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Dr. Anthony Fauci:
a mastermind of medical research and public service
“The first major breakthrough, with important implications globally, is the role that we played in the development of effective antiretroviral therapies for HIV infection”
redacció COMB.cat
friday 10.26.2007
What has it meant to receive the Lasker Award 2007 for Public Service?
Dr. Anthony Fauci: It is very exciting to have received the Lasker Award but also very humbling, in the sense that, the cast of people who receive it are among the world's best in medical research and public service. It is wonderful to be recognized for your work and it serves as a reminder of all the things still needed to be done. Although it was an award for something that has been accomplished, I still feel that there is so much more that all of us, particularly I, need to do in medical research and public service. The award has given me an added incentive to continue the work that I have been doing for so many years.
Can you tell us about the President's Emergency Plan for Aids Relief (PEPFAR) and Project Bioshield?
AF: In the spring of 2002, President Bush sent Secretary of Health and Human Services, Tommy Thompson, and I to Southern Africa to determine if there was anything that the United States could do to help these poor nations with HIV. I formulated a policy after visiting there that focused on mother to child transmission. The President thought this was a good idea but encouraged us to put together a broader and bolder plan to help the people in Southern Africa as well as those from other developing countries (such as countries in the Caribbean). Over the next several months, I formulated a detailed plan to treat two million people, to prevent seven million infections, and to care for ten million people including AIDS orphans. After several months of fine tuning this plan we came up with a five year, fifteen billion dollar strategy. The President agreed with this plan and signed it into law; this plan became known as the President's Emergency Plan for Aids Relief (PEPFAR). It has been very successful, treating large numbers of people, and the President has now reauthorized it for an additional five years for double the originally proposed amount (30 billion dollars).
Project Bioshield consisted in the formulation and development of a biomedical research plan to develop countermeasures against deliberate bio-terror attacks and naturally emerging and remerging infections. The NIH had done a lot of basic research to develop concepts but we needed to push the process to the development of countermeasures in the form of diagnostics, therapeutics, and vaccines. Certain members of congress and I, with the help of the Vice-President proposed Project Bioshield, a legislation that set aside 5.6 billion dollars over ten years to incentivize pharmaceutical companies to partner with us in the development of diagnostics, therapeutics, and vaccines. This money would be set aside by the federal government to guarantee the purchase of these products as long as they were approved by our regulatory agency, the FDA. This project was a very important step forward in preparing the United States not only against bio-terror attacks but also against naturally emerging infections such as influenza, drug resistant tuberculosis, and others.
What are the National Institute of Allergy and Infectious Diseases (NIAID) main objectives?
AF: NIAID's main objective is to do basic and clinical research in immunology and infectious diseases in order to develop tools to prevent, treat, and care for people who have infectious and immune-mediated diseases.
Which have been the most significant projects developed within the institute during the 23 years you've spent heading it?
AF: There have been several and I will attempt to highlight a few.
The first major breakthrough, with important implications globally, is the role that we played in the development of effective antiretroviral therapies for HIV infection. We not only developed the drugs themselves, but we also proved that you could block mother to child transmission. We also proved that when treating people chronically over a period time, you could block the progression of the disease.
The genomic sequencing of key pathogens determining their molecular fingerprints was another important development. Just recently, for example, we sequenced the entire genome of the most serious malaria parasite Plasmodian falciparum as well as the genome of several of the mosquito vectors of malaria such as the Anopheles gambiae.
Another major accomplishment was the clinical trial that proved that medically supervised adult circumcision was very effective in preventing HIV in populations in which it was implemented. We were also able to precisely delineate the mechanisms whereby the HIV virus destroys the immune system.
The development of a long list of important new and improved vaccines such as haemophilus influenzae B vaccine, the acellular pertussis vaccine, the pneumococcus vaccine, vaccines for a variety of other infections such as herpes virus and others were also key accomplishments. We established the Vaccine Research Center at NIH which is playing a major role in vaccine development.
We have developed and established a very robust bio-defense program. Furthermore, we have highlighted the importance of infectious diseases which is the second largest killer in the world. In the 23 years that I have been heading NIAID, it has gone from the 6th largest institute with a budget of about 300 million dollars to now the 2nd largest institute with a budget of 4.6 billion dollars.
What relationship does the National Institute of Allergy and Infectious Diseases (NIAID) have with other international centers that work with microbiology and virology? What projects / actions are carried out jointly?
AF: We have several very important relationships with other international centers and organizations. We work closely with the World Health Organization (WHO) in our efforts against seasonal flu and the threat of pandemic flu. We work with the Centers for Disease Control and Prevention (CDC) on a large number of infectious diseases, bio-defense, pandemic flu, and HIV. We work with the Gates Foundation very closely focusing on malaria and tuberculosis, and also with a variety of other NGO's such as Médecins Sans Frontière.
You are considered one of the best immunologists in the world. Which do you consider has been your greatest contribution to AIDS research?
AF: My most important contribution to AIDS research is the work I have conducted over the last 20 years in delineating the precise mechanisms of the pathogenesis of HIV disease; work that has allowed us to formulate strategies for the development of effective therapies. This research is the reason and the rationale why I received the National Medal of Science from President Bush in July of 2007.
How do you see the current situation of HIV / AIDS in the world? When do you think there will be an effective vaccine?
AF: The current situation of AIDS in the world is that although we have made a number of advances and much has been accomplished, there is still much to do. We have an epidemic that is still raging throughout the world. There have been a total of over 65 million infections, 25 million deaths, and there are currently 40 million people living with HIV. Last year we had 4.3 million new infections and 2.9 million deaths. The state of affairs is that we are still in the midst of a historically serious pandemic throughout the world. When will there be an effective vaccine? To be perfectly honest, I cannot predict that. The reason I cannot is that this is a very special virus that is very problematic and difficult to develop a vaccine for. We are slowly but surely making small steps towards understanding what routes we need to take to develop a vaccine, but given the recent failure of an important vaccine trial, I think it would not be appropriate for me to even begin to predict when we will have an effective vaccine.
In the last years, the World Health Organization has warned of the growing possibility of animal to human transmission of infectious diseases. What is your opinion?
AF: My opinion is that it is indeed a serious issue; in fact, history has proven this. If you look at the number of new infections, over the last 25 years, which have been recognized for the first time in humans, 70% of them are infections that have jumped species (from animal to the human). We have very good examples: HIV coming from a non-human primate, the SARS virus from bats to civet cats then to the humans, and Influenza from birds and pigs and other animals to humans. Therefore, the idea of infection crossing species and being transmitted from animals to humans is extremely important.
Which viruses are currently the most dangerous and able to provoke a world pandemic?
AF: The virus with the greatest potential for a world pandemic is influenza. It universally occurs each season with a threat of changing enough to become a new virus; it also has a strong capability of spreading rapidly from person to person. There are a number of other dangerous pathogens, like Ebola for example, but these do not spread very easily from person to person. The one that you have to worry about is the one that has the potential to be very virulent, but also has the innate capability of spreading from person to person. This is the reason why we are so concerned about the pandemic flu.
You have said that an avian flu pandemic is inevitable in the near future. Do you continue believing this?
AF: I have never said that an avian flu pandemic is inevitable in the near future. I have said that it is likely that we will have some form of a pandemic flu within several years since history has taught us that pandemics occur approximately 3 times per century. The last pandemic flu was a relatively mild one in 1968. The next pandemic flu may or may not be an avian flu.
To what extent are western countries ready to combat a possible avian flu pandemic?
AF: This varies from country to country. Over the last several years there have been remarkable advances by a number of countries in strengthening their public health apparatus in developing stockpiles of anti-flu medications. The developed world, particularly the United States, has developed (with both domestic and international pharmaceutical companies) a number of pandemic influenza vaccines in limited supply that are available for stockpiling. I think western countries have made a major contribution, predominantly in the development of vaccines and the stockpiling of drugs, which we will hopefully make available to developing nations.
What are most recent advances in basic biomedical research in microbiology and virology? What does the future hold?
AF: One very recent advance in basic biomedical research is the molecular work in the genomic sequencing of microbes. An example is the sequencing of the HIV virus which has allowed us to pinpoint targets for therapy, diagnostics as well as for vaccines. The same holds true for malaria and tuberculosis. In addition we have been able to understand the relationship, on a basic level, between our body's ability to protect itself and how that interacts with various microbes and viruses. Fundamentally, that advance consists of bringing the discipline of microbiology and virology into the genomic era of the 21st century.
