against treatment as prevention (TAP); however, he does not like the model and want
to do it differently.   (More on Qatar later – stick with USAID/PEPFAR for now)
Released by Chairman Rand Paul
256Nov. 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,
Released by Chairman Rand Paul
257Congratulations on getting NIH-supported HIV research the airing it
deserves at the highest levels of government. We are all looking
forward to Secretary Clinton's speech at the NIH next week.
We are trying to use the USG momentum to leverage new commitments from
the UK for World AIDS Day. So far DfID and other government actors are
interested in a "step up" initiative that we have also been pitching to
USG, South Africa, and Germany to pay for implementation of accelerated
treatment.
Today we had a bit of a minor set back: the Secretary for Development
Andrew Mitchell just heard from Bill Gates at a Tory event "Friends of
International Development" that HPTN 052 will not yield great effects
and the role of ART in limiting incidence is more limited than what is
being portrayed. It was unfortunate.
It would help greatly if the policy makers in government could hear the
science themselves. If the All-Party Parliamentary Group on AIDS
invited you to give a briefing, and we arranged for high-level
meetings, could you attend? Would an invitation by civil society and
MSF suffice? And, hardest question of all-- do you have any free days
where you could be in London in November?
Thank you,
Sharonann
--
Sharonann Lynch
HIV/AIDS Policy Advisor
Access to Essential Medicines Campaign
Médecins Sans Frontières (MSF)
Tel: +1.646.824.3066
Email: sharonann.lynch@msf.org
Also see below e-mail from Nov. 3 from Michael Iskowitz describing what
the community actually is hearing about.   It is amazing how things
leak sinceI have told no one what I am doing regarding USAID, PEPFAR
and the WH.
Finally, tonight (11/02/11) went to Book Signing party at Hay-Adams
Hotel for Chris Matthews on his new book “Jack Kennedy – Elusive Hero”.
Another example of the A group of Washington.   It is clear that at age
70, being on the public/political/media scene for >30 years, I am
extremely well-known and even friends with so many public figures, who
merely on the basis of my being on TV/Radio/newspapers, etc. and the
fact that we run into each other at so many of these functions have
gotten to know me well.   Just a sampling of people at event: Andrea
Mitchell; Alan Greenspan; Sens. Chris Dodd, John Kerry; Rep. Ed Markey,
Jim Moran; Howard Feinman; Murrey Jacobson; Luke Russert; Gloria
Borger; Joe Scarborough; etc.   Had animated conversation with my
friend Ed Markey regarding the disgraceful conduct of the Banking
Industry and Wall Street.   The “Occupy Wall Street” movement is
gaining momentum.  The Republican scramble for the nomination is hot
and heavy
Released by Chairman Rand Paul
258Nov. 3, 2011 – Incredible day.  Theme is my trying to hold together the
evolving proposal to scale up combination prevention with treatment as
prevention (TAP) being a major component of the scale-up as described
above.  Tension is USAID and Raj want to spend most of the efficiency
money on concentrating and ending the epidemic in 3 chosen countries as
opposed to going with the PEPFAR/CDC/FAUCI plan of scaling up
combination prevention across the board and doing a demonstration full
court press (FCP)in selected pockets of the countries that we have
selected: Botswana for CDC; Zambia and South Africa for NIH; Tanzania
for USAID.  Spent all day on calls individually with Tom Frieden, Eric
Goosby, Mark Dybul, Raj Shah (in the evening).   Raj call was at the
suggestion of Rick Klausner who says that I am the only person who can
broker a deal between PEPFAR and USAID.   We need USAID to support our
proposal at the WH meeting next week (Nov. 8 – the evening of
Secretary’s Clinton’s speech at NIH.   I have cancelled Seattle to ne
at the WH meeting.   WH house wants me and Frieden to represent HHS,
i.e. “plus 2”.   Mark Dybul agrees somewhat with the need to have a
bold announcement as per Raj, but we all know that there is no new
money.   Rick also feels that way.   However, what neither of them
fully appreciate is that the “demonstration project” described above is
in reality a FCP in a selected group within countries.   I had
important call with Raj.   I leveled with him and said that although he
is proposing putting all of the PEPFAR efficiencies towards a FCP in 3
countries and scrapping the PEPFAR Plan, he should look to “clean his
own house” and create efficiencies within USAID and use that money to
scale up the 3 country approach and make it more of a FCP, i.e. I am
proposing a “hybrid” of the PEPFAR plan and the USAID plan since we all
need each other and we need to provide the POTUS with a proposal that
is scientifically sound, bold, yet not unrealistic, and that does not
require significant new money.   Of note, Hillary Clinton will propose
$60 million of her money to beef up that “demonstration project”  I
called for a meeting tomorrow to see if Raj, Eric, Tom and I could
figure out a compromise with me as the referee.
Also see below e-mail from Nov. 3 from Michael Iskowitz describing what
the community actually is hearing about.   It is amazing how things
leak since I have told no one what I am doing regarding USAID, PEPFAR
and the WH.
tony dearest.
i just wanted to thank you for helping to create and drive another landmark moment in AIDS
history.
i continue to do consulting with eric -- who remains forever grateful for your friendship and
extraordinary leadership.
i am honored to have have many decades now of watching you work your magic -- forever urging
that if we remain steadfast and
follow the science, together we will win.
bless you for -- behind the scenes and in front of the cameras -- shaping another historic
moment.
know that i talk with eric frequently and if there is anything i can for you directly -- please know i
always stand ready.
thank you for being you and for all you do for the world,
if i am not at the NIH on tuesday -- i am certainly there in spirit!
much love,
michael
Released by Chairman Rand Paul
259Nov. 4, 2011 – I cancelled most of my AM calendar to attend meeting at
8:00 AM in Eric’s OGAC (Office of Global AIDS Coordinator) office at
2100 Pennsylvania Ave, N.W. (suite 200).   At meeting was the 4 of us.
After about 90 minutes I got everyone to accept the “Fauci hybrid
plan”.   Raj agreed (as I suggested last evening) that he come up with
about a few hundred million in efficiencies from USAID.   Eric will try
to find more efficiencies from the PEPFAR “Pipeline”, all to beef up
the demonstration project and perhaps include another country such as
Nigeria.  However, we will all need to see if our respective
demonstration projects could effectively absorb an additional few
hundred million $.   We will work on this over the weekend.  More to
come.
Also today met with Dr. Abdelali Haoudi, VP for Research of the Qatar
Foundation at the recommendation of Rick Klausner with whom I had
dinner on Nov. 1.   Great meeting with Abdelali.  Introduced him to JJ
McGowan, Kathy Zoon and Marv Kalt to help him with using the NIAID
model to get his Qatar intramural and extramural program set up.   I
think that we could turn out to be friends.
Nov. 5-6, 2011 – Continued strain between USAID (Raj) and PEPFAR (Eric
and Charles) in that Raj just does not want to give in about pushing
for “doing things differently”.   Nov. 5-6 is the weekend and
Department of State (Lorrie McHugh – communications) as well as Cheryl
Mills are lining up people (activists, etc.) to write blogs in
anticipation of Sec. Clinton’s Speech at NIH.  Her speech (which I have
been deeply involved in writing follows the PEPFAR model, not the USAID
model.  They have asked me to do an editorial for the NY Times giving
the scientific basis HRC’s speech.  I worked all weekend and got a
great piece which I have circulated to Cheryl Mills, Burklow (NIH),
HHS, etc.
Nov. 7, 2011 -  Full court press in preparing for Clinton visit and
speech.   Again, I get call from Raj Shah wanting me to support his
“doing things differently”.   I believe that he really does not fully
understand what PEPFAR is trying to do.   He wants to scale up heavily
in high impact countries and not go for just scaling up prevention and
TAP. We are too far down the pike to change now even if we decided to
change.  Hillary’s speech is tomorrow as is the White House Principal’s
meeting in the Situation Room.   Ariel Ramos seems more convinced that
the PEPFAR model will work now that he has examined the models more
closely; however, Raj is still skeptical.
Nov. 8, 2011 -   Beautiful, crisp, sunny Fall day!   Fabulous event
with Clinton visit.   Francis and I greeted her at the South entrance
of the NIH Clinical Center.   Also waiting in background was Harold
Varmus and Nora Volkow.   Warm and engaging conversation with HRC.   I
showed her a picture of her and me at the Clinical Center during her
first visit in Feb., 1994.   I welcomed all of the dignitaries to the
Masur Auditorium, said some warm words (see files) about the
relationship between HRC and me and then introduced Francis Collins who
introduced her.  She gave a great delivery of the speech that I helped
write.   Overwhelmingly positive response from audience and press and
bloggers immediately after.   I sent in my Op-Ed to the NY Times (see
Released by Chairman Rand Paul
260files) and then went to White House for Principals Meeting in Situation
Room at 3:45 PM.   Present were: Hillary Clinton, Jack Lew (OMB), Denis
McDonough (NSS), Chaired by Tom Donoline, Samantha Powers, Tom Frieden,
Raj Shah, Eric Goosby, Gayle Smith, Ariel Pablos-Mendez, etc.   We
agreed upon Option #2, which is greater efficiencies to provide more $
and scale-up of non-Tx prevention as well as increasing the PEPFAR
target for prevention  to 6 million by 2013 and 8 million by 2015.  I
stressed to Tom Donoline that the POTUS should strongly call upon more
involvement by other donors, particularly China.   He agreed.   Of
note, Susan Rice teleconferenced in from NYC and she voted strongly for
Option $3 (Blue Sky), which would require an additional $2.5 Billion.
This is a good sound bite, but Jack Lew pointed out that given the
budget situation, the POTUS would have to back off on commitments that
he has already made to other programs in order to do this.  Hillary
pointed out that this was not tenable.   She also pointed out that we
needed to address the ADAP waiting lists.
Amazing situation.   After returning from the White House, I heard from
Courtney Billet and Greg that HHS contacted us and said that although
they had no problem with the Op-Ed (see above) and actually cleared us
to send it to NY Times, the “White House” told HHS to have recall the
Op-Ed since it is “off message”.   Still not sure what they mean since
State, HHS and everyone else approved it.   Could be because I called
for more resources as well as more “efficiencies”
Another amazing situation – At around 7:00 PM, Raj Shah calls me up and
asks me to call a meeting with him, Eric and me to see if we could
modify the proposal that was agreed upon at Principal’s Meeting!!!.. He
still insists that the POTUS needs to come out with something
“different” and suggests using “pipeline” money from PEPFAR/USAID.   He
wanted me to broker the meeting.   I contacted Eric and bless his
heart, he is willing to meet.   Meeting scheduled for 8:30 AM in Eric’s
office tomorrow.
Nov. 9, 2001 – Still no information on why the WH ordered me to recall
my Op-Ed.   Have e-mailed Gayle Smith (NSS).  I will explain situation
to her tomorrow and see if she has any insight.
Meeting did not occur at 8:30 AM because of scheduling issues.  Will
try to do a call tomorrow
Nov.10, 2011 – Got some insight from Gayle, but am afraid she is not
telling me everything.  She claims that she heard discussion about my
Op-Ed at the WH, but not by WHCOMS.   Issue was whether it was a good
idea to put it out right after HRC’s speech since it already got  great
PR and so why waste a Fauci Op-ED.   Perhaps better to wait until the
POTUS does World AIDS Day.   This could be true, but who knows?   Gayle
did say that the OMB people might have been concerned by the couple of
words that said we need significant increases in resources, including
from other donor countries.  This implies needing more USG resources,
which would obviously bother OMB.   However, I could easily have
changed this to say we need significant new resources FROM other donor
countries.   In any event, Gayle assured me that the Op-Ed was not “off
message” in the substance of its content.   We will hold onto it for
now.   Having said this, here is another example of the ridiculous need
to control the “message” on the part of this White House.
Released by Chairman Rand Paul
261Back to the Raj Shah intrigue.   On Raj’s suggestion, Yesterday’s
scheduled meeting now a phone call among me, Eric, Raj, Tom Frieden.
Raj wanted to again bring up the possibility of doing something ”big”
since he feels that the POTUS will not have another opportunity.  After
much discussion we explained to Raj again that “Blue Sky”, i.e. $2.5
billion will never get by OMB or the Congress and even so, the best way
forward according to the models is not to just pick out a few countries
and full-court-press.   Raj goes along and we think it is over.
Apparently, immediately after the call, Raj calls Rick Klausner asking
him to convince me to not give in and adopt his plan.  Rick calls me on
my way to The Inn at Little Washington for my delayed 70th birthday
present from Denise from last December.  We are in the limo (rented by
Denise) and Rick tries to convince me to re-convene the group.   He
says that Raj feels that I am the only one who could do this.  Raj just
does not want to give up.   However, out of want to go the extra mile,
I will call up Eric and Tom.
Nov. 11, 2011 – I call Eric and Tom and explain situation with Raj.   I
convince them to give it one more try. Both are extremely skeptical,
impatient and wary of Raj.  However, I indicate that we must ask Raj to
be very specific in what he wants to do and how he wants to do it and
where are we going to get the money.   Raj has always been very vague
about all of these issues.   He just keeps saying that what Eric is
proposing is old stuff and incremental and that he wants to suggest to
the POTUS something big and transforming.   I will write an e-mail and
detail the conditions of another teleconference and/or meeting.
Nov. 15, 2011 – At the invitation of Alan Murray (Senior Editor of Wall
Street Journal) I spoke at the Wall Street Journal-sponsored CEO
Council event at The Four Seasons in Georgetown.   My purpose was to
convince the CEOs to get involved in supporting financially and
otherwise the Global AIDS Pandemic activities.  They were OK, but
somewhat clueless about the importance of global AIDS.   In retrospect,
billionaire philanthropists would be a better audience.
     That evening went to a reception at Bill Heseltine’s house for
Geena Davis.   She remembered our prior discussions during her visit to
NIH.   She is lovely – very tall, but lovely.
Nov. 19, 2011 – Gave Keynote Address at the Caribbean AIDS Conference
in The Bahamas.   The Atlantis Hotel is surrealistic.
Nov. 21 – 30, 2011 – Spent hours on the phone trying to address the
ADAP waiting list since we (HHS/PEPFAR) felt that if the POTUS
announces a scale-up of treatment for PEPFAR, then the logical question
is what are we doing about the ADAP waiting list?   Tom Frieden
suggested that we engage the drug companies.   Since I know Jim Rooney
from Gilead, I made the initial contact which led to many phone calls
involving Jim and people from Gilead; people from HHS – me, Tom
Frieden, Mat Wakefield (HRSA), Sally Howard (chief-of-staff to
Sebelius), Dora Hughes as well as people from NASTAD and Welvista.
Important issues is the Gilead agreed to greatly lower their prices for
people on ADAP waiting list
Dec.1, 2011 – World AIDS Day (WAD).  A very special day.   The White
House has decided that the venue for the POTUS statement on WAD would
be George Washington University in a program sponsored by One and RED,
Released by Chairman Rand Paul
262Bono’s organizations.  Sanjay Gupta was the MC.   We had Presidents
Bush and Clinton by live video conference and President Obama delivered
the speech that Eric Goosby, Tom Frieden and I and others wrote for
him.   As expected, he went with Option #2 (see above – Nov. 8, 2011).
In addition, he included an additional $15 million (for Clinics) + $35
million (for States) = $50 million for ADAP total.   Again, Tom Frieden
and HHS people (see above) have been working on the “domestic option”
for the past couple of weeks to offset criticism that we were paying
attention to global, but not domestic AIDS.
    Following the POTUS speech, there was a panel moderated by Sanjay
consisting of Bono, Alecia Keys, Kay Warren, Rep. Barbara Lee, Sen.
Marco Rubio and a few others.   I was told a few days prior that Sanjay
would turn to me with a question sometime during the program.  Right
after Pres. Clinton’s live video speech, Sanjay said that you cannot
have a discussion about HIV/AIDS without including Tony Fauci (who is
in the audience) and his perspective on the science and he turned to me
to speak.   I spoke for a few minutes about the fact that the
scientific data were overwhelming (circumcision; treatment as
prevention, etc.) and the task now was to implement the science.   The
statement was similar to what I had said at the IAS meeting in Rome in
July.   Right after my comment, Bono said that he must tell a funny
story and he proceeded to describe the night when he came to my house
for dinner to discuss what we could do to push the global AIDS agenda.
He was cute.  He said that his friend Bobby Schriver told him that the
only person that could break the logjam on Global AIDS programs was
Tony Fauci.  He finished by calling me a “proper hero”. A YouTube
record of this statement by Bono is available for Dec. 1.  Also, I had
a chance to say a few words to Pres. Obama as he was “working the line”
following his speech.   He congratulated me for the great work that we
were doing and that he has been hearing about.   All in all, a really
good day!!
Of note, Gregg Gonsalves wrote a scathing letter to Raj Shah (that went
viral on the internet) scolding him for obstructing the treatment as
prevention initiative (see above discussions re: Raj).   Unclear to me
how Gregg found out about all of this.
Dec. 2,, 2011 – Finishing off WAD activities, went to Harvard on a
beautiful crisp clear December day and participated in the AIDS@30
International Symposium.   I gave the keynote “Perspective” on vaccines
and participated in a panel Chaired by Bruce Walker and consisting of
Bob Gallo, Nelson Michael, Jerry Sadoff, and Julie McElrath.   Flew up
to Boston with Eric Goosby and flew back to DC with Nelson Michael.
All good.

Dec. 2 thru 21, 2011 -  Significant issues regarding dual use research.
Check press from Dec. 20-21, 2011.   Briefly, NIAID funded 2 studies –
subcontract via CEIRS (Centers of Excellence for Influenza Research and
Surveillance) to Erasmus University in Netherlands (Ron Fouchier) and
grant to Yoshi Kawaoka at Wisconsin to study feasibility and mechanism
of getting the highly lethal (60%), but poorly transmissible H5N1 (bird
flu) that has been smothering in SE Asia since 1997 to become
transmissible and maintain lethality in a mammal model (ferret).
Rationale for the study was to determine – Can it happen (in mammals)
since many people reasonably assume that it cannot since it has not
done this in nature despite being around in chickens and rarely in
humans since 1994?   Also, if it does become transmissible by point
Released by Chairman Rand Paul
263mutations followed by passaging in ferrets (the experimental
methodology), then what is the signature of it so that health officials
in the field could do better surveillance and also design better
diagnostics, therapies and possibly vaccine.  Both papers (with slight
differences found that relatively few mutations (~5) followed by serial
passage in ferrets led to virus that had better transmissibility and
kept virulence. Kawaoka paper showed increased transmissibility but not
maintenance of virulence, while Fouchier paper showed both.  Papers
submitted to Nature (Kawaoka) and Science (Fouchier).  Program staff
(NIAID), Fouchier and editors asked (because of possibility of dual
use) the NSABB to examine the results and advise if it was OK to
publish. Kawaoka was asked by NIAID to do the same.  To everyone’s
surprise, the NSABB recommended that the papers be published with the
conclusions, but with redaction of the key results, mutations and
methodologies.   I believe that this was group think and “cover your
ass”.   Decision was to do this and provide a link in the paper whereby
people (health officials, legitimate scientists, PHARMA, etc) who have
a need to know can have access to the data.   This was a precedent
setting recommendation that was virtually impossible to ignore even
though I disagreed with it since the complexity of influenza
adaptability is extremely complex and it is unlikely that terrorists
could replicate this work largely because it is unlikely that if that
this model just simply predicts that it will maintain these
characteristics if taken from ferret to human. Furthermore and more
importantly, since the data had already been presented (by Fouchier) at
an international meeting in Malta and the papers were reviewed by
several reviewers and known by many, the data are already “out their”
and would be virtually impossible to “restrict” the access to the full
papers by a “vetting” mechanism of people who “apply” for the
unredacted papers.  Journal editors were disappointed (Bruce Alberts –
Science and Phil Campbell – Nature) as were many flu scientists.
However, we heard the usual hysteria from people like Ebert and
Ingelsby who complained that the experiments should never have been
done in the first place.  Also, Mike Osterholm who is a member of the
NSABB was practically hysterical that the NSABB recommendations should
go out right away so that he could “answer all of the press calls” that
he was getting.   In reality, the only press that was agitating was –
you guessed it – Laurie Garrett. Of note, Mike Osterholm is the Head of
the CIERS group that subcontracted through the Mount Sinai group to
Fouchier to conduct these experiments.   Osterholm now (incredibly)
says that he never thought that this situation would arise when he knew
about the contract and actually was given updates through the CIERS on
the actual data.   Yet, he is the loudest one saying we should now lock
down all experiments and treat this like BSL-4.   Problem here is that
as I predicted, the White House is now involved and they want the USG
to examine all research that is ongoing and that is proposed for its
dual use potential and to put restrictions on it if it has such
potential.   What they do not understand it that in the “discovery of
science” you cannot always predict what will be dual use and the danger
is that scientific work and importantly the normal open discourse of
science will suffer because some uninformed people who live for
“intrigue” are acting out their own agenda.   More later.
Dec.22, 2011 to Jan. 7, 2012 -  Situation has escalated with wall-to-
wall conference calls with HHS and a variety of WH folks about what to
do.   Major issues are that Bruce Alberts and Phil Campbell are willing
to publish a redacted version of the papers in Science and Nature,
Released by Chairman Rand Paul
264respectively; however, they insist that the USG have in place a link or
some mechanism that they can publish with the redacted versions of the
paper that would allow legitimate scientists and Public Health
officials to have access to the entire manuscript.   I found out
through painful probing that recommendations from NSABB   guidelines 
USG policy should have been in place years ago to deal with the
upstream (prior to the start of experiments) and downstream (progress
reports and communication of results) issues of Dual Use Research of
Concern (DURC).  Problem is that the recommendations of the NSABB as to
the “7 deadly sins” of DURC never got “clearance” from the multiple
agencies to which NSABB officially reports (DoD, DHS, DoS, DoJ,
intelligence community) in order for it to get the Public Comment in
the Federal Register to give the scientific community the opportunity
to weigh in on the feasibility of controlling or not such research at
the same time a preserving the fundamental basis of open scientific
discourse.   I believe that Amy Patterson should have shown some
greater strength of leadership to make sure that this process moved
along, when in fact it just froze. The NSABB sent in their
recommendations in 2007 (NSABB started in 2004) that should have become
guidelines  USG Policy that ultimately could guide the local
institutional Biosafety Committees (IBCs) to monitor this at the local
level.   Irony is that now the papers have been reviewed, the Fouchier
paper was presented in an international meeting in Malta and multiple
people have seen the data. BTW, Fouchier has been acting like a jerk in
his cavalier attitude about disseminating the results. Now NSABB and
the journals above all want a mechanism is a few days (to coincide with
the publication dates of the papers (Jan. – Feb. 2012) that they have
not been able to do in 4-5 years.   All of the demagogues have weighed
in. People thinking that the world is not in danger of a terrorist
making a “killer virus” that spreads easily.  What is at stake is the
proper balance of doing microbial research that has DU potential with
security issues.   Of, note, I wrote an opinion piece in the Dec. 31,
2011 issue of the Washington Post on the value of the science. The
security people do not understand the scientific enterprise, although I
can understand their concerns.  This whole thing has destroyed my
Christmas Holidays.  It still is not over.   Divergent opinions in the
scientific community ranging from 1) this work should never have been
done in the first place (Ebright; Ian Lipkin) to 2) we should not
restrict publication of any of the data and should just let it out
(Racaniello; Peter Palese) to 3) we should publish only redacted
version (which is ridiculous since the data are out already) to 4) we
should destroy the virus (D.A. Henderson).    Please note that the
complexities of species adaptability to virus transmission and
lethality is so complex that just because multiple induced mutations
followed by passaging in ferrets of 1 strain of H5N1 does not mean that
this virus would do the same in humans or that anyone else could
replicate the experiment. Of great importance is the fact the Fouchier
found out (but DID NOT submit it with his paper to Science – he wants
to put it into a second paper)that if you take these 5 mutations and go
back and put them into the wild-type H5N1, you do not get increased
transmissibility, which proves my point (and that of Jeff Taubenberger)
that transmissibility is a multi-genic process that is strongly
“context-dependent”.  In other words, just knowing these 5 mutations
may have little impact on someone’s ability or not to repeat these
experiments.  Let me be clear, I believe that we need to now once and
for all get the process going of a SOP for evaluating dual use research
Released by Chairman Rand Paul
265of concern (DURC) before the experiments are performed to evaluate the
risk/benefit of even doing the experiments and to periodically look at
the data to determine whether the data should be shared (presented or
published) before one presents it or submits it to a journal. I think
that there was major multifaceted failure here of NSABB covering their
asses with the recommendation; researchers wanting attention for their
work; failure of Amy Patterson’s shop to get their job done over years;
panic and hubris on the part of USG agencies who know nothing about
science.   I can go on and on.  The problem that we are facing now is
that we (USG) is being put in an untenable position of be involved in
and associated with restricted (or as some say “censoring”) scientific
information when it is already out there.   The process sets a bad
precedent and it evokes all kinds of conspiracy theories and makes us
look foolish.   My choice at this point would be to admit that it is
too late in the process – we should publish the unredacted papers and
make this an “Asilomar moment” to make sure that we are not in this
position again.
    Of note, on Jan. 7, 2012 a NY Times (written by Phil Boffey –
unsigned – I know because he called me about it) came out with an
inappropriately alarmist editorial entitled “Engineered Doomsday”
calling into question the rationale for the research and asking for
lock down of virus in BSL-4 and ultimate destruction of virus.   He got
most of his information from Ian Lipkin (my good friend) who feels
strongly about this and was nice enough to tell me that he was going to
do this.   This editorial has only inflamed the hysteria and posturing.
Jan. 15, 2012 – I still believe that there is no reason for the
Journals insisting that the papers (redacted) need to be published by
end of Jan/early Feb.  Why not wait until this mess in openly discussed
in an “Asilomar-like” setting.
Jan. 16 – 21, 2012 - Major development pushed by my decision to be much
more proactive in this process.   Too many people were posturing and
playing the “sound bite game” – Richard Ebright (who is a complete
asshole), Mike Osterholm (with whom I am becoming progressively more
disillusioned with due to his hysteria) and other well-meaning people
who just like to comment, like D.A. Henderson. I never liked the fact
that the journals (Science and Nature) were on a fast track to publish
when we still did not know how we were going to develop a system to get
the unredacted manuscripts only to “those who had a legitimate
scientific need to know”.  We were getting significant pressure from
the White House via HHS to make sure that there are no surprises with
other such projects appearing.   In addition, additional data were
leaking out from Ron Fouchier’s group having WH/HHS asking whether we
should be shutting off their funding.   I became concerned over the
possibility that outside (non-scientific) influences would force us to
set a bad precedent and stop funding these flu projects.   Therefore, I
took the bull by the horns and contacted Fouchier and strongly
suggested that he and the flu scientists call a moratorium (60 days) on
all work dealing with increased transmissibility and/or virulence of
highly pathogenic H5N1 virus.   At first, Fouchier was reluctant to do
so since he felt that this would be an admission that what he did was
dangerous and that he was backing down.   He totally disagrees with the
NSABB recommendations.  In addition, I felt and told this to many in
the press that we need to get more international involvement in this
situation with WHO playing a major role.   I felt that people were
concerned that this was too much of a USA-centric situation and the USG
Released by Chairman Rand Paul
266was driving things that affect many others outside of USA.   I agree.
Therefore I agitated and accomplished that WHO (Keiji Fukuda) should
hold a meeting in Geneva to add an international component to this
situation.
Importantly, on Wednesday, Feb. 18 I called Ron Fouchier in his home in
Rotterdam (actually I e-mailed him and asked him to call me) at 4:30 PM
DC time – 10:30 PM Rotterdam time.   I strongly suggested that he call
a moratorium on this work and encourage his flu colleagues to also do
so.   He was not totally convinced and said that he would consult with
the others tomorrow (Feb. 19) AM and get back to me.   I emphasized
that it is likely if he does not do it voluntarily that forces beyond
our control (i.e. the security people) would force us to defund the
work.   The next morning he called me and said that they had agreed to
call a moratorium for 60 days and see what the Geneva meeting brings.
Furthermore, Francis Collins and I called Bruce Alberts (Science) and
Phil Campbell (Nature) and convinced them to delay the publication
until at least March.  Fouchier came out with a press statement on Feb
20 and Francis Collins and I came out with an NIH statement the same
day applauding their decision.   This was a good example of my having
to take the bull by the horns since things were not going in the right
direction.   Now we wait to see what happens.  There was wide coverage
in the press about this “breakthrough” in negotiations with big stories
in Washington Post, NY Times, Wall Street Journal, etc.
Jan. 23, 2012 - Went to Situation Room in the White House at 3:15 PM.
Cold, very damp, gray day.   Purpose to discuss the H5N1 situation and
brief the National Security Staff (NSS) about my upcoming trip to the
Geneva meeting scheduled for Feb. 16-17, 2012.   Present at the
meeting:  John Brennan (Chief, NSS), Heidi Avery (Deputy Chief),
Francis Collins, Amy Patterson, Bill Corr (Deputy Secretary-HHS), Sally
Howard (Chief-of-Staff to Sebelius), Bill Shultz (OGC-HHS).   NSS
concern was what we would agree to or not at the Geneva meeting.   I
tried to explain that the information was already out there and
multiple papers have already described the methodology.   I explained
that what I wanted to get out of the meeting was a transparency to
others about what we are trying to do in order to get away from this
USA-centric perception.   Of note, after the meeting, Heidi sent an e-
mail to Bill Corr saying that there are certain “redlines” that we
should not give in to at the meeting.  I fear that she is not fully
getting what I want to accomplish at the meeting.   Also, of note, she
mentioned in her e-mail that she does not want total unbridled
availability of the information in the papers (her “redline”) even
though she knows that certain USG scientists do not agree with her.  I
am certain that she is referring to me.
Feb. 11, 2012 – The past couple of weeks have been intensively involved
in discussion about the H5N1 issue.  Extraordinary “legal” issues come
up about what can and cannot be discussed in public.   I pushed for and
it will happen next week for a WHO meeting to make all of this more
transparent and international.   The issue is what can and cannot be
discussed at this meeting.   There are 2 options to allow discussion at
the meeting: 1) an “export control license” from the Dept. of Commerce
that restricts discussion to the people listed on the license, i.e. all
the attendees at the meeting or; 2) An advisory opinion from the dept.
of Commerce saying that the information is intended to be published by
the journals and therefore the expert control requirement does not
exist. Some subterfuge has gone on with HHS in getting the journals to
Released by Chairman Rand Paul
267say that they have every intention of publishing the papers without
restrictions (which is not true) just so that they can get an advisory
opinion.   The problem is that since Commerce grants both the export
control (which assumes restriction) as well as advisory opinion (which
assumes open publication without restriction) you cannot have it both
ways.   Bottom line is that based on the journals declaring that they
intend to publish an advisory opinion will be granted.  I expressed my
concern that this was not entirely honest, but it went ahead anyway.
This is something that I do not control.  I leave for Geneva on Feb. 14
for a meeting on Feb. 16-17, 2012.
Feb. 13, 2012  -  You really cannot make this up if you tried.   They
(HHS, DoC, White House) have finally decided that we all need export
control licenses to go to Geneva.  The DoC and HHS are working
feverishly to get them on time before we all (me, Nancy Cox, Paul Keim
– representing NSABB) leave for Geneva.  The entire process has been
ludicrous with regard to the concern over security as well as the
craziness of the laws related to export control licenses.   Export
control was originally designed as a multinational agreement to protect
against the shipment of sensitive products such as computer chips,
weapons, etc. to countries with whom we (USG) or other countries have a
problem with.   In this case (uniquely), the export control applies to
shipping of information or even being in a room where information
(sensitive) is shared.   In this case, the information is the H5N1
unredacted manuscripts.   I need an export control license (even though
I am not taking anything with me) to go to Geneva and I must name on
the license everyone who will be at the meeting.   I cannot do this
since the WHO will not release the names of the attendees until the day
of the meeting and so DoC cannot put in for a license for me.  OK, we
get the names and then Tom Countryman from State has deep concern that
we are even going to such a meeting to discuss potentially sensitive
information.   We calm him down and then the White House (John Brennan
and Heidi Avery) do not want Fouchier to discuss the 9 mutations that
are capable of giving the ferrets transmission/lethality without the
requirement for passage among ferrets (more below on that).  They only
want him to discuss what is in the unredacted paper (5 mutations +
passage).   They (through Sally Howard of HHS) want me to call Ron
Fouchier to ask him to not mention the 9 mutations and to restrict his
discussion to the paper.   The discovery of the non-passaged virus’s
ability with 9 mutations by reverse genetics to allow
transmission/lethality is not contained in the paper.   Now here I am
(very uncomfortably) asking Ron to voluntarily withhold any information
both during the question period and the discussion about the other 4
mutations that together with the original 5 make a wild type H5N1
transmissible/lethal in ferrets without the requirement of passage.
Ron reluctantly agreed because he wants the meeting to occur and the
White House said that the meeting will be nixed if we discuss the 9
mutations.   Here is the irony of this all.   The meeting was called by
WHO to add “transparency” to the process and to preserve the PIP
agreement so that the Indonesians and Vietnamese do not feel that we
are withholding information from them and a White House condition for
supporting the meeting and allowing me to go is that Ron “withholds”
information if asked about the obvious questions that any virologist
would ask, i.e. if you took a wild-type H5N1 (cloned) and only inserted
the 5 mutations, would it transmit in ferrets – answer = no.   Then
what did you do?   Ron would answer that the virus after 5 mutations
(commonly known in the literature) + 12 passages obviously also
Released by Chairman Rand Paul
268accumulated other mutations besides the original 5 (3 + 2).  Ron then
did deep sequencing of the transmissible virus and by reverse genetics
figured out that you needed the 5 + an additional 4 (now he says less
than 4).   This was not in the original manuscript (unredacted).
White House does not understand that the 5 mutations + Passage = the
unpassaged 9 mutations.  They fixate about not mentioning the precise 9
mutations when anyone can just take any quasispecies and get a
transmissible virus after many passages.   You just need a virus and
some ferrets.   I again am very uncomfortable in asking Ron to hold
back this information and told him that this would be his choice and he
would have to play it by ear at the meeting, but he will try his best
to be vague about the 9.   Another ludicrous happening is that this
export control issue must also get input from the iPC (interagency
Policy Committee) which includes DoD.   The night before I am leaving
for Geneva (tomorrow on 5:47 PM flight) DoD says that they want to know
when I am leaving since they are not sure that I can go since they want
the WHO to disinvite the Chinese (where the disease is occurring) since
we (USG) do not share restricted information with them.  They fail to
realize that Margaret Chan (Director General of WHO) is Chinese!!!!!
You cannot make this up.
    DoD is examining this issue tonight and will let me know tomorrow
if I can go to Geneva.
Feb. 14, 2012 – Approved at the last minute (literally) that I can go
to Geneva and was granted an Export Control License for me, Barbara
Jasny (representing Bruce Alberts of Science), Paul Keim (Chair,
NSABB), and Yoshi Kawaoka (author of Nature article)
Feb. 16-17, 2012 – Geneva – Astounding!! During Ron’s presentation of
the data, I asked the “transforming” question that exposed the
confusion that has been propagated regarding the study.   It relates to
the uncoupling of the issue of aerosol transmission from deadly
pathogenesis.   Bottom line is that the aerosol-transmitted virus when
transmitted to uninfected ferret, not only does not kill them, it does
not even cause significant disease.   At worst, some mild flu like sxs.
See below for my detailed description of the data gathered from the
papers, the Geneva presentation together with discussions during the
Geneva meeting including a dinner at Keiji’s home with Ron, AB
Osterhaus, Keiji Fukuda, and Yoshi on the evening of Feb. 15 (more on
that later) as well as extensive discussion by phone with Ron after I
returned to USA on Feb. 19 and 20, 2012. Recommendation (consensus) of
the WHO-convened group was to 1) respect the PIP agreement; 2) extend
the voluntary pause (“moratorium”) on H5N1
transmissibility/pathogenicity research; 3) Delay publication of the 2
manuscripts until the safety and security issues of such research could
be solidified for others.   General agreement that the experiments of
Yoshi and Ron were carried with safety and security that met or
exceeded the guidelines; 4) After meeting conditions in #3, then
publish the manuscripts in full; 5) discussion that the publishing of
redacted manuscripts with mechanism for vetting and distributing to
those with a need to know was completely impractical.   This point was
fortified by the almost unbelievable and counterintuitive requirements
of Export Control Licenses.   There was a unanimous recommendation for
everything except the recommendation to publish.   Nancy Cox did not
comment, but Paul Keim and I stood by the recommendations of the NSABB.
In the roll-out after the meeting in Geneva, Keiji at first messed up
and said that everything was “unanimous consensus”, which is an
Released by Chairman Rand Paul
269oxymoron.   Christ Feig is a former CNN producer and old friend of mine
and is the communications director for WHO.   I noticed the slip-up and
she got Keiji to correct while still on the TV press conference.   E-
mails were going back and forth from me to HHS (Bill Hall) to some of
the NSS people when he made this mistake, but everyone calmed down
after he corrected it.   I was in the unusual position of officially
sticking with the NSABB recommendation while being the one who actually
led the WHO discussion to come to this point.  The smart reporters like
Jon Cohen and Helen Branswell picked this up and were sympathetic.
The decision was written up on the front page of the NY Times by Denise
Grady on Sunday.   It was interesting how she quoted me with an
articulate explanation of why the WHO group came to this decision at
the same time that she mentioned that I stuck by the NSABB
recommendations.   Anyone with insight could figure out what I did.  Of
note, Paul Keim did not realize that the aerosol-transmitted H5N1 did
not make the animals ill, much less kill them!!! There was a media
storm after the decision was announced. See below for summary of
meeting:
Sunday, February 19, 2012
Summary of discussion at the WHO Geneva Meeting on Feb. 16-17, 2012 plus additional
discussion with Ron Fouchier and Yoshi Kawaoka.
Anthony S. Fauci, M.D.
Fouchier Experiments (Science)  and related information:
Fouchier worked with a high pathogenicity (HP) H5N1 influenza virus obtained from a patient in
Indonesia (A/Indonesia/5/05).   He had been working for 4 to 5 years on trying to study the
transmissibility of H5N1 for the purposes of determining the molecular aspects of increased
transmissibility.  His attempts at developing an H5N1 with increased transmissibility in a
mammalian model have failed up to now.
Recently, he used the already existing literature to identify the mutations that have been
reported to be associated with the emergence of previous pandemics (1918 H1N1, 1957 H2N2,
1968 H3N2, 2009 H1N1 and other non-pandemic outbreaks, e.g. 1977 H1N1).  He analyzed
these and determined the 3 mutations that statistically seemed to be associated most closely
with emergence of pathogenic pandemic viruses.  Again, these mutations have already been
reported in many published papers.
With regard to the “technique” of passaging in ferrets, there are many papers that have
appeared in the literature for decades (since the 1930s) describing the ferret passage technique
to increase transmissibility.   This is similar to passage techniques widely used to adapt a virus to
a particular species.   It has been done in mice, monkeys, etc.   Usually (not always), when
viruses are passaged in a particular species, as they gain transmissibility, i.e. species-specific
adaptation, they develop decreased pathogenicity, i.e. attenuation.
Released by Chairman Rand Paul
270Fouchier took these 3 mutations and inserted them into a wild type (WT) HPH5N1 (see above).
This technique is widely used in molecular virology.  He then passaged the virus 10 times in
ferrets.  “Passaged” means inserting the virus into the nose of the animal, getting the animal to
get infected, then taking virus from the nasal passages of the infected animal and inserting it
into the nasal passage of the next animal in the sequence, and so on.   The endpoint that is
aimed at is to get a virus that is then able to be transmitted by aerosol (i.e. not relying on direct
insertion into the nasal passage).  Since ferrets sneeze when they are infected, one determines
“aerosol transmission” by housing an infected ferret in a cage next to a separate cage of an
uninfected ferret that is constructed such that an aerosol can get from one cage to the other
due to “holes” in the barriers between cages.   The virus resulting from the passaging was able
to be transmitted by aerosol and was a “quasi-species”, i.e. it contained different “versions” of
the mutated virus.  The viruses that were transmitted by aerosol were then sequenced and all of
these viruses had 5 mutations in common:  the 3 mutations that were inserted by reverse
genetics and 2 additional ones.  In addition, the viruses had 4 to 7 variable mutations (this latter
sequencing information was not ready for reporting in the original manuscript).   This virus
isolate was used in the pathogenesis studies reported in the manuscript.  It was the isolate with
the minimal number of mutations (9 mutations  -  5 common mutations  + 4 variable mutations).
After submission of the manuscript the authors took a wild-type H5N1 clone and inserted this
minimal number of mutations to develop a virus that was transmissible without the need for
passage.  The pathogenesis studies with this cloned virus were identical to those of the isolate
reported in the manuscript (see below).
It is EXTREMELY IMPORTANT to point out that the animals that got infected by aerosolized virus
described above did not die nor did they get sick. They were followed for 14 days.  A few got
minor flu-like symptoms, all recovered, they then were sacrificed since logistically the author
could not house them indefinitely.  Thus, the “engineered” virus that was made transmissible,
did not kill or make the animals sick when exposed in the manner that flu in transmitted in
humans.
PATHOGENICITY.  The classic way that influenza virus pathogenicity is established (well-
described in the literature) for the ferret model is by direct insertion of the virus into the nasal
cavity and/or directly into the trachea.  Fouchier did both nasal and tracheal insertion of the
viruses.
In the nasal insertion studies , 106 (1 million) infectious doses of virus is inserted into the nose.
This is a dose that far exceeds a dose that one gets through aerosolized virus (i.e. sneezing).
When this dose of the pandemic  2009 H1N1 virus (not considered a particularly pathogenic
virus, particularly in people who have been exposed to H1N1 over years by infection or
vaccination - children who are naïve to this virus have had more problems) is inserted into the
ferret, the animals develop flu-like symptoms but do not die.  When HPH5N1 is inserted the
animals essentially all get neurovirulence, they recover, none die. When the modified (aerosol-
transmitted) H5N1  virus is inserted, there is some neurovirulence, but actually less
neurovirulence than with the wild typeH5N1.  Again, all recover and none die.
Released by Chairman Rand Paul
271In the tracheal insertion studies, 106 virus is inserted directly into the trachea.  Again, this is a
dose and a situation that would be extremely difficult, if not impossible, to achieve by
aerosolized transmission.  In these experiments, when this amount of wild type (unmodified)
HPH5N1 is inserted into the trachea, all animals die on day 3.   Similarly, when the modified
H5N1 is inserted, all animals die on day 3.   However, and importantly, when 2009H1N1 that
was shown to be a mild pathogenicity virus was inserted under the same conditions, it killed
some, but not all the animals.  Although, this was a qualitative and not a quantitative study, it
strongly suggests that in this model, the modified H5N1 is not dramatically different from the
2009 H1N1 in pathogenicity.   Also, it should be pointed out that in the ferret model, 2009 H1N1
is much more transmissible (100% transmission on day one) than is the modified H5N1.
Specifically, transmission with the modified H5N1 does not occur until day 3 to 4 and even then
it is only 75% transmissible.   This suggests that the R 0 may be less than 1.   This is important with
regard to concerns over the potential catastrophic effects of lab accident and the known
conditions that are needed for the start of an epidemic/pandemic.   In this regard, there should
be serious discussion of how pandemics occur.  Nancy Cox can elaborate.
Ferrets are naïve to influenza virus, i.e. they have no pre-existing immunity.   Humans do have
pre-existing immunity to influenza viruses due to repeated exposures (except in young children)
and/or vaccinations.  It is EXTREMELY IMPORTANT to point out that if you vaccinate the ferrets
with seasonal H1N1, they are not protected against death from tracheal insertion of high dose
(106 infectious doses) modified or wild type H5N1.   Fouchier did not test the effect on
transmission yet (moratorium).  However , if you pre-infect ferrets with seasonal H1N1, let them
recover and then insert high dose H5N1 into their trachea, this fully protects against disease and
no ferrets die.   This strongly suggests that pre-existing immunity due to prior infection with
seasonal influenza A protects against serious disease with this modified virus (heterosubtypic
immunity).  This could be a possible explanation for why so few people get infected with H5N1
in the wild.
Yoshi Kawaoka Experiments ( Nature).   The studies of this investigator are very similar to those
of Fouchier except that Kawaoka took the HA from the HPH5N1 and did random mutations from
which he selected those that enhanced transmissibility when this HA was reassorted with the
2009 H1N1to make a hybrid of the H5N1 and the 2009 H1N1.  This is something that we are
concerned could happen in the wild.   He then did similar passages as described above.
Kawaoka’s results differed from the Fouchier study in that although his virus was transmissible,
it was not any more pathogenic than the 2009 H1N1 influenza.
EPIDEMIOLOGICAL DATA:   With regard to the importance of these data for the real and present
danger of the evolution of H5N1 in the wild, as well as for the impact on surveillance, Kawaoka
and Fouchier have done some epidemiological “mapping” of their modified virus with what is
going on in the wild.   Viruses were studied that were obtained from chickens in Japan,
Mongolia, Nepal, and Egypt as well as viruses from people infected with H5N1 in Egypt.   Some
of the mutations that Fouchier and Kawaoka described involving the PB2 gene (627 K) and the
receptor binding genes (HA) were present in 100% of the H5N1 viruses that infected humans
Released by Chairman Rand Paul
272and only in 30% of the chicken viruses.  This suggests that the viruses that accumulate the
mutations in question are the ones that transmit from chickens to humans. In addition, many of
the viruses circulating in chickens are only 2 to 3 mutations away from the mutations described
by Fouchier in their modified viruses.
People will argue that knowing mutations cannot help predict or alert public health officials to
what will emerge as a pandemic.  They state that since viruses have several routes to get to
where they want to go, i.e. to be able to be transmitted, the studies in question should not even
have been performed.    However,  historically, after pandemic viruses emerge and infect people
and then you go back and trace what was evolving in birds, or (more importantly) in mammals
you see a pattern where you could have actually traced and connected the dots pointing to the
emergence of a pandemic.  This was clearly the case where the pandemic  2009 H1N1 virus was
evolving in pigs for at least 10 years and was “working its way” towards human transmissibility.
If there had been better surveillance in both pigs and humans as to what was evolving, then as
Tom Frieden has said, we could have had a major head-start on the 2009 H1N1 virus.  What the
Fouchier and Kawaoka viruses tell us is that the virus in the wild is creeping towards a virus that
they have shown is capable of transmission in mammals, presumably including humans.
Whether the virus ultimately uses that precise pathway or those precise mutations is not clear,
but clearly these studies are critical to understand the process of evolution and adaptability of
viruses that are a real threat of working their way to transmissibility in humans.   Not making
these data freely available to scientists only slows down the necessary work and the incentive to
get more scientists involved, and does not really provide a serious terrorist with any additional
advantage since these techniques have been widely available for years.  An uninformed terrorist
would not be able to do this.  An informed virologist-terrorist just needs to go to PubMed to
easily figure out what was done and how it was done.   Not publishing the work may do more
harm than good by discouraging legitimate scientists from getting involved.   Clearly, there
needs to be assurance of biosafety and biosecurity in the laboratories that work with
transmissibility of H5N1.  The laboratories in question (Fouchier and Kawaoka) have met or
exceeded our standards for these types of studies.
Redacted versus Unredacted:  The impracticality of redacted versus unredacted manuscripts
was clear to everyone at the Geneva meeting and the likelihood of the unredacted manuscripts
ultimately reaching the internet were important factors in the consensus at WHO to publish in
full after a pause to assure biosafety and biosecurity and to have a better articulation of the
benefits of the research as described above.
The way forward. People are making incendiary statements without really having discussed
with the investigators the precise details of the experiments as described above.  The
interaction of the NSABB with the investigators (Fouchier and Kawaoka) was on a relatively brief
conference call.   Much additional information that was available during the intensive 2 day
discussion in Geneva was not available to the NSABB.   My recommendation is to reassemble
the working group of the NSABB for a face-to-face meeting with the investigators, security
Released by Chairman Rand Paul
273people, international public health people (similar to the WHO meeting) and a larger number of
influenza experts with hands on expertise in such studies.
Post- Geneva:     Have spent the past few days explaining the above summary to HHS, White
House NSS X 2.   Could not comment too much to the press.
Feb. 22, 2012 -   Briefed the NSS in the Situation Room with Heidi Avery leading (I had pre-
contacted her explaining that I had to do the briefing and she agreed), Laura Holgate and Brian
Kamoi from NSS, Kris Beardsley (more of her later), Francis Collins, Amy Patterson, Nancy Ann
De Parle, Bill Shultz (HHS OGC), Bill Corr (Deputy HHS Sec.).
Feb. 21-24, 2012 – had conversations and e-mail exchanges with Ron Fouchier trying to work
out that he re-submit a manuscript and that the NSABB reconvene to review with the new data
and the clarifications from Geneva.   Also, spoke with Journal editors to try and get them to
agree (which they did) to hold off on publication, but agree to quickly consider a revised
manuscript.    Of note, during the Feb. 22 Situation Room meeting, I outted Kris Beardsley as a
“leak” to the NSABB.   Paul Keim had asked how things were going right after we returned from
Geneva (see e-mails on file).   I told him that I was about to brief the WH on Feb. 22.   He said
good luck and that he already had spoken to Kris Beardsley.   I did not return e-mail, but I was
astounded.  She is NSS!!!.   Now it became clear that the NSABB people were directly trying to
get to and agitate the WH through Kris and also with Mike Osterholm getting to Rick Weiss, the
Press person for John Holdrin at OSTP.  Rick is a former Washington Post reporter.   I believe
that Paul Keim is OK, but it is incredible that Kris Beardsley and Rick Weiss are doing this.   In
order to make sure that Kris would not undermine my presentation to Heidi and the NSS, I
started my explanation (see summary above) by saying that I know that Paul Keim has briefed
Kris about part of this a day or so ago, but I will give a little more information since I spoke with
Ron after the WHO meeting and Paul did not.   Kris almost fell through her chair and Heidi gave
her a very mean look followed by a statement that we have only one point of contact with
NSABB and that is Fauci.   Clearly Heidi not only was not briefed by Kris, she had no idea and was
extremely pissed that Kris had spoken about this with Paul.   Paul is advisory to HHS and NIH and
NOT to the White House.
BTW, I have been completely wearing myself down by this getting virtually no sleep and doing
1000 things at a time that are very heavy, i.e. White House stuff, Press misinterpretation. Mike
Osterholm acting in his usually hysterical manner, Laurie Garret getting it wrong as usual.
OF GREAT IMPORTANCE:  How is it possible that everyone got it wrong?   Why did not anyone
ever ask the “Fauci question” that I asked in Geneva of Ron.    This includes the reviewers of the
papers, the entire NSABB including the Chairman Paul Keim, the outside influenza expert called
to advise the NSABB (Rob Webster), the editors of the Journal.   After I briefed him, Bruce
Released by Chairman Rand Paul
274almost comically stated. “You know, I knew there was something funny here when I read the
paper and found that after aerosol transmission, blood samples were taken from the ferrets for
12 days.   If the ferrets all died in 3 days, did they take samples from dead animals?”   Clearly his
own editorial staff did not pick it up.   There is plenty of blame to go around.  Clearly Ron did not
say in the manuscript that the aerosol-transmitted animals died, but he never said in the
manuscript that they did not die.   Clearly he was doing what many scientists do, i.e. play up
their own data to make it seem exciting.   Yet, he knew that the media were clearly getting it
wrong.   He will say that he was never given the chance to explain this to the NSABB and his only
comments to the press that they clearly misunderstood were before the NSABB and he did not
realize that they misunderstood.   However, after the decision of the NSABB, he still spoke to the
press, yet never made it explicit what really happened.  He could claim that at that point he
could not discuss the data since it was confidential and the press could not ask the specific
question sine they did not see the data.  It is clear to me that a lot of people are embarrassed for
not asking the Fauci question and as human nature goes, people are running for cover and/or
looking to blame someone.   Ron is in danger of getting thrown under the bus when the press
finds out that he never clarified things.   As an example, ABS World News on Saturday PM, Feb
18 had a piece showing all aerosol-infected animals dying schematically on the screen with the
ever-present Laurie Garret commenting that “This virus just should not be allowed to exist”.
See Important e-mails below:
Thursday, Feb. 24, 2012 11:26 AM
Ron:
    In follow-up of our previous conversations,  it is important for you to revise and
expand your manuscript to include the important new data that were presented in
Geneva.   In addition (and this is critical), you need to make exceptionally clear the
differences between the transmission studies and the pathogenicity studies, i.e. the
response that you gave to me when I asked that direct question in Geneva whether there
was any illness or death in the animals that had been infected by aerosol with the
engineered highly pathogenic H5N1.   You responded that some of these animals
developed flu-like symptoms, all recovered, none got seriously ill and none died.   This
seems to be the key point about which many people were and are confused.   It would be
very important to make this exceptionally clear in the manuscript. There are also other
important data that we discussed that would be important to include in a revised
manuscript.   I believe that the best course of action would be to resubmit this revised
manuscript  to the NSABB so that they have the opportunity to have all of the data that
we discussed in Geneva  in front of them as well as to directly question you in person in
order to clarify any important points.   Amy Patterson will request that the NSABB meet
and review this manuscript.   As I had mentioned to you, Francis Collins and I have
spoken to Bruce Alberts about the importance of your having enough journal space to add
the  new data and a broader discussion of the issues.  In our initial conversations with
him, he seemed amenable to this approach.    Obviously, we cannot know for sure what
the journal decision will be.  Francis and I will be speaking to Bruce again today (I hope)
Released by Chairman Rand Paul
275and we will bring this up to him.   However, the important issue is that the NSABB have
the opportunity to see the expanded manuscript as described above.
    I would be happy to discuss this further with you.   Please give my office a call at your
convenience at (301) 496-2263.   I am not available between 12:00 and 12:30 PM and
3:30 – 4:00 PM   Washington time.
Best regards,
Tony
Anthony S. Fauci, MD
Director
National Institute of Allergy and Infectious Diseases
Building 31, Room 7A-03
31 Center Drive, MSC 2520
National Institutes of Health
Bethesda, MD 20892-2520
Phone: (301) 496-2263
FAX: (301) 496-4409
E-mail: afauci@niaid.nih.gov
______________________________________________
Tuesday, Feb. 21, 2012 to Paul Keim
Paul:
   Line-up and tasks sound good to me.   We should strategize by phone on how to handle
discussion of the WHO meeting.   I have a meeting at the White House tomorrow to brief
the security people on the WHO meeting and the outcome of those discussions may
impact our decision on how to handle this.  We should talk after that.
Best regards,
Tony
Tuesday, Feb. 21, 2012 from Paul Keim referencing Kris bearsdley
Good luck with the meeting. I've prepping Kris today on the issues.
Paul Keim, PhD
TGen/NAU
On Feb 21, 2012, at 5:41 PM, "Fauci, Anthony (NIH/NIAID) [E]"
<AFAUCI@niaid.nih.gov> wrote:
Paul:
   Line-up and tasks sound good to me.   We should strategize by phone on how to handle
discussion of the WHO meeting.   I have a meeting at the White House tomorrow to brief
the security people on the WHO meeting and the outcome of those discussions may
impact our decision on how to handle this.  We should talk after that.
Best regards,
Released by Chairman Rand Paul
276Tony
Feb. 23, 2012 -   Finally, a pleasant evening.   Attended reception at the Jefferson Hotel
for the Global Health Corps (GHC) created and led by Barbara Bush, George W’s
daughter.   Great reception.   It was a fund raiser for the fellows of the GHC.  Laura Bush
was there and she and Barbara during the speeches called me out for praise for all that I
have done for AIDS research.   All the GHC fellows were so happy to meet me since they
had been hearing about me for years and now were meeting me.   I met Marvin Bush,
George’s brother.  The usual crew was there – Mark Dybul (host), Eric Goosby, Stephen
Hadley former National Security advisor to GWB.   Many other luminaries.   The
Ambassador for Woman’s issues of DoS mentioned in her speech how much Sec. Clinton
admired me.
Feb. 25, 2012 – Went to a (now commonplace for me) dinner at Café Milano hosted by
Catherine and Wayne Reynolds in honor of Gov. Jerry brown (D-CA) and his wife Anne.
Brown in DC for Governor’s Convention.   Sat next to Anne and got major insight into
the Gov.   He was known as Governor “Moonbeam” in the  70s during the hippy years
when he dated Linda Ronstadt.   However, he is an amazing person in that he just tells the
truth without an obvious ideology.   Anne told me that Pres. Obama completely shuns
even other Democrats such as Democratic Governors.   Obama has never once asked
Jerry for any advice about anything.   It was a lively evening talking about the
Republican Primaries and the ridiculousness of it with Romney vs Paul vs Gingrich vs
Santorum. Other usual notables at dinner. Chris and Kathleen Matthews, Supreme Court
Justice Anthony Kennedy.   I sat next to his wife Mary who is extremely conservative
and not too bright (scary),   Also there was Bob Barnett and his wife.   NPR Nina
Totenberg and husband David, Peter Agre, etc.
Feb. 27, 2012 – Briefed the senior, but sub-Interagency Policy Committee on the Geneva
meeting. Chaired by Laura Holgate from NSS (National Security Staff).  Also present
were Brian Kamoi (NSS – he has lost about 90 lbs. and looks great); Sally Howard
(Chief-of-Staff to Sec. Sebelius); Kevin….. from Commerce; a bunch of representatives
from the various US Government departments.  Tom Countryman from State Department
is really a jerk, pompous and uninformed.   I alleviated the anxieties of the group
regarding the studies by clarifying the difference between transmission and virulence in
the Fouchier study.   I strongly suggest that we reconvene the NSABB to allow them to
see the new data and hear the clarification of the old data.
Feb. 28, 2012 – Ron Fouchier flew in from Rotterdam to be on a panel tomorrow AM
(Feb. 29) organized by American Society of Microbiology (ASM) to discuss this issue.
Invited Ron over my house for dinner (rigatoni and sausage with tomato sauce) with Cliff
Lane and Hugh Auchincloss to discuss the approach for tomorrow.  Ron related to me
that the NSABB never gave him a chance to explain his experiments and that he met
them via teleconference.   Clearly they were hostile to him and when his interview was
over, Mike Osterholm started speaking before Ron signed off and Mike said (without
knowing that Ron was still on the line) that Ron was a “liar”.   Ron stayed on the line in
Released by Chairman Rand Paul
277secret and described what sounded like a major ad hominem to Ron.   After intense
discussion with me before and during the dinner, Ron Finally got it that he has to be very
clear tomorrow that the ferrets who got infected by aerosol transmission did not get very
ill (flu-like sxs at worst), all recovered and NONE died.  Only animals who got 1 million
infectious doses of H5N1 directly inserted into the trachea died.  It is clear that everyone
NSABB, all the pundits who commented (Laurie Garret, Tom Ingelsby, Richard Ebright,
D.A. Henderson, etc.) and the press thought that after aerosol transmission, the ferrets
died.  We had long discussions about future experiments and upcoming issues.   Later in
the dinner, Bruce Alberts (Editor of Science) flew in from San Francisco, called my cell
phone to let me know he arrived, and I invited him over for the remainder of the dinner.
Feb. 29, 2012 – ASM panel at 7:15 to 8:15 at Omni-Shoreham in D.C.   Standing room
only, fed live on Website with many reporters tuned in.   Paul Keim chaired panel that
included Ron Fouchier, me, Bruce Alberts, and Mike Osterholm.  Everything was
clarified and most people asked the question that I have been asking all along – how
could this pervasive misunderstanding have occurred.  It was clear, but no one wanted to
embarrass anyone, that the NSABB missed this major point.
March 1 and 2, 2012 – Much press coverage going on trying to decide what went wrong.
Jon Cohen from Science is coming close to figuring it out.   However, when he asked
several members of NSABB to answer some questions, it become clear that they are
being defensive and saying that it is the mere fact of making the virus “transmissible”
that prompted them to recommend against publication, even if it was not clear that the
aerosol-transmitted virus did not kill the ferrets.   We are going to reconvene the NSABB
ASAP to review the revised manuscripts from Ron and Yoshi to that they can see the
additional and clarified data.   I am afraid that they will not change their minds because
they need to save face that they actually dropped the ball badly.   I believe that Mike
Osterholm and to some extent David Relman aggressively persuaded the others to vote
not to publish.   HOWEVER, I believe if the other members of NSABB  knew that the
aerosol transmission did not result in death of the ferrets, they would not have been
convinced by the histrionics of Mike who told the press that this was equivalent to
“thermonuclear war” if this virus gets out.
March 5, 2012 – It is starting to become clear that the NSABB are saying that the basis
for their recommendation is the fact that the virus was made transmissible and the
decision had little or nothing to do with whether or not the virus was lethal via aerosol
transmission.   I just cannot believe this.   I believe that most of the NSABB group did
not know enough about flu to know the importance of this distinction.   They now are
embarrassed that they missed this and are likely covering their asses.   Interesting that the
N.Y. Times (Phil Boffey) editor wrote another Sunday editorial yesterday (May 4, 2012)
criticizing the process and implying that “the NIH, whose reputation is at stake…..” is
somehow at fault.   He clearly is taking the side of the NSABB calling them fiercely
independent.   He wrote me an e-mail prior to the Sunday editorial giving me a “heads-
up”.   He implied in his e-mail that I was trying to have him retract his prior editorial
based on information from Geneva.   He is totally missing the point.   I do not want him
to retract anything nor do I want to influence the NSABB to change their minds.   I
Released by Chairman Rand Paul
278merely want them to reconvene so that they can have all of the information that was
presented in Geneva and at the ASM meeting on Feb. 29, 2012 in Washington.   Things
that they almost certainly did not know at the time of their December, 2011
recommendation:  1) aerosol transmitted H5N1 does not kill ferrets; 2) engineered H5N1
is poorly transmissible, i.e. it takes 3 to 5 days after exposure to transmit to 75% of ferrets
compared to 2009 N1N1 that transmits in 100% of animals within 1 day; 3) pre-infecting
ferrets with either seasonal H1N1 or H3N2 and letting them recover and then instilling 1
million infectious doses of H5N1 into their tracheas completely protects the ferrets from
disease and death.   If they still feel after they hear this that the papers should be redacted,
then so be it.   I believe that they are incorrect and were driven by the hysteria of Mike
Osterholm, the know-it-all of David Relman and the lack of understanding of the rest of
the NSABB.
Mar. 8, 2012 – Went to special premier showing of the movie “Game Changer” about
Sarah Palin starring Julianne Moore, Ed Harris and Woody Harrelson.   All the usual DC
glitterati were there, both political and media.   Tammy Haddad was responsible for my
invite.   Went with Chris.
Mar. 9, 2012 – PCAST meeting at the Carnegie Endowment for International Peace.
Presented on a panel with Paul Keim (Chair of NSABB), Bruce Alberts (Science editor-
in-chief), Peter Palese (Mt. Sinai) regarding the H1N1 manuscript controversy.   Chaired
by John Holdren and Eric Lander.   Reviewed the pros and cons of publication.   I gave
presentation similar to my ASM presentation on Feb. 29.
Mar. 12, 2012 – Gave my yearly talk to the Zuckerman Fellows on “A Career in Public
Service”.   Very engaged group; was told by conveners that the fellows loved the talk and
found it the best among many talks by White House people, and other government
officials.   Usual cocktail reception and dinner at the home of Ron and Beth Dozoretz.
Mingled with the usual DC glitterati – Andrea Mitchell and Alan Greenspan, Mort
Zuckerman, David Gergen, Chris Matthews, etc.
Mar. 20, 2012 – House Appropriations Subcommittee Hearings – Rayburn Building.
Unusual situation that the Hearing was confined to a discussion about NCATS.   Only
official witnesses were Francis Collins and Tom Insel (Director NIMH) who was there in
his capacity as Acting Director of NCATS.   Harold Varmus and I were there as “token”
attendees for rest of NIH.   It was a disgrace that the Hearing was only NCATS.
Chairman Dennis Reyberg is not the brightest bulb on the porch.
Mar. 22, 2012 – Small intimate dinner at Café Milano sponsored by Wayne and
Katherine Reynolds.   Dinner in honor of Susan Hockfield the retiring President of MIT.
Usual glitterati – Rick Atkinson (author), Head of National Geographic, etc.
Mar. 25, 2012 -  Went to Baltimore to present John Bartlett with an award from AIDS
Action Baltimore.  He was delighted at my laudation.   It was run by AIDS activist and
friend of mine – Lynda Dee..
Released by Chairman Rand Paul
279Mar. 26, 2012 – Gave my Nifty-Fifty Lecture on a “Career in Public Service” TO Walter
Johnson High School in Bethesda.   It was fun since the students were so engaged with
me.
Mar. 27, 2012 – Went to National Portrait Gallery to have historical filming of my
experience with HIV and my career.   It is part of the National Portrait Project to film the
histories of important Americans who have made major contributions.
Mar. 28, 2012 – Senate Appropriations Subcommittee Hearing for NIH.   Francis
Collins, me, Varmus, Griffin, Insel, Hodes.   Too bad that these hearing are only a total of
2 hours when we used to have 2 hours for NIAID alone.   I got questions on the H5N1
issue.
Mar. 29-30, 2012 – Intense meeting for 1 ½ days of the NSABB to re-visit the decision
regarding publication of the 2 manuscripts – Fouchier (Science) and Kawaoka (Nature).
It was clear that the driving forces to still block full publication were Mike Osterholm
and David Relman.   Surprisingly, Arturo Casadevall was also adamant.   I spent the
entire 2 days in the room and gave rationale argument why the manuscripts should be
published without my being too aggressive.   At the end of the meeting it was voted 18 –
0 to publish the Kawaoka manuscript and 12 – 6 to publish the Fouchier manuscript.
Thus, the NSABB reversed themselves.   Several factors went into this.  First was
(although they were reluctant to admit it) was the fact that although the Fouchier
manuscript was not clearly written and Ron himself had given the impression that these
were really dangerous results, the fact is the NSABB completely misinterpreted the
transmission experiments (see above regarding Geneva meeting of Feb. 16-17).   They
had thought that the animals that had been infected by aerosol had actually died when
they did not.   They only died when 1 million IDs were inserted directly into the trachea
of the ferrets.   In addition, some epidemiology data were presented that showed that in
the wild in Chickens and even in some infections in people (in Egypt), the virus was
assimilating some of the mutations described and engineered by Fouchier and Kawaoka.
     An interesting note:  in typical bullshit fashion that I have seen before, Mike Imperiale
and Lynn Enquist (NSABB members told May Patterson that they wanted me to declare
right before the 2nd day that since I was a funder of the research that I had a conflict of
interest in the discussions even though I had every right to be there since I am an ex
officio member of the Board.   They actually felt that I might not give grants to people
who were funded by NIAID and who voted to not publish the
manuscripts……..absolutely amazing bullshit!   In any event, I merely said at the
beginning of the second day that as everyone knows I am the funder of the research, but
that I respect greatly the members of the board and their opinions and this was “nothing
personal, but strictly business”.    You could tell that the good people on the Board had no
idea why I was saying this, but it apparently satisfied the “cowards” on the Board.   If
they are not strong enough to stand up for what they feel, they should not be on a USG
Advisory Board.
    It will be interesting to see what the press such as Laurie Garrett who was blogging
like crazy regarding how “courageous” the board was in standing up to the self-interest of
the influenza research community when, in fact< she had no idea what the data showed –
Released by Chairman Rand Paul
280typical Laurie Garrett.   Also, I wonder what Phil Boffey is thinking.   He was skeptical
of me on our phone conversations when I said that he went too far with his alarmist
Editorial in the NY Times on “Engineered Doomsday”.   He sort of rebuked me saying
that the NSABB was a Board of “Top Scientists” and how could I be so at odds with
them.   I could not tell him at the time that they had completely mis-read the manuscript.
Interesting and unprecedented situation.
    Also, on the first day of the meeting (March 29), the USG (mainly NSS) came out with
the official DURC Policy that guides how we should approach DURC.
April 5, 2012 – Appeared on Channel 8 “Capitol Insider” to discuss the NSABB
situation.
April 11, 2012 – Amazing shit.   Mike Imperiale (mostly likely him) of the NSABB
called a New Editor from Nature (Brendan Maher) and told him that he felt nervous
about voting against publication of the manuscripts since he was afraid that I would not
fund his grants if he did.   I cannot believe the pettiness and cowardice of some people in
Science.
April 12, 2012 – I called Paul Berg is Stanford today to get his perspective since he was
so involved in a leadership role in the Asilomar situation in the 1970s.  We had a great
conversation as we discussed the similarities and differences between then and now.   I
pointed out and he agreed that there is still today “scientific hubris” on the part of some
people.   Ron Fouchier showed that early on.   Hopefully now he is “cured”.   However,
Paul emphasized (as I feel) that the issue with bioterrorists is really a non-issue.   He is
concerned about sloppy science and public trust.   He said that in the 1970s there was
little concern about “germ warfare”.   I told him that that is the biggest difference from
todfay when biodefense and biosecurity is a cottage interested with people (Ingesbly et
al) and Agencies (DHS) who think about and work on this full time.   In addition, there
are the biodefense “Beltway Bandits”.   This “Biosecurity intimidation” matches the
“Scientific Hubris”.
More amazing shit.   Mike Osterholm wrote a letter to Amy Patterson with a cc to the
entire NSABB membership excluding the ex officio members saying that he feels that the
NSABB meeting was “rigged’ by us to come up with the outcome that happened.   I truly
believe that he is traying to cover his ass that the NSABB completely missed the point of
the transmissibility.   This is similar to the Nature issue from yesterday.   In addition, he
disingenuously mentioned to Amy in the e-mail that he does not want this to be a public
statement and does not want it to leak even though he copied about 50 people.   Give me
a break!!!!   See letter below.
NSABB letter final
41212.pdf
Released by Chairman Rand Paul
281April, 13, 2012 – It has leaked 12 hours after it was sent.   There is no way that Mike did
not know it would leak since he sent it to so many people.   It has appeared on the Nature
website and in and “Science Insider” article by Jon Cohen.   It is clear to me that Mike
Osterholm is bipolar.   If you look at the letter, it is crazy.   He keeps referring to
“anonymous” influenza researchers who are not involved in transmissibility research who
say that the research should not have been done.   In the Science Insider piece, Susan
Ehrlich, another NSABB member says that she agrees with Mike.   She is a complete
goof-ball, having spoken with her at the NSABB meeting.    Mike goes on in the letter to
say that the NIH did not invite any experts on surveillance or non-transmission influenza
experts, even though he requested this.   We checked all of the files and he never made
any such requests.   He asked for a security briefing that said that there was no credible
terror threat with H5N1.   This is not what he wanted to hear and so he said that the
briefing was useless.   BTW, it was given by the CIA and the NIA.   He also states that
according to discussions at the March 29-30 NSABB meeting, Ron Fouchier already has
the necessary mutations to create a ferret-transmissible virus that do not require passage.
Since Mike absolutely knew that this letter would leak, he has egregiously violated the
confidentiality agreement of the NSABB.   This together with the paranoid statement of
Mike Imperiale that he was uncomfortable because he thought that the NIAID would not
fund his grant if he voted to not publish makes me certain that the NSABB as it is
presently constituted is fatally flawed.   As you can imagine, the press and bloggers are
having a field day with this.   I am astounded that Helen Branswell (Canadian Press) was
more interested in why she was not given the leaked document than she was in the fact
that the very leaking of the document reflects the craziness of some people on the
NSABB.
     This whole process has circumvented our plan to coordinate with the Dutch our
release of the NSABB recommendations since Mike in effect has made public the
“minority vote” before the actual majority vote to publish. Remember, the committee
voted 18-0 to publish the Kawaoka manuscript and 12-6 to publish the Fouchier
manuscript.
April 14, 2012 – Went over John and Elaine Gallin’s to first have John and I fish in the
Potomac and then have dinner.   Unfortunately, John backed out of his garage going very
fast without looking in his rear view mirror and smashed the rear-end of my car.
Damages = >$5000.00.  More later.
April 18, 2012 – Went to Palo Alto to give the Thomas C. Merigan Lecture at Stanford.
Great day.   Lectured on “Ending the AIDS Pandemic” and had several long Qs and As
sessions with students, fellows and faculty.   I thoroughly enjoyed it.   Got me out of the
craziness of the Washington scene with H5N1 (see below).   Of note, Stan Falkow wrote
me a terrific note of how amazing I was with the fellows and students.  It was important
coming from him since he had been one of the people who were against me 10 years ago
when we began the $1.5 billion biodefense program.   He wrote me an e-mail after the
Merigan Lecture and said that he knew that I loved my job as NIAID Director, but I am
truly a great “professor” and teacher in the classic sense. Several students and faculty told
me it was the best lecture that they had ever heard there and the best interaction with
students/faculty.   Also, had dinner with Ali the night before at “Cuccina Italiana” in Palo
Released by Chairman Rand Paul
282Alto.   It was great seeing her.   She is amazing – getting great grades in Computer
Science and rowing stroke on the II Varsity 8 boat.   She is a walk on to the Stanford
nationally ranked Division I  crew team and last year started on the Varsity 4 and now
she is stroke on the II Varsity 8.   Last year and this year she was given a $24,000 athletic
scholarship.
April 13-23, 2013 -   For the past several weeks there has been intense activity regarding
the situation with H5N1.   General press not really involved, but Helen Branswell
(Canadian Press) and Laurie Garrett as well as some bloggers are stoking the flames and
coming up with mischief.   USG (NIH/HHS/Amy Patterson) have put together a letter
point-by-point countering the crazy accusations in Mike Osterholm’s letter.   Big
discussion at HHS/NSS about whether to have Sec. Sebelius officially accept the NSABB
recommendations about publishing the 2 papers.   Out of respect for the Dutch, State
Department wants to wait until the April 23-24 meeting of the Dutch for the
announcement.  Real circus → White House (Heidi Avery) want us to release the
acceptance now; Dutch are now saying that they may not allow Fouchier to resubmit the
revised manuscript to Science without an export control license; Fouchier says that this is
basic research that is not controlled by export control and so threatens to release it to
Science anyway.   He can theoretically face a fine and 6 years in jail.   HHS releases
Secretary Sebelius’s acceptance on Friday afternoon, April 20; however, in order to half-
way not offend the Dutch, they have Francis Collins announce on the NIH Website that
the Secretary has accepted the recommendations of the NSABB to publish without her
actually saying it.   Meanwhile, the bloggers (Helen Branswell and others) are accusing
the USG of releasing it on a slow news time (Friday afternoon).  I know that this is
clearly not the case since they have been trying to get it out for days, but the bureaucracy
has held it up.   I have a Senate Hearing coming up on April 26 where much of this will
get hashed out.
       I am getting extremely stressed by all of this since the really bad outcome would be
if biomedical research on dual use issues will be severely impeded by somewhat
hysterical responses to things that really are non-issues.   Most of the people (scientists or
not) really do not understand the issues of ferret experiments and their limitations and the
extremely unlikely possibility of a bioterror attack with flu compared to the importance
of doing and communicating science to prepare against the natural emergence of
pandemic influenza.

         Just to reiterate, there have been so many aspects of this “perfect storm”
surrounding the manuscripts: 1) Ron Fouchier’s original over-selling the scary nature of
this “I have here one of the most dangerous viruses in the world” likely and innocently
trying to push his research and the paper. 2) The NSABB amazingly mis-reading the
papers to believe that the aerosol-transmitted virus actually killed the animals upon
aerosol transmission instead of only after intra-tracheal insertion of 1 million IDs. 3) The
demagoguery of Mike Osterholm and his probable bi-polar hysteria leading the
uninformed NSABB members.   4) The relative lack of influenza expertise of the
NSABB members. 5) The scientific “hubris” of the influenza community, i.e. Peter
Palese who believes (correctly) and says (unfortunately) that the non-influenza people are
clueless. 6) The relative weakness of Paul Keim (good guy) as a Chairperson. 7) The
Released by Chairman Rand Paul
283opportunistic news people (Branswell – Canadian Press and Phil Boffey – NY Times). 8)
The occasional incompetency of Amy Patterson in dealing with the NSABB even though
everyone in the USG thinks that she is doing a great job. 9) The “bioterror-industrial
complex”   who sees bioterrorists everywhere and whose jobs depend on the fear of
bioterror (Thomas Ingelsby – think tank; Tara O’Toole – DHS; multiple Beltway bandit
companies, etc.).
Apr. 25, 2012 – Went down to Hart Building to brief Sens. Harken and Roger Wicker in
preparation for their trip to Africa (South Africa and Namibia) where they will visit CDC
and NIH-funded sites.   Also briefing them were Julia Martin of PEPFAR (Eric’s Deputy)
and Debbie Birx from CDC.   This is mostly a boondoggle for the Senators.
Apr. 26, 2012 – The heat is still on and the focus high (in some circles) regarding the
H5N1 issue.   I testified before the Senate Homeland Security and Government Affairs
Committee today.   Chair – Joe Lieberman and ranking minority – Susan Collins (R-
Maine).   Other witnesses were Dan Gerstein (DHS), Paul Keim (NSABB) and Tom
Inglesby (Univ. of Pittsburgh).   Lieberman started the Hearing by stating that I was his
“hero”.   Paul Keim more and more is making me believe that he is a poor Chair of
NSABB and a weak person in that he continuously says that Mike Osterholm is off base
with his letter to Amy and then he defends him strongly at the Hearing.   He wants it both
ways.
The media (mostly bloggers like Laurie Garrett and others such as Helen Branswell) keep
thinking that the USG is acting in some sort of conspiratorial manner regarding letting
out information such as Amy’s response to Mike Letter.   In this regard, I mentioned to
Lieberman when he asked about the accusations in Osterholm’s letter to Amy that I
completely disagreed with most of what was in Mike’s letter and that Amy had written a
comprehensive refutation of Mike’s points and that I would make this letter available to
the Committee if they wished.   The press picked this up to mean that we were releasing
the letter to the public.   That was not the case, but eventually ( a couple of days later)
when HHS Legisl. Affairs sent the letter to Lieberman, then HHS released the letter.
Made nice remarks at Memorial for Frank Neva at the Audubon Society in Bethesda.
Apr. 29, 2012 – Went to Annual Brunch given by John McLaughlin on the roof of the
Hay-Adams Hotel in celebration of the White House Correspondence Ball the night
before.   It has been several years since I was invited to the Ball.   Usual DC celebrities at
the Brunch.
May 1, 2012 – Partook in NAS Workshop Panel on 20 F Street on H5N1.   This was part
of the NAS Annual Meeting.  Controversy continues.   At the meeting, Richard Roberts
(1993 Nobel Laureate and known Gadfly) came to the microphone and said that many
virologists who disagree with Francis Collins and me about doing DURC are afraid to
speak up because they fear retribution and will not get their grants funded – Holy Shit!!
The epitomy of paranoia.   This is not the first time that I have heard this.   I blew him out
of the water (nicely) by saying that if anyone has even a slight awareness of the NIH peer
Released by Chairman Rand Paul
284review system, they would know that this was impossible even if we wanted to do this,
which we clearly do not.
May 2, 2012 – Went to and spoke at a “Garden Party” at the home of Ellen and Gerry
Sigal in honor of Mark Harrington and the 20th Anniversary of the Treatment Action
group (TAG).   I honored him and reminisced about the activist years in the late 1980s
and early 1990s.   Also speaking was Peggy Hamburg.
May 3, 2012 – Spoke at the Lasker Board Dinner held at the Howard Hughes Medical
Institute Headquarters on Jones Bridge Road.   Spoke about H5N1 issue.
May 10, 2012 – Met with old friend Ron Dellums (Former Chair of House Armed
Services Committee and former Mayor of Oakland).   He has retired from politics and
wanted to chat with me about opportunities in consulting in global Health.   He had come
on the original trip with Tommy Thompson in 2002 to Africa.   I referred him to Stewart
Simonson.
     Reviewed data with Ian Lipkin over the phone of study that he coordinated.   Data
showed that the prior studies from Judy Vitkovits and Harvey Alter/Shy Lo indicating a
connection with XMRV/MLV and Chronic Fatigue Syndrome were in fact artifact and
there is no connection.
     Appeared on The NewsHour interviewed by Ray Suarez on the positive
recommendation of the FDA Advisory Committee to approve Truvada as PrEP.
May 11, 2012 – Flew to Miami for U of M Commencement and had dinner with
awardees and commencement speakers for the entire University.   Donna Shalala
(President of U of M) was my sponsor.   Dinner at amazingly palatial home of Leonard
and Jayne Abess.   Formerly home of Sylvester Stallone.   Susan Rice (US Ambassador
to the UN) was also there.   She had given Commencement Address to the Law School
that day.  Sat next to Stuart Miller who had donated $200 million to the U of M Medical
School, which is now named after him.   Stayed at Biltmore Hotel in Coral Cables and
went on nice long, warm run
May 12, 2012 – Received honorary Doctor of Science at University of Miami and
delivered Commencement Address.   Beautiful and enjoyable day.
May 14-16, 2012 – Megan’s graduation.   Arrived evening of May 14 and had dinner
with Meg, Jen, Chris, and Amanda at Gazala restaurant (Israeli) on Columbus Avenue
and 78th Street.  Great time.   Day of May 15 – Megan’s College of Arts and Sciences
Commencement.   Megan graduates Summa Cum Laude!!!!   Amazing kid.   Dinner that
night at a Vegan restaurant.   Stayed at Denise and Jack apartment.   May 16 – full
University graduation.   Columbia president Bollinger gave address.   Of note, President
Obama gave commencement address at Barnard 2 days before, much to the dismay of the
Columbia Community.
Released by Chairman Rand Paul
285May 16, 2012 – Barry Bloom sends me pre-print of Commentary that will appear in
Science at the same time as my and Francis Collins’ article.   Barry’s co-author is the ever
crazy Lone Simonson.   They are proposing that the USG create an Interagency
Committee with final authoritative power to decide what DURC experiments can and
cannot be done.  There really are well meaning people who just do not understand this
issue and it worries me.   There is a real danger of inadvertently hindering science in
Infectious Diseases by censoring it.
May 17, 2012 – Appeared on “Talk of the Nation” on NPR on the recommendation of
the FDA Advisory Panel to Approve Truvada as PrEP and the OraQuick test for HIV.
May 18, 2012 – Spoke at the NAS/IOM President’s Circle Annual Meeting on the H5N1
issue.   This is still hot among certain circles.   Meeting took place at the House of
Sweden at 2900 K Street, N.W. in Georgetown.
Gave talk to IDSA Fellow at Bethesda Hyatt on “A Career at NIH”.
May 21, 2012  - Met with Sanaria people including Steve Hoffman today about an update
on the work he is doing with his vaccine for malaria.
May 23, 2012  -  Had a great and moving evening at the Annual Sons of Italy National
Education Leadership Awards Gala at the National Building Museum.   I presented a
scholarship to a student who will be going to Harvard next year.   Various awards went to
different people.   Hillary Clinton got if for a Lifetime of Public Service and responded
by video.   Most moving moment of the night was when Tony Odierno (son of Gen. Ray
Odierno), who lost his left arm in Iraq due to an RPG presented an award to Gen. Peter
Pace, who is a Brooklyn boy and with whom I received the Presidential of Freedom and
so I know him.  Pete told the story of his first soldier whom he commanded who was
killed in action in Viet Nam when Pete was a 22 year old 2nd Lieutenant.  His name was
Lance Corporal Guido Farinaro.   Pete was incredibly moving and mentioned how
throughout his entire military career he carried a picture of LCP Farinaro with him.
Also, a little drama at the dinner.   I was called to see and take care of the famous tenor
Michael Amante who sings often at the Galas.   Mike had recently (3 months) lost his
wife to a cerebral hemorrhage.   Mike is 49 years old.   He is left caring for 3 children –
9, 7, and 5 years old.   He is overwhelmingly stressed, did not sleep the night before and
was clearly dehydrated.  He is on several meds for hypercholesterolemia and high BP.
He felt woozy and “spaced out”.   I tanked him up with fluids and he responded quickly
and well.   He resting heart rate went from 88 to 70.   He then sang beautifully and at the
end of the medley he pointed his finger at me (seated at a Table in the front).
May 24, 25, 26, 2012 – Drove up to Princeton with Chris to watch Ali compete in the
Women’s NCAA National Championships.   Ali had recently been promoted from the 2V
boat to rowing Stroke for the 1V Eight boat!!!!    Stanford had a mishap in the first heat
when their rudder broke.   Ali and her team were not to be put aback.   They had the
opportunity to row again in the reportage race and came out 1st among 7 boats and so
entered the semi-finals.   Their time of 6 min. 47 seconds was their best time yet this
Released by Chairman Rand Paul
286year.   Unfortunately, they missed out in the semis even though they broke their own time
record by rowing a 6 min. 22 second race.  They were in a heat with the top 3 teams in
the country – Virginia, Cal, and USC.   She rows tomorrow in the “petite final”.
May 30-31, 2012 – Went to NYC  to give Commencement Address at Brooklyn College
and receive an honorary degree.   Bright sunny day.   I lot of déjà vu driving from
Manhattan to Brooklyn through Atlantic Avenue and then Bedford Avenue.   God bless
Brooklyn College, they tried (for the first time in their history) have all 1600 graduates
from all of their schools come on the stage to shake the hand of the President – Karen
Gould.   My co-recipient of an honorary doctorate was the jazz legend Cecil Taylor, a
feeble old man, but very gentle.   Sen. Chick Schumer came and said a few words to the
graduates.  Brooklyn Borough President gave a hilarious speech about Brooklyn.   Had
dinner with Jenny the night before.   Went to Kefi restaurant on 85th and Columbus
Avenue.   I never really appreciated the West Side of Manhattan when I lived for so many
years on the East Side.   Jenny is an amazing young woman who is trying to figure out
who she is and what she wants in life.   She is currently a graduate student at Teachers
College of Columbia University getting a Masters in Developmental Psychology.
On May 30 right before I left for NYC, CNN’s Wolf Blitzer’s producer called and said
that Wolf wanted me on CNN Situation Room to discuss a recent paper by Peter Hotez
(formerly of GW and now at Baylor) who wrote a paper in PLoS  journal saying that
Chagas disease was the new HIV/AIDS.   I like Peter, but I had to contradict this
potentially misleading statement.   I could not appear live and so CNN did a telephone
interview and showed me testifying at a Congressional Hearing at the same time that they
played my voiced interview.   Nice trick.
June 1, 2012 - NIAID had our annual spring policy retreat at the Hilton Hotel in
Rockville which was a meeting between our group and the Bill and Melinda Gates
Foundation (BMGF) in order to determine possibilities of strengthening current
collaborations and forging new collaborations.  Present at the meeting were the senior
leadership of the Institute together with Trevor Mundel (President of the Global Health
Program for the BMGF), Nina Russell, Dan Hartmann, Chris Wilson and Jan…..   The
discussions went very well and I feel that our collaborations will strengthen.   I was
impressed by the sincerity of Trevor.
In the early evening, paid tribute to Ed Tramont at a symposium in his honor at the
USUHS across the street from NIH.    Tornadoes and thunderstorms hit the DC area
during the late afternoon and early evening.
June 9, 2012 – Went with Chris to Annual Garden Party at the home of Jamie Gorelick
and Rich Waldron.   Usual good time with the usual Washington elite there, i.e. Ruth
Marcus, Chris Matthews, etc.  Always good to see Jamie and Rich.  Wonder whether
Jamie will ever get back into USG.
June 12, 2012 – Had dinner over my house with the 3 week-day bachelors (i.e. their
wives live and work in different cities): Harold Varmus (Connie in NYC); Gary Nabel
Released by Chairman Rand Paul
287(Betsy in Boston); and Eric Goosby (Nancy in San Francisco).   I served a Ziti pasta with
grilled shrimp and tomato sauce.   Had great time – good friends all.
June 14, 2012 – At the invitation of Larry Kramer, I attended the “official” opening of
“The Normal Heart” at the Arena Stage Theater.   Had dinner with Larry and NYC and
DC theater notables in the absolutely beautiful new atrium in the new Arena Stage
(totally different from when Chris and I had season tickets decades ago).   The play was
amazing – truly moving.   Had reception afterwards and met the cast and the Director
(George C. Wolfe) who, according to Larry, is the top Director on Broadway today.
June 15, 2012 – Went to a cocktail reception honoring Larry Kramer at the home of Don
and Ann Brown at 3005 Audubon Terrace, N.W.; Washington, DC).   Ann is a childhood
and high school friend of Larry from when he lived in DC.   Larry went to Woodrow
Wilson High School.   Amazingly elegant home.   Brought Chris as well as Megan and
Ali, who was in DC for 3 days between Stanford (just finished her exams) and Seattle
(summer job with Microsoft).   Also met Larry’s partner – David Webster – really nice
man.  Good that Megan and Ali and Chris got to see Larry.   I explained to Meg and Ali
what an iconic and controversial figure Larry was and is.
Also, for past months I have been preparing for and putting together my Plenary Talk for
the IAS on July 23.   Need to get it done since I go to the big Harrison’s meeting in
Martha’s Vineyard for 9 days right before the IAS meeting and need to get my talk
finished and out of the way before I go to the Vineyard.
June 22, 2012 - In Boston today to participate in the 200th Anniversary Celebration of the
New England Journal of Medicine.   I had been asked to write one of about 12 articles
over the year 2012 (NEJM started in 1812) summarizing the advances in a given field.
Obviously, my assignment was Infectious Diseases.   My article came out a few months
ago – co-author was David Morens.   The symposium today was reflection on 30+ years
of HIV.   I gave the opening overview lecture and then there were comments from David
Ho, Bob Massie, Beatrice Hahn, and Paul Farmer.   Moderator was Marty Hirsch and
Panel discussion followed.   Held at Joseph Martin Auditorium across the street from
Harvard medical School on 77 Louis Pasteur Avenue.   Hot, hot June day over >95
degrees.   Nice conference.   Audience filled with medical students from all over the
world who won essay-writing competition.
June 28, 2012 – Supreme Court with Chief Justice Roberts pulling an amazing maneuver
actually confirms the constitutionality of the Affordable Care Act, but calls the Individual
Mandate a “tax”.  Everyone thought that he would be the deciding vote against, but he
was the deciding vote for the Law.  Nonetheless, by calling the mandate a “tax” he makes
Obama look bad since Obama has always insisted that it was not a tax.
June 29, 2012  Had a historic thunderstorm with winds up to 80 to 90 miles an hour on
the night of June 29. Major power outages were experienced throughout the area. No
major damage to my house but again we have several days and up to a week of power
outages.  Incredible how PEPCO can let outages go for 1 week.
Released by Chairman Rand Paul
288July 3, 2012 – Saw “Normal Heart” again at Arena Stage.  Wonderful play.   Many
people in audience recognized me and thanked me for my work.
July 9-18, 2012 – Went to Martha’s Vineyard (MV) for the “Big” meeting of the
editorial Board of HPIM-19 with the McGraw-Hill people.   Great meeting, great
weather.   Chris and Megan came for 2 days on July 14-15.  Went sailing with Dennis
Kasper on his boat on July 14.  Great time. Democratic National Committee also has
meeting on island.   Met and chatted a few times with Sen. Sherrod Brown (D-OH).
Good guy.   I know him for years.
     Left 1 day early.  July 18, 2012.  Good that I did since at the airport at MV I got a call
from CNN that Wolf Blitzer wanted me on the show tonight to discuss the FDA approval
of Trivia as Prep   I accepted and had a scare since the plane took off late from MV and
then circled DCA for 25 minutes before landing.   I had intended to go home and change
first from my casual clothes to TV clothes.   However, there was no time and CNN send
limo to airport to pick me up and go directly to CNN studio for the live shot.   Had just a
few minutes to change into shirt and tie.   All went well. Also did WTOP News, local
Channel 9 TV, and ABC radio.   Looking forward to IAS meeting in DC this coming
week.
July 20 – 28, 2012 – Most amazing week leading up to and during the XIX International
AIDS Society (IAS) Conference. 25,000 people attended (largest AIDS meeting in
history). I am including as an attachment my schedule for this week and I will comment
below on some salient issues.
ASF DC 2012 FINAL
Schedule - July 27.do
Truly amazing.   The theme of the meeting was “Turning the Tide Together”.   I
Delivered the Opening Scientific Plenary Lecture on Monday, July 23, the morning after
the Opening ceremony (see below).  My talk was entitled: “Ending the HIV/AIDS
Pandemic: From Scientific Advances to Public Health Implementation”.   The DC
Convention Center main lecture hall was packed with approximately 10,000 people.   It
was one of the best Plenary Lectures that I have ever given and I have spoken as a  main
speaker at every one of the 19 IAS meetings.   The number of kudos I got regarding my
talk was incredible.   The amount of press coverage of the event was astounding.  Jon
Cohen did a feature on me in Science that came out right before the meeting started and
everyone was talking about it.   It was a story he wrote after spending an entire day with
me at NIH.  In addition, there were several articles that I wrote (usually with Greg
Folkers) that came out right before or during the meeting such as a piece in Health
Affairs, JAMA, JAIDS, etc.   In a separate piece in Health Affairs, John Donnelly wrote a
history of PEPFAR and described my involvement.   He also interviewed Mark Dybul
and Mark made it seem that he played a greater role at the White House level than he
really did although Mark’s role behind the scene was incredibly important during the
creation of the blueprint for PEPFAR.   But, who cares?   It was a good article although
Gary Edson got pissed off at it when he saw it since he knows exactly how PEPFAR
Released by Chairman Rand Paul
289happened. Gary sent me an e-mail saying there were only 2 important people for
PEPFAR – me and pres. Bush.    There was major Press and very interesting and
entertaining social events.
 A few comments on my Press appearances:  CNN with Wolf Blitzer (The Situation
Room) on July 16 (days before the meeting started) associated with the FDA approval of
Truvada for PrEP; Diane Rehm Show on July 24 (day after my Plenary); Op-ed by me in
the Washington Post on the last day of the meeting (Friday July 27); MSNBC with
Andrea Mitchell on July 27; Bloomberg News on July 24.  Also, about 30 appearances on
blog videos.  Also, multiple radio interviews (CBS, ABC, NPR, etc.)  Mentioned in NY
Times Editorial the day after the meeting. On Tuesday, July 24, spoke at panel at
Washington Post for 1 hour.
With regard to the social events, it was amazing.   At a ONE –sponsored event at the
Eisenhower Theater at the Kennedy Center on July 21 (night before the opening of the
meeting), I was asked to give a few remarks from the stage concerning an AIDS-Free
generation.   I paired up with Kay Warren, wife of Rick Warren the pastor of Saddleback
Church.  Others who presented to the audience and whom I interacted with and talked
backstage were:   Alysia Keyes, Annie Lennox, Herbie Hancock, Nancy Pelosi,
Congresswoman Barbara Lee, among many others.  Annie Lennox gave a smashing
rendition of her classic song “Sweet Dreams”.  Right before that, I was invited to an
Awards Dinner hosted by AMFAR for Bill Gates (I also had a 1-on-1 meeting with Bill
on Monday, July 23).  At the dinner, I met and chatted with Anderson Cooper, Sharon
Stone among others.   During the Opening Plenary Session, I led it off, followed by Phill
Wilson of Black AIDS Institute, followed by Hillary Clinton.
      Big deal social event (July 24) that I really enjoyed was reception given by Open
Society Foundation and Syringe Access Fund at the Open Society Foundation D.C.
Headquarters in honor of Elton John.   I had never met Sir Elton, but he specifically
requested that I introduce him at the reception together with his partner David Furnish
who is Chairman of the Elton John AIDS Foundation.   Got great pictures of Elton and
me and he was very moved by my introduction.   I had just finished reading his new book
:Love is the Cure” focused on how his relationship with Ryan Whyte turned Elton’s life
around for good as he was at the time an egregious cocaine addict and alcoholic and
bulimic.   He has been clean for 22 years.   Really nice guy who clearly understands what
I have done.
    Signed Letter of Intent with the French (Jean Francois Delfraissy and Yves Levy) for
collaboration on a “cure” on Monday, July 23.   Parenthetically, the cure people at the
meeting were really egregiously promoting their results with “flushing out the virus”
(David Margolis from UNC and Steve Deeks from UCSF).   Margolis used to be at
NIAID and he really in barely mediocre and is using the enthusiasm for a cure as a means
to get new money. Their over-exaggeration is really pissing me off.
     Thursday, July 26 – called to White House by Heidi Avery for a different issue.   I am
going to NYC for the Centers of Excellence for Influenza Research and Surveillance
(CEIRS) meeting of influenza scientists to discuss the lifting or not of the moratorium on
gain-of-function work on transmissibility/pathogenesis of H5N1 (see above).   White
House, including the POTUS is concerned about a misleading story by Nell Greenfield
Released by Chairman Rand Paul
290Boyce of NPR that said that I was going to expedite the lifting of the moratorium at the
NYC meeting and the White House is worried that people will react to my “rushing”
things.   I told Heidi that this was nonsense and that in the NPR interview I meant that I
wanted to expedite a conversation among the flu scientists to try to make their case, but
they are not the only voice.   We need input from the general public, other non-flu
scientists, biosecurity and biosafety people and the global community before we again
embark on experiments that some in the rest of the world may perceive could endanger
them without input from them.   Bottom line is that I told Heidi that I was going to
recommend to the CEIRS scientists NOT to lift the moratorium.   I suggested she tell the
WH staff and the POTUS not to worry and that I will not sanction lifting the moratorium,
Also on July 26, Pres. Obama held a reception at the White House East Room for
HIV/AIDS “players” and stakeholders.   I went straight from Heidi’s office to the East
Room.    Obama gave his usual pep talk.  Of note, he thanked the usual people (Pelosi,
etc.) and also Eric Goosby (clearly deserved it) and Grant Kolfax the new WH AIDS
coordinator who has been on the job for a couple of months.   The POTUS speechwriter
clearly is out of touch since he did not call me out is his speech to the amazement of
many in the room.   However, as Obama looked around the room as he was talking from
notes, he saw me and clearly recognized me, but obviously could not remember my name
and so stuttered a bit apart from his notes and thanked “people from NIH for their good
work”.   I do not blame him for forgetting my name but his staff clearly is out of it.
Speaking of names, Bush never would have forgotten.   Just shows Obama’s weak
connection to the AIDS issue.   But, to his credit, as he walked the “line” shaking hands
afterward, he shook my hand and pointed to me saying “nice job”.   Whatever….
All in all a truly amazing week.   Weather was sunny and hot all week.   No rain; typical
sunny, hot DC week.
July 31, 2012 – Controversy continues regarding CEIRS investigators and the
“moratorium” on H5N1 research (see immediately above meeting with Heidi Avery).   I
went to NYC to the Marquis Marriott Hotel on 46th and Broadway to address the
investigators of the CEIRS (Centers of Excellence on Influenza research and
Surveillance).   We opened it to the Press and NPR (Nell Greenfield Boyce) and Science
and Nature were there.   I insisted that my presentation (25 minutes) be fully recorded as
with the Qs and As so that there would be no misquotes.  I made a firm argument for
continuing the moratorium.   The usual people opposed it such at Ron Fouchier, Danny
Perez, Peter Palese; however they respected my opinion.   They still do not “get it’ and
think with all the public furor that they can just go on and do these DURC experiment
without full public by-in and comment.   See my written remarks file for July 31, 2012.
Also, I got great kudos from many investigators (see Arturo Casadevall’s e-mail below).
Also, great stories in NPR radio the next AM (Aug. 1) and in various blogs and Science,
Nature, etc.
From:  Arturo Casadevall [mailto:arturo.casadevall@einstein.yu.edu]
Sent: Tuesday, July 31, 2012 1:29 PM
Released by Chairman Rand Paul
291To: Fauci, Anthony (NIH/NIAID) [E]
Subject: Awesome speech at flu meeting
Dear Tony,
I feel bad adding one more line to your inbox but I must tell you were terrific today –
clear, powerful, articulate, logical.  My ‘take’ is that it was a very successful
presentation.  You are a great scientist and public servant.  It is an honor to know you.
Arturo
Arturo Casadevall MD, PhD
Professor and Chair
Leo and Julia Forchheimer Chair
Department of Microbiology & Immunology
Albert Einstein College of Medicine
1300 Morris Park Ave
Bronx, New York 10461
August 31, 2012 -   Slow month of August in D.C. Summer.   On Aug. 8, 2012 did a
“Science in the Cinema” performance at the AFI Theater in Silver Spring with Ian Lipkin
for the movie “Contagion”.   Fun being with Ian.   Always a character.
Problem over past 2 weeks with the PR associated with Klebsiella pneumonia –
carbapenam-resistant organism (KPC) in the NIH Clinical Center.   The Clinical Center
(CC) and NHGRI people published a paper in Science Translational Medicine on the
genetic analysis by deep sequencing of a KPC the originated from an index case in the
CC and then infected spread by people or fomites to 17 other people in the CC – 11
deaths – 6 from KPC bacteremia.   The PR people at CC did not handle it well.  They got
so absorbed in the science of the paper that they did not realize that the community
reaction would be “Why did not anyone tell us about this outbreak – even though there
was no actionable information here since the organism does not bother healthy people
and the man-on-Wisconsin Avenue is at no risk.
Aug 15 to 25, I had bad URI with fever and malaise that took 2 weeks to resolve.
Over the past few weeks, I have become enamored/obsessed with the Washington
Nations baseball team.   I feel like I felt when I was 12 years old and knew the batting
averages of all of the N.Y. Yankees.   The Nats are 7 ½ games in first place and they have
the best pitching staff in baseball – Steve Strasburg, Gio Gonzales, Jordan Zimmerman,
Ross Detwiler, Erwin Rodriguez.   There hitters are amazing.   Bryce Harper (19 years
old) is pounding the ball and he runs and throws and fields like Mickey Mantle.   Also,
Jason Werth, Adam La Roche, Ryan Zimmerman, Michael Morse, Ian Desmond, Danny
Espinoza – all very good hitters.
Released by Chairman Rand Paul
292Sept. 7, 2012 -  As part of the kick-off of the “Celebration of Science” weekend here in
D.C. and at NIH sponsored by Michael Milken, I was on a 2 man panel run by Greg
Simon, formerly of  Faster Cures”.   The panel (filmed for TV) was on the science and
real world of HIV/AIDS.   My co-panelist was Magic Johnson.  It was a fun experience.
He is a wonderful guy with an amazingly infectious smile.  He commented to the
audience during the panel that he wanted to go on a “road show” with me since I explain
“stuff” so well.  He said that I “…really get it and can speak to the common man”.  We
spoke about basketball and baseball. We spoke about our children. His son is at NYU,
and loves NYC as do Jenny and Megan.   He has another son who works for him in his
Company/Foundation.  His daughter is a High School student in L.A.   He is part-owner
of the L.A. Dodgers and we spoke about how good the Washington Nationals are this
year (see above).
Sept 8-12, 2012 – The past few days have been very intense, but exciting. Following the
Celebration of Science meeting in Washington DC,  I immediately went up to Boston to
deliver the opening plenary lecture at the 2012 AIDS vaccine meeting. It was extremely
well received.  Following my talk Gov. Deval Patrick got up and welcomed the audience
to Boston and made the comment that it was an honor to be on the same stage with Dr.
Tony Fauci and the thanked me for my service to the country.
Over the past few days that has been continued activity concerning the dual use research
of concern issue particularly regarding highly pathogenic H5N1  influenza virus.   I had a
conversation with Heidi Avery of the National Security Staff on September 12 during
which she encouraged me to continue to try and find the right balance between safety and
security as well as the benefits of doing such research. Heidi has always been a very good
friend to me and she informs me that she will be leaving the national security staff to go
back to her major post at the CIA.  We have a major meeting coming up in December,
2012 to discuss the moratorium on H5N1 research. This should be an important meeting
to set general principles of the types of research that should or should not be done.   I
have really enjoyed working with Heidi over the past few years.
Sept. 12, 2012 -  Conversations with Heidi Avery continued – Heidi called my office
when I was out running on an absolutely beautiful September day.   My office contacted
me and I came up to office and called Heidi with my running clothes on.   Bottom line is
that Heidi re-confirmed her strong feeling that the NSABB or any other advisory body
should not be dictating to the USG what we can or cannot do, particularly when it comes
to national security.   She wanted to emphasize that she does not want NSABB making
any pronouncements about the general “straw man” principles about what H5N1
influenza research should or should not be done.   When I explained to her how the
NSABB (which is scheduled to meet in October) was insistent that they determine the
principles, Heidi was adamant.   She finally said (in good spirits since we are good
friends) that no way did she want any pronouncement about the general principles about
conducting research (particularly from Mike Osterholm – she has his number) from the
NSABB BEFORE THE NOV. 6 ELECTION.  I told her that I understood.   This will
really be dicey since we have to figure out a way out of the October NSABB meeting
and/or a way to get them off this subject.   Heidi also confided in me that Leon Panetta
Released by Chairman Rand Paul
293really wanted her back at CIA for a “special assignment”   (remember, she was counter-
terrorism before coming to NSS).   Also, I finally told Heidi that there is definitely a
direct leak from IPC (likely Kris Beardsley) to Mike Osterholm.   Heidi said she knew
this all along and she knows exactly who it is, although I am not entirely certain.   More
later, since we now have to decide whether to cancel the October NSABB meeting which
will cause an uproar among some of them or take the chance of their coming up with
something that Heidi does not want to see happen.
Sept. 15, 2012 – Exceptionally pleasant and enjoyable evening.   Bob and Deborah Seder
invited Chris and me to join them for the Bruce Springsteen concert at Nationals
Stadium.   He arranged an amazing group of 10 people for the event.   It included Bob
Woodward and his wife Elsa Walsh, a couple Christen (executive director of the Four
Seasons Hotel in DC) and his wife Meg (? last name), Bob (very wealthy entrepreneur)
and wife Alison (? Last name) Bob and Deborah, Chris and me.   We met at Café Milano
and had a great meal; a van took us to Nat’s Stadium and back.  The concert was truly
amazing.   Springsteen and his E Street band gave the best musical performance that I
have ever experienced.   We had seats on the infield right in front of the stage that was set
up on where the outfield is for baseball games.   However, we did not sit since everyone
was standing.   Springsteen played for 3 hours and 45 minutes without stopping for a
minute.   He went from one song to another.  The crowd absolutely loved it.   It was a
beautiful “Indian Summer” evening at around 70 degrees.  Got to know Bob Woodward
with prolonged conversations about what I do and what he does.  He feels passionate
about what he wrote in his latest book (came out this week) entitled “The Price of
Politics”.   He is a good guy and it was fun getting to know him.
Sept. 18, 2012 – Pleasant surprise.   Received an inscribed copy of Bob Woodward’s new
book “The Price of Politics” with a note written in the first page – “To Tony Fauci and
Christine Grady – What a great night it was! – With greatest regards, Bob Woodward”.
Sept. 19, 2012 – Received “The Starlight Award” together with Roy Vagelos from the
Children’s Inn at NIH.   I received it for the “Science” and Roy for his extraordinary
influence on building of the Inn in 1990 with Merck money when he was at the time the
CEO of Merck.   Ceremony held at the Liaison Hotel at 415 New Jersey Avenue, N.W.
Many notables from Congress and entertainment at the event.  To name a few:
Congressmen Chris van Hollen, John Dingle, Barney Frank, Doris Matsui; Sens. Frank
Lautenberg, Roy Blunt; TV Anchor Gordon Peterson.   MC was Cokie Roberts.  Twenty-
eight year old former AIDS patient Hydeia Broadbent gave speech and I was praised for
helping to develop the drugs that saved her life when she came to the Inn and NIH at age
6 years old with advanced AIDS and now she is healthy and happy – many tears in the
audience.
Sept. 25, 2012 – Meeting in the Situation Room of the White House (1:30 to 3:00 PM)
called by Heidi Avery.   Discussed the issues around DURC and how we are going to
address the voluntary (on the part of the scientists) moratorium on gain-of-function for
transmissibility in mammals research on highly pathogenic avian  H5N1 influenza.   We
(ASF, May Patterson, Francis Collins, Larry Tabak and the HHS crew led by Sally
Released by Chairman Rand Paul
294Howard,  Chief-of-Staff to Sebelius and Bill Corr, Deputy Secretary, HHS)  have been
working for several weeks on a meeting-working group-consultation (to take place
hopefully in December, 2012) to develop principles for making decisions regarding
funding  (mostly by HHS) for these types of H5N1 experiments.   These principles could
then serve as the basis for guidelines for DURC that go well beyond H5N1.   The
Europeans (mostly the Dutch with Ron Fouchier) want to end the moratorium now.   I
have written a commentary to appear soon in mBio (online Journal of the ASM) that asks
for keeping the moratorium on H5N1 gain-of-function until the abovementioned
December meeting.   The NSABB people, particularly Mike Osterholm, Mike Imperiale,
and David Relman are continuing their somewhat hysterical comments in and out of the
press about how dangerous these experiments are and how they should never be
performed.
     Heidi is adamant that they could be very important to do these experiments for the
national security and she does not tolerate any “advisory group” such as NSABB
dictating to the USG what it can or cannot do in the line of National Security.   I love
Heidi; she is a tough CIA operative and unfortunately for us will return to the CIA soon.
She confided this to me a week or so ago.   Apparently, Leon Panetta has some important,
secret assignment for her.   As always, she e-mails me or calls me after an important
White House meeting to get my take on it.   I am inserting below an e-mail she sent me
(10:15 PM – Sept. 25, 2012) the evening after the White House meeting:
Tony,
Just to say thank you for your time today, along with your NIH colleagues.  I am very
sorry for how tedious parts of the discussion became.  We were not all on the same page
before the meeting.  Hopefully you agree we identified a path forward.  I will not be
around to see this through, but very much hope success is achieved in terms of HHS
guidelines enabling researchers to be comfortable moving forward with this important
work.  Really is a national security imperative.
Best regards, Heidi
Sept. 27, 2012 – Attended World Leaders Forum at the Low Library at Columbia
University.   On a panel with Wafaa El-Sadr, Eric Goosby and Michel Sidibe (Director,
UNAIDS).   Very enjoyable.   Jenny attended.   Discussed the potential end of AIDS.
Oct. 6 – 10, 2012 – trip to South Africa mainly to participate in the opening of the
Kwazulu-Natal Research Institute for TB and HIV (K-RITH) in Durban.   Flew to
Johannesburg and gave special lecture on Ending the AIDS Pandemic to the University
of Witwatersrand.   Then drove to Pretoria to participate in the 10th Anniversary of the
PHIDISA project with the South Africa National Defense Force (SANDF).   This
program largely championed by Cliff Lane.   Then flew to Durban to Open the K-RITH.
Amazing architecture of the new building.   Many luminaries present at the opening –
Ron Daniels (Pres. of JHU), Pres. Of Mass. General, Rob Tjian – President of HHMI
Released by Chairman Rand Paul
295who funded the project.  NIAID funds Bill Safai (PI of KRITH).   Great dinner at the
Oyster Box Hotel.  I gave some after dinner remarks.
Oct. 12, 2012  - Lunch at the Italian Ambassador’s (Amb. Bisogniero) home (Villa
Firenze) on Albermarle Street, N.W.   Lunch in honor of former Italian Ambassador, now
Foreign Minister of Italy Giulio Terzi di Sant’Agata.
Oct. 15, 2012 - Attended the Elton John AIDS Foundation Benefit Gala at Cipriani’s
Restaurant on Wall Street by special invitation of Sir Elton John whom I had met at the
IAS meeting in DC in July, 2012.   The entertainment by Stevie Nicks was amazing.
Many people came up to me thanking me for my work.   Most of these I had never met
before.   Heavy representation of donors and business luminaries.
Oct. 16, 2012 – Spoke at the Annual Meeting of the Institute of Human Virology (Bob
Gallo’s Institute) held at the Marriott Waterfront Hotel in Baltimore.   Took train from
NYC (Elton John Gala) directly to Baltimore.
Oct. 17, 2012 – Participated at the National Press Club in the launching of the WHO
Global TB Report.   Panel moderated by Jeanne Meserve (old friend from CNN, now
with WTOP) and neighbor.   On panel was Mario Raviglione (WHO), Ken Castro
(CDC), someone from USAID, someone from PEPFAR.
Oct. 18-19, 2012 – Went to Cornell Medical School Reunion and gave Keynote Lecture
on Ending the AIDS Pandemic.   Went up night before (Oct. 18) and had dinner with
Jenny at Gazala Restaurant.   Great time with her.   On the evening of Oct. 19, had class
of 1966 reunion dinner at Nino’s Restaurant on 1st Avenue between 72 and 73rd Street.
Really great to see some of the old crew, many of whom have retired.   They were all
very gracious in saying how proud they were to have been my classmates.   Great to see
Patty Downs, Suzie Stewart, Mark Kaplan, Mike Dosik, Dave Fraser, David Tucker, Jim
McSweeney, Carmine Bedotto, Frank Duggan, Randy Bell, among many others.
Oct. 23, 2012 – Met with Howard Koh (Assist. Sec. for Health) and Deputy Ron
Valdesarri in my conference room 7A-24.  They wanted to discuss and were actually
putting pressure on me/us at NIH to put together a guidelines panel for treatment of HCV.
They clearly are getting pressure from constituents.   Since we (NIH) have done such a
great job on the HIV treatment guidelines for HHS, they wanted us to do the same for
HCV.   Problem is that if we start doing guidelines for HCV, then other diseases would
want us to do guidelines and we should not be in the guidelines business.   Howard was
friendly and somewhat fawning over me.   Ron Valdesarri in my opinion is somewhat of
a jerk.
Oct. 26, 2012 – Participated in a panel on Global Health and award ceremony at
Georgetown.   Mark Dybul was given the Timothy Healy Award.   Panel consisted of me,
Mark, Eric Goosby and Barbara Bush (daughter) with Marty Federov moderating.   Good
time and enjoyable to do this with good friends.
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296Oct. 27, 2012 – Spoke at Panel of the Annual Meeting of the Academy of Achievement.
Panel held at Top of the Hay Adams in the Hay-Adams Hotel.   I led off the panel
speaking on Ending the AIDS Pandemic and an AIDS-Free Generation.   Followed by
Pulitzer Prize winning Poet Louise Gluck   and Nobel Laureate Roger Tsien.
Night of Oct. 27 went to Gala Dinner of the Academy at the Willard Hotel – Reception is
Crystal Room; Black Tie Dinner in Willard Room.  Typical classy Catherine and Wayne
Reynolds Affair.  Great entertainment topped off by Aretha Franklin.   Again, Catherine
and Wayne gave Chris and me the best tables right in front of the stage.   Usual terrific
guests.   Wolf Blitzer MC’d.  Colin Powell was dancing on stage with Aretha Franklin.
Lots of fun.  At my Table – Chris and Kathleen Matthews, Bill Cohen and wife Janet
Langhart; current USA Poet Laureate Natasha Threthewey, economist (?) and his
girlfriend Heather Hughes (29 yrs old and amazingly beautiful and friendly), Attorney
General Eric Holder and wife Dr. Sharon Malone.
Oct. 29, 2012 – Beginning of monster hurricane “Sandy”.   Supposed to be the worst
storm in memory with convergence of a true Atlantic Ocean Hurricane with a Nor-Easter
coming from Canada and the West.   All airports (DCA, IAD LGA  Kennedy, etc) and
public ground transportation (Amtrack, METRO, NYC subways) up the entire East Coast
of USA pre-emptively closed prior to the storm.   Storm scheduled to peak here in DC
tonight and into tomorrow.   I came to work since there is an almost 100% chance that
my house will lose power since even lesser storms cause power outages in my
neighborhood.   Likely will sleep here at NIH tonight.   Stay tuned……
Oct. 30 – Nov. 3, 2012– “Sandy” totally devastated parts of the East Coast, particularly
NYC and New Jersey shore.   One of the worst, if not the worst “natural” disasters to
strike NYC.   Wall Street under water.   Flooding of the Brooklyn-Battery tunnel and all
NYC subway tunnels.   Con Ed plant exploded and all of lower Manhattan without
power.   Had to evacuate Bellevue-NY University Hospital.  Atlantic City destroyed.
Truly historic.
Nov. 6, 2012 – As I had predicted over and over again, Obama won re-election handily
with 330 electoral votes.
Nov. 7-8, 2012 -   Went to San Francisco to give Keynote at 25th Anniversary of CFAR
and 25th Anniversary of FDA approval of AZT.   Great trip. Went to Stanford during the
day to see Ali before going to SF.
Nov. 19, 2012 – Appeared on ABC’s ONLINE TV show hosted by Christianne
Amanpour on the subject of the ongoing dengue epidemic in India as well as in Madeira
and Puerto Rico.   These ONLINE shows are fast becoming the new type of news outlets.
A cross between regular TV and a blog.
Nov. 27, 2012 – I present the C. Everett Koop HIV/AIDS Public Health Leadership
Award to Rep. Henry Waxman at the Mayflower Hotel.   The award is given by the
Forum for HIV/AIDS chaired by Veronica Miller.   I gave a nice laudation with slides
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297praising Henry who has become an old “warrior” friend of mine over the years.   I have
testified before Committees that he either chaired or was minority about 25 times over the
past 28 years.   He was very appreciative of my presentation.
Nov. 29, 2012 – Big day today.   It was the official celebration of World AIDS Day
(WAD) and there was a celebration at the State Department from 10:30 to 11:30 AM.
Hillary Clinton unveiled the “Blueprint” for PEPFAR to end the AIDS Pandemic.  It took
place in the Franklin Room of the State department.   She called me out from the
audience and thanked me for being the scientific leader that got us to where we are.
Beautiful chilly Fall day with bright sun.
After the State event, went to the White House to celebrate WAD.   Program of several
speakers.   I was the final speaker giving a talk about the scientific basis of being able to
end the AIDS pandemic.   Extremely well-received.   Other speakers include:  Valeria
Jarrett; Michel Sidebe; Eric Goosby; Sec. Sebelius; a panel chaired by Rosie Perez.
Nov. 30, 2012 -   Viewed a screening at the State Department of the acclaimed movie
“How to Survive a Plague” about the HIV activist movement.  Host was the director of
the movie, David France.  After the movie I was on a panel with Mark Harrington and 2
others to discuss the movie and answer questions from David France who moderated and
from the audience.   Went very well.   Have seen the movie before, but it still brings me
to tears.   I was seen several times in the movie looking extremely young from the 1980s.
Also, very poignant features of Peter Staley, Mark Harrington, David Barr, Spencer Cox,
Jim Eigo, Larry Kramer and many others from “the old days”.
In the afternoon I taped a World AIDS Day segment that showed that evening on the PBS
NewsHour hosted by Ray Suarez.   I thought that it was one of the best segments that I
have done .
December 1, 2012  - had dinner over Mark Dybul's home on Wallach Place in northwest
DC together with Chris Grady,  Jason Claire, Kristen Silverberg (former assistant to
President George W. Bush and an old friend of mine from that administration (see above
(2002) and her husband, and other guests. We celebrated the appointment of Mark to be
the executive director of the Global Fund for AIDS, Tuberculosis, and Malaria.
December 3, 2012 - had a town hall meeting with the Vaccine Research Center principal
investigators and other staff to reassure them that they have nothing to worry about
related to the departure of Gary Nabel to Boston to work at Sanofi. Gary left the VRC
solely because his wife Betsy Nabel took the job 3 years ago as President of the Brigham
and Women’s Hospital in Boston.   Gary has been commuting ever since to be with her
on weekends and it is wearing him out.   Unfortunately, Gary is leaving the best job in the
world at the VRC and he has done a spectacular job.   He is clearly damaging his
scientific trajectory of his career by making this move.  I told them (the VRC PIs)  that I
was extremely satisfied with the performance of the VRC and would do everything in my
Released by Chairman Rand Paul
298power to maintain the momentum and culture of the VRC.   I would not hire someone to
replace Gary that would possibly damage this culture.
 December 4, 2012 -   That evening had a senior staff dinner in which I discussed my
desire to tighten up the work ethic of the front office.   The work load is being
disproportionately falling on me, and particularly Greg Folkers who is killing himself
trying to polish up the sometimes sloppy work of others, particularly David Morens, who
is a good guy, but will have to be let go.   We met at Positano’s restaurant in Bethesda
(Fairmont Avenue) with Cliff Lane, Hugh Auchincloss, and JJ McGowan. Good
discussion.
December 7, 2012 - went to dinner at the home of Connie Milstein on 3210 – R Street,
N.W. in Georgetown.   Connie is the owner of the Jefferson Hotel in Washington DC.
The occasion of the event was a fund raiser for the organization called Key to the Cure
2012. This is an organization aimed at curing epilepsy.  It is run by Susan and David
Axelrod who have a child with epilepsy. It was an extraordinary evening with all the
glitterati of Washington DC at the meeting including a visit from VP Joe Biden. I had the
opportunity to chat a bit with the vice president and discuss our work with HIV-AIDS.
He clearly knew who I was since I have met him several times when he was in the Senate
and he was present at the East Room ceremony when I received the presidential Medal of
Freedom.  In addition there were number of other known media and political stars
including Alex Castellanos, the Republican Strategist. The joke of the evening is that
David Axelrod had just shaved off his mustache to raise money for the CURE.   He had
been joking on TV Sunday Talk Shows that he would shave off his mustache is Obama
lost the election.   Obviously, Obama won, but now David shaved it off for a cause.
Alex Castellanos now promised to shave off his moustache to raise money for the CURE.
December 8, 2012 - Saturday morning spent an hour on C-SPAN television (National
Journal) in Washington DC (400 North Capitol Street) discussing seasonal flu and other
infectious disease issues.   I was on the show with my friend Tom Frieden, Director of the
CDC.
December 11, 2012 - engaged in a National Academy of Sciences Symposium in
Washington DC at the Keck Building on 5th St., NW to discuss emerging infectious
diseases and the 20th anniversary of the 1992 IOM report on emerging infectious
diseases. Later in the day I gave a talk at the treatment action group (TAG) event run by
Mark Harrington at the Fairfax Embassy Row Hotel on Massachusetts Avenue in DC.
The subject of the meeting was ending the HIV pandemic in the United States. This
meeting was put together in order to emphasize that we have a significant problem in the
United States even at the same time as we are making enormous progress globally with
having the end of the AIDS pandemic globally in sight, which was the topic of the
Internal AIDS meeting in DC in July (see above) and the recent World AIDS Day events
at the White House and the State Department.
December 13, 2012  - travel to New York City to give the keynote lecture at the Drugs
for Neglected Diseases Initiative (DND1) symposium run by Medicins Sans Frontiere
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299(MSF, aka Doctors Without Borders) entitled  “Lives in the Balance: Delivering Medical
Innovations for Neglected Patients and Populations” I spoke on the research issues
related to neglected infectious diseases.  My talk was very well received it took place at
Mount Sinai Hospital on Madison Avenue and 99th St. The evening before I had dinner
with my daughter Jennifer at Café Vida on Amsterdam Avenue and 97th Street.
That evening when I got home I discussed the newly formed Office of Global Health
Diplomacy with Eric Goosby.   He wanted to give me a heads-up about the fact that
Secretary Clinton would make an announcement the following day about the formation of
this new office and that she would appoint Eric Goosby as the director of the new office
while simultaneously maintaining his position as the director of PEPFAR.   In typical
manner, Eric is such a good person and friend that he wanted to keep me in the loop.
December 14, 2012 - attended Lessons and Carols at the National Cathedral in
Washington DC at 7:00 to 9:00 PM. This is a tradition which our family has done for all
the years that are children attended the National Cathedral School. It was lovely and
nostalgic.  Megan and Ali attended with Chris and me.   Jenny was still in NYC and
would come down for Christmas in a few days.
December 15, 2012  - had dinner with Wayne and Catherine Reynolds at the Adour
Restaurant at the St. Regis Hotel on Connecticut Avenue in Washington DC.  As usual
Wayne and Catherine put together a very interesting group for dinner. This time it
included my friend Rick Atkinson the Pulitzer Prize winning author as well as Buzzy
Krongaard and his flakey wife Cheryl.  Buzzie was formally the Executive Director of
the CIA.   We were joking about the smash TV Showtime hit series called “Homeland”
starring Claire Danes as Carrie Mathieson (a bipolar CIA agent tracking terrorists) and
Damien Lewis as Sarg. Nicholas Brody (a marine turned reluctant terrorist, turned back
to good).   Buzzie was saying that the CIA could never act domestically the way it was
portrayed in the series.   That would have to be FBI.   Other guests included Francis
Collins, Congressman John Dingell and his wife Debbie and others.
December 17, 2012 - We had an “international consultation” on the problem of gain of
function research on H5N1 highly pathogenic avian influenza (HPAI) (see above
discussions).  The meeting took over two days from December 17 to December 18 and
was conducted at the Natcher Auditorium at the National Institutes of Health.  This is a
continuing issue and a source of great discussion about what experiments should or
should not be funded by the National Institutes of Health on this topic. I gave the opening
keynote which everyone felt very clearly defined the issues.  We will now finalize the
draft of “Framework” for addressing the issue of what grants and contracts we should or
should not fund that relate to a gain of function regarding respiratory transmissibility in
mammals of the HPAI H5N1 influenza.  I am trying to get myself out of this argument
which has consumed a considerable amount of my time over the past 14 months.
Dec. 30, 2012 – Interesting and potentially bad news regarding Sec. Hillary Clinton.   A
couple of weeks ago she reportedly fell and had a “concussion” that kept her out of the
public eye for ~ 3 weeks.   Report today that she was admitted to NY Presbyterian
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300Hospital for a “clot” and is supposed to be receiving anticoagulation.   Her staff are being
very close-to-the-vest about his.   Cannot figure out if she just has thrombophlebitis or if
she had a pulmonary embolus.   Certainly could not have had a subdural hematoma since
one would never anticoagulant under these circumstances.  Turned out she had a venous
thrombosis of a skull vein, not involving the brain
Jan. 3, 2013 – A lot of influenza activity exploding throughout the country with H3N2
that matches the vaccine.   Early start and big spike with widespread activity throughout
the country.   Appeared on Fox Local News this evening.
Jan. 7, 2013 -  Interesting telephone call with Paul Stoffels today.   Paul is CEO of
Johnson and Johnson that owns Janssen Pharmacueticals as well as Crucell.   He is
excited about the Dan Barouch HIV candidate using Adenovirus 26/35 + MVA boost and
wants to develop it as an HIV vaccine.  He wants to partner with me and NIAID in this
endeavor.   This is relevant to the meeting tomorrow night in Building 31
Jan. 8, 2013 – Flu activity accelerating.   Appearing on WUSA – Channel 9 today.  Also,
appeared this evening on Wolf Blitzer “Situation Room” regarding the flu epidemic.
Went very well
 This evening meeting of the P5 vaccine consortium in Building 31, 7A-24. Successful
meeting involving all of the players from Gates Foundation (Trevar Mundell, Stefano
bertozzi, Peggy Johnston, Nina Russell), the Army (Nelson Michael, Jerome Kim),
HVTN (Larry Corey, Peter Gilbert, etc.) See pdf for full contingent.
image.pdf
Main purpose of the meeting was to re-group and summarize where we are in the
planning of the P5 (Pox Protein Public Private Partnership) for HIV vaccine).
Presentation by Larry Corey, Gepi Pantaleo, Peter Gilbert, Julie McElrath, Glenda Gray
(RSA) on the NYVAC  +/- DNA +  protein approach; and by Dan Barouch, Hanneke
Schuitemaker (Crucell) on the Adenovirus (Ad 26/35 + protein + adjuvant) approach.
One of the problems is that Novartis, who is supposed to supply the envelope protein for
the Corey trial will be about 1 year late in delivering the protein.   Many of us are angry
with them about this since they have not been forthcoming.   Also, the correlates of
immunity from the RV144 (Thai) trial indicate that protection might be related to
response against the V2 loop of the envelope and specifically against residue 169 in this
region.   Problem is that the envelope used in both proposed trials will not even address
this.   The envelope that grows well in cell cultures will be used.   Balance of empiric
with scientific.   Gepi Pantaleo, Larry Corey and I went to dinner in Bethesda at
Grapeseed Restaurant after the meeting (5:30 to 7:45 PM) to reflect and commiserate.   It
will be largely my responsibility to decide go-no go from Phase 1 (starts in mid-end of
2014) to Phase IIa/b (2015 - 2016), the latter costing over $100 million and so this will be
an important decision based on a combination of science and best guess.   Stay tuned.
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301Jan. 9, 2013 – Appeared on C-SPAN (TV) and on WTOP radio early this AM to talk
about the erupting influenza epidemic.
Jan. 9, 2013 -  Attended an important dinner at the home of John Monahan and his wife
Annie at 3340 -  Runneymede Place, N.W., Washington, D.C.  to discuss the relationship
between PEPFAR and USAID with regard to the new Office of Global Health
Diplomacy.  John formerly worked in the Clinton Administration and for the past 4 years
has been Counselor to Secretary Sebelius in HHS and Acting Director of the Office of
Global Health Affairs at HHS.  He recently moved to the State Department to help with
the Global Health issues there.   Hillary Clinton had just established this Office of Global
Health Diplomacy and made Eric Goosby (Director of PEPFAR)  the Director of the
Office  with Ambassador Louise Rowe as Deputy.  Apparently Raj Shah and the USAID
are trying to take control over this new initiative that has just been put out by the Obama
administration. Raj has been trying to take over PEPFAR for some time now without
success. I have been backing Eric Goosby from the very beginning since I believe that
Raj is driven by ambition on the background of a terrible track record of USAID. In the
second Obama administration the people in the State Department and in the White House
are trying to create a legacy for Pres. Obama with regard to global health. They believe
that this new office of Global Health Diplomacy could be the vehicle to do that. Right
now it appears that we are engaged in the struggle Raj Shah and USAID wanting to take
over the process. The dinner included a number of people with knowledge in the field.
Participants included John Montague his wife Annie, Francis Collins, Tom Frieden,
Peggy Hamburg, a woman from the State Department (Laurie) who worked in the
Clinton Administration, Nils Daulaire, and a number of other people. The plan discussed
at the meeting was to help support Eric Goosby is trying to make the office of global
health diplomacy a productive and viable enterprise and to ward off any attempts on the
part of USAID to take it PEPFAR and the new office. Tomorrow I will go to the State
Department for the first of the number of meetings that will address this issue.   More to
follow on this subject.
Jan. 10, 2013 – Did CNN Situation Room with Wolf Blitzer regarding the Flu outbreak.
I made casual statement in response to a question by Wolf that the outbreak had passed
the epidemic threshold (which was true (7.3% with threshold at 7.2%).   Anderson
Cooper later on in his CNN show “Anderson Cooper 360” made announcement that NIH
Official Dr. Anthony Fauci has now declared the influenza outbreak “an epidemic”.   The
CDC was coming out with their weekly report with a big press briefing the following day
(tomorrow) and this must have gotten them pissed with their usual jealousy of my being
on TV and the media in issues that they think they own.
Jan. 11, 2103 – Did morning CNN and Soledad O’Brien on CNN and further discussed
the flu situation.   Much, much press interest.   As expected, Bill Hall (HHS Press office)
wrote a note to Courtney Billet, Greg Folkers and John Burklow saying that from now on
the CDC should handle press on the flu and I should only do local media and national
media only when they want to talk about research associated with flu like universal flu
vaccine.   This has shades of Jenny Backus.  Almost certainly a result of a complaint
from CDC.   We (NIH/NIAID) are trying not to clash with them, but this is really
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302insulting and we will have to see how this plays out and how we should push back on
this.
Jan. 12, 2013 – Did WJLA – Channel 8 news on flu on this Saturday AM.   Also,
received request that Soledad O’Brien wants me again on her show on Monday AM.
This will be the test regarding my above comment concerning Bill Hall.
Jan. 14, 2013 – HHS turned me down on requests from CNN Wolf Blitzer and Soledad
O’Brien.   I asked John Burklow to call up Bill Hall and find out what the heck is going
on and what the reason for all of this is.   John told me that CDC complained to Bill Hall
and HHS that I was getting all of the publicity on an issue (influenza “tracking”) that they
considered was their issue.   I do not know who at CDC did this.   It could be anyone
from Tom Frieden (I doubt this) to more likely Tom Skinner (CDC PR person).   In any
event, it has nothing to do with my use of the word “epidemic” on Wolf Blitzer Show and
everything to do with pure jealousy that I am a “rock star’ stealing their thunder.  Shame
on the CDC.    Bill Hall promised John Burklow that as the epidemic stabilizes, I will be
allowed to do the big shows and that starting now, I can do anything that has to do with
the science and vaccine development.  In this regard, see below – tomorrow
Jan. 15, 2013 – Appeared on the “Situation Room” (CNN) in a piece that featured the
quest for a universal flu vaccine.   I did the interview from the NIAID Vaccine Research
Center.   John Mascola also appeared as we showed the CNN crew around the VRC.
Very nice piece.  Tomorrow I do a 1 hour call in show on WTOP.
Jan. 16, 2013 – Did a very successful 1 hour show with call-in on WTOP at 10:00 to
11:00 AM.   Rainy day in Washington, D.C.   Also, local NBC News and WUSA
Channel 29 filmed me during the radio show and I gave on camera interview to them
after the show.
Jan. 17-23, 2013 -  As expected, due to the beginning of drop-off of influenza cases,
even though we are in the middle of the influenza season, the press interest has almost
completely dropped off the radar screen.   Almost no stories this week on the 2012-2013
influenza outbreak.
Jan. 23, 2013 – The “60 day moratorium” on gain-of-function research on respiratory
transmission of HPAI H5N1 influenza in mammals has been lifted by the scientists who
originally signed to moratorium.   The moratorium actually lasted just over one full year.
We at HHS and NIH have been developing a framework for making funding decisions
for this type of research (see above – Dec. 17, 2013).   The framework should be ready
for implementation in a few weeks and so we can start making funding decisions.   Much
press coverage today (I was in NY Times, Wall Street Journal, AP, etc.).  The nay-sayers
who feel this research should not be done at all (David Relman, John Roberts (Nobel
Prize winning ass-hole) or should not be published (Mike Osterholm) are still out there
bad-mouthing the decision to lift the moratorium.
Jan. 25, 2013 – Appeared on CNN “The Situation Room” with Wolf Blitzer to discuss
the ongoing breakout of norovirus in the USA.   Good interview.   There are about 20
Released by Chairman Rand Paul
303million cases of norovirus in the USA each year with 70,000 hospitalizations and ~800
deaths.
Feb. 3, 2012 – Super Bowl night. Ravens beat 49ers 34-31.  Nonetheless spent the
evening at a dinner and panel discussion at the Fairmont Hotel (24th and M Street, N.W.),
Colonnade Room. Occasion was a pre-Summit dinner for the Global Women’s Cancer
Summit to take place the following week.   Panel discussion between David Rubenstein
(Carlyle group) and Wolf Blitzer (CNN) with Mark Dybul contributing.   Sat a dinner
table with David Rubenstein (who is still trying to get me to work for him at Carlyle
because he thinks that I am “…the smartest person in the world”), Laura Bush, Wolf
Blitzer, Agnes Binagwaho (Minister of Health of Rwanda), Nancy Brinker, Mark Dybul,
Julie Gerberding.   Great discussion about transforming events in global health.   Chatted
with Laura about President George W. who recently had back surgery as well as about
President George H.W. who is slowly recovering from bronchitis hospitalization.
Feb. 14, 2013 – Valentine’s Day.   Very interesting and enjoyable evening.  Chris and I
were invited by Wayne and Catherine Reynolds to a dinner in the Adams Room of the
Hay Adams Hotel to honor Ehud Barak, Defense Minister and former Prime Minister of
Israel.   He is in the USA for a meeting with Leon Panetta (Secretary of Defense).  Great
time.   Usual A crowd of DC, which this time included David Petraeus and his wife
Holly.   Had the chance to speak with Petraeus and mentioned that I often said Hi to him
as we passed running on the C & O Canal.   He said he recognized me, which was
probably just being polite.   I thanked him for his years of service to the country.   He was
very gracious.  Obviously, some degree of awkwardness in the crowd given the Paula
Broadwell scandal and his wife being there on “Valentine’s Day”.   Also present among
many other were Bob Barnett and wife, Ed Markey (soon to run for Senator from
Massachusetts) and wife Susan Blumenthal, Rick Atkinson (Pulitzer Prize winner
author), Lyric Winik and husband Jay, Ben Carson and wife Candy, Josh Bolten and his
new girlfriend (?name), Bill Cohen (former Sec. of Defense) and wife Janet, etc.
     Barak gave a very insightful speech on the challenges facing Israel in the context of
the Arab Spring, Syria, and Iran.
Feb. 25, 2013 – Still no solution to the impending sequestration deadline of March 1,
which will result in across-the-board cuts to Pentagon and discretionary spending
(including NIH).   The POTUS is doing some severe posturing that this is all the fault of
the Republicans and is having all of the Cabinet members out there saying how disastrous
the cuts will be.   Meanwhile, Bob Woodward points out in an editorial in the
Washington Post on Feb. 24 that the POTUS “moved the goal posts” on the GOP by
wanting to bring up tax increases even though the original discussions surrounding the
budget deal of a few months ago is that the Bush tax cuts were allowed to expire and so
taxes are “off the table”.   Woodward says the POTUS now wants to put them back in
play.   Looks like sequestration will occur.
Sad day in that former Surgeon General C. Everett (Chick) Koop dies at age 96.   I had
the pleasure of giving the laudatios at his 80th and 90th birthdays.  My quotes appeared in
many newspapers regarding his amazing life and also on local FOX TV.
Released by Chairman Rand Paul
304Mar. 1, 2013 – Sequester kicked in and so spending cuts are in effect.   Incredible
posturing on part of GOP as well as the POTUS who is stating that the “world will come
to an end” and the GOP is to blame since they refuse to raise taxes.   This is pitiful
government.
     Also, interesting finding being presented at CROI meeting in Atlanta in a couple of
days of an infant who was treated (not prophylaxed) with ARVS within 30 hours of birth
since his mother who was infected had no anti-natal care and obviously no ARVs.   She
presented in an ER in Mississippi at labor.   The physicians felt that since the risk was so
high for the baby that they treated the infant before the tests for HIV came back.   They
usually take several days to come back.   Right choice.   The baby was infected and
stayed on ARVs for 18 months.   Then lost to follow up and mother D/C’d the ARVs for
10 months and reappeared.   Only now the baby is well and no evidence of replicating
virus (some probably dead residual DNA by PCR.   Also, immune response to HIV
disappeared (not surprising in the absence of persistent virus).   This may be the first real
case of a cure, not the “Berlin Patient” whom I always thought was totally non-feasible
for scale up and danger.   Of note, I have been saying for years that the best bet for a cure
was to treat as early as possible to prevent establishment of a large reservoir and to
prevent destruction of immune system by persistent viral replication over months to
years.   The best scenario for this is to treat a child at birth.  Perhaps there are other
children on therapy who received ARVs relatively early (not necessarily within hours)
who are in fact cured and do not know it.   Much study to be done.
Mar. 4, 2013 – The media interest in the “cured” baby has been as intense or more than
anything I have experienced here at NIH.   Yesterday I did WUSA 9 nightly news and
today I did: CBS Morning News with Charlie Rose and Nora O’Donnell; WTOP Radio;
Fax Morning News; CBS Radio LA; Fox Radio News; NBC News and NBC Nightly
News; ABC Evening News; BBC World Service Radio; Canadian Broadcast (CBC) TV;
CNN International with Christianne Amanpour; CNN Situation Room with Wolf Blitzer;
WLS radio; PBS NewsHour with Ray Suarez; BBC Radio; Canada CNN Radio; CNN
Anderson Cooper 360; Al Jazeera.   Quite a day.   I stressed that we must be careful since
this is only a single case in very unusual circumstances.   All media went very well.
Mar. 5, 2013 – Media frenzy continues.   I have now gone over the data from the Hannah
Gay and Persaud presentation at CROI and I have some doubts that the child was ever
truly infected in the first place.   Tough to really tell whether the virus that was detected
and ultimately disappeared on ARVs was the virus from the mother or really infected
baby cells making virus.   The authors claim that the 2 phase decay of virus on ARVs is
characteristic of the response to active virus replication.   Cliff Lane pointed out that the
decay curve has very few points and is also compatible with a single phase decay.   In
any event, I have been taking the conservative approach of emphasizing that this is just a
single case and it needs to be replicated and validated and importantly, it has little to do
with infection in the adult where reservoirs are firmly established prior to the start of
ARVs.
       Nonetheless, the media frenzy continues with interview for Men’s health, Huffington
Post, NPR- San Francisco (KQED), Boston Globe.
Released by Chairman Rand Paul
305Mar. 6, 2013 – When it rains, it pours.  CDC came out with a “Vital Signs” alert out of
MMWR about the growing threat of Carbapenem-resistant Enterobacteriacea (CRE),
which includes Klebsiella pneumonia carbapenem-resistant (KPC) that gave the NIH
Clinical Center the outbreak of 18 cases (11 deaths, 7 of which were due to the KPC) in
2011.  Another media frenzy starts with me on NBC Nightly News X2.
Mar. 7, 2013 – CRE media with Diane Rehm Show,   Briefed Laura Friedel of Senate
Minority Staff at Appropriations (Staffer to Ron Moran)
Mar. 8, 2013 – Guest on Geraldo Rivera Show for “cure” baby; CNN tape for tomorrow
on CRE; the Washington Post “The Fold” (online TV) on HIV.
Mar. 11, 2013 – Flew to Boston for the day to give Keynote Lecture at the dedication of
the new building for the Ragon Institute of MGH, Harvard, and MIT.  Held at 400
Technology Square in Cambridge, MA.  Orchestrated by Bruce Walker who is amazing
at raising money for his biomedical research.   Terry and Susan Ragon (software
billionaires) gave Bruce $10 million per year for 10 years and now an additional $30
million to renovate the building for the Ragon Institute.   I spent a few hours interacting
with the Ragon scientists, gave my Keynote and then had dinner at the “Catalyst”
restaurant in Cambridge.   Many Boston scientific and other luminaries at lecture and
dinner including Bob Kraft, owner of the New England Patriots, and his family (wife and
son Jonathan).   Also at lecture and at dinner and with whom I had great conversations
were Drew Faust (President of Harvard), Raphael Reif (President of MIT), Ray Slavin
(President of MGH) among others. We discussed the potential effects of the
“sequestration”  Very nice visit.
Mar. 13, 2013 – Did nice interview at Biocentury (WUSA – Channel 29) on the
Sequestration.
    That evening went to Research America Gala at Mellon Auditorium on 13th Street and
Constitution Avenue, N.W.   I sat at the Duke University Table with Congressman
George Holding, Victor Tzau, and others.   My friend Diane Rehm (NPR Diane Rehm
Show) received one of the awards.
Mar. 15, 2013 – Have received indications from Judith Shamir (Exec Sec of IOM) the
Alan Leschner, Chair of IOM President Search Committee is very interested in my
submitting my application for the job.  I told her that I was not interested, but I would let
her know.   I called current President, Harvey Fineberg, and asked his opinion.   He said
that I would be fantastic for the job.   I explained that I was not that interested.  The only
reason (weak) to take the job is that I could start writing my book in that job, which I
cannot really do now since I would have so much more time in that much-less-demanding
job compared to NIAID Director.
Mar. 18, 2013 – Met with Congressman Andy Harris (R-MD) in Building 1 together
with Francis Collins, Griff Rogers, Gary Gibbons.   Harris is a Tea Party person who is
second rank on House Appropriations Subcommittee behind Chairman Kingston.   Funny
interchange since Harris brightened up when I introduced myself, saying that he was
Released by Chairman Rand Paul
308Latest count of H7N9 in China today is 78 cases and 16 deaths.
April 17, 2013 – Went to Princeton to deliver the Gilbert Omenn Lecture at the
Woodrow Wilson School of Public and International Affairs.  Spoke on “Ending the
HIV/AIDS Pandemic:  From Scientific Advances to Public Health Implementation”.
Hosted by Cecilia (Ceci) Rouse formerly on the economic team in the Clinton and
Obama White House.
April 19, 2013 -  Terrorists identified by surveillance cameras.   Tamerlan and Dzhokhar
Tsarnaev.   Two Muslim brothers born in Chechnya.   Older one recently spent about 6
months in Chechnya, likely getting trained in terrorism.   Most intensive manhunt in US
history around Boston Area.   Entire city of Boston shut-down.   Wild car chases and gun
battles. Terrorist murder campus policeman at MIT and seriously wound another
policeman.  Tamerlan shot dead; Dzhokhar escapes, seriously wounded, ultimately
captured in Watertown MA.
April 21, 2013 – Informed by Francis Collins that he spoke with Bill Corr (Deputy HHS
Secretary) about the issue of my being muzzled, almost certainly because Tom Frieden
and the CDC want the spotlight on the H7N9 story.   Corr agrees with Francis that I
should always be allowed to speak to Press (Print/TV/Radio) when they directly ask for
me.   Let us see how this turns out.  Also, it is clear now that I have joined the 2x/week
conference calls with HHS that CDC really wants to be in control even though I believe
they are missing important stuff.   For example, they are claiming that they cannot detect
the virus in chickens, likely because the PCR assay is specific, but not sensitive.   I just
found out from the CEIRS people (including Mike Osterholm) that the Chinese are
looking in the wrong place.  The cloacal swabs are negative, but there are tons of virus in
the trachea swabs.   Case now well over 100 and counting.   The Chinese need to start
massive culling of chicken or the virus might adapt itself to humans after many dead-end
jumps.
April 22, 2013 – Cases of H7N9 continue to accumulate.   First case in Taiwan. HHS is
now clearing me for press (see above); however, there have not been any requests from
major network and so still not clear what will happen.   I have decided without question
to defy them if they try to muzzle me, which I do not believe they will now that Francis
has spoken with Bill Corr; but we shall see.
Had dinner with Bob Gallo tonight and discussed the upcoming Paris meeting sponsored
by the Pasteur institute (Francois Barre-Sinoussi) to celebrate 30th Anniversary of
discovery of HIV by the French.   Bob is scheduled to give an after dinner speech.   I
stressed that he should behave and not re-hash old issues.   Also, Bob told me that he and
Joe O’Neill are writing a book about the history of AIDS and they want to devote a
chapter to me.   This is nice, but now it is clear that I must write my book and do it soon.
Will get advice from David Willman (L.A. Times) and Rick Atkinson (author of World
War II books) – both Pulitzer Prize winners on how to proceed.   Also, will contact Ari
Emanuel’s Book person.
Released by Chairman Rand Paul
309April 25, 2013 – Went to reception at the home of Sen. Jay and Sharon Rockefeller to
celebrate 10 years of service and retirement of Amy Lawson as CEO of DC Prep (where
Jenny taught).   Amazing home – 2121 Park Road, N.W.   Had chance to chat with the
Senator about NIH.
April 26, 2013 – Had important discussion with Eric Goosy by phone about whether we
(NIH and PEPFAR) should fund the Africa START study proposed by Wafaa El Sadr
and Kevin DeCock.   Eric is skeptical about doing this since he feels that very soon many
in Africa will be starting therapy at below 500 CD4+ T cells and the study may not be
able to be done.
April 27, 2013 – Went with Chris to White House Correspondence Garden Brunch at
Beall-Washington House on 2920 R Street, N.W.    Tammy Haddad as usual MC’d it.
Sponsored by CURE Epilepsy and the Miss America Foundation.   Great party.
Fantastic weather – bright sun and 70 degrees.   Usual cast of celebrities – political,
media and Hollywood.   Ran into old friends David Axelrod, Sharon Stone, Nora
O’Donnell, Charlie Rose, Gordon Peterson.  Discussed NIH budget with Eric Cantor.
Had most fun meeting and taking picture with Navid Negahban who played the arch-
terrorist Abu Nazir on “Homeland” (Showtime).  We told him how much we admired his
work.   He sort of recognized me but not quite.   After a few minutes, he came over to me
and said how impressed he was about how many lives I have saved and as he was saying
it, he choked up.   He clearly had asked someone who I was.   Seems like a fine human
being.
April 29, 2013 – Went to dinner at Matisse Restaurant on Wisconsin Avenue and
Fessenden Avenue, N.W.   I took out Richard (Rick) Atkinson to dinner to get his advice
on writing my book (autobiography).   He was extremely helpful on how to approach this
and gave me several names of agents, editors, historians, etc.  he encouraged me to “shop
around” for the best people.   He confirmed what Edwin Grosvner and Ari Emanuel said
that I clearly have a NY Times bestseller and possibly Pulitzer Prize autobiography in me
and encouraged me strongly to pursue this.
I am very excited (almost agitated) about doing this.   I have a worrisome feeling that the
USG will not allow me to do this.  Even though it is MY autobiography, most of it relates
to my government service.   I will probe this and see what happens.
Parenthetically, the Washington Nationals, who are supposed to win the World Series this
year on the basis of pure talent have gotten off to a bad start.   The only people that are
doing great thus far are Bruce Harper and Jordan Zimmerman.
***H7N9 continues to occur in China from chickens to human → 126 cases and 24
deaths.   Still confined to China.   Need to keep an eye on this.
May 1, 2013 – Attended the “Heroes of Military Medicine Awards at the Mellon
Auditorium on 13th Street and Constitution Avenue N.W.   I was present because Lt. Col.
Released by Chairman Rand Paul
310Nelson Michael (my old friend) was receiving one of the awards and I had been part of
the video that was shown at the event that honored him.  Nice affair.  Inspiring keynote
address by Admiral William H. McRaven, Commander of United States Special
Operations Command (the group – Seal Team 6 that got Osama bin Laden).  Other
awardees besides Nelson were USAF Lt. Col. Raymond Fang – Trauma surgeon with
multiple tours in Iraq and Afghanistan.   He spoke by video since he is currently deployed
in Afghanistan.   Also Hospital Corpsman 1st Class Darrel L. Enos – 3rd Marine Special
Operations Battalion who received it posthumously – killed in action.   Entire evening
very moving.   Special awards to Marine Staff Sergeant Johnny Joseph (Joey) Jones who
got his legs blown off while trying to dismantle and IED in Helmand Province,
Afghanistan.   I was in tears after his speech.  Also talks by Gen. Jack Keane (USA-
retired), Gen. James Amos (USMC).  Special Award to Gen Joseph F. Dunford (USMC),
Commander of Forces in Afghanistan who spoke in video from Afghanistan.  General
Amos introduced him.   Gen. James Peake, Former US Army Surgeon General and
currently Sec. of Department of Veteran Affairs received a special award.   He fought as
a combat platoon leader in Viet Nam and was highly decorated with Silver Star, Bronze
Star with V device and Purple Heart.   After war, went to Cornell Medical School,
became a cardiac surgeon – quite a guy.   I have known him for years.   Mistress of
Ceremonies was Jennifer Griffin of FOX News Channel.   When she called out
“notables” in the audience, she mentioned my name.   I was embarrassed to be called out
together with General McRaven, Amos, Peake and others.   The evening made me proud
to be an American.
May 6, 2013 – H7N9 still smoldering, but with the closing of some of the open bird
markets in China, the pace of new cases has slowed.   130 cases and 31 deaths total.
HHS is now allowing me to do press on this without hassle.   Francis Collins meeting
with Bill Corr has apparently worked (see above).
Went to cocktail reception/book signing for Paul Farmer’s new book – “To Repair the
World” at home of Greg and Derry Craig on 3155 Highland Place, N.W.; also co-
sponsored by Tim Broas.   Paul, as usual, was very generous in his remarks about my
accomplishments in being the architect of PEPFAR and the influence that I had on his
career.   Several notables there including Kathleen Matthews and Paul Wolfowitz.   Had
good conversation with Paul about how we worked together when he was Deputy
Secretary of Defense.  Paul gave 2 signed books to me – one for Chris and me and one
for Jenny.  Also, I spoke with Paul about getting one of his acolytes to come work for me
as my assistant at NIAID.  (Turns out I contacted one Hillary Marston who will be
joining me in August – see below))
May 7, 2013 – Went to the Capitol with Francis Collins to meet with the House Majority
Whip – Congressman Kevin McCarthy (R-CA).   Kevin is very interested in the problem
of Valley Fever (Coccicioidomycosis) in his district of Bakersfield.   We discussed
having a workshop and partnering with CDC in doing clinical trials of new drugs such as
Nippo Z and developing a vaccine.   Good idea to cultivate relationship with McCarthy,
given his position.
Released by Chairman Rand Paul
311May 8, 2013 – Appeared on NPR Morning Edition radio with Richard Knox regarding
H7N9 flu.   Also, gave Opening Keynote Address at the Annual Meeting of the
HPTN/IMPAACT Networks held at Marriott Wardman Hotel on Calvert Street, N.W.
Myron (Mike) Cohen presented me with a basketball signed to me from Roy Williams,
head coach at UNC.  Mike gave it to me to “neutralize” the signed basketball that I
received years ago from Duke Head Coach Mike K.
May 9, 2013 – Had Congressional visit here at NIH in the Clinical Center medical Board
Room on 4th Floor of Building10.   Delegation led by Eric Cantor (R-VA).   Also present
were Congressmen Andy Harris (R-MD), Elliot Engel (D-NY), Ted Yoho (R-FL), Chaka
Fattah (D-PA), Renee Ellmers (R-NC). Tim Murphy (R-PA), Earl Blumenauer (D-OR).
NIH was represented by me, Francis Collins, Gary Gibbons, Eric Green, Chris Austin,
Larry Tabak, Kathy Hudson, John Gallin.   We were trying (successfully) to familiarize
them with the NIH and what we do.   Also, to impress on them the damage due to
sequestration.   I spoke about the major advances in treatment of HIV and the possibility
of a universal Influenza vaccine.   All in all it was a very good meeting.
Went to Book party at the home of Bob and Deborah Seder in honor of Andrea Redmond
who co-authored book called “Rwanda, Inc.” about entrepreneurship in Rwanda and the
effect on the economy.   Had long conversation with my good friend Cheryl Mills,
Former Chief-of-Staff to Sec. Hillary Clinton and long-time Counselor to Clinton about
the “scandal” associated with the Benghazi incident where the Republicans are trying to
attack the Administration and especially Hillary Clinton for negligence/incompetence in
not protecting and responding in time to the Sept. 11, 2012 terrorist attack on the US
Embassy in Benghazi, Libya in which the US Ambassador was killed.   Cheryl says that
the whistle-blower Greg Hicks is clearly not telling the story as it happened with regard
to the State Department responding or not to the threats against the embassy.   I obviously
believe Cheryl.
May 13, 2013 – Slow down of activity on H7N9; uptick of activity with MERS Corona
virus (Middle East Respiratory Syndrome).  I appeared today on WTOP and BBC
television discussing MERS CoV.
May 15, 2013 – Testified at the Senate Appropriations Subcommittee Hearing for NIH
today.   Testified with Francis Collins, Harold Varmus, Story Landis, Richard Hodes and
Gary Gibbons.   Friendly Hearing.   Asked me questions about DURC, Antibiotic
resistant bacteria, H7N9 influenza pre-pandemic, universal flu vaccines and
autoimmunity.   As mentioned many times above, the Hearings are very different from
10-20 years ago.   We had 2 hours for the entire NIH, when back then we had a week of
Hearing with individual half-days for the big institutes.
May 17, 2013 – Interesting dinner with my friends Catherine and Wayne Reynolds at
Adour Restaurant at the St. Regis Hotel on 16th and K Streets, N.W.   Other guests were
John Rogers who was Assistant to the President during the Reagan Administration.   He
remembered me from back then.   He went off to be Deputy to Jim Baker when Baker
became Secretary of State for Reagan.   His wife Deborah was charming and a nice
Released by Chairman Rand Paul
313June 1, 2013 – Ali’s II Eight boat came in 2nd in the Petit Final and 8th overall in the
tournament – Great job, Ali!  Ali ultimately makes 1st Team All-Pac-12 Academic All-
American (for second year in a row).  She has the highest grade point average (4.05) of
any Pac-12 athlete.
June 3, 2013 – Press interest continues regarding MERS-CoV.   Was on daytime CNN
today plus lately other TV media “feeds” such as AP, VOA, Reuters.
David Morens, Jeff Taubenberger and I just got Commentary accepted in NEJM on
H7N9 – to come out Online on June 5.
June 4, 2013 – Had dinner at Matisse with Bob Bazell, 38 year TV medical reporter for
NBC.   He is leaving NBC to join Yale Faculty.   He is a trained microbiologist before
working for NBC.   He must have interviewed me hundreds of times over the 30 + years
of HIV/AIDS.   We have become friends and he wanted to have a catch-up dinner and tell
me of his plans.
June 6, 2013 – See e-mail below from  to me and my forward note to Chris,
my children and Denise.   It describes my role as physician at NIH in the pre-AIDS days.
Important historical perspective.
-----Original Message-----
From: Fauci, Anthony (NIH/NIAID) [E]
Sent: Thursday, June 06, 2013 6:19 PM
To: Grady, Christine (NIH/CC/BEP) [E]; Jenny Fauci
(jennyfauci@gmail.com); Alison Fauci (ali.fauci@gmail.com); Megan Fauci
(megan.fauci@gmail.com); Denise Scorce
Subject: FW: Personal from
Folks:

   They call it "of childhood" because patients never lived
beyond childhood.   I first started taking care of her  at NIH when she
was 6 years old.  These patients die of fungal and other infections.
I kept her alive for several years until she had had so many liver
abscesses that when she was 12 years old, she had another liver abscess
with Aspergillus, a deadly fungus.   The surgeons refused to drain it
because they said that the surgery would kill her and they did not want
to have someone die in the operating room.  I wanted to keep her alive
in hope that  we could some day find a therapeutic approach that might
save her.   I told the surgeons that she definitely would die if they
did not operate on her and that this tradition that "no one should die
in the operating room" was frankly "b--s--t".  They still would not
operate.   I kept pushing and pushing them until they reluctantly
complied.   She survived the operation and then a couple of years
later,  treatment (gamma interferon) was found (by John Gallin) to
prevent her infections.   Several years later she "grew out" of her
disease and now she does not require any therapy. She has 3 children,
one boy and 2 girls.   She named the boy Anthony, after me.  Life is
good.
Released by Chairman Rand Paul

314Dad/Tony/Anthony
-----Original Message-----
From: cdean002@cfl.rr.com [mailto:cdean002@cfl.rr.com ]
Sent: Thursday, June 06, 2013 2:59 PM
To: Fauci, Anthony (NIH/NIAID) [E]
Subject: Personal from Carla Heeke-Dean
Just a note to say, Hi.
I reached a milestone today that some thought I would never reach.
Today is my 50th birthday, not bad for my parents being told I wouldn’t
live to 18?  I want to thank you for all the times you have stood up
for me even when others didn’t believe I would survive. Thank you for
all the long hours and every time you went beyond the call of duty.  I
truly love my life with my family and friends, and know I wouldn’t have
it without you.  Enjoy this day, because I am!
All I have for you is admiration and thanks.
Love,
Carla Heeke-Dean
June 9, 2013 – Had dinner with the Heads of International Research
organizations (HIRO) at the Hyatt Bethesda Hotel.   Francis Collins is
the Chair this year and so they meet in the USA.   Francis asked me to
be the after dinner speaker with Eric Goosby.   I spoke about the
threat of MERS-CoV and H7N9 Influenza and Eric spoke about PEPFAR.
June 10, 2013 – Met with Tim Hallett (of the UK’s London School of
Tropical Health and Hygiene) and Eric Goosby in Eric’s office to
discuss Tim’s mathematical model for

Summary:
Watcher-discovered document from paul-readingroom (2026.07.27_Diary-Prequel-.pdf), auto-indexed 2026-08-05.

Excerpt: Wisconsin Avenue  and Fessenden.   Discuss the Qatar initiative, see above and below.  But, conversation  turned to Raj Shah and the PEPFAR/USAID story.  Bottom line is that Raj has been  talking with Rick and it appears from Rick and my prior conversation with Raj that Raj is  not against treatment as prevention (TAP); however, he does not like the model and want  to do it differently.   (More on Qatar later – stick with USAID/PEPFAR for now) Released by Chairman Rand Paul 256Nov. 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…