For Immediate Release
May 29, 2003

O'Neill, Fauci Discuss President's AIDS Initiatives
The Washington Foreign Press Center
Washington, D.C.

FOREIGN PRESS CENTER BRIEFING

BRIEFERS: DR. JOSEPH O'NEILL, M.D., DIRECTOR, WHITE HOUSE OFFICE OF NATIONAL AIDS POLICY AND
DR. ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

TOPIC: PRESIDENT BUSH'S HIV/AIDS INITIATIVES AND THE U.S. LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS AND MALARIA ACT OF 2003 (H.R. 1298)

THE WASHINGTON FOREIGN PRESS CENTER, WASHINGTON, D.C. 3:15 P.M. EDT, THURSDAY, MAY 29, 2003

MR. DENIG: Good afternoon, ladies and gentlemen, and welcome to the Washington Foreign Press Center. Welcome, also, to the journalists assembled in the New York Foreign Press Center.

We are very pleased today to have for a briefing on President Bush's HIV/AIDS Initiative and the recently passed legislation, "U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003," two real experts and dedicated public servants. We have Dr. Joseph O'Neill, the Director of the White House Office of National AIDS Policy, and we have Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. Dr. O'Neill will have a brief opening statement and then the two gentlemen will be glad to take your questions.

Let me also remind you to please turn off your cell phones at this time.

Dr. O'Neill.

DR. O'NEILL: Thank you. Do you pick me up okay on the mike I've got?

Tuesday was a historic day in the fight against HIV and AIDS globally. President Bush signed into law his program, his global AIDS program, which will provide $15 billion over the next five years to fight this epidemic around the world.

With this program, we intend to get 2 million people in Africa and the Caribbean on HIV treatment. We intend to prevent 7 million new infections, and to provide care and support for another 10 million children orphaned by AIDS and other people needing support. This is a remarkable undertaking by the people of the United States. President Bush has provided tremendous leadership to this country and will now be providing that same leadership to the rest of the world when he attends the G-8 Summit.

I'm very pleased to be here, along with Dr. Fauci, to answer any questions you may have about this initiative. Thank you.

MR. DENIG: Let me remind you to please use the microphone and identify yourself and your news organization. We'll take the gentleman up front here.

QUESTION: Good afternoon. My name is Philip Tazi and I am with the Cameroon Herald. And the question I want to ask is, I've read of quite a number of press releases on, on this initiative, which I think it's a wonderful idea. But I would like to know which countries would be beneficiaries of this program? I know that there are about 12 countries, which have already been identified, but I just want to know the names of these countries.

DR. O'NEILL: I will -- after we're done -- give you the list of names. I want to point out there are 12 countries in Africa and two in the Caribbean that have been specifically targeted. But let me back up for a moment.

When we talk about $15 billion that are going to be devoted towards this initiative, $5 billion of those are existing activities, which cover 50 to 51 countries around the world.

$1 billion of this $15 billion will be devoted to the Global Fund to Fight HIV/AIDS, TB and Malaria, and $9 billion will be dollars to support the initiative in the 14 targeted countries. The $5 billion that I mentioned initially, which are already in our plan, already existing, were an 82 percent increase in global funding for HIV/AIDS over what this administration was handed when we came into office.

DR. FAUCI: Another important point to bring out, and it relates to your question: Besides the fact that there are other countries besides the 12 Sub-Saharan African countries and the two Caribbean countries; because of, as Dr. O'Neill mentioned, the Global Fund, which would extend beyond that as well as some of the initiatives that are already ongoing in the programs, that $5 billion difference between the $10 billion new and $5 billion money that would have already been gone on, that if you look at those 14 nations, they comprise 50 percent of all of the HIV-infected people in the world and 70 percent of all of the HIV-infected individuals in the Sub-Saharan African region and the region of the Caribbean.

So although the number appears to be restricted to a finite number of countries, at least the part that has gotten the most attention, those 14 countries, were picked because of a number of reasons, including the fact that they encompass a very broad spectrum and a significant proportion of the HIV-infected individuals in the world.

QUESTION: Hi, Madame Ouologuem with The African Sun Times and Afrique Tribune in Canada. My question is about -- you just mentioned for 12 country in Africa. My country, Mali, is left over. I know that, but don't you feel there is a solution for AIDS, but that there is no solution at all for malaria, which is killing most of the kids in Africa? The solution for malar-- for AIDS is abstention, so don't you feel that most of those $15 billions should go to malaria, not to AIDS?

DR. FAUCI: Well, you bring up an important point and this is not at all to pit one disease against another. There are other initiatives in addition to the President's Initiative on HIV/AIDS, Malaria and Tuberculosis that are addressing malaria. For example, a very much accelerated effort on the part of the NIH and research on the development of a malaria vaccine, which we feel would be very important in addressing the problem of malaria not only in Sub-Saharan Africa, but in other countries.

But by no means, this program is meant to pit one disease against another. In fact, the President was very enthusiastic about coupling HIV/AIDS with malaria and tuberculosis because of his appreciation and realization that AIDS is not the only problem in these countries. So I look at it as a very positive indication of the realization on the part of the President that these diseases come as a group, and together, the three of them are the major causes of morbidity and mortality in those developing countries. So you bring up a good point and the President is very well aware of that.

DR. O'NEILL: I think it's also important to recognize that when the President of the United States walked into the Congress and delivered the "State of the Union" address, and when he made Africa the centerpiece of that address, when he had a citizen of Uganda sitting in the Presidential Box with the First Lady, it needs to be seen, I think, as a tremendous endorsement and a tremendous example of his commitment to the continent of Africa and to the problems of Africa, of which he is very aware that malaria is one of them.

QUESTION: I'm Jay Chen, Central News Agency of Taiwan. If I may turn to China for a minute, many experts have said that AIDS is a serious problem in China and not enough attention is being paid to it or has been paid to it. I'm wondering whether you can -- I would like to hear your assessment. And also, I'm wondering whether you can talk about what, if any, cooperation is underway between the United States Government and China to deal with the AIDS problem in China? Thank you.

DR. O'NEILL: Let me first of all say that you're absolutely correct. HIV is -- by all of our measures and understanding -- emerging as a very, very critical and important issue in China and you're probably as aware of the statistics as I am.

I mentioned earlier that even before this new initiative was announced, our administration had increased spending for global HIV by 82 percent. That increase was felt all around the world, including China. The important piece here is that we are focused on this new initiative particularly in the part of the world where the need for treatment is the greatest and where the infrastructure is the least.

One of the lessons that we've learned from countries in Africa like Uganda, from Thailand, I think and now from the United States with what President Bush has done, is the critical importance of leadership: high level political leadership, leadership at the highest level to recognize HIV/AIDS is important and to mobilize all resources -- indigenous, domestic resources as well as international resources in the fight.

DR. FAUCI: We, actually, in the Department of Health and Human Services at the NIH, have made China a very high priority in our work on HIV, particularly, we awarded China one of the few of what we call "CIPRA," which stands for Comprehensive International Program for Research on AIDS, that we have awarded on an international basis. China has been awarded a CIPRA. China is part of our vaccine and prevention trials network. So we in the United States Government have enthusiastically incorporated in our efforts the HIV problem in China. Obviously, China was not one of the named countries in the 14 countries of the President's initiative, but to reiterate what Dr. O'Neill and I said, that this really encompasses all countries, given the other amount of resources that are part of that $15 billion package.

But in addition to the $15 billion package, what I'm talking about with what the NIH and the Department is doing is over and above the amount that's contained in the President's initiative. So we feel very good about the interactions. We've had our Chinese colleagues here in the United States to talk about coordinating efforts. And I myself, personally, and my colleagues have been to China more than once to try to get the groups together.

QUESTION: Hi. I'm Judith Smelser with Feature Story News Report for the South African Broadcasting Corporation and some other networks. But I'd like to ask you -- as you probably know, the World Health Organization has endorsed the Brazilian model of dealing with HIV/AIDS, and Dr. Fauci I'd -- and both of you, really, I'd like to know what you think of that model? Thanks.

DR. FAUCI: Well, if by the Brazilian model you're talking about the strong involvement of central government in providing drugs for the constituencies who are HIV-infected, I think the Brazilian leadership has been extraordinary in this and it's a model that, in fact, does work.

Brazil has the independent resources to do that, and they've taken the initiative to make the treatment and care of HIV-infected individuals part of their high priority policy. That is a very good policy. Unfortunately, not a lot of developing nations have the capabilities that Brazil has, so the Brazil model works very well for developed nations or nations that are somewhere between what we call "less-developed" and "developed" nations.

We embrace the Brazil model and think it's a very important model for Brazil. However, when you're dealing with some of the countries in Sub-Saharan Africa or the Caribbean, the resources just are not there, which is one of the reasons why the President took the initiative to try to jump start not only the resources that are going to be given, but what's going to happen in the next week or two at the G-8 Conference in France where he's going to use that as a background to encourage the other nations to themselves get involved and to join. Because, as you know, the broad picture that has been painted by you and other people who have been advocates of the global AIDS problem is that the developed nations need to give up to $50 billion over a five-year period, or about $10 billion a year, and interestingly saying that the United States should probably give somewhere around 30 percent of that. And, as it turned out independently, the calculation that we made for the maximum effect would turn out to be just about that: an average of about $3 billion a year. So the President is going to be making that point in Evian, namely, that we need the other countries to step forward and join with us. Brazil is a good example of how they did it on their own.

DR. O'NEILL: I think the important piece about the Brazilian model is that they took on treatment as a fundamental component and that is also one of the most important pieces of the President's initiative, it really has moved into center stage: the vision that treatment is necessary and that treatment is possible and that treatment is doable.

DR. FAUCI: 55 percent of the initiative is treatment -- of the President's initiative. Right.

QUESTION: I'm with the Voice of America, David McAlary. Why did the President's initiative not fund more money through the Global Fund, but rather -- I know why you chose the 14 countries because they represent such a big part of the international AIDS problem. But why not fund it through the Global Fund because critics have said the Global Fund really has the expertise to identify the best programs for this money?

DR. O'NEILL: This administration has been very supportive of the Global Fund. In fact, we made the first -- President Bush and Kofi Annan walked into the Rose Garden many months ago and announced the formation of the Global Fund, and we made the first donation to the Global Fund. And you may or may not be surprised to know that United States' tax dollars now comprise 50 percent, nearly 50 percent of pledges to the Global Fund at this point.

So point number one I want to make to you is that we are tremendous supporters of the Global Fund. The President's initiative, though, has a particular focus on the countries in Africa, where Dr. Fauci was saying the disease is the most prevalent. 70 percent of the cases of HIV in Africa and the Caribbean are in those 14 countries that we chose. It also has a very strong focus on treatment and on treatment using models that have proven themselves successful in these settings.

We felt, and I think we're absolutely correct in this, that it was only through bilateral mechanisms that we would be able to achieve this kind of focus and this kind of impact.

DR. FAUCI: You know, we've obviously discussed this in some detail. We feel that getting the program in a bilateral fashion, and not excluding the Global Fund -- because although the amount of the Global Fund was not as much in the eyes of some as it should have been -- clearly, as Dr. O'Neill mentioned, the commitment to the Global Fund is there and we feel strongly that the other countries that the President will be encouraging to join this battle, this global battle against HIV, would be perfectly fine if they feel within their own framework that they would like to make a much greater proportion of what they do go into the Global Fund. So it really is much less pitting Global Fund against bilateral because one was never meant to supplant the other. They were meant to complement each other. And the nature of the program that the President put forward was one that was much more amenable, at least in the stages that we are now, to have direct accountability and feasibility within the program that was developed.

So I think at the end of the day, you're going to see a seamless interaction between Global Fund initiatives and the President's initiative. We feel confident of that.

QUESTION: Sir, are you going, one of you or the two of you are going to the forthcoming AIDS Conference in Paris in July? And do you expect soon to visit some of those 12 countries in Africa? Because I was fortunate enough to spend 14 days in Center for Infectious Disease in Africa and I can tell you that AIDS does not only kill. It's a very humiliating disease. Do you plan to attend to this conference or to visit some of those countries?

DR. FAUCI: In July, in Paris I will be sharing the podium with Nelson Mandela and giving a plenary address on the 20 years of science in HIV/AIDS, and former President Mandela will be talking about the social and other implications that have occurred over the 20 years of HIV. So the answer to your question is, I will be there. I'm not sure, Joe, whether you will be there, but the administration will be well represented there, I can tell you.

And we've been to Africa several times and plan to continue to go to Africa as needed. So the answer to your question is yes, and yes. We'll be in Paris and we will continue to go to Africa.

QUESTION: $15 billion sounds a lot of money to invest towards this project. But we also know that much more money has been invested towards projects in Africa and when we look at the bilateral nature of this commitment, don't -- does the White House not feel that, as has happened in the past when most American money which goes towards Africa has end up in private pockets.

Is there not a concern at a level that much -- a lot of this money would not go towards what it is intended for? And I think I might just go ahead and ask. We know from how the World Health Organization has addressed the issue of the spread of SARS that they seem to have a very well refined infrastructure to deal with these issues. What role will the WHO play in how this fund is administered in Africa?

DR. O'NEILL: Of course we're concerned that these dollars be used appropriately and for the benefit of the people for whom they are intended. We are very focused on this and are designing and implementing management mechanisms and reporting mechanisms that will watch this very, very closely. But we are not going to let that fear stop us from doing the right thing, which is to extend our hand and the hand of the American people to people in Africa and around the world who are suffering. We are absolutely concerned that these monies be used appropriately and we'll watch it very, very closely.

We work very closely with the World Health Organization in many ways and will continue to work closely with them in this initiative. The exact nature of that relationship will be worked out over time, but the type of commitment that the President and this administration has made towards this disease and towards Africa and the Caribbean and the rest of the world is really unprecedented. And it's going to require an unprecedented effort on the part of all other countries to join with us, and be it through mechanisms like the World Health Organization or the Global Fund, we really are calling on the rest of the developed world to do what the citizens of the United States have done, which is to really come to the table and to really make a sincere commitment to achieving these goals.

DR. FAUCI: Much of the money will be going -- again, and we need to negotiate and discuss what's going on in country. We made it very clear, and the President is also sensitive to this, that you don't want to, as we say, just parachute money and programs in without accountability or without making sure you're sensitive to the ongoing infrastructure and ongoing activities in the country.

Many of the groups that will be recipients of this money are groups that have a proven track record in their commitment to HIV treatment, care and prevention in the countries involved. So this is not going to be creating a separate mechanism that will bypass already successful programs, and that's the reason why we fashioned it against a model that is working very well in Uganda and that, in fact, is applicable to many other countries, not only in Sub-Saharan Africa but also in the Caribbean.

QUESTION: My name is Andrei Sitov. I am with the Russian News Agency ITAR-TASS. I apologize for being late. I was kind of shooting for 3:30. I thought it started at 3:30.

My questions are for Dr. Fauci. Again, I apologize if you already touched on this. About the epidemics of AIDS, how do you see it developing? When do you feel it might break? What regions are mostly vulnerable? How well advanced are we on the road to a vaccine against AIDS and HIV/AIDS? And also, do you see anything similar between the epidemics of HIV/AIDS and the SARS?

DR. O'NEILL: A lot of questions there, Tony. Take it away.

DR. FAUCI: Your first question. Well, HIV/AIDS globally, as we've seen right from the very beginning in the 1980s, really is an epidemic that is in waves and differs from region to region. Obviously, in many of the developed countries, there has been a peaking and a plateauing of the epidemic. Unfortunately, like in the United States, it has plateaued at a level that we feel is unacceptably high, with 40,000 new infections each year. In other countries, the curve is still on a very, very high level. Even some of the Sub-Saharan African countries have not yet peaked. Many of them have such a high prevalence and incidence of infection that they're struggling to make sure it doesn't get worse, but there have been some positive results that we have seen, particularly in countries like Uganda, in Senegal. Thailand, we know, has done a very good job.

There is concern, particularly for your own interests, for example, in Eastern European countries, the Russian Federation is one of the highest incidences that we're starting to see now of new infections. If you look at the plotting of the curve of new infections, it's really quite alarming, so that we need to pay close attention.

China and India and other of the Southeast Asian countries are clearly at that level, with exceptions such as Thailand, which seems to be doing a pretty good job of that, but it is still not at a point where you can accurately predict that you're going to get something under control. And for that reason, we have to be very vigilant, we have to be very aggressive in our prevention, and we have to try to provide treatment in the manner in which we are seeing represented by the President's initiative for the Sub-Saharan African and Caribbean countries.

With regards to vaccine, vaccine is quite problematic. It's problematic because this is a disease in which the normal immune system of the body has not shown itself to be very successful in eliminating the virus. So although I believe that we are making very positive steps in the development of a vaccine, I think it would still be years before we have a safe and effective vaccine, which underscores that component of the President's plan that is devoted to prevention. So it isn't just the treatment; it's the treatment, care and prevention. So classical prevention methods are very important.

And then finally, the similarities, or lack thereof, between AIDS and SARS. There are some similarities. It's an infectious disease. It's communicable. It's deadly. The differences are also striking. One is a behaviorally modified disease where certain types of behavior put you at risk. When you're dealing with a respiratory transmitted infection, it has often very little to do with normal behavior; you just find yourself in a situation where you can get infected.

There are now over 8,000 infections, over 700 deaths. The potential for SARS is quite alarming, but it can be contained with proper infection control and public health measures. HIV/AIDS is now so widespread globally that it's going to require very intensive prevention and education and behavioral modification.

So there are some similarities, but some striking differences.

QUESTION: Dr. Fauci, since you just mentioned SARS, I'm just -- my name is Vincent Cheng with the United Daily News, Taiwan. Since you just mentioned SARS and the vaccine problem, I'm just wondering, can you foresee when a SARS vaccine will be possibly ready?

And by the way, would you care to comment on Taiwan's handling of the disease since Taiwan has been seriously affected by the epidemic for -- since March?

And for Dr. O'Neill, I haven't heard of any comment from the White House regarding SARS. Would you also care to comment on that?

DR. FAUCI: Okay. Let me start off and then I'll pass it over to Dr. O'Neill, who will comment about the White House's comments.

Certainly, a vaccine for SARS is entirely feasible for a number of reasons. We have the agent. The agent is growing well in culture. We likely will have a good animal model in the monkey, although we'd like some smaller rodent models that we can use to test the vaccine. But the virus grows in monkey culture cells, which is a strong indication that the monkey himself or herself would be a good model.

Now, first thing. The second, it's a virus, a corona virus, for which we have successfully developed vaccines for the porcine diarrheal component of the corona virus and some of the avian pneumonias of that. So the idea, the concept of "can you develop a vaccine against a corona virus," that concept, at least in the non-SARS corona viruses, has proven to be a proof of concept that works.

So although there's no guarantee, and there's no chance that I will guarantee you here that we're going to have a SARS vaccine, things look good for the direction of being able to do it. Now, there's a majestic leap between the proof of concept and actually having a product that you could deliver to people. That generally takes years. I believe the proof of concept in an animal model we'll be able to successfully do within a year, but generally after that it would take a few years. There are multiple concepts that are already actively being worked on here in the United States and grantees and others internationally: whole killed virus, the recombinant viruses, where you look at a vector and do a molecular manipulation for it. We know the sequence of the virus. All of those things are ongoing now. So it looks favorable in the direction, but I can't give you a time.

Taiwan has had a difficult situation because they have not had -- they do now, but early on in the epidemic they didn't have -- the advantage of direct interaction with WHO, which now that they are having that, they're able to mobilize a bit better and take advantage of the expertise of people who have had experience in Hong Kong, in China and in Toronto. So I think things will be getting better. Unfortunately, they were dealt a difficult blow because they had cases that got out of control and now, just this past week, as I'm sure you're aware, the new crop of cases was alarming, but hopefully they'll get those under control. So, in general, I think they've done a good job.

DR. O'NEILL: President Bush is very aware, acutely aware, of the situation of SARS around the world. He pays very close attention to this, has frequent briefings on it, and has particularly been interested in making sure, as you've just heard, that the very finest resources of this country -- our research establishment, the CDC, NIH and other of our universities and the resources that we have in this country -- are effectively and immediately and appropriately mobilized to fight this epidemic.

QUESTION: Jay Chen, Central News Agency of Taiwan, again. I wanted to also ask Dr. Fauci about the situation of SARS in both China and Taiwan. Do you see -- where do you see the situation developing? Has it plateaued or peaked at all in both China and in Taiwan? How do you see the situation developing?

DR. FAUCI: Yeah, I want to be clear because it's an excellent, appropriate question, but when you're dealing with this type of infection, which is so easy to have a person slip through and create another mini-outbreak, that if you look at it from 30,000 feet and look at what are we doing in China and what are we doing in Taiwan and what are we doing in Hong Kong, that clearly the slope of the curve is not like that now; the slope of the curve has gone like that. But even though it has, you still have, in China, for example, many of the outer provinces that don't have the intensity of the capability that you see around Beijing, which is being, obviously, very aggressive in quarantine and isolation and getting people to practice infection control. And the same thing holds true in Taiwan.

But the alarming thing about this infection is that we saw what happened in Toronto. We thought the chain of transmission had been completely interrupted, and then all of a sudden there was a crop of 40 suspected cases, 11 probable cases, and even some new deaths. That was alarming because that didn't look like that would happen because it appeared that the chain of transmission was interrupted.

Since you can take that and magnify it much more because of the numbers of cases that are in China, Hong Kong and in Taiwan, although it looks like it's plateauing, you have to be continually vigilant against the possibility of there being an escape out of a patient that leads to another cluster of an outbreak. So whenever we talk about things plateauing, we've got to be very careful that we don't rest on our laurels and claim victory before victory is really here. It is far from over. It is far from over in both places.

QUESTION: Hi, again. Just getting back to the AIDS proposal, or AIDS plan, as I understand what Congress has just passed is the authorization for these funds, but that they still have to be appropriated. So correct me if I'm wrong, but if that is the case, will the administration be actively involved in making sure that the program is, indeed, fully funded and the full 15 billion get appropriated?

DR. O'NEILL: Absolutely. A couple of points. First of all, you're absolutely correct. The President signed an authorization. In our system of government, the next step is to get an appropriation, which is the cash. We fought extremely hard. The White House, the National Institutes of Health, the entire breadth and depth of this administration focused intensely for a period of time to make sure that we got this authorization done. And it's really remarkable because from the time that the President made the announcement to the time that he signed the bill was less than a hundred days. That's some sort of record, I think, for something of this magnitude.

So I mention that to give you the sense of the seriousness and the intensity of focus that this administration has placed on getting this done. We intend to place, are placing, the same level of interest and intensity and focus on getting the full amount of money that we request. I want to make a point, though. We have requested -- and the President's plan is for -- $15 billion over five years. We realize that we will be needing to spend more money in the out years than we will in the early years, and we have received some criticism -- and maybe one of you have this question -- because our 2004 budget request was for not for 3 billion. That was planned. We understand that in the initial year or two it's going to take some groundwork and that when we get that done we'll be able to speed up the pace of our funding. So it's not that we committed for $3 billion a year. We committed for 15 billion over five years, the average of which would be 3 billion.

DR. FAUCI: So it's a question of scale-up, how rapidly we scale up, and efficiently spend the money. And we actually plotted it that way. It's very interesting. When the President was involved in encouraging us to put this together, he said he wanted it to be effective, efficient and feasible and accountable. And that's what we try to do, because if we had thrown a whole bunch of money in right up front, it may not necessarily have been able to have been spent as well. So we planned a program for scale-up so that there's more than 3 billion per year in the out years, but less in the early part. But at the end of the program, you'll have $15 billion over five years.

QUESTION: Sir, how well Americans is well protected against SARS, which is next door to America? Canada is not far from here. So how well are Americans protected against SARS?

And also, I heard about a new medicine for HIV/AIDS. When can you emphasize about the new medicine and how can African people, African sick people, get that medicine?

DR. FAUCI: Well, I don't know what medicine you're referring to, so --

QUESTION: It was in the news today.

DR. FAUCI: Well, you have to hum a few bars for that. What medicine was it?

QUESTION: I don't know.

DR. FAUCI: A lot of things get into the news as new medicines. It could have been another anti-retroviral.

QUESTION: It was.

DR. FAUCI: That was -- yes, if it's an anti-retroviral, a classical anti-retroviral agent that may have been approved by the FDA, I think that what you're talking about is a drug that had been in clinical trials and was approved by the FDA.

Again, there is no anti-retroviral that is inherently far superior to the ones that we already have, so another one --

QUESTION: Triple therapy?

DR. FAUCI: Excuse me?

QUESTION: The triple therapy?

DR. FAUCI: Yeah, we generally treat people with more than one drug. It's usually three, and sometimes it's more than that. But the new drugs that are in the pipeline now, and there have been a few that have been approved by the FDA over the last several months, they're good drugs and they're good because there are some people who have run out of options. So it's not going to transform the treatment of HIV. It will be another drug added to the armamentarium of the already 18 or 19 FDA-approved drugs that we already have.

Now, your question about how protected are the citizens of the United States: Again, everyone is vulnerable to SARS. What we have in this country is quite a good public health system. We're trying to make it even better. We have good infection control mechanisms, which we're trying to make even better. And I believe that our alertness to that and our aggression in approaching SARS was one of the reasons we didn't get hit too badly in this country. But I also think it was a bit of luck also, to be quite honest with you, because, unfortunately, the people in Canada didn't know about the potential of SARS until after the woman had gone, the Canadian citizen of Chinese extraction who had gone from Hong Kong to Toronto, spread it not only to her family but to people in the hospital in Toronto, which then spread it out.

We were about a week ahead of the curve here in the United States, so we knew about that before it started happening. So we're as vulnerable as anyone else here in the United States, but we feel that our system has served us well of a good public health infrastructure system.

DR. O'NEILL: You also asked a question how people in Africa could access new treatments, and that's the point, really, of the President's initiative. One of the major points of the initiative is to make the funding available and make the money available so these drugs can be purchased and can be put to work.

DR. FAUCI: I just want to get back to the point that you were making because the gentleman -- the point that I made about what the situation is in China and Taiwan, when I say it's far from over, I don't mean it's still raging because it isn't. Because if you look at it, the curve is flattened out. When I say it's not over, I mean that China and Taiwan need to be continually vigilant against the cropping up of new cases, because just because the curve flattens out, that doesn't mean it's going to stay flat.

The reason I bring it up to your question is because we in the United States need to be continually vigilant, because just as much as we did well and are doing well with only 67 probable cases and no deaths, just as easily someone can slip through, create a cluster of cases, and then you have a problem. So China and Taiwan, even though they're doing relatively well now compared to a month ago, they need to be continually vigilant. We need to be continually vigilant.

QUESTION: Jorge Liu, Central News Agency of Taiwan. You are working hard to fight against AIDS. Do you worry about the coming, the spreading of new A-I-D-S? I mean, do you worry about today's SARS may that would become new A-I-D-S tomorrow?

DR. FAUCI: Well, we continually -- I spend my life worrying about these things. So the answer to your question broadly is yes, but the concern we have is that we are continually being confronted and emerging and reemerging diseases. Every once in a while, an emerging and reemerging will come that has global public health impact. Many of them are little blips on the radar screen that are curiosities but don't have major impact globally. HIV had major impact. The influenza epidemic of '19 had major impact. SARS has the potential to have an even greater impact than it has now. That's one of the reasons why everyone needs to be very aggressive in containment.

But there is a possibility that next year, the year after, or decades from now that we'll have the emergence of another very serious, dangerous disease. It could be a new pandemic flu, which we're concerned about. So we need to be very much on guard for the emerging and reemerging of microbes.

QUESTION: Philip Tazi with the Cameroon Herald, again. I just wondered, you seem to have picked out the Rwanda -- no, not Rwanda, but Ugandan ABC program as a model. But I think I read somewhere that the model also focuses significantly on abstention. I just came back from Africa a few months ago, and I think sometimes one needs to take into consideration what has happened to the economies of Africa where families have become so poor that young people go out on the streets and pretty much prostitute themselves.

I just wanted to ask is there this focus, a significant focus, on abstention? Are you taking into consideration the reality in place, which is making these young people to indulge in this kind of behavior?

DR. O'NEILL: Go ahead.

DR. FAUCI: Well, I think it's important to emphasize, and those of us who put the program together and the proposal for the President and his discussion of them, this is comprehensive prevention program. This is not -- and there's some misunderstanding. This is not only on abstinence. This is a program that includes a variety of prevention methods. True, the ABC's of Uganda have worked for Uganda and that's a model that is important to take a look at and, in fact, even go by. But there are also, if you look at the list of prevention, it includes the A of abstinence, the B of be faithful, the C of condoms, but also prevention of mother-to-child transmission, broad public service educational campaigns, treatment of sexually transmitted diseases which make it much more efficient to transmit, blood safety programs, a variety of things.

So if you look at the list that's in the President's program, it's quite comprehensive.

DR. O'NEILL: I just make the point on prevention that we're really operating from a classic public health model here. I mean, we have been taught from the very beginning in public health that the way that you turn an epidemic around is a function of the number of exposures, of the number of individuals exposed to an agent, and the function of the risk of transmission at any one of those exposures. A comprehensive model like ABC recognizes both sides of the equation. We're looking at reducing the number of exposures, i.e., that's the abstinence and faithfulness component, and also reducing the risk of transmission during any particular exposure, which is the condom and eventually vaccine.

QUESTION: Andrei Sitov, again. Not often, but from time to time, one hears reports of a supposed cure-all for a disease like AIDS. I remember, for instance, such a report out of Armenia a few -- a couple years ago.

I don't want to ask you about those specifically, but as scientists, do you believe in the possibility of a cure-all for AIDS, of a major bullet, so to speak.

And also, on SARS, with the high level international contacts, the G-8 summit coming up, this great gathering in St. Petersburg where the Chinese, for instance, sent a big delegation to, the people there seem to be doing some kind of preposterous-looking things, like requiring medical certificates of the guests or something. In general, do you feel that -- what do you feel needs to be done to ensure safety of the guests at such functions?

DR. FAUCI: Well, let me start off with your first question about the cure-all. Unfortunately, there are a lot of claims with no bases. As a scientist, and as Joe is himself, we both work on HIV, we both see HIV-infected individuals, that it is very unlikely that there will be a drug, at least in the reasonable future, that alone or in combination is going to cure someone of HIV. And we know that because we have a number of patients that we have followed for greater than three or four years whose viral load in their plasma has been undetectable for three years or longer in whom, when you stop therapy, the virus just comes back. That is, in many respects, ominous for the possibility of truly curing people. That's not necessarily such bad news because many, many people have very good control of the virus on drugs. But the specific question that you're asking, to purge the virus from the body and completely cure an individual, I'm not saying it's impossible, but it's something that's going to be very, very difficult to do.

DR. O'NEILL: I think one of the things that I find very interesting is that when we hear these stories of someone finding a supposed cure, and it becomes very exciting and very popular, you know, what's driving that? And I think what is driving that is a search for hope that people are looking for something. And what this new initiative has done for the world, really, is to provide a different sort of hope. It's a more realistic hope, that it's, I think, critically important that people feel that there is now a chance that they may be able to be on treatment, to live longer, to see their children grow.

QUESTION: Vincent Cheng with the United Daily News, Taiwan. A question regarding SARS for Dr. Fauci. Well, taking the examples from Toronto and Taiwan, can we say that it's easier to get SARS in the hospital than in the ordinary environment?

DR. FAUCI: There's no question about that, that one of the most vulnerable groups of individuals are health workers. We hope to counter that vulnerability by getting health workers to understand the importance of proper infection control and protection with masks, gloves, goggles and gowns.

Unfortunately, if someone comes in to the hospital with SARS and it is undetected as SARS, the person, the people in the hospital, may not have the opportunity to have the proper precaution.

But the answer to your question is that because it requires close face-to-face contact, people who are taking care of sick individuals are much more vulnerable than people in the general population. No question about that.

MR. DENIG: Dr. O'Neill, Dr. Fauci, thank you very much.

DR. O'NEILL: You're quite welcome.

DR. FAUCI: Thank you.