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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Dr. Anthony Fauci
Director, National Institute of Allergy and Infectious Diseases
May 19, 2004

Dr. Anthony Fauci
Dr. Fauci: Good to be here. Let's take your questions.

Greg, from Morgantown, WV writes:
Do you expect quick passage in the Senate?

Dr. Anthony Fauci
Well, I can say we certainly hope to have quick passage in the Senate. It is a very good bill. It addresses many of the issues which have been stumbling blocks in our way of getting countermeasures for bioterror agents. It provides incentives for industry; it facilitates the research process; and it facilitates the emergency use of these countermeasures where necessary in time of an emergency.

I would hope that we get quick passage today. Senator Judd Gregg among others has been very supportive proponents of the bioshield legislation and we are hoping that we will get a facilitated passage in the very near future.

Jenni, from Abilene writes:
Should we in the United States be worried about Ebola?

Dr. Anthony Fauci
Ebola is on the category-A threat list for us for the following reasons:

It is a highly lethal pathogen that naturally occurs rarely but nonetheless occurs fundamentally in sub-saharan Africa. So access to this microbe is freely available to those who want to go to Africa and get specimens. So it isn’t something that is restricted like smallpox. That is the first thing. So it is something that can actually be obtained by people with nefarious motives.

The second issue is that it falls within the category of hemorrhagic virus fevers. It is one of those highly lethal microbes like lasa (sp) fever and Marburg Hemorrhagic Fever that we know that the Soviets were working on to weaponize in the 60s, 70s and 80s before it came clear that they were violation of the Biological Weapons and Toxins Convention treaty.

So the material has been made. It is something that we need to be concerned about because if weaponized as much for its biological impact of being highly lethal. It has a strong terror impact and that is why we call things “bioterror.” Because the thought of a hemorrhagic fever which people die a very gruesome death is something that a terrorist might be very inclined to pursue purely for psychological and societal disruption potential.

So for that reason we are preparing rather aggressively for Ebola. And we’ve made some significant progress. There has been a “monkey model” established at the NIH in which monkeys have been vaccinated with a vaccine and then challenged with Ebola and they have been completely protected.

We took the next step and have now in humans the first phase one trial of an Ebola vaccine in humans. And we are moving along rapidly on that. And I would expect in the next few years we will have an Ebola vaccine that we will be able to stockpile in case we are faced with such a bioterror attack.

Maggie, from Evergreen writes:
What are your thoughts on the emergence of "superbugs"?? How scared should we be?

Dr. Anthony Fauci

I don’t like to use the words “we should be scared.” I would rather say, “how prepared should we be?”

And the answer is we should be prepared as much as we possibly can. Superbugs are generally referred to as those microbes which have evolved over a period of time resistant to anti-microbial agents.

We know that some common microbes like staphylococcus aureus which used to be easily treatable by penicillin are now over a period of decades evolved to be resistant to our best antibiotics. We now have a few antibiotics left that are able to counter these multiple drug resistant staphylococcus.

There are also other microbes that fall under the semantic of superbug – such as resistant malaria and resistant tuberculosis. We need to be prepared for this by not only the basic research that helps us understand the microbes better but also to target new drug development.

So it is a combination of the prudent use of antibiotics in hospitals and physicians because if you use them indiscriminately you set up very good conditions for the evolution of anti-microbial resistance.

The other is public health surveillance to be able to detect these superbugs as they emerge in hospitals or in physician practices.

And third is to keep the research stream going so we stay several antibiotics ahead of the emerging resistant microbes. And also there are some microbes for which vaccinations, vaccines, might be developed to prevent the actual infection which is a very good way to prevent the emergence of resistance if you can prevent those infections by vaccine.

So there are several ways to prepare ourselves. So again rather than saying, “should we be scared” we should say “we should be prepared.”

Trini, from Portsmouth writes:
How worried are you that such a bioterrorist attack will happen?

Dr. Anthony Fauci

Again, I hate to use the word “worry.” If worry interferes with your preparedness then you shouldn’t be doing it. Concerned that there is going to be a bioterrorist attack.

We’ve already had at least one bioterrorist attack and a minor ricin attack. But the anthrax attacks in Fall of 2001 was a clear indication of a bioterrorist attack.

Those of us who are in the public health arena generally feel strongly that it isn’t a question of whether we are going to have another bioterrorist attack, but when we are going to have a bioterrorist attack.

For that reason, the President has supported a plan that is a multi-agency plan involving the Department of Homeland Security, the Department of Health and Human Services and the Department of Defense as well as other agencies to help prepare our nation for a bioterrorist attack.

For example, the President’s plan has enacted is that the National Institute of Health alone there has been increase of an enormous amount of resources that strengthen our biomedical resource capabilities to develop countermeasures in the form of vaccines therapeutic and diagnostic. Similarly for the Centers for Disease Control and Prevention a considerable amount of resources has been infused to prepare our nation for bioterrorist attacks including strengthening what has been a somewhat deteriorating public health infrastructure in our country to get us back up to a level in which we would be able to meet the challenge of a bioterrorist attack. Be it smallpox, anthrax, botulism or any other agents for which we are concerned.

So we have a rather aggressive acceleration in our preparedness in everything from public health measures to surveillance to research enterprise which is geared toward preparedness.

Robert, from San Clemente writes:
A study by the Center for Biosecurity at the University of Pittsburgh Medical Center released late last year found that the US is not ready for natural or other biological-related threats and remains unprepared to stockpile treatments.

If Bioshield passes, how quickly will it take before we are ready for such an attack?

Dr. Anthony Fauci
It is important to say that since the scope of potential of bioterror and naturally occurring microbes that could confront us are rather limitless particularly in naturally occurring microbes, I don’t think that anyone can be fully prepared but we can prepared enough to significantly lessen the threat.

Bioshield will play an important role in our preparedness because Bioshield has a number of components to it.

First of all it expedites our capability to rapidly move our research progress along by trimming down some of the bureaucratic obstacles in the way of getting a program running up to full speed.

Next and importantly it provides for a secure source of funding for the federal government to purchase countermeasures to put in our national stockpile as an incentive for industry and others to get involved in the process of making these countermeasures.

One of the issues that we’ve dealt with not only in the arena of bioterror but also in the arena of naturally occurring microbes that require vaccines for prevention is that the pharmaceutical industry is generally disinclined to getting involved in making major investments because there has been no guarantee that even if they develop a successful product, that anyone will buy their product – making their investment not be worthwhile. They are concerned about their risk in the process.

With Bioshield , there is a guaranteed source of funding would provide for the pharmaceutical company a confident incentive that if they do get involved and successfully make a product we will in fact utilize it.

The third part of Bioshield is the emergency use authorization for the FDA so if there is a product which has yet to be licensed or which is on its way to being licensed but an emergency occurs and we need to distribute that product in an expeditious manner that we could so under an emergency use licensure for that particular product.

So Bioshield would be a very important mechanism whereby we can be prepared against either naturally occurring or biologically related threats.

Teresa, from St. Paul writes:
Two weeks ago, the World Health Organization warned that the emergence of infectious diseases that pass from other animals to humans is accelerating and was a trend that was likely to continue.

1. Do you agree with this? 2. Can Bioshield help with this?

Dr. Anthony Fauci
Well certainly the emergency of infectious diseases which pass from animals to humans is accelerating because of the modernization of our society in which mankind in a progressive manner either encroaches upon the environment and comes into contact with microbes which can jump from animal species to humans or conditions in certain countries like China or now Thailand and in Vietnam where there is jumping of influenza from a chicken to a human and rarely lethal. It has about a 65 – 75 percent mortality rate. Fortunately it has not jumped from human to human.

So the evolution of microbes and the continual emergence of new diseases – many of which jump from an animal to a human is clearly accelerating. So I agree this is happening.

Bioshield is directed against bioterror agents and agents that are deliberately released, the entire process of creating incentives for industry to get involved in making vaccines and countermeasures will certainly play an important role in helping us to prepare for deliberately released microbes but for the naturally occurring microbes that we have just been discussing.

Carl, from Japan writes:
Dr. Fauci, I am curious if there is a cure to the west Nile virus as of yet. The summer is coming, and I wonder it it is coming back. Or is it nothing to worry about?

Dr. Anthony Fauci
First of all, there is no treatment currently available for West Nile. The way that you can prevent West Nile is mosquito control and by prudent in allowing yourself to be exposed to mosquitoes at vulnerable times in the early evening at dusk where protective clothes and bug sprays are needed.

There is no question that West Nile in the US is here – I would necessarily say to stay – but certainly for the foreseeable future. It first appeared in 99 and each year it has progressively involved a larger part of the country such that virtually every state with few exceptions have been involved.

There is no doubt in my mind that we will have West Nile virus come back this summer. We don’t know is the seriousness or the extent that it will come back this year.

The best protection besides mosquito and other controls is to develop a vaccine for West Nile. In fact, that is what we are doing. We have a number of promising candidates for West Nile.

One always needs to be concerned but I would not let it interfere with our daily living – but just take the prudent steps against mosquitoes until we get a vaccine.

Dr. Anthony Fauci
Gotta run. Thanks for your questions on Ask the White House. Hope to do it again soon.

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