U.S. and Hong Kong (2003)

President Bush's HIV/AIDS Initiatives and the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R. 1298)

Dr. Joseph O'Neill, M.D., Director, White House Office of National AIDS Policy; Dr. Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, Department of Heath and Human Services
Foreign Press Center Briefing
Washington, DC
May 29, 2003

3:15 P.M. EDT

[ ...Intervening Text... ]

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.

[ ...Intervening Text... ]

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.

[ ...Intervening Text... ]

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.

[ ...Intervening Text... ]

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.

[End]

 

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