Thursday, November 3, 2011

Incredible day. Theme is my trying to hold together the evolving proposal to scale up combination prevention with treatment as prevention (TAP) being a major component of the scale-up as described above. Tension is USAID and Raj want to spend most of the efficiency money on concentrating and ending the epidemic in 3 chosen countries as opposed to going with the PEPFAR/CDC/FAUCI plan of scaling up combination prevention across the board and doing a demonstration full court press (FCP)in selected pockets of the countries that we have selected: Botswana for CDC; Zambia and South Africa for NIH; Tanzania for USAID. Spent all day on calls individually with Tom Frieden, Eric Goosby, Mark Dybul, Raj Shah (in the evening). Raj call was at the suggestion of Rick Klausner who says that I am the only person who can broker a deal between PEPFAR and USAID. We need USAID to support our proposal at the WH meeting next week (Nov. 8 – the evening of Secretary’s Clinton’s speech at NIH. I have cancelled Seattle to ne at the WH meeting. WH house wants me and Frieden to represent HHS, i.e. “plus 2”. Mark Dybul agrees somewhat with the need to have a bold announcement as per Raj, but we all know that there is no new money. Rick also feels that way. However, what neither of them fully appreciate is that the “demonstration project” described above is in reality a FCP in a selected group within countries. I had important call with Raj. I leveled with him and said that although he is proposing putting all of the PEPFAR efficiencies towards a FCP in 3 countries and scrapping the PEPFAR Plan, he should look to “clean his own house” and create efficiencies within USAID and use that money to scale up the 3 country approach and make it more of a FCP, i.e. I am proposing a “hybrid” of the PEPFAR plan and the USAID plan since we all need each other and we need to provide the POTUS with a proposal that is scientifically sound, bold, yet not unrealistic, and that does not require significant new money. Of note, Hillary Clinton will propose $60 million of her money to beef up that “demonstration project” I called for a meeting tomorrow to see if Raj, Eric, Tom and I could figure out a compromise with me as the referee. Also see below e-mail from Nov. 3 from Michael Iskowitz describing what the community actually is hearing about. It is amazing how things leak since I have told no one what I am doing regarding USAID, PEPFAR and the WH. tony dearest. i just wanted to thank you for helping to create and drive another landmark moment in AIDS history. i continue to do consulting with eric -- who remains forever grateful for your friendship and extraordinary leadership. i am honored to have have many decades now of watching you work your magic -- forever urging that if we remain steadfast and follow the science, together we will win. bless you for -- behind the scenes and in front of the cameras -- shaping another historic moment. know that i talk with eric frequently and if there is anything i can for you directly -- please know i always stand ready. thank you for being you and for all you do for the world, if i am not at the NIH on tuesday -- i am certainly there in spirit! much love, michael