Read Tony's Diary: The Prequel (Part 6 of 7)

Hotel Excelsior on
81st St. between Columbus Avenue and Central Park West. The ceremony at the
Museum of Natural History was stunning in the positive sense. I completely
underestimated the importance of this particular function. The annual function makes
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326three major awards to biotech companies, pharmaceutical companies, and companies that
develop devices. It is essentially the Academy Awards of pharmaceutical/biotech
companies. I gave the keynote address associated with my receiving the Pro Bono
Humanum Award.   This award is given every year.   Over the past 3 years it has been
won by Francis Collins, Paul Farmer, and Bill Clinton.   The dinner gala was held in the
Whale Room of the Museum of Natural History. All the elite of the biotech world, the
pharmaceutical world, and the academic world were in the audience, which consisted of
about 500 people I gave an address on “Ending the HIV/AIDS Pandemic:   From
Scientific Advances to Public Health Implementation.  Importantly I was introduced and
presented the award by Elie Wiesel. It was an extraordinary honor to receive the award
by him. I returned to Washington DC first thing in the morning to a very busy week.
October 27, 2013 – Went to reception and showing of a movie by famed young Indian
actor, director, producer Aamir Khan at Jefferson Hotel at invitation of Catherine and
Wayne Reynolds.   Film was on female fetocide in Indian culture.   Quite moving.  Khan
is a multi-millionaire visionary and pioneer for human right causes.
October 28, 2013 – Appeared via teleconference at a NY State AIDS Institute
Conference in NYC organized by Mark Harrington and TAG.   They wanted my input on
how we can truly put an end to the AIDS epidemic in NY State.   Mark Dybul phoned in
after me from Geneva and the Global Fund.
October 31, 2013 – Been in press over past few days regarding recent papers in Science
and other journals on the HIV envelope resolution by cryo-EM by Ian Wilson, Dennis
Burton, John Moore.   Also on WTOP today regarding polio in Syria.
Nov. 3, 2013 – Went to San Francisco for day – flew in the AM, gave Keynote at the
Lancet/Cell Conference on “Achieving an AIDS-Free World”.   My talk was widely
quoted and praised for its comprehensive analysis of the opportunity and challenges in
achieving an AIDS-Free world.   Richard Horton (Editor of The Lancet) praised me in
several subsequent commentaries and editorials.   This is now a highly visible and much-
discussed issue of an AIDS-free generation.   I am leading the discussion, but with the
usual caveats that it is not yet time for a “victory lap” since much needs to be done and
despite great scientific and implementation advances, this is not on automatic pilot.   I
flew back on “red eye”.   Hence 12 hours in the air and about 10 hours in SF.   This is my
life.
Nov. 11-16, 2013 -   Great trip with Christine to visit Oxford and give the Unither Baruch
Blumberg Lecture at Oxford on “Ending the HIV/AIDS Pandemic:  From Scientific
Advances to Public Health Implementation”.  Met with Raymond Dwek and other
colleagues.   Visited historic sites within Oxford and enjoyed seeing places where Willis
(Circle of Willis), Harvey (circulation) and Francis bacon lived and went to school.   I am
not usually moved by these things, but this was good.
On Nov. 13-14, went to Berlin to receive the Robert Koch Gold Medal.   Great honor.
Jeffrey Gordon of Washington University received the Robert Koch Prize for his work on
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327microbiome.   My Medal was for lifetime achievement in medical science.   Peter Palese
gave the best introduction of me ever.   He seriously compared my career to that of
Robert Koch in that I attacked a brand new disease (HIV/AIDS) in the same manner that
Koch approached and studied Anthrax, TB, etc.   It was a humbling and exciting visit.   I
gave the Robert Koch Lecture at the Max Planck Institute and reacted with many
students.  Also saw old friends Stefan Kaufman (nominated me), Fritz Melchers,
Hermann Wagner, etc.   Visited Checkpoint Charley, Brandenburg Gate, The Reichstag.
Great honor and enjoyable visit.
November 19, 2013 -  Yesterday I appeared on Local TV Station WUSA – Channel 9
News  at 7:00 PM to discuss the recent outbreak of meningococcal meningitis at
Princeton University. Since March, 2012 that have been a total of seven cases of
meningitis among Princeton students. Six of the cases were among resident students and
one was a case from a visitor. The type of the meningitis was meningococcal type B,
which is not contained in the vaccine that is distributed generally among students and
young people in United States. The standard vaccine contains types A, C, Y, and W-135..
None of the students died from the meningitis. I will be appearing today on the radio
WTOP to discuss the situation. The FDA has given approval for importation of type B
vaccines from Novartis Company in Switzerland. It still remains to get approval from the
institutional review board of the CDC. As usual HHS Public affairs has balked at my
going on the media because they consider this a CDC issue. This time with support from
John Burklow, we asked for permission, they said no, and I went on TV last night
anyway. I am going to appear on radio this morning again. This is a turning point in our
relationship with HHS who continue in a completely crazy way to rty to block our going
on the media in situations that they feel belong to CDC even though the Media
specifically ask for me.
November 20, 2013 – This was one of the most magical evenings that I have had in
Washington in the 40 years that I have been here. I was invited with Christine to go to a
Celebration of the 50th anniversary of the conferring of the Presidential Medals of
Freedom. The event was held at the Smithsonian Museum of American History on 1300
Constitution Ave. NW., District of Columbia. The event was in celebration of several
things. It commemorated the 50th anniversary of the assassination of Pres. John F.
Kennedy. It also was the 50th anniversary of the establishment of the Presidential Medals
of Freedom by Pres. Kennedy. We found out in a historical examination of the situation
that Kennedy established the Presidential Medal of Freedom in February of 1963. He was
intending to give out the first metals in December of 1963. However, as we know, sadly
he was assassinated on November 23, 1963. Pres. Lyndon B. Johnson went ahead and
conferred the medals one month after the death of Pres. Kennedy. He conferred the
Medal to Pres. Kennedy post-humously and gave it to Jacqueline Kennedy who received
it on her deceased husband's behalf. The reception and dinner that was held at the
Museum of American History was extraordinary. Virtually everyone who is anybody in
Washington, DC was there and it was highly populated by people who in the past had
received the Medal. I had the opportunity to speak with Pres. Obama, President Clinton,
as well as a nice conversation with Hillary Clinton. It was also the first time that I had the
opportunity to speak with first lady Michelle Obama. The number of celebrities that were
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328brought together for a group picture of all the former Medal winners as well as the people
who recently won this year including people like Ben Bradley, Ernie Banks and others. It
was truly an extraordinary evening. I mingled and talked with Ernie Banks and Hank
Aaron,  Bill Russell, generals, statesmen, et cetera. The evening was highlighted by a
speech by Pres. Obama regarding the legacy of Pres. John F. Kennedy. In a poignant
point in the evening, Pres. Obama was introduced in his speech by Jack Schlossberg who
is the son of Caroline Kennedy and the grandson of Pres. Kennedy. Sitting at my table
was former CIA director and FBI Dir. Bob Webster, Doug Kramer who is the former
staff secretary to the President and currently General Counsel for USAID. Sitting right
next to Christine was the legendary race car driver Richard Petty. All in all it was a truly
spectacular evening there was entertainment by one of this year's Medal winner, Cuban
musician Arturo Sandoval who was a protégé of Dizzy Gillespie. He gave one of the
most extraordinary trumpet performances that I have ever heard in addition to
extraordinary singing ability and a phenomenal piano piece that he played. Again this
was truly an extraordinary evening.   It was black tie, elegant setting.  Military regalia as
per the presence of the POTUS.   The night was chilly, crisp and clear.
LIST OF ATTENDEES AT GALA on Nov. 20:
Expected Attendees at the Dinner in Honor of Presidential Medal of Freedom Awardees  The White House.mht
November 21, 2013 - Funding of PEPFAR and Replenishment of Global Fund to
Fight Aid TB and Malaria (GFATM) – Over the past several days there has been
considerable activity about the issue facing the funding of PEPFAR for 2015. The
activists are pushing to have 12 million people on therapy by 2016. The global goal is 15
million people on therapy by 2015. The Obama administration will not give additional
funding for PEPFAR that would allow them to reasonably achieve the goal of 12 million
people on therapy by 2016. Therefore, the State Department and the people at PEPFAR
are struggling with how to message something that would be disappointing when you
look at the numbers. I've had pre-calls with Deborah VonZinkernagel and today (Nov.
21, 2013) we had a call with three people from the State Department – Daniella Ballou-
Aares, Lorrie McHugh-Wytkind, Eric Goosby and Deborah.  I was up in NYC for the day
to appear on an Atlantic Magazine-sponsored panel and Webinar on a similar subject:
“Talk is Cheap: Saving Lives, Ending AIDS and Putting Our Money Where Our Mouth
Is”.  As an aside, other participants in that Atlantic Magazine panel where Peter Staley,
Nancy Mahon (MAC Cosmetics), Jeffrey Sachs (Columbia), Phill Wilson (Black AIDS
Institute), Luis Loures (UNAIDS).  Stephen Lewis (AIDS-Free World), Wafaa El-Sadr,
Danny Resnic (Origami Condoms) and Deborah Persaud (Hopkins).  The Session was a
big hit.
Back to the telephone conversation with PEPFAR and State.  I made the strong
suggestion that the PEPFAR people and the Department of State bite the bullet and tell
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329the truth about what they can and cannot do. One of the problems is that if they stick by
the promised numbers without the resources to achieve those numbers it will turn out that
they will overpromise something that they cannot deliver on. Note the similarity to the
roll-out of the Affordable Care Act – a true mess-up).  I warned them as to the danger of
this. They should suggest to the White House that they assume a leadership role in getting
the entire global community to increase their support of the treatment goals. We cannot
get to that goal ourselves since we do not have the resources. I feel that it would be
appropriate for us to put more resources in. However, OMB refuses to put any more than
just about $150 million more into the 2015 PEPFAR budget. The phone call went well
and I hope that they take my advice. More to come.
Announcement was made today that David Ho and I have won the Prince Mahidol
Award from Thailand.   We will receive it for medical research and Peter Piot and Jim
Kim will receive it for Public Health.   Ceremony will take place in Bangkok on January
28, 2014
November 26, 2013 – We here at NIH have been working on the schedule for the visit of
Bill Gates to the NIH on December 2, 2013. There was considerable concern that this
might conflict with the annual World AIDS Day celebration at the White House which
would involve Pres. Obama that might be scheduled on December 2. However the White
House announced that they will have the celebration on December 3 which avoided a
conflict with the Bill Gates visit. Considerable planning went into the scheduled Gates
visit with my playing a major role in showing him around and leading discussions.
However I just heard literally minutes ago from the White House that the World AIDS
Day ceremony will take place on Monday, December 2. This directly overlaps and
conflicts with the Bill Gates visit. This will be very disruptive and upsetting to both Bill
Gates and the NIH since the last time Bill Gates was scheduled to visit the NIH was the
time that the government shut down in October, 2013. I will wait further instructions
from the White House since I have been assigned a major speaking role at the World
AIDS Day celebration at the White House. I am supposed to speak on the “Care
Continuum” and the road to a “cure” for HIV/AIDS.  More to follow.
December 2, 2013 – Monday and cold cloudy day is DC.   Celebration of World AIDS
Day (WAD) today since December 1 was a Sunday.   Also, Bill Gates visited NIH to
deliver Barnes Lecture and to be shown around NIH:
Gates – Francis Collins, I, and Clif Barry showed Bill Gates around the BSL-3
containment facility in Building 33 where we do experiment on marmosets with drug-
resistant TB.   Clif does drug screening.   We suited up with all the contained gear
(“space suits”) and had a good time showing Bill around.   This was followed by a
roundtable discussion with certain IC Directors (me, Varmus, Pettigrew, Guttmacher,
Glass, Somerman and Collins.   I know Bill well from multiple interactions over the years
and I spoke with him about our ongoing collaboration with the Bill & Melinda Gates
Foundation (BMGF) over the years.   I did not remain for his lecture since I had to rush
down to the White House for the WAD ceremony
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330White House – Ceremony in the South Court Auditorium of the WH.   Speeches by
POTUS, Sec. Kerry, Sec. Sebelius, Valerie Jarrett, Cecilia Munoz (Domestic policy
Council).   Panel with Collins, Gates, Dybul, Chris Beyrer (Hopkins), Amanda Castel
(GWU), Kali Lindsey (National Minority Council), and Dr. Ngozi Okonjo-Iweala
(Minister of Finance of Nigeria).   POTUS had announced a reprogramming from within
AIDS budget at NIH $100 million over 3 years for a “Cure Initiative”.   I was asked and
gave the final talk of the ceremony on the links between the care continuum and a cure.
Very well received.   I, of course, am somewhat cynical about a “cure initiative” with no
new money.
Global Fund Replenishment – Today and tomorrow are the 2 big days for countries to
meet here in DC to pledge for the next 3 year cycle of the Global Fund to Fight AIDS,
TB, and Malaria.  I attended meeting at Willard Hotel where Sec Kerry gave a terrific
speech.
Dec. 3, 2013 – Hectic but very good day.   Started early in AM and went to Reserve
Officers Association at one Constitution Avenue, N.E. for a Friends of the Global Fight
Against AIDS, TB, and Malaria had a breakfast.   Multiple speeches; Moderated by Mike
Gerson; several speakers called me out for my “pioneering work on HIV/AIDS”
including Bill Gates, Nancy Pelosi, Mike Gerson and others.   I left the meeting at 9:00
AM, went to the AAI Council meeting in Rockville as I do every year to update them on
NIAID and then immediately went to DCA to fly to NYC to attend as guest of Bob Seder
and Debbie Harmon the Women for Women Gala in honor of Hillary Clinton at the
American Museum of Natural History at W 79th Street and Central Park West.   I stayed
at the Excelsior on W 81st.   It was an amazing evening.   I was among about 12 people
who greeted and had special ‘audience” with Hillary Clinton.   At my table (#18) was my
“dinner date” Cheryl Mills (we are becoming good friend), Virginia Moseley (VP and
Deputy Bureau Chief of CNN), Marty Edelman (Counsel to real estate practice – big
contributor to Wounded Warriors project), Norma Kamali (Fashion designer – flakey and
interesting lady who wants me to come to NYC again and talk to her “health group”
about immune enhancing), Nella Domenici (Daughter of Sen. Pete Domenici and sister-
in-law to Cheryl Mills), Ngozi Eze Nigeria Country Director for Women for Women),
Susan Goldberg (Exec. Editor of Bloomberg News).   Also met with Sheryl Sandberg
(“Lean in” and COO of Facebook).   Also, importantly met Jeff Zients who fixed the
computer catastrophe of the role out of Obamacare. Jeff will likely become Economic
Advisor to Obama.  All-in-all a very festive evening.   Clinton gave a great speech.
Returned to DC on 6:00 AM on Dec. 4 shuttle in time to be on panel at Georgetown
University Copley Lounge of the Global Fund.   Was on panel with Eric Goosby, Tom
Frieden, Admiral Tim Ziemer (head of the President’s Malaria Initiative).   My panel
moderated by Larry Gostin.   Mark Dybul gave very moving speech as Keynote.
Dec. 5, 2013 – Meningococcal meningitis breakout among a few students at Princeton
and then at UC Santa Barbara.   Was on WTOP radio today to discuss.  Was Group B for
which we do not have an FDA approved vaccine for in the USA.   Used in Europe and
Australia.   FDA giving emergency use authorization for use in Princeton.
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331Had dinner with Danny Hultzen and Chris Hultzen.   Danny had significant operation on
torn labium and rotator cuff in his left (pitching) arm.   On rehabilitation now.   Amazing
that he was 5 and 1 with a 2.3 ERA in AAA ball pitching at 93 mph with torn shoulder
ligaments.   Hopefully he will fully recover since he was slated to go up to MLB last
year.
Dec. 14, 2013 – Had quick trip to NYC on Saturday for Editorial Board meeting of
HPIM.   Big issue is the decreased sales of the printed book, particularly domestically.
Reason clearly is that students and others are not using print books very much to study
and learn and look up material.   Almost all online.   We need to emphasize more out
online versions, i.e. iPAD, HOL, HP, etc.   Good to see the other editors.
Dec. 17, 2013 – Grant Colfax, the White House AIDS person and Directors of the Office
of Nation AIDS Policy (ONAP) called me to give me heads-up that he was stepping
down.  Interesting since he has been on the job for only 1.5 years.  Not sure what his
reason was for stepping down.   He is returning the San Francisco.
Dec. 27, 2013 – Influenza season starting to spike with predominance of 2009 H1N1.
Interesting that ever since 2009, the 2009 H1N1 has bumped H3N2 off as the major strain
that circulates during seasonal flu.
I appeared on CNN “The Lead”.   Interviewed by Joe Johns who was subbing for Jake
Tapper.
Dec. 28, 2013 – Jan. 8, 2014 -  Children home for the holidays.   Unusual to have all 3
together, particularly since Ali has been at Stanford.
Influenza activity (mostly H1N1) starting to crank up.   Have been on WTOP radio and
Al Jazeera America TV talking about the seasonal flu.
Jan. 9, 2014 – Was on panel at The World Bank at 1818 H Street, N.W. to discuss Social
and structural determinants to combat HIV/AIDS and poverty.   All the usual
international AIDS players were there.
Jan. 10, 2014 – Went to White House for farewell reception for Grant N. Colfax, head of
the Office of National AIDS policy (ONAP).   He had been at the job for 1 ½ years.   He
is returning to be in San Francisco with his partner and family.   He is a good guy who
did a good job.   During the speeches, he called me out as “a legend in HIV/AIDS” and
said how wonderful it was to work with me.
Jan.14, 2014 – Seasonal influenza is beginning to peak and I am doing the usual media.
Did FOX News.
Jan. 24 – Feb. 1, 2014 – Prince Mahidol Award – Bangkok.  See attachment for daily
schedule:
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332
Mahidol - Bangkok
2014.doc
In summary, I received the 2013 Prince Mahidol Award in Medicine together with David
Ho.   Peter Piot (Director, London School of Public Health and Hygiene) and Jim Yong
Kim (President, World Bank) received the Prince Mahidol Award in Public Health.  It
was a most extraordinary trip. We were hosted by the Royal Family of Thailand and we
were afforded luxurious treatment. Indicative of this treatment was the fact that we were
picked up at the airport in Bangkok by a representative of the royal family and was driven
to our hotel with a double police escort. By double police escort I mean a motorcycle
policeman leading the motorcade followed by a police car followed by a brand-new
Mercedes which carried me, my wife Christine and Gray Handley, my associate director
for global affairs, at NIAID. We spent an entire week in Thailand. The center of the
activities was the award ceremony at the Palace of the royal family. The pomp and
circumstance was most extraordinary. I received a gold medal and a check for $50,000
from the Princess of Thailand. In addition to the extraordinary ceremony followed by a
festive dinner at the Palace, we were treated to police escorted tours of several of the
other palaces, the Emerald Buddha, as well as other historic places. In addition Chris and
I and Gray toured the famous Thai canals on a boat as well as went to the major market in
Bangkok, which is the largest open market in the world. Our hotel was lavish. I also did a
considerable amount of work giving two official lectures, a panel discussion together
with David Ho, Peter Piot, and Jim Kim, when he was present. Jim was only there for
part of the time since he had just come back from Burma where, as President of the
World Bank, he gave $2 billion to Burma. In addition, I visited this Siriraj hospital, the
Thai Red Cross and anonymous clinic, the CDC facility, the Silom clinic, and other
facilities (see attached agenda) where we discussed some of the NIAID sponsored clinical
trials on HIV. Of particular interest was the study that was done in collaboration with the
Armed Forces Research Institute of Medical Science (AFRIMS) on acute HIV infection.
I met some outstanding people from the CDC including Mitchell Wolfe Tim Holtz and
Marcel Curlin. In addition I was accompanied throughout the entire trip by Lieut. Col.
Robert O'Connell. Rob works with Nelson Michael and Jerome Kim, is the liason to the
US Embassy and was an extraordinary asset to the trip. Christine and I flew back and
forth first class from Washington to London (United) and then from London to Bangkok
(Thai Airways). There were many perks associated with the trip. One that stood out was
the fact that the royal family arranged for Chris and I to have a professional Thai massage
at the spa at Bangkok airport on our way home.  Of note was the fact that there was
considerable political unrest in Thailand during our visit. I learned a lot about the
political situation from observing and listening to my Thai colleagues. Apparently, the
current Prime Minister (Yingluck Shinawatra)  is the sister of the recently deposed Prime
Minister who is in exile. He was exiled because he of corruption (he paid off members of
Parliament to support him). However, much of the Thai population at least in Bangkok
and certainly among the academics, feels that his sister is merely an extension of him and
although she was democratically elected, they feel that she should be put out of office and
a special council run the country until the corruption is cleared up. This creates a
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333considerable dilemma for the United States Embassy since they want to side with
democracy; however, everyone knows that the democratically elected person is steeped in
corruption. I actually wound up meeting the Prime Minister at the award ceremonies at
the Royal Palace. There were several demonstrations while I was there in anticipation of
the elections which took place after we left on February 2. The demonstrators wanted to
block the election because they wanted to have reforms before the election. It is likely
that the election will not come to majority vote and that a new government will have to
be formed. There was a small amount of violence while I was there including someone
throwing a hand grenade into a crowd of demonstrators as well as a person murdering
one of the leaders of demonstrators. We were never in any danger as we were always
accompanied by a police escort. I also learned a lot about Prince Mahidol, who was the
father of the current king, who is very ill.   Prince Mahidol started off as a naval officer
(trained in Germany, but then when he realized the poor health conditions in his country,
he wanted to do something about it.   He wanted to learn Medicine first and so he went to
Harvard Medical School and graduated cum laude.    He is considered the father of health
care in his country. This was truly a memorable trip from so many standpoints.
Feb. 3, 2014 – Just back from Thailand and extremely jet-lagged
 as the fact that I was
travelling for over 24 hours in a plane.
     Did interview with Washingtonian magazine regarding my opinion of the movie
“Dallas Buyer’s Club”, great movie starring Matthew McConaughey about an HIV-
infected individual in the early 1980s who did not want to take AZT because he felt that
it was too toxic and started a buyer’s club to buy and sell unproven drugs.   Great
performance (likely an Oscar – did win Golden Globe already).  They called me because
I was there when it happened and also I was the one that started the AZT distribution
system through a contract paid for by NIAID.
       Met in Building 10 with Sen. Durbin (D-IL) and then a separate meeting with
Congressman Pitts (R-PA) regarding NIH accomlishments and implications of a bad
budget.   Durbin is new Chair of the Defense Approp. Subcommittee and unfortunately
he wants to get more money for biomedical research for Dod.   Menas well but does not
appreciate that it may not be well-spent.
February 5, 2014 – went to the NIH FDA leadership Council meeting at the new FDA
headquarters in Silver Spring. I presented the NIAID strategic approach towards
antimicrobial resistance research. The FDA presentation was made by Dr. Peter Lurie. In
attendance were Dr. Francis Collins, Dr. Peggy Hamburg, members of the FDA, as well
as members of the NIH. This is an initiative in which we will be engaging industry in
trying to get expedited approval for antibiotics against resistant organisms.
February 7, 2014 – went to the American Society of Microbiology annual Public and
Scientific Affairs Board meeting at their headquarters on 1752 – N Street, NW.,
Washington, DC.  I do this every year and update the group on activities of NIH and
NIAID.  As usua,l my presentation was extremely well received by the group. These are
people who are great supporters of me and my role as the director of and NIAID.
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335however, Francis shunned him.   Issue is that John wrote into the report language of the
NIH appropriations that we should have a “strategic plan” and Francis refuses to do a top
down plan. Francis is completely correct on this, but he should compromise and agree on
a “communications plan” since that is all the Committee wants is a document to refer
constituents to when they inquire about what NIH is doing and why.
Feb. 24, 2014 – Did the “Nifty-Fifty” talk at Montgomery-Blair High School in Silver
Spring.   Great group of kids with many questions and interest.   I spoke on my career in
public service at NIH.
Sen. Mikulshy visited NIH and gave “pep talk” about the budget.
Feb. 25, 2014 – Went to NYC for the day to the DDCF Board meeting.   Always like this
– seeing Nan Koehane, Jim Gill, Ed Henry, Peter Nadoscy, John Zuccotti et al.
Someday, I might even be able to take the honorarium 
Feb. 26, 2014 – Dinner with Larry Corey at Cesco Osteria in Bethesda.   Extremely cold
streak of weather in DC over past few weeks.  We spoke of Larry concern about DAIDS,
the vaccine program, esp. Mary Marovich, whom he feels is a poor substitute for Peggy
Johnston.   I am also hearing this from Gepi.  They worry that Mary and her staff have no
leadership and cannot make decisions.   Feel that they do not represent me well as did
Peggy.
Feb. 27, 2014 – Break-in at my house.  Stole only change on my dresser and Euros in my
drawer (~$200 worth).   Looks like inside job of someone who had key.   Perhaps one of
many people that we had lent the key to over the years.   Have now changed lock on front
door.   They likely exited out back (porch) door since this was unlocked when I came
home at night.
Feb. 28, 2014 – CROI meeting coming up next week and a few paper out in NEHM.
Many print media interviews on CCR5 gene editing.
March 4, 2014 – Gave Keynote Lecture at Global Vaccine and Immunization Research
Forum at the Bethesda Hyatt Hotel.  Big audience of Decade of the Vaccine crowd, i.e.
GAVI, BMGF, WHO, etc.   Well-received.
Much press associated with CROI meeting and new baby cure questions and Carl June
gene editing for CCR5.
Jim Lehrer (Newshour) contacted me for advice about his granddaughter Olivia who has
juvenile idiopathic arthritis.   I spoke with him and his wife Kate and made some
recommendations and just chatted with them about the disease.   Jim was very grateful.
Diane Rehm had originally suggested to Jim that he contact me.
March 5, 2014 – Lunch at Bethesda Hyatt with Margaret Chan, Director General of
WHO.   Margaret is old friend since mid-1990s with the original H5N1 situation in Hong
Kong where she was Commissioner of Health at the time.   Pleasant wide-ranging
discussions.  Present were Lee Hall, Hilary Marston, and a couple of people from WHO.
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336March 6, 2014 – Much, much media today surrounding a NEJM paper on CCR5 (see
above – Carl June’s paper) as well as a second baby who might be cured as well as
monkey studies on long-acting PreP (David Ho).  I was on WTOP; ABC Morning News
(bumped because of Ukraine-Russia crisis, but likely will be shown this weekend);
NewsHour with Jeff Green; NPR- All Things Considered – Audie Cornish; Al Jazeera;
VOA; tomorrow we do MSNBC and NPR Science Friday with Ira Flatow.  Also,
multiple printed press including NY Times.
March 7, 2014 – The Dalai Lama visited NUH and I went to hear him speak at the
Natcher Auditorium.   I could barely understand what he was saying due to his strong
accent and bad acoustics.   However, he won everyone over with his smile and infectious
laugh.
March 10, 2014 – Appeared on NPR “On Point” talking about the recent AIDS stories.
(see above).
March 13, 2014 – Salim (“Slim”) Abdool Karim visited from Sotuh Afrtica at my
invitation to deliver the John la Montagne Lecture in the Lipsett Auditorium.  Slim had
take the job as the Director of the South Africa MRC to essentially shake up the place
and fire a bunch of dea wood.   He took the job on a contingency that he would leave is 2
years.   He has done a great job of “cleaning up”.  He will be replaced by another friend,
i.e. Glenda Gray.
March 14, 2014 – Spoke with Rick Atkinson today to update him on the progress of my
memoirs and to ask his advice about whether I should engage Bob Barnett for advice
about the legality of my writing my memoirs while I am a USG worker.   Recall that Bob
Barnett has offered to be my agent when I write my book.   He offered to do this years
ago.
March 20, 2014 -  Received horrible news tonight at around 9:30 PM from Howard
Boltansky who called my cell phone.   My dear friend and physician for 16 years, David
Jacobs died suddenly in Las Vegas today where he was with his brother to watch the
NCAA Tournament (March Madness).   David had shown me an MRI of his abdomen.
About 6 years ago he was struck by a car while running his daily run down by the Mall.
He got badly bruised up, but there was no concussion and so other ‘apparent” injuries
exception getting banged up badly.   About 6 months later on a routine medical
examination and MRI, they found a major tear the length of the aorta with clotted blood
stably keeping everything in place.   Amazingly, his renal vessels and femoral arteries
were being perfused, but the tear and clot was extensive.   Clearly, this happened at the
time of the accident.   He had gone to several vascular surgical consultants who told him
that this was not repairable and that if they attempted to repair it, he had a very high
likelihood of dying on the OR table.   They told him that he could live 30 years or he
could die suddenly at any time.   No way to predict and so he has lived with this hanging
over him.   In my conversations with his, he was always in good spirits and seemed to
accept the risk.   Unfortunately, this has happened.   I am terribly saddened.   I loved
David and he took such good care of me.   I had trained him when he was an NIAID
Released by Chairman Rand Paul
338Was on WTOP for the NYC measles outbreak.
March 25, 2014 – Appeared on Diane Rehm Show on WMAU with Anne Ginsberg and
…. To discuss TB for World TB day.
March 26, 2014 – Testified at the House Appropriations Subcommittee Hearing with
Francis Collins, Harold Varmus, Story Landis, Gary Gibbons.   Chairman Kingston
stayed for 10 minutes and then handed Chair to Dr. Andy Harris (R-MD).   Harris
questioned me on why we are spending so much money on AIDS given the decreased
deaths compared to diabetes, CVD, cancer, etc.   I explained that we are still in the
middle of a pandemic.
 Appeared on Al Jazeera regarding Ebola in Guinea.
March 27, 2014 – Dennis Kasper flew in from Boston to work for 2 hours with me on
preparing me to present his NAS nomination.
Met with Debbie Birx who is waiting for Senate Approval for head of PEPFAR (OGAC).
To my dismay, the White House has not submitted her to the Senate for final approval.
She has already had her hearing and did very well.
April 1, 2014 – Ebola still raging in Guinea.  Appeared on BBC TV with Katty Kay to
discuss as well as BBC radio to discuss pandemics and gave interview with SLATE
Magazine on Antimicrobial Resistance
April 2, 2014 – testified at the Senate Appropriations Subcommittee Hearing in 192
Dirksen Building.   Witnesses were Francis Collins, me, Harold Varmus, Gary Gibbons,
Story Landis and Chris Austin.   Chaired for last time (historic) by Sen. Tom Harken (D-
IO).   I have been testifying before Sen. Harken for every one of the 25 years that he has
been in the Senate as a member, Chair, or Ranking Minority of this committee.  Present
were Sen. Mikulski, Shelby (ranking minority of full committee), Moran (R-KS).   It was
a love fest for NIH, but there is not going to be any new money for NIH (~0.7% increase
over 2014) because of budget constraints on discretionary spending.
April 3, 2014 – Nice visit from Paul Huijts – Director General for Public Health in The
Netherlands.   He is very interested in antimicrobial resistance.   We in USA and NIH are
accelerating our efforts in this area due to increasing concern over this emerging problem.
April 8, 2014 – Went to Princeton for the day to give “Public Lecture” at the Woodrow
Wilson School of Public and International Affairs.  Invited by Dean Cecilia Elena Rouse
(formerly with Hillary Clinton).   Met with students (lunch), chaperoned by Adel
Mahmoud, gave lecture on pandemic influenza preparedness with many questions.
Good visit.   Ran into my old high school friend and college roommate – Lou LoBosco.
Released by Chairman Rand Paul
339April 9, 2014 – Larry Corey flew in from Seattle to see me.   He is still dissatisfied with
Mary Marovich – Vaccine person at DAIDS.   He feels she cannot make a decision and
shows no leadership.
April 14, 2014 – Continued smoldering of cases of Ebola in Guinea (and spread to
Liberia) has sustained media interest.   I appeared on NBC Nightly News for this tonight
April 15, 2014 - I appeared on WTOP radio for MERS-CoV and Ebola
April 17, 2014 – Went to Harvard School of Public Health to appear on their web
broadcast of “Senior Leadership Series”.   Nice experience.   Hosted by David Hunter
and Dean Julio Frenk present.   Many good questions about my accomplishments and
leadership style.  Broadcast on web throughout the world.
April 18-24, 2014 – Preparing by phone with Bart Haynes and Dennis Kasper, whom I
am presenting for nomination for National Academy of Sciences next week.
April 24, 2014 – Went to private dinner at café Milano to celebrate swearing in
tomorrow of Deborah Birx as Ambassador in charge of PEPFAR.
April 25, 2014 – Swearing in of Deb Birx at Franklin Room of the State Department.
Big crowd and festivity.
Immediately after swearing in, went to PAHO (a block away) to give talk at the 10th
Anniversary of the Sabin Vaccine Institute.   Many old friends there – Peter Hotez, D.A.
Henderson, Ciro deQuadros, etc.
April 26, 2014 – Went to Chicago to deliver after dinner speech at the AAP Dinner at the
Fairmont Hotel.   AAP President Larry Jamison invited me.   Spoke on The HIV/AIDS
Saga:   Science and Policy”.   Spoke of my experience with 5 Presidents.   Big hit.
April 28, 2014 – Went to NAS meeting at Fairmont Hotel in DC to defend Haynes and
Kasper for membership.   Response to them (in voting) was only fair to good.
April 30, 2014 – Spoke at amfAR event at Kennedy Caucus Room at Senate Russell
Building.   Big affair.   Sen. Harkin praised me; Kenneth Cole (fashion designer)
introduced me. Many people there:  Douglas Brooks (new head of ONAP); Jim Kim
(World Bank); Paul Farmer was interviewed on stage by Judy Woodruff (NewsHour).
May 2, 2014 – Still smoldering concern about MERS-CoV with 1st USA imported case
from Saudi Arabia to Indianapolis.   I appeared on Fox5 TV and AP TV.
May 3, 2014 – Big social day.   White House Correspondence Brunch at Katherine
graham’s old house at 2920 R Street, N.W. hosted by Tammy Haddad, Steve and Jean
case, etc.   Many, many celebrities. Had fun with cast of “House of Cards”, particularly
Released by Chairman Rand Paul
340Sebastian Arcelus who plays Lucas Goodwin on the show.   Very nice guy.   His wife
(Stephanie Block) was very taken up by the fact that I worked on HIV/AIDS.
That evening attended White House Correspondence Dinner as gust of AP (Cynthia
Sharp).   Much fun.   President Obama was hilarious as was comedian Joel McHale.
Great evening.
May 8, 2014 – First MERS-CoV case in Lebanon.  Total numbers up to 495 with 141
deaths.   I appeared on CNN International tonight.
May 10. 2014 – Elizabeth Sherwood-Randall (National Security Staff, White House and
Special Assistant to the President, Coordinator  for Defense Policy, Countering WMD,
and Arms Control had met me at a Wayne and Catherine Reynolds function some time
ago and took the initiative to invite Chris and me for dinner at her home at 4920 Indian
Lane, N.W. her husband Jeff is a neurosurgeon in Bay Area near SF.   He is on faculty at
USCF.   Children (Richard and William go to STA and heard my recent lecture there).
Also at dinner was Al Hunt (Bloomberg News – wife Judy Woodruff could not attend –
was giving Commencement Address at Alleghany College).   Also present was  Diana
Farrell (recently Deputy Director, National Economic Council at White House and
currently CEO of Kinsey. Inc.).   Very pleasant and fun evening.
May 14, 2014 – Yesterday was 2nd imported case of MERS-CoV from Saudi Arabia – a
health worker at a Saudi hospital.   Went from Ryaad to London to Boston to Atlanta to
Orlando.
Went to University of Pennsylvania to give the 12th Annual Neal Nathan son Lecture on
“Ending the HIV/AIDS Pandemic:   From Scientific Advances to Public Health
Implementation”.   Spent whole day meeting with people many old friends – George
Shaw, Beatrice Hahn, Larry Jameson.   Megan had just decided last week to go to Penn,
having also been accepted to Cornell, Columbia, Michigan, Hopkins, among others.
Penn p [people are excited about Megan coming there.   Had dinner at great restaurant
(Bukkadan) in Philly before taking 9:10 PM Amtrak back to DC
Did radio interview on new Guidelines for PrEP  with CBS Radio in Men’s room of the
30th Street Station in Philadelphia while I was waiting for the 9:10 PM train back to DC.
May 15, 2014 – More MERS cases.   Did CNN with Jake Tapper at 4:30 PM on the
issuance by CDC of Level 2 alert for travelers to mid-East and airport alerts to pilots to
report people with fevers and illness on mid-east flights.   HHS now becoming more
flexible in not giving us grief about being on TV for issues that they inappropriately think
are CDC topics.   CNN specifically said they wanted me and NOT CDC.
May 16, 2014 – Did Al Jazeera TV on recent CDC guidelines for PrEP.   I am becoming
“the darling” of Al Jazeera.  Producers really like my style and they keep coming to me.
Released by Chairman Rand Paul
341May 18, 2014 – First transmission of infection (sero-conversion) from the Indiana
imported case to someone who had “handshake” contact.   Again, news blow up.   I taped
segment for the Today Show (NBC) to appear on May 19.
May 19, 2014 – MSNBC wants me this AM.   Return of the “problem”.   CDC
complaining to HHS that I am on TV for MERS-CoV even though the producers are
specifically asking for me.  They do not want me talking about “their issue”.   Amazing!!
Typical situation where HHS says no to me, MSNBC cannot contact CDC and arrange in
time and so now nobody from HHS is on TV and the slot goes to a health official from
Illinois.   The communications people from HHS are truly idiots to listen to CDC and
back them.   Courtney Billet blows HHS (Bill Hall, Sye Tait, Ira ?) away with several e-
mails telling them how ridiculous this approach is.   CDC is totally paranoid.   I really
wonder if Tom Frieden knows about this or if it is just the Communications people.
Also did AP TV today for wide distribution to networks.
Also, White House very interested in Antimicrobial Resistance and they are putting
together a White paper through NSS, PCAST, OSTP.   We are obviously playing role in
its being drawn up
May 20, 2014 – Travelled to Los Angeles to receive the “Heroes in the Struggle” award
from the Black AIDS Institute (BAI).   Phill Wilson (President of the BAI) presided.
Co-awardees were Mo’Nique (actress/comedian who won Academy Award in 2009 for
Acting in the film “Precious”) and Jamar Rogers (entertainer formerly on The Voice).
Red Carpet ceremony before the awards held at the Director’s Guild of America on
Sunset Boulevard.   Jamal Rogers was a beautiful young man who was so thankful to me
for “my saving his life by developing drugs for AIDS”.   He found out he was HIV
infected (drug use in the South Bronx) a few years ago.   He is a very popular entertainer
with beautiful voice.  All-around good time.   Stayed at the old Hollywood hotel –
Millennium Biltmore.
May 21, 2014 – Went to Thai Embassy on 1024 Wisconsin Avenue to a reception in my
honor and in honor of co-awardee Jim Kim (World Bank President) for our winning the
Prince Mahidol Award last January.   Megan and Christine came.   Of note, the next day,
the Thai army pulled a military coup to take over the government of Thailand.
May 22, 2014 – Gave Commencement Address at Hopkins Medical School and then
drove immediately back from Baltimore to attend the Sons of Italy NELA Awards Gala
Dinner at the National Building Museum.   Usual good time.   Seated at my table was
Leon Panetta, Gen. James Jones, Franco Nuschese.  Also we schmoozed with General
Ray Odierno (Chairman of the Joint Chiefs of Staff), Nancy Pelosi, Sen. Chris Dodd
(now president of Motion Picture Academy), Master of Ceremonies Joe Montegna.
May 25, 2014 – The HBO movie “The Normal Heart” played tonight.  Larry Kramer’s
play about the early years of AIDS.   I say the play X2 and now the movie was terrific.
Mark Ruffalo played Ned Weeks and Julia Roberts played the polio physician.
Released by Chairman Rand Paul
342May 28, 2014 – Gave the John E. Enders Lecture at Boston Children’s Hospital/Harvard
Medical School.  Great audience, SRO.  Extremely well-received.   Spent entire day
meeting with faculty and students.   They are so young, I feel like some historic figure to
them. Some were not even born yet when the AIDS epidemic was recognized in 1981.  I
spoke on “Ending the HIV/AIDS Pandemic:   From Scientific Advances to Public health
Implementation”.   Went up the night before and had dinner with Jenny in the North End.
She is doing great.   Just finished the first year of her 6 year Ph.D program at Boston
College in Clinical Psychology.   Had tough year following her bicycle accident that
resulted in a severe concussion.  Recovery had been slow, but she is much improved now
with some residual headaches.
May 30 – June 1, 2014 – Went to Indianapolis to watch Ali row for Stanford Varsity 1
boat in the NCAA Women’s crew Championship Tournament.   Went with Chris and
Megan and met Jenny coming from Boston at the Indianapolis Airport.   Stanford and Ali
have been amazing this year.  Stanford was not expected to get to NCAA tournament, yet
they won the “Big Row” against arch-rival Cal-Berkeley.   Then they won the PAC-12
Tournament and now they are in NCAA.   Ali was selected as the Scholar-Athlete of the
Year in the PAC-12 for Women’s Crew!!   This is huge since she was first among all
women crew members in the PAC-12.  She had the highest GPA (4.05) of all athletes in
any sport in the PAC-12.  Also, she was chosen for the 3rd year in a row as the first team
Academic All-PAC-12 team. She also was voted as “most inspirational” by her team
mates  In the NCAA tournament they won the semi-finals by 4/100ths of a second.  Had a
somewhat disappointing Grand Finals Race coming out 6th in the race (started off slow
and could not catch up) and 4th overall for the tournament.  Ali was obviously
disappointed, but what a year she had!
June 3, 2014 – Together with Robin Robinson, I briefed Senate HELP staff (Harkin,
Alexander, Burr, etc.) on MERS.   Did it is the Dirksen Building.
June 9, 2014 – Partook in CSIS conference on TB at their headquarters at 1616 Rhode
Island Avenue, N.W.   Good symposium.  Shared panel with my dear friend Eric Goosby
June 12, 2014 – Went to San Francisco to give Grand Rounds at Moffett (invited by
Marcia Glass (Kat Glass’s sister).  Timed the trip to coincide with Ali’s graduation from
Stanford on June 13-15.   Great time; extremely well-received by UCSF community.
Visited with Eric Goosby, Jaime Sepulveda and others from UCSF; spent time with
students and fellows.
Chris and Megan flew to SF with me – I went north to UCSF and they went south to Palo
Alto.   That evening met in SF for dinner.   Great time.   Drove back to Palo Alto that
night
June 13-15, 2014 – Magnificent time at Stanford graduation events.   Ali received
multiple academic honors in addition to sports honors.   Graduated “with distinction” ,
which means summa cum laude.  Also, received Engineering Award and inducted into
School of Engineering Honor Society.
Released by Chairman Rand Paul
343Socially, had great time.   Dinner at NOLA sponsored by Chris and me and the parents of
several of the seniors on Ali’s boat – Ad Bax, Dawson’s, etc..   Present at dinner were all
the seniors on the boat – Anna Dawson (Olympian), Daphne Martschenko (All-
American), Kayla Cornale, Christina Bax, etc.  Wonderful, joyous meal.
On Thursday night Chris, Jenny, Megan, Ali and I drove to Half Moon Bay and had
dinner at Miramar Restaurant by the sea – open pit fireplace and dining by the beach -
great wine, calamari, etc.   Seems not to get any better than this – so wonderfully proud
of Ali who is truly a superstar – self-effacing, but a real superstar.
Has another great lunch with the Ayers on Sunday afternoon before I took the “red-eye”
back to DC.
The formal graduation on Sunday had Bill and Melinda Gates as co-commencement
speakers.   They were good , but a bit self-congratulatory.   I viewed the famous Stanford
“Wacky Walk” entrance of the seniors.   Ali and friends were dressed as “cars”.  Really
fun.
June 24-25, 2014 – Went to Aspen Ideas Festival.   Gave 2 minute “Big Idea “during
Opening Ceremony and was on panel on Emerging IDs with Tom Frieden and Yu Wang
of China CDC.   Moderated by Rich Besser (ABC News).   Good panel.  Many
compliments for this and Big Idea.   Met the usual DC glitterati at the festival – Walter
Isaacson, Barbara Bush, Bill Frist, Corby Kumar, etc.
June 29, 2014 –  Interesting spin-off of my “Big Idea” at the Aspen Ideas Festival.   My
idea was that we can end the AIDS pandemic in 10 years (by 2024 – theme of festival –
global health by 2024 and we were asked what single thing (big idea) do  we think would
greatly influence global health by 2024).   Gov. Andrew Cuomo has stated that he wants
to end the AIDS pandemic in NY State in 6 to 10 years.   The NY Times wrote this up in
the Sunday Times and quoted me since the reporter had heard about my Big Idea from
the Aspen Festival.   The article had me praising Gov. Cuomo and my saying that NY
could be a model for the rest of the country.
July 3, 2014 – The Ebola outbreak in Guinea, Sierra-Leone and Liberia is getting out of
control.   Latest number are 759 cases and 476 deaths (63% fatality) making this the
largest outbreak of Ebola on record.   Net highest was in 2000 in Uganda with ~400
cases.  Major concern since it is now spreading in the cities of these countries and the
population is not cooperating in containing it by ignoring the recommendations about
how to handle patients and dead bodies.   Also, major ignorance causing population to
attack and stone doctors and nurses from Doctors without Borders and WHO, saying that
there is a conspiracy on the part of the government to deplete the population.
I appeared on CNN today to discuss the situation.
Released by Chairman Rand Paul
344July 4-8, 2014 – Interesting 4th of July weekend.  Found out from Deb Persaud and
Hannah Gay that the “Mississippi baby” rebounded at 27 months following D/Cing of
ART.   Baby is 46 months old.   Unfortunately,  so much for the “cure” baby.   We are
sequencing the virus now to determine if this is not a “new” infection, i.e. abuse from an
HIV-infected person.   More on this later.
Also, heard (and spent many hours on conference calls) that an FDA employee who was
cleaning out a cold room in Building 29A (FDA building on NIH campus) found a
cardboard box that contained 6 glass undisturbed vials labelled “variola”.  Likely there
unnoticed since the 1950s.   CDC and FBI notified.   Good news is that leaks did not
occur and within a couple of days, the CDC came up to NIH, area secured by FBI, and
material flown down to CDC  on FBI plane.   Examined there by Select Agent people and
PCR’d to confirm smallpox.   Will determine if viable within 1 week and will be
destroyed as witnessed by WHO.   Technically, the presence of this material in Building
29A was a violation of an international agreement to destroy all smallpox samples except
for 2 aliquots kept at CDC and at VICTOR in Russia.
July 9, 2014 – PCR confirms that the Mississippi Baby has indeed rebounded with virus
at 16,000 and 10,000 copies RNA per ml.  Baby has been off cART for 27 months and is
46 months of age.   Disappointing, but raises many questions.   The baby had no
detectable immune response for these many months.   Since the virus was obviously there
in a reservoir somewhere, what then was the mechanisms that was preventing it from
rebounding.   Will hold press conference with Deb Persaud, Hannah Gay, and Katherine
Luzuriaga on Thursday  (tomorrow).
Had interesting rounds today to see our first patient (Phil Diers) that received an
allogeneic PBMC transfer from a HLA-B27 HIV-infected Elite Controller donor.
Recipient has CD4+ T cell count of 0-4 and >150,000 copies of HIV on cART (resistant
virus).   Hope is that the immune response of donor cells will impact in some way the
infected cells of the recipient.   More to come.   Way out chance of a graft versus infected
cell effect that might eliminate reservoir (too much to ask for).   See picture below of me
on Rounds the day after the allogeneic transfer.
Released by Chairman Rand Paul
345July 10, 2014 – Press briefing with Deb, Hannah and Katherine today (Thursday –
thunderstorms).  Followed by major press that appeared tonight and tomorrow (July 11)
with my quoted or appearing on TV or radio tonight or tomorrow:
AP TV that subcontracted to BBC TV seen  in Italy by Bruce Gellin (sent me e-mail);
CBS Evening News
July 11, 2014 – Front page NY Times and Washington Post.  My picture and front page
LA Times; Wall Street Journal, USA Today and all major print papers and many, many
blogs including CNN
BBC Radio; BBC TV; NewsHour with Jeff Borwn; VOA, Reuter’s TV, NPR.
I make the point that this is disappointing and not a “setback” since we are still in the
early discovery phase of cure research and this is what happens when you are in this
stage.
July 13, 2014 – Had conference call today on Sunday with Francis Collins and Tom
Frieden of the CDC. Tom has a significant problem in that they have been multiple lapses
at the CDC with people not adhering to protocol in the experiment with a transfer of
select agents such as anthrax,  Brucella and influenza. He wanted to run this by Francis
and me so that the NIH and CDC could be on the same page. We had the problem
described above with the smallpox discovery in a cold room in building 29a and so his
issue and ours are somewhat aligned. He is under pressure to decrease the number of
Released by Chairman Rand Paul
346investigators throughout the country who are working with select agents. The rationale
for this is the fact that if the CDC could make mistakes like this, then virtually anyone
can. This is aligning with the issue of many people wanting to put a clamp on gain of
function research, particularly with influenza. More to come.
July 14, 2014 – More press on Mississippi Baby (Al Jazeera TV) as well as fluff over the
WHO coming out with recommendation that MSM who practice unsafe sex should take
PrPE (Truvada).   Press misinterpreted this (partly fault of WHO) to mean that all gay
men should be on Truvada as PrEP.  I had to clarify this on Al Jazeera and in the NY
Times (article soon to appear).
Preparing to go to Melbourne for the IAS International AIDS meeting.
July 16, 2014 – The situation is heating up considerably with regard to the three
infractions that have occurred in HHS concerning potentially lethal microbes. The first
was the finding of the smallpox vials in the FDA building (29A) on the NIH campus. The
next was the egregious dysfunction of the teams involved in dealing with selective select
agent research down at the CDC and third was the contamination at the CDC of a highly
pathogenic influenza virus (H5N1) with a nonpathogenic influence virus (H7N9). This
has been all over the media in a very intense way. The White House as well as the
Department of Health and Human Services is involved.  Francis Collins and I received a
letter from Nobel laureates Paul Berg and Richard Roberts to discuss how we might
address this escalating issue. They have been consistently against gain-of-function
research, especially on influenza.  In addition Francis and I together with Peggy Hamburg
and Tom Frieden were called to a meeting this evening at HHS with Secretary Sylvia
Burwell to discuss the HHS plan as well as the fact that Sylvia will be meeting with the
POTUS on Friday, July 18 to discuss the matter and she needed to be briefed by us. I
have suggested to Francis and he agrees that we call a temporary moratorium on all gain
of function research on influenza and the MERS virus involving increasing pathogenesis
and increasing transmissibility by the respiratory route. Also, Francis and I brought up
(clearly my idea for some time now) to re-invigorate the NSABB and get them much
more in the mix of recommendations and involvement.  We had a good meeting with
Sylvia Burwell in her office tonight that lasted from 7 PM to 9 PM. Francis and I will be
talking over the phone tomorrow with Richard Roberts and Paul Berg about a plan for the
future. Also, today Barry Bloom called me from the Harvard School of Public Health to
ask whether or not he could help us in addressing this new and emerging political
problem. In addition,  I received a call from Michael Osterholm to warn me, as he is often
doing, that there will be problems “for me” that he wants to help. I get concerned when
Michael wants to “help” me.   He generally gets hysterical about microbial threats and
loves to be in the press.
July 17, 2014 – Francis Collins and I had conference call with Richard Roberts and Marc
Lipsitch regarding the above issues.  Great conversation.  We told them that changes
were going to occur and that we cannot give details, but we are going to look carefully at
all the issues.  In particular, I told them that we were going to re-examine the risk/benefit
ratio of doing gain-of-function research in influenza, in particular.  They were pleased.
Released by Chairman Rand Paul
347July 17 – July 23, 2014 – Attended the 2014 International AIDS Society  Meeting in
Melbourne, Australia. Before I left, I became aware of a terrible tragedy that had
occurred on July 17 the day that I left the NIH to travel to Melbourne. Malaysian Airlines
flight 17 from Amsterdam to Melbourne via Kuala Lumpur was shot down by a surface
to air missile likely fired by Ukrainian separatists/terrorists. This was to totally dominate
the international news over the next days to weeks.  I was quoted in most outlets.   297
people were killed including over 100 Dutch.  Lost on the flight were six individuals who
were flying to the meeting that I attended. Prominent among them was my longtime
friend Joep Lange an Infectious Diseases/AIDS researcher from Amsterdam  and his wife
Jacqueline van Tongeren. In addition, well-known public health advocate and WHO
spokesman Glenn Thomas and AIDS action group activist Martíne De Shutter were also
on the plane in addition to AIDS activist Pim deKuijer and Dr. Lucie van Mens. I gave a
number of media interviews discussing the terrible tragedy and the loss of our colleagues.
This appeared in multiple media outlets. In particular, I was interviewed by David
Gregory on Meet the Press on Sunday, July 20. The topic of the interview was the mood
of the meeting and some personal reflections on Joep Lange.
 My Plenary Lecture was extremely well received and from my own vibrations of how
the audience reacted, as well as how I felt, it clearly was one of the best lectures that I
had given. The subject of the lecture with the scientific challenges of an HIV Cure and an
HIV vaccine. There were a number of events of note throughout the meeting.
Saturday, July 19 – Stayed at Crown Metropol Hotel (very elegant – on of nicest and
most confortable hotels on all my international trips).  I attended a dinner at a place called
Rasheen which is an old and historic building in Melbourne that was formerly the
residence of the Archbishop of Melbourne.  The dinner was given by the Pratt foundation
and the host was Ambassador John Berry, the United States ambassador to Australia.
With him was his husband Curtis. I have to leave towards the end of the dinner in order
to give an interview live on WTOP radio that was broadcast back in Washington. The
interview was about the plane tragedy.
Sunday, July 20 - I made a presentation on TB HIV followed by a panel discussion at
the Crown Promenade Hotel where I was staying during the meeting. In addition, on that
Sunday I made some opening remarks at a Point of Care Symposium that discussed rapid
point of care diagnostics for viral load. That evening I went to the Opening Session of the
conference which was really not very well done since there were many boring speeches. I
had to leave towards the end in order to do the taped version for Meet the Press. Of note,
Melbourne is 14 hours ahead of Washington DC. Therefore, even though I taped the
Meet the Press session on what was Sunday evening in Melbourne, it was actually early
morning in Washington DC. Went to Global Leaders reception at The Cargo Hall on the
Wharf after the Opening Ceremony
 Monday, July 21 -  I gave my plenary lecture. In addition I did a filming in celebration
of the opening of the Doherty Institute for Infection and Immunity. This is an Institute
named after Peter Doherty, the Nobel prize-winning Australian immunologist. Peter was
the other speaker at my symposium earlier that day. On Monday night I went to a
reception at the Red Desert Dreaming Art Gallery at the Hilton Hotel. The reception was
Released by Chairman Rand Paul
348co-sponsored by CSIS with Stephen Morrison, together with Amb. John Berry. That
night on Monday, July 21, I went to dinner with Mark Dybul at the Spice Temple
Restaurant along the wharf. We discussed broad aspects of the AIDS pandemic and I
came up with an interesting idea of providing resources to do phenotypic tracing of virus
in hotspots in various regions including southern Africa and Washington DC. The
purpose of the phenotypic tracing of viral transmissions was to determine if you test and
treat and completely control the epidemic in any given region or location, would virus
spill over back into that region and if so could one trace where it was coming from. This
has particular relevance with regard to whether or not we would truly be able to end the
AIDS pandemic and if we do would, we be able to end it in one region at the same time
that it is raging in another region. I will go back to Washington and discuss with Carl
Dieffenbach the possibility of funding such studies.
Tuesday, July 22, 2014 – I did a Voice of America panel at the Convention Center on
HIV AIDS stigma which was in association with a documentary film that was narrated by
Elton John. I had a number of other meetings that dayincluding with Wayne Koff who
tried to convince me to give major support of NIAID to his “Human Vaccines Project”,
which I am very skeptical about since it smacks of the old HIV Vaccine Enterprise.   The
latter was nothing more than a time sink.   I was straight with Wayne and told him of my
skepticism.  I told him that I would watch to unfolding of the “project”, but I cannot lend
NIAID support at this time since I do not know what “it” really is and I really do not see
any purpose for it.   He understood, but he needs NIAID support for it to work.   We left
it amicably.
 Of particular note was a reception at the Club 23 in the Crown Towers Southbank of the
Crown Hotel. The reception was hosted by the Kirby Institute and discussed the Test and
Treat in Indonesia concept which Cliff Lane and I had been working with and have
convinced the Minister of Health Dr. Mboi of Indonesia to go ahead with the study. In
her remarks at the reception, Minister Mboi credited me with this idea and said it would
not have happened had I not brought it up to her. This was very nice of her. On Tuesday
evening we had the international AIDS Society Dinner at this Stokehouse City
Restaurant, an elegant location in downtown Melbourne. The dinner was sponsored by
Sharon Lewin and Françoise Barre-Sinoussi. It was an excellent time. After that I went to
a birthday party for Jen Kates and Judy Auerbach in a saloon in the Provincial Hotel.
Wednesday, July 23, 2014 - Departed on the extraordinarily long 26 hour trip back to
Washington DC. I went from Melbourne to Sydney, Sydney to Los Angeles, and then
Los Angeles to Washington DC. I traveled with Richard Koup and it was an uneventful
trip. The day that I left, President Clinto arrived for his keynote.
Thursday, July 24, 2014 – Continued press on the MH17 tragedy mixed with interest
about the IAS Meeting in Melbourne.   I appeared on NPR Radio “Tell Me More” with
Michelle Martin.   Of note, there has been a recent recommendation from WHO and prior
to that from CDC that certain groups (MSM at high risk; discordant couples;
heterosexuals who practice risk behavior) should use PrEP (Truvada), which has recently
been approved by FDA for PrEP.   There is a growing controversy about whether use of
PrEP will actually lead to more risky behavior.   Data say that it will not.   Recent study
Released by Chairman Rand Paul
351of Building 31); CNN New Day with Sanjay Gupta; MSNBC with Chick Todd; WTOP
Radio; NPR “Here and Now”; BBC radio; MSNBC; Hearst TV.   Tonight I do MSNBC
again at 8:15 PM from Nebraska Avenue and BBC Radio at 10:15 PM.
Much discussion from the media about the role of “NIH scientists” in getting the ZMapp
to Brantley.  They are referring to Lisa Hensley.   We needed to clear up her role in that
CDC (Kevin DeCock) asked her to point Samaritan’s Purse in the direction of the people
who had the antibody.   There was some feeling that there was some “government
conspiracy”.   I will discipline Lisa when she returns from Liberia because she got out of
her lane by getting involved in the procurement of the antibody.
I am exhausted from media.
August 5, 2014 – Media, particularly CNN and Sanjay Gupta still pursuing the issue of
an NIH scientist (Lisa Hensley) who they claim actively pursued and obtained the zMapp
antibodies for the 2 American patients.   Lisa returns today and we must get the truth.
She claims that she just steered Samaritan’s Purse (SP) people to the individuals/groups
that had interventions and SP decided to obtain the zMapp from Gary Kobinger (Canada)
who apparently brought a dose to Sierra Leone.   As it turns out, Lisa got on a helicopter
provided by the State Department to pick up the zMapp from Sierra Leone and bring it
back to Liberia.   When she got to SL, she found out that SP had already obtained a
helicopter themselves and had already picked up the zMapp and brought it to the patients
in Liberia.   I find out today that the helicopter that Lisa flew in was a CIA helicopter!
The State department will deny any role in this since the CIA is not supposed to be
operating out of the Embassy.  However, the Embassy certainly “tried to” facilitate the
transport of zMapp.   I will straighten all of this out and get to the truth after we question
Lisa.
Getting exhausted by media.   Today I did: CNN Squawk Box; MSNBC; CTV News;
CNN with Sanjay Gupta; Fox News; Reuters TV; CNN International; Al Jazeera; BBC
TV; Fox News with Lou Dobbs; CNN Anderson Cooper; MSNBC with Larry O’Donnell.
August 6, 2014 – Some of the events that occurred today are very important. Lisa
Hensley, an NIAID employee (Ph. D) is a NIAID scientist who reports to Peter Jahrling
at Fort Detrick.  She was in Liberia to give technical assistance.   She had informed Cliff
that her role in Samantha's Purse (SP) getting the zMapp antibodies for Dr. Brantley and
Nancy Writebol was only peripheral and facilitating.  Lisa has been called back by Cliff
and returned from Liberia last night and Cliff Lane gathered a considerable amount of
information from her. It appears that she has been much more active in assisting the
people from SP in procuring the zMapp antibodies from Gary Kobinger of the Canadian
Health Agency. In addition to just pointing the SP people in the right direction, she was
actively involved in organizing an attempt to procure the antibodies and deliver them to
the patients. The CDC was actively involved also in the person of Kevin DeCock who put
Lisa in contact with SP. In addition, the United States Embassy in Monrovia, Liberia was
very actively involved in this process. With regard to the latter the embassy provided a
UN helicopter to take Lisa and the military attaché from the embassy to the border of
Released by Chairman Rand Paul
352Sierra Leone and Liberia to pick up the package of monoclonal antibodies. However, SP
had already chartered their own helicopter and picked up the material themselves.
Nonetheless, our prior determination and announcement to the media that the NIH as well
as the federal government played only a minor role in the procurement of these antibodies
is technically not correct. When I found out about this, I felt it was very important to alert
HHS Secretary Sylvia Burwell. I briefed her on the fact that the original statement from
the Department of Health and Human Services regarding the role of NIH was not
technically correct. She agreed and indicated that we would have to let the White House
know particularly the General Counsel. The reason why this is important is that
technically speaking SP has broken the law by bringing in a drug from Sierra Leone to
Liberia without the permission of the health officials of Liberia. In addition, there is also
the issue of ethics in procuring a drug for one individual when there is very short supply.
And so the question is asked how can one get drug for American doctors and health
workers when hundreds of Africans are dying from the disease. We will have to face this
issue in the press even though technically speaking NIH did not procure the drug. The
appearance is that we at least assisted the SP in getting it. It is important to emphasize
that Lisa Hensley was acting on her own accord without asking permission from any of
her superiors and so she was really not representing the NIH.  It appears now that this
was what Sanjay Gupta of CNN was talking about when he told me by phone that he had
e-mails that indicated that an NIH person was actively involved in procuring zMapp
antibodies for SP and that the US Embassy was also involved and that he could not show
me the e-mails since the person who gave them to him had a lawqyer who advised against
it.   I believe that the secret party who gave Sanjay the e-mails is SP who are now afraid
that they have broken the law and are trying to say that the USG helped them and so how
could it be wrong.  It will be interesting to see how this all plays out.
Billy Fischer from UNC visited NIH to help the Clinical Center get ready for the
possibility of admitting Ebola patients since the CDC is sending 50 people to West Africa
and there is the possibility that they may get infected and might need care.   Billy spent
time in Sierra Leone directly taking care of patients.  He was great!
Again, much press today →  CBS Morning Show with Charlie Rose and Norah
O’Donnell; NBC Channel 4 Local News; CNN with Jake Tapper.
August 7. 2014 – Re-visit of part of the African Delegation that is visiting DC.   Francis
Collins and I and other IC Directors briefed them in Medical Board Room of the Clinicial
Center at 11:15 AM.   Present were Mali President Kweita and Zambia Vice president
Guy Scott and his wife Charlotte.  I presented information about NIAID activities
relevant to their countries (Mali – malaria; Zambia – HIV, TB).
Media frenzy continues with Gaza war and Ebola.  Ebola dialogue now focusing on the
ethics of distribution of scarce interventions during medical crisis.   Triggered by the
availability of zMapp for the 2 American patients.
Press today CNN New Day; MSNBC with Ronan Farrow; CNN International; Sirius
Radio (Fox) with Marc Siegel
Released by Chairman Rand Paul
353August 8, 2014 – Frenzy continues.  Press includes WTOP Radio, WNYC Brian Lehrer
Radio, Fox Business TV, NPR Los Angeles.
Gaza + Ebola – now ISIS is taking over Iraq and the USA in now bombing their advance
to a Kurdish city where American diplomats are holed up.   The USA wants to avoid
another Benghazi.   Because of this the White House is not allowing any government
people to go on Sunday AM TV and so I had to cancel invitation from This Week with
George Stephanopoulos and “Face the Nation”.   White House is in the controlling the
message mode.
August 8, 2014 – (Saturday) - Having daily Secretary and NIH (Collins) call.  Issue is
that we are trying to expedite going into phase 1 trials of interventions that have only
been in pre-clinical.  These include zMapp, the Canadian VSV vaccine, the VRC
ChimpAd3 vaccine.   Emory is making “side deals” with Mapp for zMapp and Canada
for VSV to get pre-exposure prophylaxis for doctors at Emory.   Potential problem is an
“optics” problem in that USG is helping Westerners get interventions that Africans
cannot get.
This is all getting very intense and similar to the Anthrax issues from 2001.   Sylvia is
starting to see more clearly what I can do regarding leadership on the phone calls.
August 11, 2014 – The frenzy around Ebola still continues with the major issue being the
ethics of getting experimental drugs to the two Americans, and most recently to a Spanish
priest who was flown from West Africa to Madrid and who received the experimental
zMapp cocktail of monoclonal antibodies. The media are pushing the story of favoritism
towards the West and developed nations as opposed to the Africans who are suffering
from the disease. They fail to understand that there is no evidence that zMapp actually
works, and the fact is that there are only three doses left in the possession of the company
that owns it, i.e. MAPP Biopharmaceuticals. Of note, the President of Liberia has
contacted the White House to see if the United States can expedite either transfer of two
sick Liberian doctors to the United States for care and/or obtain doses of zMapp for them.
It is interesting that Larry Zeitlin, the CEO of MAPP Biopharmaceuticals, has contacted
Cliff Lane telling Cliff that he wants to get rid of the three doses of zMapp that he has in
his possession because of the pressure on him to distribute it to a number of people in
Africa who need it.   He does not want to be put in this ethically difficult position.  He
wants to give it to either WHO or MSF. However, he does not want the US government
to react negatively to this. He wants to make sure that we do not criticize his giving the
doses to another entity, thereby making them responsible for its distribution. We have
been having a daily conference call including this past weekend on Saturday and Sunday
with Sec. Sylvia Burwell to keep up with the rapidly evolving E bola situation. During
that call yesterday (Sunday), Secretary Burwell suggested that since we helped the
American doctors to get doses of zMapp that we might suggest to Larry Zeitlin that he
give the doses to the Liberians. This would accomplish two goals: 1) it would allow
President Obama to respond to the Liberian president, and;  2) it which show the world
that we do not just favor Westerners, but that we are helping to make drugs available to
Africans.
Released by Chairman Rand Paul
354We had a conference call yesterday (Sunday) with Canadian health authorities to inquire
about the availability of their experimental VSV  Ebola vaccine. On the call were our
HHS team with me, Cliff Lane, Hilary Marston, Nicki Lurie, Dawn O’Connell (Sec.
Burwell’s Chief-of-Staff), Tom Frieden and CDC folks, Robin Robinson, Leslie Dasch
(Counsellor to Burwell).  On the Canadian side there was Gregory Taylor (Deputy Chief
Public Health Officer), Judith Bosse (Assistant Deputy Minister, Infectious Diseases
prevention and Control Branch), Theresa Tam (Branch Head, Health Security
Infrastructure branch) and Supriya Sharma (Assoc. Assist. Deputy Minister, health
Products and Food Branch).   The Canadians are still in preclinical studies and have not
yet gone into humans. There is an ongoing disagreement between me and Tom Frieden.
Tom wants to give the vaccine to health workers in Africa even before it has gone into a
phase 1 trial (I believe that he has been speaking with his CDC people who are preparing
to go to Africa and are understandably concerned about their risk). I do not believe that
Tom understands the clinical trial process since he says that we are “ethically obliged” to
allow the healthcare workers to make the decision themselves about whether they are
willing to take a potentially unsafe, potentially ineffective vaccine.  If this were a drug to
be given to a desperately ill patient, then that is one thing about going directly from pre-
clinical to human treatment.   However, this is a vaccine to be given to a healthy person.
On the call with the Canadians, I pointed out our experience with the HIV vaccine which
was effective in monkeys, but in humans it actually significantly increased the risk of
acquisition of HIV infection. In order to expedite things Cliff Lane will organize a quick
phase 1 trial at the NIH Clinical Center to test the safety of the Canadian vaccine.
Once again, I have been all over the press. Last night I was on CNN with Jim Sciutto as
well as on CNN International. Today I will do the Diane Rehm Show.
August 12, 2014 – We are having a daily (including Saturday and Sunday) conference
call with Secretary Burwell and a separate call among NIHers with Francis Collins.
Press interest in dying down somewhat (I was only on Colombian (Bogotá) radio and
Czech Radio only.   The issues are centering now around the ethics of using experimental
drugs (we actually have none available) and vaccines (getting ready to go into Phase 1
with the NIH (VRC) Chimp Ad3 vector with Ebola env gene inserts) prior to proof of
safety and efficacy.   The Canadians also have 2 VSV Ebola vaccines.  There is no more
ZMapp left – 2 courses went to Brantley and Rightbol, 1course went to the Spanish priest
who died, and 2 courses were sent to Liberia to treat 2 Liberian doctors who contracted
Ebola caring for patients (President of Liberia appealed to President Obama.   The USG
put Liberia in touch with Larry Zeitlin and MAPP Biopharmaceuticals.
August 13, 2014 – My invited Perspective on Ebola came out online at 5:00 PM in the
New England Journal of Medicine .  Cliff Lane and I are trying to reconcile the need for
data of safety and efficacy of the NIH vaccine and the need to get it to people who need
it.   We drew up a proposal for a Randomized Clinical Trial (RCT) to take place in the
countries in Africa right after the Phase 1 here at the NIH.   This would settle the ethics
issue (randomization is “fair” and also would collect data to prove efficacy and safety.   I
Released by Chairman Rand Paul
355will propose this at the next Secretary’s call.   The logistics of this will be difficult due to
the lack of infrastructure in the 4 African countries.
Did WBAI Radio in NYC and Al Jazeera TV today.
Latest numbers for Ebola – 1900+ cases and 1050 deaths
August 14, 2014 – Things quieting down a bit in the press.  Still struggling with ethics
issues and clinical trials issues.   Canada has “hot-dogged” by announcing that they are
“donating” 400-800 doses of their vaccine for use in Africa.   Of course, that is exactly
where we will give it when we show that it is safe.   Also Jeremy Farrar, the head of
Welcome Trust is grandstanding a bit saying we must not just “sponge down the patients
and let them die”.   Give me a break.   Now WHO wants to use the Phase 1 doses of
vaccine to vaccinate their people who are going to Africa.   They want 200 doses to do a
“phase 1 trial” in their staff.   200 doses is a product distribution program, not a phase 1
trial.
Did CBS News and AP TV today.
August 15, 2014 – Went up to Philadelphia to see the White Coat Ceremony at the
University of Pennsylvania Medical School where my daughter Megan is beginning her
first year of medical school.   Beautiful day and wonderful ceremony.   We are so proud
of Megan and hope that she will be happy.   I know that she will do well having
graduated summa cum laude from Columbia and then excelling in the Post-Bacc pre-med
year at Hopkins.
August 16-19, 2014 – Media blitz stopped, but the epidemic still rages.   The West
African countries are instituting quarantines and border closings, which may slow down
the epidemic, but there is the beginning of a humanitarian crisis to get food, water and
supplies to the quarantined areas.
Tom Frieden and I are working out how we can reconcile the issue discussed above about
the balance of open access of vaccine following phase 1 versus the need to know by RCT
whether the vaccine actually works and whether it might actually do harm, as per the Ad5
HIV vaccine enhancement of HIV acquisition  in a former clinical trial a couple of years
ago.   The department was clearly concerned (Andrea Palm – chief-of-staff to Burwell-
pissed me off on a conference call by acting annoyed with Tom and me in our discussions
on the daily conference call) about the disagreement between Tom and me; however,
Tom and I are now trying hard to work it out behind the scenes.

August 20, 2014 – Ebola still on an upswing.  No explosion yet in Nigeria following the
infection of cluster (8 to 11) health care workers who took care of
(Liberian/American) who flew from Liberia to Nigeria).
Tom Frieden and I still trying to work out an agreement/compromise regarding the
distribution of Ebola vaccine (RCT versus expanded access) following the Pahe 1 trials
that will begin in September and have data by November on Safety and immunogenicity.
Released by Chairman Rand Paul

356Press low level but consistent.   For me → Federal News Radio; Canadian TV; VOA TV
– “Straight Talk Africa Show – 1 hour);
ISIS (Islamic State in Iraq and Syria) taking over parts of Iraq
Gaza still a mess with rocketing of Israel and retaliatory air strikes by Israel.
August 21, 2014 – 2 secondary cases of Ebola (beyond cluster of health care workers)
from the index in Nigeria.  Getting close on agreement with Tom Frieden.  Cliff Lane
very helpful; in hammering out details with CDC people – Tim Uyeki and Steve Redd
(Steve is a rally good guy with whom I dealt during the Flu issues).
Continued press →  MSNBC; WTOP radio; CNN with Lou Dobbs; BBC Newsday
Radio.
August 22, 2014 – Situation same with epidemic.   Good news – have come to agreement
with Tom Frieden on approach to Ebola vaccine following Phase1 trials.   Agree to go for
RCT with control group as first choice.   There well may be obstacles on the ground to
this approach including perception of keeping interventions from those who need it (even
though we still do not know whether the vaccine is either safe or effective).   This may
necessitate a modified RCT without a control group or even skipping an RCT and going
to emergency open access.   The plan is to do a “rolling” approach staring with RCT →
modified RCT → open access in priority order.  I will present this to Secretary’s call next
week.
Tom Leaves for West Africa over the weekend.
Press still active → Fox 5 WTTG; CNN International; BBC Radio – The World; WNEW
CBS Radio – NYC; PRI (BBC) – Boston – “The World” with Marco Werman
August 23 – 27, 2014 -  Still escalating Ebola situation. Now a secondary case in Nigeria
with  having infected a person who took care of him.   That person (who
recovered) then infected a doctor in Port Harcourt. The doctor died, but the doctor’s wife
is now infected.  The numbers are going up.   Tom Frieden now in Liberia to assess the
situation.  He is saying that it is catastrophic and out of control in a press conference from
Monrovia.  People on the Secretary’s 3x per week call have criticized him for being
“hyperbolic”.   How should they know – he is there and they are here.   Typical
government cover-your-ass bullshit.   Still getting modest press.
August 28, 2014 – Our big press teleconference announcing the beginning of the Ebola
vaccine Phase 1 trial of the Chimp Adenovirus 3 vector with the Ebola GP bivalent gene
insert.   Trial to start on September 2 at NIH Clinical Center.  Also coinciding with
slightly later start of monovalent identical vaccine in the UK with Oxford, Wellcome
Trust and extension into Mali and the Gambia.  Also, we announced our collaboration
with NewLink and Public Health Agency of Canada (PHAC) in a Phase 1 trial (in Silver
Spring, MD with WRAIR) of the VSV – Ebola vaccine.
Released by Chairman Rand Paul

358contamination of hands outside of the classical hospital setting should in my mind at least
be considered as a potential route of transmission.
Press interest continues with: Columbia (Bogota) Radio; VOA TV; NPR Weekend
Edition with Scott Simon; NPR Science Friday; CNN with Jake Tapper; Reuters TV
August 30, 2014 – Case from Guinea went to Dakar, Senegal and lied about exposure.
Took bus and stopped in 2 health care facilities.   Contact tracing now going on in
Senegal.
Spoke with Tom Frieden who is in Liberia.   Trying to get him to appreciate that giving
VSV Ebola vaccine as post-exposure prophylaxis (PEP) is risky due to the induction of
cytokines by the live VSV, which might actually enhance the acquisition upon exposure
since cytokine dysregulation plays a negative and potentially positive role in Ebola virus
disease.  He wants to pre-position VSV vaccine for PEP and TKM drug (siRNA – not yet
is phase 1) at all Ebola treatment Units (ETUs). I understand the desire to protect the
CDC and other health care workers on the front lines, but we must be concerned about
giving drugs/PEP vaccines BEFORE they have even been in the earliest Phase 1 trials.
Yesterday CDC evacuated a WHO worked who had a low risk needle stick (clean needle
through potentially contaminated gloves) and they gave the person TKM drug and
wanted to give VSV, but could not get it.   That is why he now wants to pre-position it.
 See below my e-mail to Tom Frieden sent to him on Sunday, August 31 while he was in
Liberia:
Tom:
    I am including a few attachments: 1) 2 slides (from Nancy Sullivan
who does our pre-clinical Ebola studies)  that summarize the issue of
"cytokine dysregulation" in Ebola disease and potentially following
vaccination; 2) 2 reprints (referred to in the 2 slides) on the types
of cytokine responses in Ebola disease and following vaccination with
different vaccine platforms; and 3) the Heinz Feldmann paper with which
you are familiar and which shows that in the monkey model of Ebola
virus disease, the VSV Ebola vaccine used as post exposure prophylaxis
(PEP) protected 50% of the monkeys from lethal challenge with Ebola if
administered 20-30 minutes following the challenge.
   Getting back to our discussion and your question concerning the
issue of any risk of administering VSV as PEP, I certainly would not
characterize the inflammation following VSV vaccine administration as
"cytokine storm".   It certainly induces inflammation and can cause
fever.  Note that the only human to my knowledge who received this
vaccine was the laboratory worker in Germany who had a needle stick
injury and she got a fever following vaccination.   Inflammation that
results in fever will virtually always induce secretion of cytokines of
various sorts.  Since VSV in the NewLink vaccine is a replicating
virus, it will almost certainly induce the secretion of
cytokines.   The reason that this might be important is that a whole
array of cytokines are important in the pathogenesis of Ebola virus
disease.   It certainly can kill you (advanced cytokine storm) and it
is almost certainly involved in protection and recovery from Ebola
infection.  It is a delicate balance that we do not fully
Released by Chairman Rand Paul
359understand.    At this time, we are unclear about the positive versus
negative effects of cytokine secretion (or call it dysregulation)
related to the precise cytokines in question and the timing of their
secretion vis-à-vis Ebola infection (see first bullet in the first of 2
slides in the first attachment.
   In my mind, this does not mean that one should not provide VSV as
PEP for your people (or others); however, if administered to them, it
should be made clear to the recipients that 1) VSV Ebola vaccine
provided 50% protection in monkeys if given 20-30 minutes following
exposure.   I would mention that monkey models are somewhat different
from human Ebola (see 3rd and 4th bullet of 2nd slide in first
attachment) and so direct extrapolation to humans should be made with
caution at this point in time;  and 2) importantly, the vaccine
recipients should clearly understand that there is a theoretical
possibility that the VSV, due to the complexities of the cytokine
dysregulation that accompanies Ebola infection and the perturbation of
this cytokine network that might occur with a live virus vaccine (VSV)
that induces inflammation and fever, might actually cause them harm by
disturbing their normal inflammatory/immune response to Ebola
infection.   If they understand these caveats, then it would be their
choice to receive the vaccine with informed consent.
    Finally, as you certainly know better than anyone, the FDA will
have to be involved in the approval of allowing this pre-positioning
and potential use of an experimental vaccine by whatever is  the
appropriate regulatory mechanism.   I hope that this information is
helpful to you in your deliberations about PEP.   I look forward to
discussing these issues with you.
Best regards,
Tony
-----Original Message-----
From: Frieden, Thomas (Tom) (CDC/OD)
Sent: Sunday, August 31, 2014 3:49 AM
To: Fauci, Anthony (NIH/NIAID) [E]
Subject: Cytokine
I had heard of cytokine storm with tekmira but not with VSV.  Can you
confirm?
Did MSNBC
Sept. 1, 2014 – Labor Day – had usual call with Secretary Burwell (SMB) this AM at
8:30 AM.   Clear and muggy day.   We are going around in circles.   I am concerned that
the Secretary is a really smart and very competent person, but she is surrounded by
people who may be good at management, but who have never been in a situation like this
and who really do not have a clue how to address it →  Leslie Dach (formerly of
Walmart); Andrea Palm (have no idea where she came from).   Bill Corr (Deputy
Secretary) is the only one with corporate memory of former crises and he has been
completely marginalized by the new kids in town.
Released by Chairman Rand Paul
360There really is no command and control at a higher level.   At my suggestion, Francis
sent a note to SMB suggesting that we bump this up to the White House level (perhaps
the VP) in order to get DoD, USAID, HHS, and NSC working together.   She has not yet
responded to him.   I mentioned on the call today that Tom Frieden is dealing with
Assistant Secretary Lumpkin of DoD.  He is a good person, but nothing is happening
with the promise for mobile hospital beds.   They are still quibbling about a 25 bed
hospital when they really need 1000 beds.   Plans for 5 X 100 beds have gone nowhere.
My experience with the DoD is that they are well-meaning, but the culture and chain-of-
command is such that you never know when you are speaking with someone who really
has the authority to actually do what they are talking about.   Something strange about the
military culture in that they will never say “you are speaking to the wrong person; I
cannot help you”.  They will try to help (although they cannot) and all that happens is that
time is wasted.   I tried to make that point on the conference call.
Importantly, WHO is saying that the epidemic could reach 20,000 cases.   In fact,
mathematical models that came out in ScienceInsider today from a physicist named
Alessandro Vespignani showed that the curve is exponential, not linear, which means that
there could be 10,000 cases by September 24.
This is turning into a total catastrophe.   Just spoke with Dawn O’Connell (Counsellor to
SMB) and explained to her that the situation is out of control and that we need a higher
command and control.   I also explained to her the importance of the “exponential” curve
of the epidemic.   Dawn is really trying to be helpful.
Sept. 2, 2014 – Tom Frieden back from West Africa, gives press conference and says that
the situation is out of control and could result in 100,000 cases!   HHS people concerned
that he is being hyperbolic; I do not think that he is hyperbolic.  Worrisome things – an
American missionary M.D. got infected while got infected in Liberia in a hospital that
was not for Ebola patients.   Turns out he was doing an OB-GYN exam on a woman who
was infected, but did not know it and did not tell the missionary that she had been
exposed.   Big problem – people are not telling the truth for fear of stigma.
Epidemiological curves are now exponential.   A lot of planning, but not much action.   I
am supporting Tom in the press and at HHS even though he still thinks that we should
pre=position TKM drug (siRNA) and VSV vaccine for PEP for health workers in the
ETUs even though they have not been in Phase 1 yet.
Did Panel at CSIS on 1616 Rhode Island Avenue.   Very hot muggy day.   Panel on
Global Health issues in the context of Larry Gostin’s new Book of Global Health Law.
Panel was me, Larry and Tim Evans of World Bank.   Ebola was a major topic.
Important – Secretary Sylvia Burwell called my cell phone at 2:30 PM to ask my opinion
of whether we were not doing enough or were doing it wrong.   I told her that
quantitatively we are not doing enough.   But as the epidemic grows exponentially, then
the quantitative defect transforms into a qualitative defect and then we are doing it wrong
since doing the same thing minimally while the epidemic grows, then becomes doing it
wrong.    She also tasked me to find out whether there are options to improve the tobacco
Released by Chairman Rand Paul
361plant yield of the ZMapp antibodies or as suggested by some, that we go to CHO cells.
She wanted me to contact the Agriculture people at the BMGF where she used to work to
get their opinion.  I called and spoke with Susan Hellmann (President of BMGF), Chris
Elias (BMGF), Rob Horsch (Ag expert at BMGF), Larry Zeitlin (CEO of Mapp
Biopharmaceutical to get their opinion.   Consensus is that it will take too long to fix the
poor yield in tobacco and that we should go for CHO in 2 of the 3 antibodies.   The 3rd
does not do well in CHO and so stick with tobacco on that one.   I wrote a long e-mail to
Sylvia explaining this.
Press – CNN with Erin Burnett
News still dominated by ISIS who beheaded another USA journalist; Russia invading
eastern Ukraine; Gaza and Ebola
Sept. 3, 2014 – Big meeting at World Bank Headquarters on 18th Street, N.W. to exam
and discuss the response to Ebola.   Jim Kim (President of World Bank) specifically
invited me (as did Paul Farmer),   Discussed the WHO Roadmap and David Nabarro’s
UN Plan.   Present at meeting were: Tom Frieden, Jim Kim, Tim Evans (Senior Director,
GHNDR), Jan Eliasson (Deputy Secretary General, UN), Margaret Chan (Director-
General, WHO), Gayle Smith (by phone – Special Assistant to the POTUS at NSC),
Mark Dybul (by Phone), Keiji Fukuda (WHO), Raj Panjabi (Harvard), Ariel Pablos-
Mendez (USAID), Jimmy Kolker (HHS), Joia Mukhajee (PIH)Sri Mulyani Indrrawati
(World Bank), Olusoji Adeyi (World Bank), and other World Bank people.
Jim Kim took the lead and emphasized that we need to translate “planning” into action
and took Margaret Chan to task for not exercising her authorities under the International
Health Regulations (IHR) to take the lead.   Despite Jim Kim’s strong urging, it still
appears that we are not headed to great action.   David Nabarro had some action items
with no way to actually act.   I mentioned gently to Margaret that she should not say that
“We plan to have to Epidemic under control in 6 months”   since this would signal to the
world that we actually have a way of ending it in 6 months, when in fact we have no idea
when it will end given the exponential nature of the increase in cases.   I also told story of
when Colin Powell and I went to the UNGASS in the early 2000s and he declared the
AIDS pandemic a global security threat and this got the attention of everyone.   We
should do the same thing with Ebola.
 Press – MSNBC with Peter Alexander; Fox News with Lou Dobbs.
Sept. 4, 2014 -   After discussions with me and having me see and edit his column, Mike
Gerson wrote a scorching editorial in today’s Washington Post criticizing the world and
the White House for not doing more for the Ebola situation.   In my discussions with
Mike, he indicated that when he was in the WH with Josh Bolton as Chief-of-Staff, they
would have pushed George W. Bush and he would have responded to do something
dramatic to help West Africa.   Mike sent me a note that Denis McDonough (Obama
Chief-of-Staff) sent to Mike in response to Mike sending Denis a copy of the article.
Denis note to Mike below:
Released by Chairman Rand Paul
362Tony,
In confidence, this is the note Denis sent back to me when I sent him the link to the
column.  I thought you might be interested.
Thanks, Michael.  It is good to hear from you, and I look forward to reading your column (which I
have not yet had the chance to do but will soon).

I did think it was worth mentioning that the President had a good – if alarming – discussion with
Dr. Frieden on Monday after Tom returned from the region where he went to get a candid view
of how this is progressing.  Tom was concerned with what he saw, and the President was
concerned with the same.  As a result, POTUS directed even more aggressive action than we
have been taking so as to treat this like the national security challenge it is.

Lisa, who is leading this effort, and John may have additional thoughts.  But we feel this urgency
– deeply.

Thanks again for the note,
Denis.
Press – MSNBC with Ronan Farrow,
Sept. 5, 2014 – Got note from Tait Sai saying that my interview in Newsweek where I
said that the Epidemic was “completely out of control” was “10% too hyperbolic”.   Lots
going on.   USAID assigned Nancy Lindborg to run their shop.   She is pretty good.   Jim
Kim is exercised that WHO is not doing enough.   Tom Frieden says that the DoD is
useless since they can never commit to anything.   This is interesting since Cliff Lane
thinks that they are the only ones that can control this with Command, Control and
Communications.
Jim Kim wants to engage me, Paul Farmer, Mark Dybul to see to the clinical care issue
and incorporating clinical trials into the picture.
Spoke with Tom Frieden today and Tom feels better those things are now moving with
the $75 million that USAID is putting in.   I believe that Tom was told to tone down the
rhetoric about this outbreak being totally out of control and that is why he is saying that
things are on track.   This coincides with Tait telling me that I am 10% too hyperbolic
Did boat-load of print media today.
Sept. 7, 2014 – POTUS said on Meet the Press today the following:
POTUS on Ebola on Meet the Press, 9/7/14:
*Americans should not be concerned about prospects of contagion here in US, short-
term, because it is not airborne disease like the flu.
Released by Chairman Rand Paul
363*No public health infrastructure in Liberia/SL/Guinea.
*What should be containable problem is breaking loose, because people aren't being
quarantined properly, people aren't being trained properly, not enough public health
workers.
*We have to make this a national security priority. Mobilize international community, get
resources in there, get US military assets just to set up isolation units and equipment, and
provide security for public health workers surging from around the world.
*If we do that, still going to be months before this problem is controllable in Africa. But
it shouldn't reach our shores.
*If we don't make that effort now, and this spreads, not just through Africa, but other
parts of the world. There is the prospect the virus mutates, it becomes more easily
transmittable. And then it could be serious danger to US.
*This is example of where US leadership is important in dealing with crisis. But, also
argument for when I go before Congress, and say let's give some public health aid to
Liberia. Short term investments now, pay off in the future.
It now remains to be seen what actually happens.   The POTUS is getting beaten up in the
polls and by the GOP for his inaction.   He let the Left down by delaying action on
immigration reform until after the November Congressional elections in a purely political
cave-in.  He is paralyzed in inaction on bombing ISIS in Syria and in doing nothing to
stop Putin and the Russians from taking over part of Ukraine.    He is having a bad
summer.
Yesterday, Mike Gerson contacted Francis Collins in the same manner that he had
contacted me, asking Francis what he thinks should be done.   Francis responded as I did
that we should bring in the DoD for their Command, Control and Communications
capability.   Also, someone needs to be in charge.   John Podesta (Counsellor to the
POTUS) contacted Mike Gerson asking him what he thinks we should do.   John was
taken aback by Mike’s Post editorial the other day.   Mike asking Francis/me who should
be put in charge at the WH.   I suggest any of the following:   David Petraeus, Stanley
McCrystal, Colin Powell, and Bill Frist.   I doubt if they will choose any of these.   They
probably will ask Lisa Monaco – head of NSC.   We really need a General.
I believe that we are missing the boat.   USA is missing an opportunity of saving many
lives and coming across as the savior of West Africa, much like George W. Bush saved
all of Africa with PEPFAR.
Am getting e-mail from Jim Kim and Paul Farmer asking for my help/advice should they
get more heavily involved.
Released by Chairman Rand Paul
364Sept. 8, 2014 - The situation is evolving rapidly where the Department of HHS is now
telling us (NIH and others) that things are now going in the right direction and that we do
not need to have daily phone calls anymore and could probably move them to every week
or every other week. This is stunning to me since I do not see that anything has really
changed and it appears to me that they are trying to paint a rosy a picture when things are
actually getting worse. The reason for this is unclear. It could be that the White House
has told them to tone down the rhetoric since they do not want to put pressure on the
President. Also amazing is the fact that even Tom Frieden has told me on the phone that
things seem to be going in the right direction now and they have work streams and points
of contact and he is much more optimistic. I cannot believe that he has completely
changed from the passionate person demanding an overwhelming amount of resources
and beds to someone who now says everything seems to be going okay. There is
something very fishy here.   I suspect that HHS has promised him that resources are on
the way and have told him to cool it.   I will find out what is going on.
Appeared on Diane Rehm show today with Sheri Fink from the New York Times as well
as Sophie Delaunay from MSF and Mvemba Dizolele from the Democratic Republic of
the Congo.    Dvemba said that he has been reading about me since he was 16 years old
and that I was his hero.   He made me feel rather old despite the flattering comment (he is
right about the age ).  The host was Steve Roberts and we spoke about the drastic
situation in West Africa. Also appeared on BBC radio. WTOP radio and Reuters TV.
Although the President has said on Meet the Press that the military will now be involved,
reports and news outlets such as Reuters quote officers at the level of Colonel saying that
the military will deliver the 25 bed hospital to Liberia; however, there will not be “boots
on the ground” of military personnel staffing the hospital. As far as I can see, this is no
different than what was going on before the President's announcement. There were
already plans to get a 25 bed hospital shipped by military aircraft to Liberia. I think this is
a smoke and mirror game in which nothing will get done.
September 9, 2019 - There is a considerable disagreement going on about the role of
randomized placebo-controlled clinical trials (RCTs) in determining the efficacy and true
safety of the GSK/NIH chimp adenovirus vaccine. The British in the form of Jeremy
Farrar Head of Wellcome Trust as well as the WHO (Marie-Paule Kieny) seem to want to
distribute the vaccine outside of a clinical trial. They are responding to what is an
emotional need to get some intervention out there even though we have experience to
indicate that the worst thing that can happen is the widespread application of the vaccine
or other interventions that  either do not work or actually paradoxically make things
worse as we have seen with the HIV vaccine experience where a HIV vaccine that looked
good in preclinical as well as in phase 1 actually increased the risk among the vaccinees
of HIV acquisition by up to 41%.  This is the worst thing that could happen in the Ebola
situation. Cliff Lane and I are trying hard to strike a delicate balance between making our
vaccine available following phase 1 trials which have just started here at NIH and
continuing to pursue the scientific path of determining if it works and is safe without a
paradoxical effect of harming.
Released by Chairman Rand Paul
365Had an extraordinary conversation with Tom Frieden tonight. Tom had been at a National
Security Council meeting at the White House today hoping that he would guess an
indication that they would be many more resources to address the Ebola outbreak. He had
been secretive about the meeting; I can understand that since I have been at many WH
meetings where they wanted to keep things secret until they made a decision.  He
obviously was very disappointed after the meeting since he called me on my cell phone in
my car as I was driving home late tonight from the NIH. Tom was more animated and
distressed that I have ever seen him. I knew this to be the case since he used foul
language (“Fucking ….”) and I have never heard Tom used foul language before. He was
completely frustrated by the fact that his meeting with the National Security Council and
representatives from USAID as well as the secretary's office indicated to him that nothing
new was going to happen and this whole idea about getting the military involved was
really more PR than anything else. He also found out that Cliff Lane in his role as a
member of the Defense Medical Board will actually be meeting with Gen. Martin E.
Dempsey, Chairman of the Joint Chiefs of Staff, tomorrow (Wednesday, September 10)
and he essentially implored me emotionally to get Cliff to emphasize to the Chairmen
(General Dempsey) that it is absolutely essential that we have a major military presence
in approaching the epidemic in West Africa. We need plans, thousands of beds, trained
personnel, Command and control, etc.  Without these assets, Tom feels that the epidemic
will remain out of control and spread to many countries in West Africa and throughout
Africa as well as to other countries outside of the African continent. He also indicated to
me that some people who he did not name were telling the military that they need not get
involved since vaccines and ZMapp will soon end the epidemic before they even get their
planes in the air. This is obviously complete nonsense and Tom knows it. He emphasized
the need to please tell Cliff Lane to tell the Joint Chiefs of Staff that this is not the case.
Finally, Tom indicated to me that the military are afraid of getting infected because they
hear that so many healthcare workers are getting infected. He implored me to tell Cliff
that with proper personal protective equipment there really has been no infections among
individuals from MSF. This is turning into a very interesting scenario we will see what
happens tomorrow on September 10 when Cliff actually meets with the Joint Chiefs of
Staff. I assured Tom that Cliff and I strongly feel the way he does and we both have been
pushing hard behind the scenes to get the military involved.   In fact, I have been talking
with Mike Gerson (as has Francis Collins) about approaching John Podesta in the WH to
get the POTUS to agree to military intervention.   I spoke again with Mike Gerson about
this today.   After my call with Tom Frieden, I called Cliff and related the story.   I did
not need to encourage Cliff to say these things since I knew that he would.   I got back to
Tom and told him that things were on track with Cliff for tomorrow and Tom felt better
and thanked me for my help.
In addition today I had conversations on the phone with Paul Farmer who was very
willing to set up more facilities in West Africa via Partners in Health (they are already in
Liberia with Raj Punjabi) together with Jim Kim of the World Bank so that we can do
some good clinical work as well as clinical research. Paul indicated that I did wonders
with PEPFAR, and that he would like to partner with me to do some good with Ebola.
Released by Chairman Rand Paul
366Sept. 10, 2014 - The debate still continues as to whether or not we will have military
assistance in dealing with the Ebola epidemic in West Africa. There is a disturbing lack
of transparency between HHS and us here at NIH in that they are obviously negotiating at
the level of the National Security Council and the Department of Defense about what to
do in the epidemic without telling Francis Collins or me what is actually going on. In the
meantime, Cliff Lane as a long-term member of the Medical Defense Board of the
Department of Defense has met with Gen. Martin E. Dempsey, chairman of the Joint
Chiefs of Staff today. Cliff relates to me that Gen. Dempsey seemed quite receptive to
Cliff's pleading for a massive military logistic support for the Ebola situation in West
Africa. Also at that meeting with the Joint Chiefs was Laurie Garrett, because of her prior
experience with Ebola epidemics. According to Cliff, Laurie also pleaded for a massive
military effort.
      It should be noted that today another important event occurred in which the President
announced at a TV appearance that he will initiate a scaled up military attack on ISIS (he
calls it ISIL)  including their assets in Syria. He declared that ISIS is a threat to the
Middle East, the surrounding regions, and the United States and Europe, largely due to
the fact that they have publicly said that they will attack Western nations. This is a
particularly important problem because many Westerners with Western passports and
Visas including those from the United States have joined ISIS. The President stated that
he would not include ground troops in this effort. However it is clear that Special Forces
will be needed to guide the air attacks. The press is sharply criticizing the POTUS for
having no plan, missing prior opportunities, and now doing too little, too late.  More later.
I bring this up because this is certainly a complicating issue when you are also asking the
military to help with Ebola outbreak.
Had a momentous evening today in that I gave a keynote lecture at the PhRMA Research
and Hope Awards Gala at the Mellon Auditorium on Constitution Ave. It was particularly
important because the other speaker was former Pres. George W. Bush. We resumed our
warm personal relationship in that when he entered a small room of VIPs to shake hands
and take pictures as soon as he walked into the room he caught my eye and said out loud
for everyone to hear: “Hey, Tony it's great to see you”. He gave me a big hug; we took
pictures; chatted a bit and then when he was on the stage for his talk which was actually a
conversation with a moderator, the first thing he said is that:  “We have with us tonight
my friend Tony Fauci. I gave Tony the Presidential Medal of Freedom several years ago.
I did that because you should know that he is one of the most important American heroes
of our time.”   It was extraordinarily flattering, but this is exactly the way he has been
treating me for years. The talk that I gave was entitled ending the HIV-AIDS pandemic: a
realistic goal. Overall the evening was very pleasant. I sat down next to my old friend
form NIH director Elias Zerhouni and the evening was full of warm praise by many
people for me and what I have been doing with HIV over the last many years.
Sept. 14, 2014 - A lot has happened over the past few days. There has been a
considerable amount of disorganization, diffusion, and lack of direction at the level of
HHS as well as the rest of the USG (USAID, DoS, etc.). It has been announced that the
President will visit the CDC on Tuesday, September 16. It is anticipated that he will
announce that the United States military will get heavily involved in the response to
Released by Chairman Rand Paul
367Ebola by providing up to 1700 hospital beds as well as the logistics for transportation and
provision of equipment. However, it is very clear that they will not provide medical
personnel in the form of doctors and nurses. This might leave us with the situation in
which we have equipment but the inability to implement it. HHS (Leslie Dach) is
desperately trying to figure out ways to recruit and train medical personnel to man the
hospitals.   Of note, it might take up to 8 weeks to get these hospitals operational, if in
fact, the US military decides to send them.
      The situation in the West African countries is still dire. I have been on the phone
discussing this on multiple occasions over the past few days with Paul Farmer and Mike
Gerson.   Paul will be leaving tomorrow, September 15, for Liberia in order to set up
hospitals under the auspices of Partners in Health, the organization that Paul and Jim Kim
founded many years ago. Francis Collins, Cliff Lane, and I are still pushing HHS to
suggest that there be a person in the White House who would be the overall Director and
point person for the government's Ebola efforts. I have suggested to Francis and Francis
has suggested to the secretary that that person either be someone like Gen. David
Petraeus, Gen. Stanley McCrystal, or even former majority Senate leader Bill Frist.
Again, I am concerned about the lack of organization, direction, and commitment on the
part of the department as well as the White House. The President is having a very
difficult time in that he is being pressured to respond firmly to the threat of ISIS in the
Middle East. I feel that this pressure may make him and the administration less
enthusiastic about getting heavily involved with the Ebola issue.
     Nicki Lurie, who is a good person and a friend, is making things more confusing by
trying to suggest how to do clinical trials, train people and other tasks when she knows
little about these issues.   She is an Assistant Secretary and so officially she outranks us
all (me, Peggy Hamburg, Francis Collins, Tom Frieden); yet, she gets in the way more
often than not.   Had a long conversation about this with Peggy Hamburg on the phone
today.   Paul Farmer is encouraging me to continue to push the envelope to get the USG
to do more.   Paul is showing an amazing amount of faith in me that I can fix this.   He is
basing this on his experience with me with PEPFAR.   However, this is different since
there are so many “cooks” in this process.
Sept. 15, 2014 – Mike Gerson called me up again this AM wanted to find out if I knew
anything more about the POTUS planned announcement at CDC tomorrow regarding
increased resources (DoD) for Ebola.   Mike is driven by his deep humanitarian values
and wanting to nudge the administration to do more.  Mike will speak with Lisa Monaco
today about administration plans.   I gave him a few questions to ask Lisa, i.e. who is in
charge?
Sept. 16, 2014 – I helped Mike gerson last night on certain elements of his column which
appeared today in the Washington Post. Mike used several of my phrases and called for
an escalated effort in various areas of need including US Military command-and-control,
transportation, logistics, and supplies. Last night the White House sent out an embargoed
fact sheet about what the President will announce today at the CDC. He will make the
announcement at 4:45 PM. I will be testifying before the Senate  HELP committee and
the Senate Appropriations Subcommittee from 2:30 PM until about 4:30 PM. There are a
large number of press including CNN with Wolf Blitzer,Hhardball with Chris Matthews,
Released by Chairman Rand Paul
368an MSNBC who want to speak to me about the President's announcement and the
implications of the announcement. As usual the White House is very nervous about
having anybody speaking to the press before or on the day that the president makes an
announcement. Therefore I am getting a lot of grief from the communications people
downtown and at the White House about all of the requests for me to appear on the
media. By grief I mean that they are not clearing me nor are they refusing me. They are
just keeping me hanging, which usually means that the requests will be withdrawn by the
media people themselves and they will find someone else. This is typical stupidity on the
part of the White House and HHS.
With regard to the announcement of the President, he is proposing many of the things that
I and several of my colleagues have been pushing for. This includes 3000 personnel, a
command-and-control center in Monrovia, Liberia, a US Army general in charge of the
process. The supply of 17 Ebola Treatment Units  consisting of 100 beds per unit, much
personal protective equipment, an education program, home health care kits, home test
kits, among many other things that are much needed. Hopefully, this will turn around the
trajectory of the epidemic. However it will depend on how quickly they get this material
on the ground. I am off to the congressional committees. More later.
Sept. 17, 2014 – Big day yesterday.   POTUS announced military involvement in Ebola
at CDC at the same time that I was testifying before a joint Senate Hearing of the HELP
Committee and the Appropriations Committee.   I testified with Beth Bell from CDC
(Tom Frieden was at CDC with the POTUS visit), and Robin Robinson.   I was
questioned on the POTUS plan, the scope of the epidemic and the possibility of
respiratory/aerosol spread of the virus.   The latter was triggered by Mike Osterholm’s (as
usual provocative and attention-getting) statement that the virus could mutate and spread
by respiratory and that would be the end of the world.   Typical Mike Osterholm.   I have
been countering this with a reality check about likelihood versus hypothetical.   Senators
at the Hearing were Dems: Tom Harkin, Patty Murray, Dick Durbin, Jack Reed, Mark
Pryor, Barbara Mikulski, Bob Casey, Al Franken, Sheldon Whitehouse, Tammy Baldwin,
Chris Murphy and Elizabeth Warren  and GOPs:  Jerry Moran, Thad Cochran, Lamar
Alexander, Richard Burr, Johnny Isaacson, John Boozman.   Kent Brantley was witness
on second panel.
Another example of the WH and HHS press people messing up.   They would not let me
go on the many press requests (CNN, NBC, etc.) since they wanted Lisa Monaco (NSC)
to go on.   As it turned out, she was with the POTUS in his motorcade in Atlanta and so
no one from USG went on and the media was saturated with the usual suspects (Laurie
Garrett, Mike Osterholm, etc.)   The WH and HHS press people are truly a bunch of idiot
amateurs.
Sept. 18, 2014 – Yesterday had Hearing before the House Subcommittee on Foreign
Affairs (Africa) chaired by Chris Smith.   On the GOP side were: Stockman, meadows,
Burgess, Royce (Chair of Full Committee).   On Dems side was:  Bass, Cicilline, Engel,
and McCollum.   My co-witnesses were Nancy Lindborg (USAID), Luciana (Lu) Borio
(FDA), Beth Bell (CDC).   Recurring question was “Who is in charge?”    Real answer is
Released by Chairman Rand Paul
369that multiple agencies/people are in charge depending whether it is health, infection
control, logistics, etc.   Kent Brantley again was on the second panel.
Still much interest and interviews with written press and blogs over the ongoing
“disagreement” between Osterholm and me on the issue of the virus mutating to
respiratory spread.   Ian Lipkin gave an interview on CNN agreeing with me and putting
down Osterholm.

Meanwhile, the House voted to give POTUS authority to arm the Syrian Free Army to
fight ISIS.
The situation continues to heat up with various mathematical models projecting anywhere
from 20,000 to 100,000 to a soon to be published CDC model that would indicate if we
do not have a highly effective control program, the number of cases could reach 500,000
within several months.
 September 19, 2014 - I continue to do small amount of press (as the press is getting
some fatigue with the same story) with Swedish National TV interview as well as a FOX
news appearance. Of note is the fact that the White House communications people are
acting in a very bizarre way. During the past week I have been receiving requests for
appearances on a variety of TV shows for the upcoming weekend including CNN and
MSNBC on Saturday, September 20, as well as Face the Nation and Fox news on
Sunday, September 21. The White House has refused to say yes or no to clearance and
despite multiple requests on the part of our communications people, namely, Courtney
Billet and Patty Conrad, we have not received a positive or negative reply for clearance.
This has gone on into the late evening of Friday, September 19 despite the fact that the
programmers were waiting for me to be on shows on Saturday. This is an absolute
unacceptable disgrace.  The White House because of their inability to decide what should
go out on the weekends and their extraordinary and unexplainable need to control all
messages is putting all of us in the embarrassing position of being unresponsive to
legitimate media requests to discuss things that are not in conflict with anything else the
administration is doing. This is unequivocally the worst administration I have ever dealt
with when it comes to the need to control the media.
This evening I had a very intense and somewhat poignant conversation with Tom Frieden
at 9 PM to 10 PM concerning how we are going to approach the issue of vaccines. Tom
still has considerable concern about a truly randomized controlled trial to determine the
efficacy of the vaccine when the control is not one of the vaccines themselves. He
continues to struggle with the fact that we are not going to be able to get efficacy data
unless we do have a control arm which conflicts with the emotional need to get vaccine to
everyone as soon as possible. The difficulty here is that we might in fact truly need an
effective vaccine if the epidemic continues to expand and reaches the CDC projected
model of 500,000 cases within the next several months. Under those circumstances we
will absolutely need an effective vaccine and if we do not know if it is effective it will be
very difficult to widely distribute it. This is a painful dilemma that hopefully we can work
out.
Released by Chairman Rand Paul
370I have been discussing this by e-mail with Paul Farmer who is currently in Monrovia,
Liberia. Paul is very sensitive to the fact that we need to do research to determine the
efficacy of the vaccine and feels that we can pull this off in Liberia with a properly run
trial. In this regard, the Minister of Health of Liberia has actually requested collaboration
with the NIH in doing research on therapeutics and vaccines. It is going to be a difficult
struggle to reconcile the emotional need of many people (in some respects including Tom
Frieden) to distribute vaccine at the same time that we are not sure if it actually works or
even paradoxically causes harm. I will continue to pursue discussions of clinical trial
designs that might be able to get us where we need to be, i.e. proving efficacy at the same
time as making vaccine available as quickly as possible.
Sept. 20, 2014 – Went to reception tonight at the home of Hilary Rosen (Democratic
pundit) at 4835 Hutchins Place, N.W. to welcome Megan Smith former VP at Google as
the White House Chief Technology Officer.   All the usual Washington glitterati were
their (some examples: Judy Woodruff, Al Hunt, Andrea Mitchell, Bob Barnett, Tammy
Haddad, Hunter and Kathleen Biden, etc.   Megan is very impressive (MIT grad; Google
exec) and we discussed the potential use of technology to address the Ebola epidemic –
cell phone distribution, GPS tracking devices.  Hopefully, she can help.
Indeed, neither a yes or no from the WH and HHS regarding the requests for my
appearances on TV over the weekend and so I did not appear.   Instead, Face the Nation
had Richard Schaffner from Vanderbilt and MNNBC had Laurie Garrett.   This
administration are a bunch of idiots.
Sept. 21, 2014 -  Had call at home from Leslie Dach wanting my opinion about a
“dispute’ between USAID and Tom Frieden about home care versus community based
care of people with Ebola or suspected of Ebola in situations where the ETUs are full.  I
backed Tom who feels that doing it at home would be counter-productive.   Leslie now
relying on me as “the adult in the room” according to Peggy Hamburg.
Sept. 22, 2014 – Tait Sye from HHS not giving me clearance to appear on CNN-Wolf
Blitzer because “CDC will be putting out an MMWR today”.   What morons!!   I just
cannot believe this administration.   I must write about this in my book.  They so
inappropriately try to control “messages” that they are laughable.
POTUS decides to bomb ISIS in Syria.   Ebola numbers expanding.
Had another night time call with Tom Frieden trying to iron out the RCT issue.   Also,
Tom is very frustrated with Nicki Lurie, saying that having her around and involved in
conversations is always counter-productive.   Also, he is frustrated with Sec. Burwell,
feeling that she seems only to want to “check the boxes” instead of getting involved in
important decisions.
Sept. 23, 2014 -  Still working with Tom Frieden in trying to get agreement on whether
to conduct an RCT of the vaccine.   Tom remains concerned about a true control
Released by Chairman Rand Paul
371(placebo) arm and wants to do a Stepped-Wedge trial of sequentially vaccinated different
cohorts without the simultaneous double blind control group.
This evening went to the Annual Friends of cancer Research Awards Ceremony on the
roof of the Hay-Adams Hotel.   Gov. Deval Patrick of Massachusetts and Gov. Bobby
Jindal of Louisiana received awards.   Had good conversation with Gov. Patrick.
Sept. 24, 2014 - On the last Secretary’s call, Burwell tasked me to get the HHS team
together and fashion out a consensus about the way forward following ending of phase 1
vaccine trial at NIH.   I had long conversation with Tom Frieden this AM and he is
starting to come around.   Seems he will be OK with an RCT simultaneously done with a
Stepped-Wedge Trial.  I arranged a conference call at 5:30 PM with me, Tom, Nicki
Lurie, Peggy Hamburg, Lu Borio, and Anne Schuchat.   We came to agreement that we
will do the two trials (RCT + Stepped Wedge) simultaneously.   CDC (Anne and Tom)
feel that the RCT may be so difficult to implement that the Stepped-Wedge approach
might give us some information, while the RCT could fail.   Cliff and I feel just the
opposite.   However, in order to get things moving, we came to a compromise.   I will
report this to the HHS Secretary’s call tomorrow.
Continue to have press interest:  Bloomberg News TV; WTOP Radio; pre-show interview
with CBS 60 Minutes for future show.
Sept. 25, 2014 – Did MSNBC this AM as a commentary immediately following the
POTUS statement before the UN on Ebola.   He gave his speech and then I was asked to
comment.   Of course, I supported what he said (since he said the right things – all
nations must pitch in).
Sept. 26, 2014 – Learned at 4:00 PM this afternoon that the NIH Clinical Center will be
accepting for observation in our special studies unit an American physician who had a
moderate risk exposure to Ebola in Sierra Leone (clean needle puncture through a
contaminated glove).  We scrambled around over the evening preparing press statements
and plans.  Patient will arrive on Sunday, Sept. 28.
Sept. 27, 2014 – Did FOX News and CNN today (Saturday) on regular Ebola issues.
Also, much press coming in since the press release went out today on the patient arriving
from Sierra Leone.   In this regard, I did CBS Radio News; NPR background; WUSA –
Channel 9 TV; various print outlets.   Likely much more tomorrow.
Sept. 28, 2014 – Patient arrived this afternoon (~3:00 PM) from Sierra Leone.   State
Department arranged his transportation.   He was given the VSV vaccine as a post-
exposure prophylaxis, which neither Cliff nor I would necessarily have done since it
induces a fever and can complicate matters.   Indeed, he developed a fever 24 hours after
receiving the VSV vaccine.    The Patient, Dr. Lewis Rubinson, is admitted to the Special
Studies Unit of the Clinical Center on the 5th Floor.      Very little of the circus that we
saw when Dr. Brantley and Nancy Rightbol were admitted to Emory, i.e. no helicopters
or TV trucks.   I did do a few interviews (some pre-scheduled even before the patient was
Released by Chairman Rand Paul
372known to come to NIH.   Did interviews for: MSNBC, NBC Network, NPR Radio; Fox5
TV, CBS Radio
Sept. 29, 2014 – No evidence of infection in the patient.  Much press today:  CNN;
Weather Channel TV; USA Today TV and ONLINE; 1 hour at the WTOP Studio with
questions from staff Deborah Feinstein and Bruce Alan; CBS Radio; FOX5 TV; CBS
TV; AP TV; Channel 8 News TV
Sept. 30, 2014 – Word from the WHO meeting in Geneva is that people are starting to
come around to our (Cliff, me, Lu Borio) idea about the necessity of conducting an RCT
rather than open access for the Ebola vaccine.   A story about me with picture appeared in
USA today with my saying that it is critical to greatly accelerate our efforts or else the
Ebola epidemic will evolve into the “worst case scenario” of the CDC prediction of 1.4
million cases by early 2015.
Oct. 1, 2014 – Big news!   A patient  from Liberia got on a plane on
Sept. 19, arrived in USA (Texas) on Sept. 20 without sxs.  On Sept. 24 developed sxs; on
Sept. 26 went to an ER in Dallas and was given Z-pack and sent home; on Sept. 28 taken
to Texas Health Presbyterian Hospital (Dallas) in critical condition.   Ebola dx confirmed.
This is first patient to come to USA with Ebola who did not know he/she had Ebola.
Soemthing that I have been predicting all along.
On conference call with Secretary Burwell, I indicated that after Tom Frieden’s press
conference at 5:30 PM yesterday (Sept. 30) there were many requests from the press.   On
the phone a CDC person said that this is Tom’s responsibility.   Burwell snapped at the
person saying that we need Tony out there and this is no time to be arguing about
“people’s lanes”.   Finally, someone put an end to that bullshit.   Thanks, Sylvia!   Sylvia
asked me on the phone to cancel my planned trip for today to San Francisco to partake in
a Gala to celebrate UCSF’s Global Health program.   Also, I was going to see Ali.  I, of
course, obliged and Sylvia said that she wanted me to take the lead in “Calming the
Country” that will certainly panic about this. She asked me to lead a teleconference last
night at 9:00 PM with HHS to discuss the clinical aspects of what this means.
 And so there is much press today:  Bloomberg News TV by phone; AP Radio; CNN
New Day; FOX News TV; NPR Here and Now; multiple print media and blogs → AFP;
New York Daily News; Washington Post., BuzzFeed; Wall Street Journal;  Also, Doctor
radio with Marc Siegel; Time Magazine; The Guardian; The Huffington Post; CNN
International (I was cut off by satellite issue); Bloomberg TV; CNN “The Lead” with
Jake Tapper; WBZ/CBS Radio Boston; MSNBC Hardball with Chris Matthews; NBC
Nightly News; FOX with Lou Dobbs; CNN Anderson Cooper 360; WUSA Channel 9.
As it turns out, and this was discussed at length on my TV interviews, on the Sept. 26
visit of to the ER, a nurse took a travel history and  explicitly said that he
told the nurse that he had just arrived from Liberia.  The nurse wrote this down, but the
clinical team either did not see it or ignored it.   It is being played up on TV as a major
mis-step on the part of the local health system.  I continue to “calm the country” by
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373stressing that contact tracing with appropriate isolation if a contact develops sxs will
prevent an outbreak from occurring.
Oct. 2, 2014 – Media frenzy continues.   The Texas patient continues to dominate the
news.  The media is really pouncing on the Texas hospital for dropping the ball in
sending the patient home with Z-Pack even though the patient explicitly told the nurse
that he had just arrived from Liberia and had sxs of Ebola.   Also, the system is being
criticized because they are unable to remove the waste from the hospital (license and
contract issues) as well as from the room where slept with his girlfriend and her
children.   Amazingly, the girlfriend and children are being legally quarantined (armed
guard at door) in the room with the soiled sheets and towels still in the room unable to be
removed.   Texas is being blasted by the media.   I am trying to add some rationale calm
to the dialogue.
Today’s media:  MSNBC with “Morning Joe”; CNN “New Day”; MSNBC – Jose Diaz-
Belart; LBC (UK) radio; Hearst TV; MSNBC Reid report; Reuters TV; Fox News; BBC
Radio; BBC World News with Katty Kay; CNN Wolf Blitzer; Canadian TV; MSNBC
with Rachel Maddow
Rachel Maddow was wonderful on the interview.   After I signed off, she told the
audience how honored she was that I went on her show and what an amazing person I
was.
Oct. 3, 2014 – Had very interesting day today.   Sylvia Burwell and Leslie Dach asked
me to join Sylvia at a Press Conference at the White House Press Room at 4:30 PM to
calm the country’s increasing fear and anxiety around Ebola , particularly related to the
mess-ups in Texas (see above).   I was on the podium with Sylvia Matthews, Raj Shah,
Lisa Monaco (Director, NSC) and Gen David Rodriguez of Africa Command.   I received
many, many e-mails commending me on my performance as a straight talker while the
others were perceived as typical political appointees.   I actually thought that Sylvia did a
very good job.   Lisa was a little double talking.
Also, Mike Leavitt (former Secretary of HHS) called me to be briefed on Ebola.
Did much press, but had to cancel Wolf Blitzer and Jim Sciutto from CNN because of
unexpected conflict with the WH Press Conference.
Press included:  FOX News; CBS TV; CNN with Sanjay Gupta; Chris Hayes at MSNBC
Oct. 4, 2014 – Some drama today.  A 35 year old man and his 5 yo daughter (Liberian
Green card lives in New Jersey) flying from Monrovia on United Airlines to Brussels and
then United to Newark.   Man throws up on the Brussels – Newark flight.  When plane
lands CDC person on the ground judges that the person does not have Ebola and
recommends that he be taken to hospital for checkup and releases the other passengers.
To Tom Frieden’s great dismay, the White House (Lisa Monaco) and Sylvia Burwell
over-rule CDC decision and have Hazmat remove man and daughter to hospital and call
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374back the released passengers who were already either on the way home or boarding
connecting flights in order to get their contact information and pass out forms telling
them what to do if they get fever or sxs.   Sylvia asked me to be on conference call
discussing this with Lisa Monaco, Sec. Jay Johnson of DHS, Leslie Dach, Jennifer
Palmieri of White House Comms and NSC Rand Beers and Ned Price.   Decision on first
call was to find out the clinical judgment of the hospital staff as to whether this person
might have Ebola.   If they felt there was a risk, they would do Ebola PCR, which would
take 2 hours for primary result and up to 72 hours for confirmation.  Decided to wait for
second call in 2 hours.   In between calls I called Tom Frieden to offer to help him out.
He was greatly distressed that the WH and Sylvia over-ruled CDC and called the
passengers back since the CDC person on the ground felt that the man did not have
Ebola.   He said he cannot do his job if he is being second-guessed by the Secretary and
her team.   He even spoke about resigning.   I told him that this was ridiculous and that I
would try to help him by speaking with Leslie and Sylvia.   Also, Sylvia and Sec.
Johnson (DHS) want to institute entry screening with questioning and temperature-
taking.   There is already exit screening at the West African airports and Tom is against
repeating things just to make people feel good.   Sylvia and Leslie want my opinion and I
will speak with Leslie tonight about this.
     On the second call at 5:30 PM (beautiful Fall day in DC with clear skies and 70 F), it
was disclosed that the Jersey hospital found that the patient had no fever or abnormal
labs; felt good; and had had an episode of vertigo.   The patient will be released without
restrictions and the passengers will be told that all is clear.    Tom is beside himself.
Also had long conversation with Mike Gerson today briefing him on story he is writing
about the complexities of doing a vaccine trial for Ebola – scientific and ethical issues.
Press today →  NBC Today Show Weekend Edition; MSNBC with Alex Witt; PBS
NewsHour Weekend Edition
Oct. 5, 2014 – It is interesting that with the 24 hour News Cycle has created its own
dynamic.   Today (Sunday) the national news was totally dominated by Ebola.   Now the
questions center around whether we should do entry screening as passengers get off the
plane from West Africa even though there is exit screening at the west African airports
with temperature taking and questionnaires.   DHS and some Congressmen want
temperature taking at the entry level also, which would only cut the window of
vulnerability down by hours that the person is on the plane.   Yet, there will be a meeting
at the White House today to discuss entry screening.  Frieden is against it, but he is going
to lose the argument.   Leslie Dach and Sylvia asked me yesterday what I thought about
it.   I told them that it would be for PR reasons only since it really substantively makes no
difference.
I went on the Sunday Shows today with FOX News with Chris Wallace and face the
Nation.   Tom Frieden did This Week and Meet the press and State of the Union.
Questions were related to Rand Paul and Bobby Jindal saying that we should shut down
flights from West Africa.   I totally disagreed.   Also, there was concern on Rand Paul’s
part that our 3000 to 4000 troops that we are sending to West Africa will get infected and
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375bring Ebola back to the USA.  Ridiculous.   I got many congratulatory e-mails from
people telling me how well I did on the Sunday Shows.   In the evening, I did CNN.
Oct. 6, 2014 – White House meeting discussed increased entry screening, but no firm
recommendations to date.   Big 24 hour News topic is whether to close the borders to
West African flights.   I have been very vocally against this (as had Tom Frieden) since it
will only isolate the West African countries and make them less able to deal with the
epidemic.   It could cause political instability and even government collapse.   In my
interviewers over the past 2 days I have said that to interviewers as good as Chris
Wallace and as less experiences as Elizabeth Hasselbeck of FOX News.   Two things
have resulted:1) I am getting a lot of hate mail from crazy neo-Nazi types who say that
we should not care about dysfunctional black Africans.   In addition, bloggers are
cheering me on about taking on the right wing news people about closing the borders.   I
do not feel that I have “taken them on”; I have just told them my opinion.   Bloggers have
been particularly hard on Elizabeth Hasselbeck saying she was completely over-matched
in her interview with me.   I did not know beforehand, but she apparently has been a star
on “Survivor” and “The Voice” TV Shows.  She clearly is very beautiful, and I do not
think that she is stupid the way the bloggers are saying.
Press appearances today:  CNN New Day; Fox and Friends (Elizabeth Hasselbeck);
Diane Rehm Show; MSNBC; PBS The NewsHour (Jeff Green)
Seems that we (Cliff and I) have won the battle to convince people that we need to do an
RCT for an Ebola Vaccine.
Oct. 7, 2014 – Continued media frenzy.   Each day they pick something else to hammer
into the ground.   Topic today is the POTUS considering increasing the level of screening
by possibly introducing “entry” screening with temperature and questionnaire.
Discussions divided along ideological lines.   Right wing saying to close borders; execute
or euthanize African patients.   I have been on the air stressing the lack of rationale for
closing the borders of African countries not permitting travel.   For the first time since the
old AIDS days, I am getting hate mail telling me to go “rot in hell”.   Also, the right wing
bloggers who comment online after my TV clips are shown online are trashing me calling
me a liberal asshole selling out to Obama and his socialist views and liberal leanings.
Very weird stuff here.
More press today →  CNN New Day; Wilson Center teleconference (call in); WTOP
Radio; MSNBC (Ronan Farrow); WCBS radio New York; FOX with Lou Dobbs; Alan
Colmes Radio Show
Oct. 8, 2014 – Media frenzy continues.   White House came out today and indicated
increased layer of screening at airport on the arrival/entry level with: 1) temperatures; 2)
questionnaire about contacts; 3) presence of sxs; 4) quarantine if necessary.   The White
House in its ridiculous need to control the message will not let Tom Frieden or I do any
TV today (OK for tomorrow) since they only want DHS out there delivering the message.
Hate mail continues as well as just criticism from far right.
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376Somewhat embarrassing AM phone call today on the HHS teleconference with Sylvia,
Tom Frieden, Peggy Hamburg, me, Nicki Lurie, etc.   Tom was concerned that with the
POTUS announcement at 3:00 PM that they would not be able to implement the 4 items
(see above) at the chosen airports of Kennedy, O’Hare, Dulles, Atlanta, and Newark
within the next couple of days.   He expressed this to Sylvia and she argued that they
would have to do it since they told the White House at the last meeting with them that
they would.   Tom said that this was not his understanding and he was afraid that there
might be some embarrassing slip-ups.   Sylvia was not pleased and in her usual gentle
way made it clear that CDC would have to make it happen.   Very awkward moment on
the phone.
Oct. 9, 2014 – Mor of the same.   Dallas patient) died today.   Black
community led by Jesse Jackson saying that he go suboptimal care because he is black
(surprise, surprise for Jesse).  Ton Frieden mad a statement at a World Bank meeting that
Ebola could be the next AIDS.  The press is jumping all over that and I am trying to bail
him out by saying that there are very many dissimilarities and the major similarity is the
fear associated with the early years of AIDS.
Much Press today – CNBC (Sqwauk Box); FOX Business with Varney and Company;
MSNBC with Andrea Mitchell; CNN with Wolf Blitzer X 2; AP TV.
Oct. 10, 2014 – Sylvia Burwell calls me at 7:45 AM concerned about the media coverage
of Tom Frieden’s statement comparing Ebola to HIV/AIDS.   Wants me to speak with
Tom to get him to understand the problem with this statement.   Called Tom right away
and discussed with him.   He now gets it and realizes that he should not have said it that
way.   I told him that the comparison is strong regarding the fear, but the magnitude and
other aspects are very different.
  Continued doing much press → WTOP Radio; MSNBC with Craig Melvin; PBS
Charlie Rose;
Has interesting dinner hosted at the Fiola Mare (on 3050 K Street, N.W.) by Catherine
and Wayne Reynolds.   Usual DC Glitterati there.   Had great conversation with ex-CIA
Director Mike Hayden about what is going on with ISIS.   He joked that the Ebola
situation and me on TV is bumping ISIS of the media coverage.   Great idea by Wayne
Reynolds.   Wolf Blitzer was at the dinner and Wayne (at the end of the dinner right
before dessert had Wolf “interview” me in front of the people sitting at dinner just as if
we were on the CNN TV set.   The dinner crowd loved it.   It was fun.
Oct. 11, 2014 – Saturday conference call with Sylvia.  Implementation of additional
screening started at JFK Airport.   Issue of a nurse who took care of  may be
infected.   More later on that.   Typical situation of what we will see more of especially as
we approach the flu season.   Everyone who has a fever, exposed or not thinks that they
have Ebola.
Press →  NBC Today (Weekend); MSNBC with Alex Witt; PBS The NewsHour
(Weekend)
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377Oct 12, 2014 (Sunday)  - A very important issue that arose this weekend. Very early in
the morning at approximately 5:45 t0 6:00 AM, I received an e-mail from Leslie Dach
that there would be a conference call with Sylvia, Lisa Monaco, White House Comms
(Palmieri), Tom Frieden, me, etc.  about a breaking situation. A nurse (turned out to be
 – see below) who had been caring for  at the Dallas hospital
reported to be ill. It is felt that there was likely an innocent, inadvertent breaking of
protocol on the part of the nurse. She had taken direct care of  during very
serious parts of his illness including hemodialysis, intubation, and insertion of a rectal
tube. The nurse became febrile on Friday evening, reported to authorities on Saturday, the
preliminary Ebola test was done on Saturday and the results came back positive on
Sunday (today), subsequently confirmed by CDC.   I was just getting ready to go on the
Sunday morning shows today  when the phone call came to discuss what approach we
would take. This ignited an extraordinary media frenzy in which Tom Frieden.  I was
virtually on every show. I was on "This Week" on ABC as well as "Meet the Press" as
well as CNN "State of the Union" as well as evening CNN. There is now considerable
concern in the country that the United States government keeps saying that we are
prepared and then something like this happens which creates a credibility gap. I have
been intensively emphasizing on my interviews that we need to distinguish between the
unlikelihood that there will be an outbreak which still does not change since the contact
tracing that has been done with the  case is working and there is a good umbrella
over and identification of the people who were contacts and they are currently being
monitored either actively or on their own. This needs to be distinguished from a
inadvertent breach of protocol in which a healthcare worker has gotten infected which is
bad for health care workers but really has nothing to do with an outbreak in the country. I
have been continually expressing this in my interviews.
One issue that has come up is a concern on the part of nurses throughout the country that
the use of the term "breach" in protocol implies that the nurses are to blame and this
nurse in particular was to blame. I have been very active in emphasizing that this is not
the case that this is an inadvertent, innocent, "breach" of protocol and that we need to
intensify the training for the nurses. The nurses themselves have said that they are
inadequately trained and although the protocol might be a good protocol, they are not
trained to implement the protocol. The CDC has responded by being very proactive in
increasing their training with webinars, conference calls, and active visits on the part of
CDC staff to the involved hospital in Dallas as well as to anywhere else where this
situation might arise.
Press - This Week (ABC); Meet the Press, CNN State of the Union; CNN evening.
Oct.13, 2014 – One of the busiest press days that I have had.   Media frenzy at high pitch.
Much, much criticism of the USG and CDC is particular saying that the USG and CDC
keep telling us we have everything under control and still there are many mis-steps.  I
have been calmly explaining on TV and radio that people should not conflate what is
working, i.e. the lack of an outbreak because of the proper implementation of isolation
and care of Ebola patients and the infection of a health care worker.   Clearly, HCWs are
not implementing the CDC PPE protocol.   CDC people went down to Dallas and the
HCWS are doing a lot of things incorrectly.  Thus, the ability of our hospital to recognize
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378(dropped the ball with  on the first ER visit) and treat Ebola safely (infected
health care worker) is not working well.   Clearly, HCWs have not really been properly
trained and although they believe that they are following protocol, they are not.   The
outbreak still rages in West Africa.
Today (Oct. 13) a second nurse who had taken care of  had a couple of days
ago flown home to Cleveland and had not had any sxs or fever.   While is Cleveland, she
developed a temperature of 99.3 F.   The CDC cut-off is 101 F.   The nurse (Amber
Vinson) called the CDC and asked if she could fly home and the CDC person cleared her
to fly.   When she got to Dallas, it was clear that she was febrile and that theoretically,
she had exposed the passengers on the flight from Cleveland back to Dallas.   Major,
major lapse in judgment on the part of CDC in letting her fly since she did not fulfill the
precise definition of febrile.   Now a massive contact tracing of the passengers is taking
place with many of them already having taken connecting flights.   This is causing a
major crisis of confidence in the CDC and specifically for Tom Frieden.
 The fact that the CDC gave her permission to fly back to Dallas was made public on
Oct. 15
Sylvia called me on my cell after a TV show and asked me to help her prepare over the
phone for her media interviews the next day.   She also tasked me to write 2 memos for
her to the POTUS to explain why PCR screening at airports is not a good idea (Bill Gates
suggested this to the POTUS) and also the explain to the POTUS what we are doing with
therapies (a Senator told him that HHS is not doing enough on therapies.
Press →   CNN New Day; WTOP radio; Fox and Friends; NBC News; MSNBC with
Andrea Mitchell; CBS Evening News; MSNBC Hardball with Chris Matthews; CNN
with Wolf Blitzer; FOX News with Megyn Kelly; Good Morning America with Robin
Roberts.
Oct. 14, 2014 – USG criticism high.   Bill O’Reilly calling for resignation of Tom
Frieden.  I meet by phone with the New York Times Editorial Board.   Also, I do NBC
Nightly News, Fox News with Greta Van Susteren and MSNBC with Rachel Maddow.
After I got off the air, Rachel tells her audience how proud she was of herself to have
gotten me on her show since I was such an icon in medicine and public health.
Oct. 14 -21, 2014 - From October 14 through October 21, the situation was so intense
that I do not have time to document historical notes on a day by day basis. I am only
doing this retrospectively now and will give dates as I recall. However over this period of
time in light of the crisis of confidence against CDC and Tom Frieden related to a
number of issues culminated by the fact that  was allowed to fly back from
Cleveland to Dallas, this was clear that Tom Frieden was in significant trouble over
several days Sec. Burwell would call me usually in the late evening and nighttime asking
for my advice about what we should do the CDC. At one point, I believe on October 14
or 15, she called me at night as I was in my car driving home. I parked the car in front of
my house and continued to speak with her. Approximately 9 o'clock at night. She asked
me what I thought about the possibility of removing Frieden from the job and wanted my
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382correctly; you are not at risk of infection.”.   I was horrified to hear this.  Now comes the
revelation.
Cliff Lane and I stop off at Chris Grady’s office on 1st floor of the Clinical Center, now
late at night and I tell Chris the story about the CDC person.   While Cliff and I are
talking, Chris pulls up the CDC website and to my amazement she reads what its
guidelines are for PPE.   It is exactly what said she was wearing including the fact
that it resulted in open skin.   And so the CDC recommendations are much less stringent
than the MSF and the NIH PPEs.  In other words, the CDC guideliens are in fact
inadequate and  was following them when she likely got infected.   I got goose-
bumps.   I was incorrectly assuming that the CDC guidelines were like the NIH strict
PPEs.   In fact they are not.
That night I e-mail Tom Frieden to call me and I explain the situation and he says that his
people tell him that if you follow the guidelines even with that PPE protocol, the
experience in Africa says that you are protected unless you break protocol.  He then says
that we really cannot tell exactly how and when  got infected.  We could
not distinguish between the first 2 days and the days after they went to more stringent
protocols.   I went ballistic over the phone.   I begged him to please not listen to his staff.
I told him frankly as a friend and as someone who care about him that his staff “had no
fucking idea of what they were talking about since none of them who are advising him
have ever taken care of a patient, or if they have it was 10 years ago”.   I pleaderd with
him not to say that the nurses must have had a breach of protocol and to realize that the
CDC protocol was entirely inadequate for a tertiary hospital intensive care setting which
is where  got infected.  I told him that common sense tells you that open
skin is much more dangerous than full PPE and that it is essential to change the CDC
recommended PPE to insist on no open skin.  He agreed somewhat reluctantly and said
he would have to check with his staff.   I told him that I love him, but I really do not give
a shit what his staff says, he must change the protocol.   In fact, within the next couple of
days with help from me and Cliff and others, the CDC did change the protocol.

Oct. 21, 2014 – Jey Johnson, Secertary of DHS, announces that all flights from Liberia,
Sierra leone and Guinea must now enter the USA at one of the 5 designated airports
(O’Hare, Newark, IAD, JFK and Atlanta) that are now having entry screening.
CDC issues the new PPE guidelines emphasizing the 3 principles that I have insisted
upon during my many discussions with CDC (Frieden): 1) Training and drilling in
procedure of donning/doffing; 2) no exposed skin anywhere; 3) trained monitors for
donning and especially a WATSAN for doffing.
Did Weill Cornell Grand Rounds by video to an SRO audience.
Also, the White House now wants me to instruct physicians around the country on Ebola
via White House run teleconferences.   Now I am a press coach.   Did one today and now
they want me to do one tomorrow or next day. On the call were Rich Carmona, Zeke
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384
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385No press today since HHS and White House wanted nothing on but the announcement of
the new PPEs by CDC and the DHS announcement of the 5 airports only.
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387might ultimately lead to collapse of the structure of the country and spread to other West
African countries. We repeat what we have said many times that the best way to protect
Americans from Ebola is to suppress the epidemic at its source in West Africa.
I went over to see  and her family including sister Kathy and mother Diane in
our special clinical studies unit at around 6:30 PM. As I have done every day, I was
accompanied by Rick Davey and Cliff Lane. has had four consecutive negative
PCRs and so we made the decision to move her out of the strict isolation room and put
her in a room where there was no need for contact isolation. In other words and we could
wear regular clothes and visit her.  Also, her dog Bentley had been shown to be PCR
negative at USAMRIID. On a visit tonight we began to plan her discharge exit from the
hospital and discussed just what course we would take regarding public announcements
and a press conference. I emphasized to  and her family that the choice was entirely
up to her and that we would help her to implement any decision that she makes. She is
leaning towards making a public announcement in front of the Clinical Center and having
a written statement that she reads and that she does not answer any questions. Hopefully
we will discharge her on Friday, 24 October.
Oct. 23, 2014 - Today was another hectic day regarding the possibility of implementing a
randomized controlled trial for a Ebola vaccine. As mentioned several times above there
is a nefarious attempt on the part of Jeremy Farrar of the Wellcome Trust  to derail plans
for an RCT of vaccine in Liberia. Cliff Lane has known him for a long time from when
he was in Vietnam with the Pasteur Institute. Jeremy feels that we should do open access
for distribution of vaccines particularly to healthcare workers without doing a controlled
trial. Jeremy has been a self-promoter and in my mind a hypocritical advocate for fairness
in global health. He completely does not get the fact that if we widely distribute a vaccine
to a black African country we run the risk of never knowing if it works and possibly
having a paradoxical harmful effect similar to what we saw in the STEP trial of an HIV
vaccine where the trial looked good in phase 1 following good animal data and when we
went into a double-blind, placebo-controlled trial, we found out that the people who
received the vaccine had a 41% greater chance of getting infected with HIV. If the same
happened with Ebola this would be a catastrophe. Yet the WHO, mostly in the form of
Marie-Paule Kieny, are acting in an extraordinarily unscientific way, even going so far as
to say that a randomized controlled trial is unethical. In fact, we feel that a wide
distribution of an unproven and potentially harmful vaccine would in fact be unethical. In
addition, they want to give it to the healthcare workers on open access and then possibly
do a randomized controlled trial on the rest of the people at  risk such as family members.
I cannot imagine how they do not realize that this in and of itself is unethical and violates
ethical equipoise. There is a big struggle going on with the USA led by Cliff Lane the
FDA, and Glaxo Smith Kline to be able to do a randomized controlled trial to as quickly
as possible determine efficacy so that we can ultimately distribute the vaccine to the
people who need it. WHO, who was been wrong on almost everything they have done
with this epidemic, is arguing that we really should distribute the vaccine according to
how they want to do it. We already have designed a phase 2/3 trial and it is ready to go.
We have buy-in from the Ministry of Health of Liberia. Glaxo Smith Kline is on board.
Yet WHO wants to be deeply involved in deciding how we do it vaccine trial. There is a
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390
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391
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392Oct. 24, 2014 - Today was an extraordinary day in the history of NIH. We discharged our
patient  via a densely attended press conference outside the north entrance of
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393the Clinical Research Center. It was a beautiful fall day, crisp air and 60° and sunny. At
12:30 PM, I walked out of the Clinical Center with my arm around and
accompanied by her sister Kathy and her mother Diana. Also, accompanying us was Dr.
Francis Collins, Dr. Cliff Lane, Dr. Richard Davey, and the nurses and technicians from
the Special Clinical Studies Unit of the NIH Clinical Center. Francis introduced me and I
announced to the world that was Ebola free. I gave a shout-out to the physicians and
nurses at Texas Presbyterian for taking such good care of her while she was there patient,
and I thanked our own staff of doctors and nurses for also taking extraordinary care of
I have come to become very fond of as she is such a sweet human being who
was so brave in taking care of the patient with a deadly disease caused by an infection she
contracted while taking care of him ( ). Over the past couple of days
while she was in the Unit, we would talk a lot about how she wants to exit the hospital
and she finally decided that she would give a very brief statement that we would help her
craft. She would give her own ideas and we would  put it in prose for her. It worked out
very well. They were in essence her own words and they were heartfelt. As I called her
up to the podium, I gave her a warm embrace in front of all the cameras. This embrace
was ultimately on the front page of the Washington Post the next day (Saturday, Oct. 25),
and on hundreds of newspapers, blogs, and Tweets and other social media.   It went
completely “viral”.    In addition, she gave me a ribbon of the colors of the nursing school
from which she graduated, Texas Christian University School of Nursing. And so I gave
a shout out to all the nurses of the world  as personified by the nurses at Texas Christian.
I answered a bunch of questions from the press after the press conference.
And then following the press conference something extraordinary also happened.
President Obama invited , and I(together with
Rick Davey and Cliff Lane) to the White House for a photo shoot as well as to talk and
chat with the President. The President was charming as usual, and gave her a public hug
in front of his photographers. We met for several minutes in the Oval Office with the
President and Sylvia Burwell.  Then Ronny Jackson, the President's physician showed us
around the White House and gave us a tour of the medical clinics in the White House.
The White House transportation group picked us up at the Clinical Center, drove us to the
White House, and then drove  her mother, his sister to a private plane in Baltimore
which flew her to her mother's home in Fort Worth, TX. It was a bittersweet goodbye
since we have become so fond of her and her family. I gave  and her family my
contact information including my cell phone number and told her to make sure if there
was any issues that they want to talk to me about that I am available to them 24 hours a
day.
I returned to the NIH completely exhausted but ready to get back to work of crafting
policies related to the emerging situation with healthcare workers returning from West
Africa infected as did Craig Spencer last night.
Oct. 25, 2014 -  An important meeting today Situation Room of White House. We
discussed the topic of what the movement and monitoring protocol would be for the
United States Government regarding HCWs who are returning from service in the 3
African countries. . The CDC has been changing their guide old journals and in a 27 June
Released by Chairman Rand Paul

395Larry Kerr, among others. The discussions centered around modifying the guidelines for
monitoring and movement of returning health care providers who have served in West
African countries. The CDC continues to be shakey. They in my mind are not definitive
or clear enough with their guidelines. However, at the meeting,we at least decided that
we would have to scale up from passive monitoring to active monitor and in many cases
ultimately to direct monitoring.  The definitions of these are as follows: passive
monitoring - you take your temperature and evaluate your symptoms and do not tell
anyone unless there is a problem; active monitoring - you do the same as passive but you
tell someone; direct active monitoring is when you have someone else visit you at least
once a day and folow-up with a phone call, take your temperature evaluate your
symptoms and make a determination has to the degree of restriction that you might have
on a daily basis.  In this way, you have a repetitive clinical judgment concering restriction
as opposed to a broad sweeping quarantine for evryone.  We all decided that we need to
point out that healthcare workers are heroes and that if we in fact quarantine them
indiscriminately regardless of their stratification of risk that we would clearly
disincentivize them for wanting to volunteer as well as stigmatize them, which is already
occurring anyway.
 The White House has decided that I will be the face of the administration in explaining
this to the public and have now put me out today (Sunday) on all five major Sunday
morning shows. This includes ABC This Week (Martha Raddatz), CBS Face the Nation
(Charlie Rose), Fox News with Chris Wallace, CNN State of the Union with Candy
Crowley, and Meet the Press ( Chuck Todd). It is interesting and ironic after all of the
aggravation I have received from media people that I am now their hero and they want
me out there. This includes Jen Palmieri the head of White House communications,
Andrea Purse the director of media broadcast of the White House, and this gets translated
now down to the HHS level. There is still a lingering distrust by the public in the
government largely because of the missteps and lack of firm, definitive, clear, concise
and understandable guidelines of the CDC. I feel very badly for Tom Frieden since he is
an extraordinarily fine person and an outstanding public health official. However I
believe that his staff does not serve him well and the White House and HHS are now
giving me the extra burden of having to check their documents which makes it very
difficult since I have a lot of work to do and I am getting quite exhausted by all of this.
Oct. 26, 2014 - Today I did all five of the Sunday morning TV shows. As indicated
above this is referred to as the "Full Ginsburg" related to the fact Ginsburg, the
lawyer/family friend for Monica Lewinsky at the time that she blew the whistle on
President Clinton related to the now famous sex scandal appeared on all 5 Sunday TV
shows. I did this last week.   Since I had done a "Full Ginsburg" last week several of the
producers of the TV shows told me that this is the first time in their memory that any
individual has done all five TV shows for two weeks in a row. And so they are now
referring to this as a "Full Fauci". The shows went very well;  however, it became clear
that I was at odds with what Gov. Christie and Gov. Cuomo had done two days ago by
initiating a full quarantine for flights into New Jersey and New York. On each of the
shows I articulated two fundamental principles: 1) the safety of the American people
comes first and is the major goal; 2) all of our policy decisions relating monitoring
Released by Chairman Rand Paul
396movement and restrictions should be based on sound scientific principles and scientific
evidence. I reiterated that all scientific data show that a person who is without symptoms
does not transmit Ebola and that one must come into contact with bodily fluids of a
person who is sick with Ebola in order to contract people. Therefore, the principles
leading to a broad general quarantine for returning health care workers is deeply flawed.
Immediately following the shows, other shows and blogs and tweets pitted me against
Christie and Cuomo. In my discussions on the five TV shows, I did not criticize them. I
mentioned that I understood why they may feel that this is the best way to go; however, I
mentioned that if they had asked my advice I would have told them not to institute a
broad sweeping quarantine. I am being praised by people who are standing up for
scientific evidence and data and I'm getting hate mail from people who feel I am trying to
protect Obama. I am listing below cuts and pastes from a couple of representative e-mails
that I have received:
-----------------------------------------------------
From: M G >
Doctor,
As you parrot the bullshit that came out of The Obomination, it makes you sound like a
moron.
No quarantining these infected boobs because it might hamper them volunteering? Are
you fucking serious? Do you KNOW how STUPID that sounded?
Yeah, we should just let them walk around, coughing, spewing,. sweating, touching other
people until we have a serious Ebola outbreak in the USA! If pray that if Ebola DOES
break out in the USA that somehow it only attacks dumbass liberals like you and removes
you from your misery. Idiot.
No wonder you're a member of Ovomit's Kakistocracy.
------------------------------------------------------------------
From: Unarmed Civilian >
Where did you get your degree from North Korea? You love Africa and Ebola so much
you go there. And don't come back. NO QUARANTINES....its the answer you'd expect
from a government agency whose greatest accomplishments are in the areas of corruption
and incompetence.
Does half of America have to come down with Ebola and be standing there bleeding from
there eyes before the EXPERTS know they are wrong.
Fuck you and Fuck your Opinions. Go take your expertise somewhere else.
LD
-----------------------------------------------------------------------
Released by Chairman Rand Paul

397It is really rather disturbing that people feel so strongly about this, with all the undertones
of racism and what clearly is  Hate for president Obama.
During the times between shows, I exchanged e-mails with  checking on how
she was doing.   Below are some of those e-mails:
From Sunday, 26 Oct., 2014 at 10:41 AM:
Released by Chairman Rand Paul

398I just saw you on Meet the Press! You did so great :) I will definitely keep you posted
with everything.
Released by Chairman Rand Paul
Released by Chairman Rand Paul
402•         Katie Fallon, Assistant to the President and Director of the Office of Legislative
Affairs
•         Jennifer Palmieri, Assistant to the President and Director of Communications
•         Rajiv Shah, Administrator of the U.S. Agency for International Development
•         Suzanne George, Deputy Assistant to the President and Executive Secretary and
Chief of Staff of the National Security Council
•         Rand Beers, Deputy Assistant to the President and Deputy Homeland Security
Advisor
•         Ron Klain, Ebola Response Coordinator
•         Amy Pope, Special Assistant to the President and Senior Director for Energy and
Climate Change
•         Gayle Smith, Special Assistant to the President and Senior Director for Development
and Democracy
•         Caroline Tess, Special Assistant to the President and Senior Director for Legislative
Affairs
•         Corey Gruber, Senior Director for Preparedness Policy
•         Edward ‘Ned” Price, Assistant Press Secretary for National Security Affairs
•         Larry Kerr, Director for Medical Preparedness and Policy Rajiv Shah, Administrator
of the U.S. Agency for International Development
The discussion centered around developing a policy of direct, active monitoring to
preserve the scientific principles as well as to avoid the issue of a broad quarantine that
had been initiated by Christie and Cuomo as indicated above. There was a two and one
half-hour discussion at a meeting that was supposed to take one hour. When the President
first came in he appeared extremely tired and somewhat detached. However, he quickly
perked up and got involved in discussion. There was some disagreement around the room
with Jeh Johnson of DHS feeling uncomfortable with just a direct, active monitoring
since he felt that there would soon be many more healthcare workers entering the country
and the social issues of public fear and concern would not be satisfied by just a direct
active monitoring. Chuck Hagel has already indicated that returning military personnel
from West Africa would be confined to barracks for 21 days following return from West
Africa. However this is a much different story than civilians since military have the
capability of easily confining personnel to barracks and providing them with all the
necessary comforts and not demeaning them or stigmatizing them. I articulated several
times, and the P resident referred to me and asked me questions multiple times regarding
my recommendation that a direct active monitoring guided by matching the stratified risk
experienced by the healthcare worker to a stratified stringency of restriction we could
functionally accomplish the same thing as a broad quarantine for everyone. The president
agreed mostly with what I said but he felt we should go a little bit further and encourage
the healthcare workers to restrict themselves to some degree even if technically they were
cleared to move around. Samantha Power was connected to the meeting by
teleconference from Guinea where she had just landed. She mentioned that the West
Africans there were very concerned about a possible quarantine.   We had been with her
the day before at the prior PC meeting. Again, Tom Frieden was relatively reserved
during the discussion; however, it was tough since he was connected by teleconference.
The final decision which has not yet been implemented since it awaits a document from
Released by Chairman Rand Paul
404able to be done by Skype or Face Time.   However, Ron Klain thinks that the POTUS and
Jeh Johnson want actual physical presence of monitor (health official, nurse, etc.).
Trying to reconcile.
Had important conversation with Jen Cohn of MSF Switzerland who kindly got on a
teleconference reps from MSF of many countries (Brussels, Paris, Geneva) to discuss the
RCT Ebola vaccine trial that Cliff is actively planning to start in Monrovia in December
following completion of the Phase 1 trial that started in Maryland in Sept. (ChAd3) and
Oct (VSV).   Looks like MSF wants to be helpful.   They are asking good questions about
supply for post-trial distribution, etc.   They seem to not be against an RCT.
CDC came out with new interim guidelines for Monitoring and Movement of people
(including HCWs) returning from West African Ebola countries.   Now based a lot on
what I and Tom have been articulating at the recent White House meetings.   First
stratification of risks to the person; and then matching the risk to the degree of
monitoring and then using clinical judgment when needed to determine level of
restriction.   All based on knowledge of how virus is spread.   Risks:  high, some, low but
not zero.  Monitoring: passive – take your own temperature and sxs and no need to
actively tell anyone; active – take your own temp and sxs and report to a health official;
direct, active – someone else takes your temp at least 1x per day and evaluates sxs and
then makes clinical judgment as to your restriction on a daily basis
Immediately following their release of guidance and the press briefing by Tom Frieden,
the White House put my out on all the evening TV shows that were either taped or live
from studio in Building 10:  PBS NewsHour; CNN Situation Room; ABC, CBS, and
NBC Evening News.
Oct. 28, 2014  - The political issues are heating up around Ebola with the elections only 1
week away. Gov. Christie is standing firm in saying that the US government, particularly
the CDC, are playing catch-up with Ebola and that his initiation of a quarantine for 21
days for healthcare workers and other travelers returning from West Africa is the way to
go. I have been on multiple television programs specifically indicating that I respect the
opinion of the governors and that I understand that they are trying in good faith to do the
best for their constituents. However, several TV commentators have now pitted me
against Gov. Christie, feeding him with somewhat out-of-context quotes from TV
interviews indicating that I am directly challenging him as being unscientific. He is
lashing back saying that I am just defending the administration. He sometimes mixes me
up with CDC. However, he has mentioned me by name several times in discussions on
TV interviews. I am very concerned about this politicizing of an important global health
problem. I was on Good Morning America with George Stephanopoulos, CNN with
Sanjay Gupta, and MSNBC with Morning Joe early this morning. In fact the ABC
producer came all the way into the NIH to make sure that the interview with George
Stephanopoulos went well. Immediately after I appeared on GMA, Gov. Christie
appeared and Matt Lauer was instigating him telling him that scientists like me was
saying that he "got it wrong on" thus instigating Christie to lash back at the scientific and
public health community including me. This is really a very unfortunate evolution of
Released by Chairman Rand Paul
405events since as has always been the case, I stay out of politics and try to just do the right
thing for public health.
I appeared via Skype on the Diane Rehm Show this AM and made it clear that I was not
criticizing Christie.
The POTUS made a brief speech in front of Marine 1 as he was about to take off re-
affirming what I said on Sunday TV (without invoking my name) that we are driven by
science and not by fear and so there is no reason to do a blanket quarantine on all
returning HCWs since they are heroes and we do not want to discourage them from
volunteering.
Ben Bradlee died at age 93 a few days ago and I have been invited to the service at
National Cathedral and to the family reception at Ben and Sally Quinn’s home in
Georgetown.   However, with the Ebola AM calls and the fact that I have to be at the WH
later for the POTUS greeting and honoring the HCWs (see below), I cannot make the
service.   Too bad.   I really liked Ben.
I am completely exhausted now and I have hundreds and hundreds of e-mails to catch up
on. It feels like I'll never catch up since the White House, the department, and the media
are making extraordinary demands on me. The White House has decided because of my
ability to be quick on my feet and articulate a clear and concise message in front of the
TV camera that they are putting me out on TV for virtually every issue that comes up
regarding Ebola. What a change of pace from just a short while ago when for one reason
or another HHS and/or the White House never approved any big TV for me. Now they
actually set  up shows and have Andrea Purse working closely with me. Such is life.

The POTUS came out today and reiterated the reasons (my reasons) for following the
science and not having a quarantine for returning HCWs.   Typically, HHS shut me down
on the many requests for TV appearances for me since they never let anyone out there
when the POTUS speaks.   Believe it or not, I am glad since I am exhausted.
Today and yesterday, there have been a considerable number of false alarms with people
from West Africa (just arriving) having fever, vomiting, etc. and getting worked up only
to have any of a number of other diseases from malaria to rhinovirus.
Still getting much hate mail!
Got e-mail from Andrea Purse asking about the safety of returned HCWs  from West
Africa (USA people) who have been invited to the WH tomorrow to be congratulated by
the POTUS (with handshakes).  Some came back less than 21 days ago and so they
wanted to be sure it was OK.   Cannot violate our own principles, but people are
somewhat nervous.   I looked at list and said it was OK.   Then Sylvia Burwell called me
up and wanted me to speak with Ronny Jackson to make sure that Ronny asks them if
they were in high risk category.
Released by Chairman Rand Paul
407on their website. Of the people involved in this forum were Secretary of State John
Kerry, Chris Matthews of NBC, and a large number of other notables.
After that I went back to the NIH and hosted a whole group of network producers with
full camera TV coverage on the process of donning and doffing for personal protective
equipment. I demonstrated to them what we do in the process of taking care of patients
with Ebola, in this case specifically  Following the demonstration which was
done by nurse specialist Kevin Barrett and hospital epidemiologist Tara Palmore, I did a
long series of TV interviews with the cameras that were there during my step-by-step
demonstration of the donning and doffing.   Clips appeared on a variety of news outlets.
An extraordinary situation occurred last night in which the state of Louisiana made an
announcement that certain scientists and others who were planning to attend the annual
meeting of the American Society of Tropical Medicine and Hygiene during the first week
of November in New Orleans would not be allowed to attend the meeting. In essence they
said that these people need to be quarantined if they came from a West African country or
if they had taken care of the patient with Ebola within the last 21 days. This is an
extension of the quarantine craziness that was started by Governors Christie and Cuomo.
In essence, they are barring scientists from a meeting where their expertise and
experience is most needed.
Finally, I have been informed that I have been named in the civil action lawsuit against
Pres. Obama, me, Thomas Friedman, Secretary Burwell, and DHH Secretary Jeh Johnson
for promoting terrorism and discrimination. They are accusing us of colluding with
president Obama who is a Muslim citizen of Kenya and trying to destroy African
countries by introducing Ebola into society. You just cannot make this stuff up.
Received a note today (dated Oct. 16, 2014) from Hilary Rodham Clinton  saying that
she was thinking of me and cheering me on saying that “The American people are
fortunate to have your leadership at NIH as we face the challenge of Ebola”.
Oct. 31, 2014 – Jeff Drazen, Editor of NEJM, contacted me to put him in touch with
some of the trusted AIDS activists with whom I have worked over the years to get them
to write a piece in the NEJM on the similarities between the stigma of HIV/AIDS and the
current “stigma” against HCWs (regarding the quarantine discussed above).   I pointed
him to Peter Staley and Gregg Gonsalves and they are willing to do this.
Kaci  Hickox  still defying orders from the Governor of Maine to remain in quarantine.
A court judge upheld her right to not be quarantined.   I did an interview for yahoo.com
and refused to get into the battle between Kaci and the State of Maine.
HHS does not want me to do TV since the news is focused on Kaci and it would be better
for me not to get into that battle.
Nov. 1, 2014 – Things calming down.   Reports of decreased infections in Liberia,
particularly Monrovia.   Not sure if this is real or if the infections are now occurring in
Released by Chairman Rand Paul

408remote areas without good reporting.   Also, the issue of second waves in Guinea and
Sierra Leone.   CDC having to put much effort into investigating Person Under
Investigation (PUIs).   These are people who are from West Africa who get a fever or
nausea or vomiting for any of a number of benign reasons.   Since they are from West
Africa, these are being investigated, sometimes using PPEs, which is an “abundance of
caution”, but a major investment (?waste) of effort.
Cliff Lane is in Monrovia doing spade work for the hopefully upcoming RCT for the
Ebola vaccine.
Heard on Secretary’s call this AM (8:30 AM on Saturday) that now WHO (likely Marie-
Paule Kieny) wants WHO to be responsible for the DSMBs of all clinical trials in West
Africa.   This is an egregious attempt on the part of WHO to stay “relevant” in an area in
which they have no expertise.   It is “stunning” to me how they just want to insert
themselves into things where they quite frankly are incompetent.  They already have
made it clear that they just want to distribute unproven interventions (vaccines and
treatments) and even though we seem to be winning the argument, they keep coming
back in insidious ways to try to derail the scientific clinical trials process.   Amazing!!
Nov. 2, 2014 – Quiet Sunday.   Trying to catch up on piles on my desk.  Election on
Tuesday.   Concern that the GOP will take the Senate, which means Obama is in trouble
with both House and Senate in GOP

Summary:
Watcher-discovered document from paul-readingroom (2026.08.05_Diary-Prequel-_Redacted.pdf), auto-indexed 2026-08-06.

Excerpt: Hotel Excelsior on  81st St. between Columbus Avenue and Central Park West. The ceremony at the  Museum of Natural History was stunning in the positive sense. I completely  underestimated the importance of this particular function. The annual function makes  Released by Chairman Rand Paul 326three major awards to biotech companies, pharmaceutical companies, and companies that  develop devices. It is essentially the Academy Awards of pharmaceutical/biotech  companies. I gave the keynote address associated with my receiving the Pro Bono  Humanum Award.   This award is given every year.   Over the past 3 years it has been  won by Francis Collins, Paul Farmer, and Bill Clinton.   The dinner gala was held in the  Whale Room of the Museum of Natural History. All the elite of the biotech world,…