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Anthony Fauci Interview

Friday, September 18th, 2009 - 19:00
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Dr. Fauci was appointed Director of NIAID in 1984.
Radio show date: 
Mon, 04/26/2010
Guest: 
Intro text: 
He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism.

NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies. The NIAID budget for fiscal year 2009 is approximately $4.7 billion.

Dr. Fauci serves as one of the key advisors to the White House and Department of Health and Human Services on global AIDS issues, and on initiatives to bolster medical and public health preparedness against emerging infectious disease threats such as pandemic influenza.

Magazine profile: 
Complete transcript: 

Originally Broadcast August 2, 2009

Washington, DC

Mr. Morales: Welcome to another edition of The Business of Government Hour. I am Albert Morales, your host and managing partner of the IBM Center for the Business of Government.

Throughout history, infectious diseases have posed a major threat to human health, and their impact continues to be an important health concern today. As economies and societies around the world have become increasingly interdependent, responding to infectious diseases, such as the 2009 H1N1 influenza A virus, and other emerging and reemerging infectious diseases has taken on a new critical importance.

With us today to discuss his efforts in this area is our very special guest, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Dr. Fauci, welcome to our show. It's a pleasure having you today.

Dr. Fauci: It's good to be here.

Mr. Morales: Also joining us today is Tom Romeo, IBM's public sector general government industry leader.

Tom, welcome back. Good to have you.

Mr. Romeo: Thanks, Al.

Mr. Morales: Dr. Fauci, before we get started, could you provide us with an overview of the history and the mission of The National Institute of Allergy and Infectious Diseases?

Dr. Fauci: Yes, The National Institute of Allergy and Infectious Diseases was formally established in 1948, but actually, historically it really is the institute that really stands for the origin of the NIH in general. It was a Public Health Service Hospital that was run by the United States Public Health Service in Staten Island back in the late 1800s. And from that, what it did was essentially screen people who were landing on Ellis Island, and if they had any illnesses, they would come in and either be quarantined or would be treated for it.

Over many years it had evolved such that it then became one of the institutes of the NIH. And then mission statement is to understand the causes of and to develop the research agenda, both basic and clinical, to develop preventions, diagnoses, and treatment for both infectious diseases and diseases of the immune system. Hence, the designation The National Institute of Allergy and Infectious Diseases, because we're interested both in infectious diseases and immune-mediated diseases.

Mr. Morales: Now, this is a very broad mission that you describe, so you can give us a few more details in terms of the scale of the operations within the organizations, perhaps how it's organized --

Dr. Fauci: Sure.

Mr. Morales: -- size of the budget, number of employees, and your geographical footprint.

Dr. Fauci: Yes, well, first of all, it's the second largest institute at the National Institutes of Health, which has 27 institutes and centers. We're very closely behind the National Cancer Institute. Our budget is about $4.8 billion per year funded through the federal government and as part of the Department of Health and Human Services.

We have a number of divisions that are devoted to the various disciplines and sub-disciplines. We have a program called the Intramural Research Program, which comprises about ten to 11 percent of our activities, both in resources and manpower where research is done on -- mostly on the NIH campus in Bethesda, Maryland, and we have a satellite campus in the -- Hamilton, Montana in the rocky mountains. That's a historic campus that was originally studying Rocky Mountain spotted fever many decades and decades ago.

We have about 1,800 full-time equivalents, or permanent positions. We also have a number of contractors and fellows that come in to give a total workforce of about 3,500 to 3,600 people. So it's a rather large organization. The divisions are The Division of Microbiology and Infectious Diseases, which obviously studies microbiology and infectious diseases. We have a Division of AIDS, since AIDS is such a major component of what we do, and we have a division of allergy immunology and transplantation.

Also, as I mentioned, ten percent of what we do are researches that are actually federally -- federal employees who are either in Bethesda or in Hamilton, Montana. The other 90 or 88 percent of what we do are grants and contracts that go mostly to universities throughout the country and the world to fund what we call extramural investigators, and these are people who are fundamentally associated with university hospitals, medical centers, who use government grants to do the basic and clinical research that is done as part of the totality of what we do.

So it's about ten or so percent by scientists that are employed right here and close to 90 percent in grants and contracts that go out to the outside investigators.

Mr. Morales: Great. Dr. Fauci, with that overview, could you tell us a little bit more about your specific responsibilities as a director of NIAID and also a little bit about the composition or the research portfolio. You mentioned the organizations. Maybe talk a little bit about the research portfolio.

Dr. Fauci: Sure. My responsibility as the director is to have the overall administrative and scientific oversight and execution of the mission of the institute. I'm involved in essentially making the scientific directions and making sure that the quality control is what it should be and making sure that we fulfill our mission.

I am the officer, as it were, the CEO. If you're looking at this as a corporation, I would be the CEO of the corporation. I have very good people that work with me, budget people, operations people, people who run the various divisions that are responsible for the science. So that's my responsibility.

When you talk about a little bit more details of what we do in the programs -- for example, The Division of Microbiology and Infectious Diseases is responsible for funding the research associated with the study of all micro-organisms, the development of vaccines, the development of therapeutics, antivirals, and anti-bacterials and understanding the pathogenesis of diseases.

Some examples of that are malaria, tuberculosis, neglected tropical diseases, childhood diseases, measles, mumps, polio, all the things that we have vaccines for now and the development of vaccines for things that were just recently developed, namely Haemophilus Influenzae B vaccine, streptococcal vaccine, staphylococcal vaccines, et cetera.

The other issue is that we have a special division for HIV/AIDS, so we do work on the pathogenesis, the diagnosis, the treatment, and hopefully the development of a vaccine for HIV/AIDS. And we also do work on transplantation, asthma, allergy, and immune-mediated diseases. Most of the immunology -- not all, but most of the immunology research is funded out of NIAID with some contribution from other institutes.

And then, as I mentioned, the Intramural Research Program -- we have two major intramural research programs. One covers multiple disciplines from infectious diseases through immunology, and those are the investigators who are working there on campus or in Hamilton, Montana. And then we have The Vaccine Research Center, which was established first to develop an HIV vaccine, but has also now gotten involved in influenza vaccines, and vaccines for anthrax and other microbes.

Mr. Morales: Great. So Dr. Fauci, I've heard that you are known for putting in some incredible work hours. So maybe you could take us through a typical work day and also mention what you feel the top three challenges facing you in your position are.

Dr. Fauci: Well, my work day is indeed chuck full. I've been doing that for a long, long time. I've been director of the institute now. I will have been director this coming winter for 25 years. And I work seven days a week, not the same amount every day. I work during the week, and on Saturday I usually go in, get in before 7:00, get up around 5:00, get into the office between 6:30 and 7:00. And I'm there usually until about 8:00 o'clock at night. Take about an hour off in the middle of the day to run.

And then the rest of it is meeting with scientists, reading, developing protocols, reading the literature, having a bunch of administrative meetings that are responsible for making sure the institute is on the right direction of where -- what we should be doing. I also run my own lab. I don't go into the lab and work with test tubes or pipettes myself, but I have a small group of post-doctoral fellows who've been working with me for years that turn over a bit, and we do fundamental research, basic research on the pathogenesis of HIV disease, and I also see patients two days a week on rounds at the NIH Clinical Center, which is a big research hospital right in the middle of the NIH campus.

So it's really divided into administrative meetings, fundamental basic research, clinical research, and a lot of reading, examining, and analyzing data and programs.

Mr. Morales: That's great. Twenty-five years is an incredible run. I'm curious, how did you get started, and what brought you to NIAID? And if I may, what's compelled you to stay and serve under -- now would be your fifth president.

Dr. Fauci: Well, I first came to the NIH back after my internship and residency in internal medicine. I trained at the New York Hospital, Cornell Medical Center, and I wanted to do a fellowship in a combination of immunology and infectious diseases. At that time, human immunology was still in its infancy as a discipline, but it was very exciting. I also was very interested in infectious diseases and its impact on global health, came to the NIH, did a three-year fellowship in combined infectious diseases and clinical immunology.

In fact, I have my boards in actually three specialties -- internal medicine, infectious diseases, and clinical immunology analogy -- even though fundamentally I'm a clinical infectious disease person who looks at immunological research related to the host microbe interaction. And I did that starting after my chief residency came down here and worked my way from being a senior invest fellow to a senior investigator to a laboratory chief, and in then in 1984 I became the director of the institute.

So it was fundamentally my love for and excitement about infectious diseases, and your question about why I've stayed there for 25 years as the director and even more so as a member of the NIH team is that what I'm doing is very exciting and it constantly changes. When I first came there, there were people who were saying that the era of infectious diseases was over and that we should be concentrating our resources on chronic diseases, since we have vaccines and therapeutics and diagnostics and things like that.

Well, that statement could not have been more incorrect because not too soon after I got there HIV came upon the scene, which really transformed by professional life, my personal life, and everything that I did because that was my area of research as well as one of the most important areas of the institute that I was soon to become the director of.

So it was a constellation of events that occurred that got me where I am and keeps me where I am.

Mr. Morales: Well, you certainly sound excited about it. Now, I also understand that you were recently selected by U.S. News and World Report, The Center for Public Leadership, and The Kennedy School of Government at Harvard as America -- as one of America's best leaders. From your perspective, what are some of the key characteristics of an effective leader? And this is a bit of a loaded question, but to what extent does the art of persuasion and being faithful to one's principles factor into your view of a successful leader?

Dr. Fauci: Well, I think they're critical. The art of persuasion, as well as sticking to your principles -- a leader must lead by example. You have to understand the subject and the terrain in which you're trying to lead, and you have to show that you are doing the leading and you're part of the process, as opposed to telling people what to do. You've got to get them to feel that they have an investment in it. You've got to persuade them that this is something that's important, that's exciting, and they're doing it not because you're pushing them to do it, because they really do want to do it. And I think that's the secret of a leader in the arena of persuading somebody to get very, very much involved.

With regard to principles, you have to set up a fundamental group of principles, particularly in the arena of science, 'cause science is uncompromising. It's trying to get to the truth. It's trying to understand and get knowledge of things that would ultimately in the biological sciences help humanity.

So you can never compromise your scientific principles. If you do that, first of all, you're not worth much and you're going to wind up getting yourself in trouble.

Mr. Morales: That's great. What about The National Institute of Allergy and Infectious Diseases response to the 2009 H1N1 influenza? We will ask Dr. Anthony Fauci, its director, to share with us when the conversation about health care continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and today's conversation is with Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Diseases. Also joining us today from IBM is Tom Romeo.

Mr. Morales: Dr. Fauci, to give our listeners a better understanding of the work of NIAID, could you give us a brief overview of the fundamentals of vaccinology? First, what exactly is a virus, and how would you define pathogenesis? And then second, what is classical vaccinology and the relationship between discovery and development within this model or paradigm?

Dr. Fauci: Well, first off all, let's start off with the definition of a virus. There are virus and bacteria and parasites. Viruses are one of the pathogens, as it were, which is -- in a virus it's not a free-living microbe because it requires another cell for it to survive and replicate, but it's made up of either DNA or RNA. There are RNA viruses and there are DNA viruses.

And what it has is the ability to co-opt functions of a cell to replicate itself, and by doing that, it generally causes disease. An example of influenza virus -- replicates -- it binds to the surface of respiratory cells, enters the cells, replicates, causes inflammation and damage to the epithelium, and that's why you wind up coughing and sometimes getting serious pneumonia. Polio does the same thing with the nervous system. HIV/AIDS does the same thing with the immune system. So they attack different tissues of the body, but they cannot live outside of cells.

There are many viruses for which we have developed successful vaccines. The fundamental principle of vaccinology is to expose a person to a weakened or killed form of a microbe -- in this case let's call it a virus, such as polio or measles -- so that the body can mount an immune response so that when you actually get exposed to the real microbe or virus -- that you will then have already a big head start on mounting an immune response that could protect you against disease.

The principles of vaccinology are based on the concept that the body has the capability of responding adequately to a particular virus in question. So even though people get sick with polio, some get paralyzed, people get sick with measles and small pox, some of these people die, at the end of the day most of the people mount an immune response that clears the virus from the body and leaves you with long-lasting, protective immunity against subsequent challenge.

So the whole philosophy and the strategy of vaccinology is to expose the person in a harmless way to either a part of or a killed virus that doesn't harm them, but that mounts an immune response that ultimately allows that person to protect themselves when they get exposed.

Mr. Morales: Interesting. So as a follow-up, what are the characteristics of a viral infection for which there are vaccines?

Dr. Fauci: Well, a characteristic for a viral infection for which there are vaccines is just what I said, the ability to mount in the body an immune response that ultimately controls the virus. We have a problem, for example, with HIV/AIDS, because HIV does not seem to mount in the body an immune response that's ultimately able to clear it and, hence, develop protective immunity. We have no idea at this point why that's the case. So when we develop, or if we develop a vaccine for HIV, we're going to have to do better than what natural infection does.

Usually, vaccinnologists, like myself and my colleagues -- we copy what natural infection does. We say, well, natural infection induces this type of immune response. Let's design a vaccine that mimics natural infection and induces this type of an immune response. But with HIV/AIDS, the immune response that natural infection induces is not very protective at all. So we have to do better than natural infection.

Mr. Romeo: So as a follow-up to that, can you tell us a little bit more about the next generation of HIV/AIDS treatments and anti-viral drugs? And how is HIV vaccinology a significant departure from classical vaccinology?

Dr. Fauci: Well, first of all, starting with therapy, we have a number now, 30 FDA-approved anti-virals for HIV. So if there's ever been any real successes in infectious diseases, the development of adequate, if not very good anti-virals against HIV is really a true success story. You develop an anti-viral by getting a compound that's directed against a vulnerable point in the replication cycle of the virus.

So, for example, we have reverse transcriptase inhibitors, which block a very important enzyme -- reverse transcriptase --t hat the virus uses to replicate itself. Once it changes itself from RNA to DNA, it inserts itself into the chromosome of the cell. It uses an enzyme called integrase. So one of the drugs that we've developed is an integrase inhibitor. When it tries to replicate itself and leave the cell, namely butt off the cell the way viruses do, go to the surface, butt off, and then infect another cell, it requires an enzyme called protease. So we've developed protease inhibitors.

So there -- what you do is you look at the vulnerable part in the replication cycle and you develop a drug against it. And as I mentioned, this has been very successful in the arena of HIV. Not so successful has been the efforts in developing a vaccine. And you asked the question about classical vaccinology. Classical vaccinology is what I was describing just a moment ago, and that is you look at what the virus does in its natural infection and you mimic it because that's what you want to do with a vaccine. That's the classical approach.

We can't take the classical approach with HIV because natural infection doesn't do a very good job of inducing this type of protection. So we've got to develop a vaccine that when the body sees it, it does much better at mounting an immune response than when it sees the natural infection. So we have a ominous task of having to do better than what natural infection does. That's not going to be easy. I think it's possible, but it's not going to be very easy.

Mr. Morales: Earlier you mentioned tuberculosis, and this is certainly a very old disease, however, it remains one of the major causes of disability and death throughout the world. In fact, today I believe almost one third of the world's population is thought to be infected. Could you elaborate on advances in TB research? Specifically, what studies are underway to determine the optimal strategies for the prevention, treatment, of diagnosis of TB, and what are some of the barriers to vaccine development for TB?

Dr. Fauci: Well, TB is a very interesting disease, because as you mention, it's an ancient disease. It's been around literally forever as far as history goes. The impact of morbidity and mortality today in our modern age of technology, of vaccines and therapeutics and diagnostics in some respects is almost an embarrassment. As you mentioned, one third of the world's population is infected with latent TB. They're not sick, but they're infected.

However, there are nine million new cases each year, and there are 1.7 million deaths each year from tuberculosis, yet our diagnostics are antiquated. They've been around for decades and decades, if not more than a century. The vaccine against tuberculosis doesn't work very well against adult TB. It works reasonable well against childhood non-pulmonary TB. And the therapeutics -- we haven't had a brand new therapeutic for tuberculosis in over four decades. We've got to bring tuberculosis into the 21st century with regard to research opportunities.

We've been victims of our own success because we've developed many, many years ago a skin test that can diagnose it, therapies that can cure it, and you can control it. We were victims of our own success. Because we were so successful, we neglected the research agenda for TB, and now the major advances of the latter part of the 20th and the first part of the 21st century have passed by tuberculosis.

So it is really important for us right now to use the research advances, the molecular approaches for diagnosis for the development of drugs as well as vaccines to try and bring TB -- the control of TB -- into 21st century technology.

Mr. Morales: So could this number of one third be actually understated and more people could be walking around with it and not know?

Dr. Fauci: Well, yeah, rather than more people walking around with -- we need to figure out how we can prevent the people who ultimately develop of active TV -- of those 2.2 billion people who are walking around with latent TB, there's a ten percent chance in their lifetime that they will develop active TB. And if they have an immuno-deficiency disease, like HIV, there's a ten percent per year chance that they will develop active TB. So if you have HIV and latent TB, the chances are overwhelming if you're not treated that you're going to wind up with active TV some time in your lifetime.

So we have a long way to go to control TB, and now we have an additional problem of multiple and extensively drug-resistant TB, which means that the old drugs that have been historically so successful in treating TB are no longer successful in a certain proportion of TB cases that are resistant to the drug. So we have got to develop a better pipeline of new drugs to replace the drugs for which the TB is now resistant to.

Mr. Morales: Interesting. So switching gears a bit, each year here in the U.S. influenza kills more than 36,000 people and hospitalizes another 200,000. On a worldwide basis, the annual epidemics cause about 250 to half a million deaths each year. Tell us about your progress in influenza research programs, particularly in the area of pandemic influenza preparedness.

Dr. Fauci: Well, that's an interesting point because we have been I believe as a society somewhat complacent about the morbidity and mortality of seasonal flu. We get very excited when there appears to be a threat of a pandemic flu. We were concerned since 2005 about the H5N1 bird flu, which killed a lot of birds, but rarely jumped species to infect humans, 400 or 500 people, and half of them died with a very high mortality. But that's a relatively few number of people.

Now, in the fall of this year we had a regular flu season, but as the flu season ended in March and April of 2009, we started to see cases of a brand new, quote, "swine flu," which is an H1N1, first appearing in Mexico and then spreading throughout the United States and globally. Now, that's -- has real pandemic potential because it can spread very easily from person-to-person. So we're watching that very closely, and part of pandemic influenza preparedness is to develop the infrastructure to develop vaccines as rapidly as we can, to develop new pipeline of drugs to treat influenza.

So there is really a connection between how well you have prepared for seasonable flu and your capability of surging up for pandemic flu. So we're right now in the process of implementing a pandemic influenza plan that was established in 2005 in response to the threat from the H5N1 bird flu, only we didn't realize it wouldn't be the bird flu that was going to be the problem. The problem was going to be an H1N1 flu that has swine influenza genes.

Mr. Morales: Sure, sure. So can you expand on this point a little bit more? So how does what happens this summer in locations, say, below the equator inform our potential response during the upcoming flu season?

Dr. Fauci: Well, we know that H1N1 is here, and it established itself in the United States and globally outside of the flu season. Luckily, it was not particularly severe. It was about as severe as a seasonal flu. The problem is it was happening out of season.

Dr. Fauci: Well, we know that H1N1 is here, and it established itself in the United States and globally outside of the flu season. Luckily, it was not particularly severe. It was about as severe as a seasonal flu. The problem is it was happening out of season.

Dr. Fauci: We were seeing illnesses, particularly among young people, in April, May, and June and beyond. So that's something that is very unusual for seasonable flu. Now, the reason we don't see as much spread now in the spring and summer of 2009 is that flu does not spread as well in the summer of a given region of the world for a number of reasons. The flu doesn't do well when there's open spaces, warm weather, and high humidity. When there's closed spaces, cold weather, and low humidity, flu seems to spread better.

However, in the summer here in the northern hemisphere is the winter in the southern hemisphere. So as we get into the summer of 2009, that is really the winter in places like Australia, South Africa, Argentina and Chili, so we're going to be watching very closely what happens during a real flu season to regions of the world that we know there is going to be H1N1 swine flu. What happens there is generally predictive of what will happen here in the United States in the fall and the winter at 2009 and as we go into 2010.

Mr. Morales: Interesting. So al eyes will be watching what happens --

Dr. Fauci: Indeed, indeed.

Mr. Morales: Okay. What is NIAID's role in combating bioterrorism? We will ask Dr. Anthony Fauci, director of the Institute of Allergy and Infectious Diseases to share with us when the conversation about health care continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and today's conversation is with Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Diseases. Also joining us today from IBM is Tom Romeo.

Mr. Morales: Dr. Fauci, today it seems malaria has resurged with quite a vengeance with half the world's population at risk for infection. Could you tell us more about NIAID's role in responding to the global effort against malaria, and specifically, what are some of the key initiatives, pharmacological or non-pharmacological, being pursued to combat this disease, and what progress is being made to date?

Dr. Fauci: Well, the NIAID is the leading funder of basic biomedical research in malaria in the world, so we have a large responsibility that we take very seriously in doing both the fundamental and clinical research and understanding everything from the fundamental pathogenesis of malaria to the developing of a pipeline of drugs. We have some good drugs for malaria, particularly the Artemisinin derivatives when used in combination.

We do not have a malaria vaccine, and that's a very, very high priority to develop a malaria vaccine. You know, approximately a million people, about 899,000, people a year die of malaria. Most of them are African babies. So this is a great deal of disease burden and death that needs to be addressed. You can control malaria by a variety of other ways besides a vaccine. I mean, there's vector control. There's bed nets that are impregnated with insecticides. There's prophylaxis of pregnant women, since they're very vulnerable to serious effects of malaria. There's the spraying of indoor huts. There's the use of prophylactic treatment.

So there are many ways to control it, but as a research organization, NAID is responsible for understanding everything from the pathogenesis, or how the disease works, but importantly, in developing a pipeline of drugs and a vaccine.

Mr. Morales: So we spent some time in the last segment talking about viruses. I want to now move to the microbial world. Now, we may never truly eliminate the threat of infectious diseases as new pathogens emerge and older pathogens reemerge in some times very unpredictable ways. But what are some examples of other emerging, reemerging, or perhaps deliberately emerging diseases that pose a continuing threat to global health, and how can we protect ourselves against these threats?

Dr. Fauci: Well, you can protect -- first of all, let me tell you examples of each so that the listener can understand what we're talking about. I tend to divide it up into three categories. One is a truly emerging disease, which means it's a disease, an infection, that we have never had any experience with before. It's new to human civilization.

The other is a reemerging infection, one that we've had, or some parts of the world have had exposure to or experience with. But it reemerges in a new form that has a particular concern, that generates particular concern. And the other is deliberately emerging infection, such as those that relate to bioterrorism.

So the mother of all emerging new infections that our generation has experience with is HIV/AIDS because prior to the early 1980s -- 1981 when it was first recognized -- it was probably around for a decade or so before that -- there was no experience with HIV/AIDS. So HIV/AIDS is truly a new emerging disease.

Another emerging disease that we haven't had any experience before had much, much less of an impact than HIV/AIDS or SARS, which occurred a few years ago and then essentially burnt out by itself without needing any vaccine or therapy. Just public health measures controlled it, and then it disappeared.

Couple of examples of reemerging infections is West Nile virus. West Nile virus was a problem in the Middle East and in Africa for centuries, and then in the late 1990s it appeared in Long Island, in New York, right near Kennedy Airport, likely got -- came over either on a mosquito or a bird or a person and then started to spread by mosquito spread, and now it's endemic in the United States.

Another example of a reemerging infection is extensively or multiple drug resistant TB. TB has been around for centuries, and for many, many years was very sensitive to the drugs we used. Then all of a sudden through genetic mutations and maybe improper use of certain drugs or the improper compliance on the part of people to taking the drugs, the resistant form of tuberculosis reemerged. So that's another example of a reemerging infection.

And the typical example in our generation of deliberately released microbes is the anthrax spores that were released in letters through the postal system that resulted in 22 cases of anthrax and five deaths. So those are examples.

We will never eliminate the emergence of new infections. That's just the evolutionary capability of microbes. Microbes will never eliminate the human species, and the human species will never eliminate all pathogens. There's kind of a balance that we have. The best we can do to protect ourselves against that is to be prepared and use the tools of biomedical research and public health for surveillance and moving quickly when we do see the emergence of a new infection, like HIV/AIDS or SARS or multiple drug-resistant diseases.

Mr. Romeo: Great. Dr. Fauci, an unfortunate reality of today's world is that biological weapons in the possession of a hostile state or terrorists are among the greatest security challenges to the United States. Have you been involved with efforts to combat bioterrorism, and what's gone into the development of effective medical countermeasures to mitigate illness, suffering and death?

Dr. Fauci: The NIH and NIAID has been very actively involved in the work to counter the possibility of there being deliberately released microbes. We look upon a deliberately released microbe as one of the spectrum of emerging and reemerging infectious diseases. Nature will likely be the worst bioterrorist because what nature gives us very often spreads very efficiently.

Deliberately released microbes are handled, or the defense against them, the preparation, the public health and biomedical research preparation against these, is extraordinarily similar to what we do to prepare against a naturally emerging infection: good surveillance; good diagnostics; molecular capability to identify what it is; the developing of new classes of anti-microbials; anti-virals or what have you; the development of different platforms for vaccines so that we can make a vaccine rather rapidly.

We have done that and continue to do that with diseases and microbes that we know have a threat because of history. For example, the Soviet Union was stockpiling anthrax and smallpox and many other hemorrhagic fevers. So we have programs now that developed. They've dismantled them, but that doesn't mean that other terrorists would not be doing them. So we have countermeasures in the form of vaccines, diagnostics and therapeutics.

Mr. Romeo: Could you tell us about NIAID's efforts in strengthening the physical as well as the intellectual infrastructure necessary to translate basic research discoveries into effective prevention and treatment strategies? Specifically, how does strengthening and expanding the national network of vaccine and treatment evaluation networks and the establishment of six centers of excellence for influenza research and surveillance factor into this effort?

Dr. Fauci: Well, I think you used the right words. There's physical and there's intellectual infrastructure. We have networks for HIV prevention, for HIV therapy, for HIV vaccine. We have a -- vaccine and treatment evaluation units for other viruses and other microbes, particularly influenza. We have a variety of networks for emerging and reemerging infectious diseases. So you have to have the physical infrastructure, the equipment, and the resources to go into combating these emerging and reemerging infections.

But importantly, as important as the physical infrastructure is the intellectual infrastructure. You have to keep training new, young people to get involved in the field. We've got to keep a pipeline of people who have new ideas. Young people have a lot of great ideas that people who are experienced are -- may be able to recognize them as good ideas, but there's something about getting fresh, new blood into a field that is very healthy for the field. So we've got to continue to train people and continue to support the biomedical research endeavor with resources.

Mr. Romeo: Autoimmune disease, allergic diseases, asthma and other immune-mediated disorders are significant causes of chronic disease and disability in our country. Could you tell us about NIAID's research efforts in immunology and immune-mediated diseases? What are some of the advances in our understanding of the mechanics underlying these diseases and in the development of strategies to detect, prevent, and treat them?

Dr. Fauci: I think the answer to that question relates very much to the relationship between fundamental, basic research and the application of that research. The NIAID is responsible in large part -- not exclusively, but in large part, with studying the intricacies of the immune system. And the immune system is the body's protective mechanism, which, when it works right -- it protects you against infections, against certain cancers, against outside threats.

When it goes awry, then you get immune-mediated diseases, the most common of which are hypersensitivity diseases or auto-immune diseases in which the body's immune system starts to attack its own tissues. We see that with rheumatological diseases, like rheumatoid arthritis, systemic lupus erythematosus. We see it in transplantation rejection. We see it in asthma when you respond to an outside antigen in a very inappropriate manner that causes inflammation and sometimes symptoms and damage to tissues.

We at NIAID study the intricacies of the immune system, particularly how the immune system is regulated. Once you know how it's regulated, then you can develop interventions in the form of drugs to modulate that to treat and prevent diseases that are of immune-mediated nature.

Mr. Morales: Going back to vaccinology, how has the application of new scientific breakthroughs, such as biotechnology of genomics, transformed the way vaccinology is performed, and to what extent does the health information technology assist in these efforts?

Dr. Fauci: Well, we have seen over the past few decades an explosion in the technology of genomics. Our ability to sequence microbes years ago, not too many years ago -- to sequence a single microbe would often take a year or so. We can do it in hours now, less than a day.

So you can have a library of information, and that's -- you get genomics and then you get informatics and then proteomics, and you could do all kinds of things, words that people are not used to hearing, which means that in a very rapid fashion you can get the molecular makeup of a microbe. You can understand the vulnerable points in the gene of that microbe that codes specific proteins that's responsible for pathogenesis, things that are susceptible to therapeutic intervention, areas of the genome, that code for proteins that are important for vaccines.

So the genomic revolution has had a major positive impact on our ability to develop vaccines.

Mr. Morales: So what is the value of pursuing this type of research within a collaborative framework or would the traditional investigator-initiated mechanisms work just as well or possibly even better?

Dr. Fauci: Well, investigative initiated mechanisms are critical to advancing science. The new idea -- once the new idea comes, very often because of the advances in technology, you need what's called big science, teams of people with different areas of expertise working together for the completion of a product. That product could be a drug. It could be a vaccine. It could be anything that is helpful to the health of mankind.

But we will never be able to do without the light bulb going off in someone's head about a particular idea, and that's what we call the investigator initiated approach. But that can work in a very synergistic way with the -- what we call bigger science, or collaborative science.

Mr. Morales: What does the future hold for The National Institute of Allergy and Infectious Diseases? We will ask Dr. Anthony Fauci, its director, to share with us when the conversation about health care continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to our final segment of The Business of Government Hour. I'm your host, Albert Morales, and today's conversation is with Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Diseases. Also joining us today from IBM is Tom Romeo.

Mr. Morales: Dr. Fauci, with all of the investments that we've discussed today, what are some of the steps to help ensure we are getting value from the public dollars being put into this research?

Dr. Fauci: What we need to do is to concentrate on what we call an attention to the translational aspect of research. And we're doing that much more than we used to do decades ago, and that is you make a basic scientific discovery and you just don't leave it there. You translate it to a meaningful advantage to human health. So we're seeing a lot now of collaboration with industry, with public/private partnerships, with the development of biotechnology firms that would take a fundamental breakthrough concept and make it into something that is beneficial for human health. And that's happening much, much more now than it had like 30, 40 years ago.

Mr. Romeo: So following onto that, you've mentioned partnership and collaboration numerous times in our conversation. Could you tell us a little bit more about the international and interagency partnerships that NIAID uses?

Dr. Fauci: Well, that's a good question, and the NIAID continually has good interagency -- within the government -- collaborations. For example, we -- particularly the Infectious Institute that I direct is very closely collaborative with the Centers for Disease Control and Prevention, the CDC. We have good collaborations with the Food and Drug Administration because we tend to make discoveries that hopefully will wind up as a product, like a vaccine or a drug. We have very good collaborations the Department of Defense and the State Department, because a lot of our work is international and the Department of Defense is interested, as is the State Department, in what goes on globally.

So for an interagency, intra-government collaboration, there's plenty of that. We also have very strong collaborations with industry. We will not have products that are beneficial to the human health if it was not for the industry, the pharmaceutical industry, the industry -- biotechnology, industry that makes diagnostics. So it is very important to the fulfillment of our mission that we have very strong collaboration with these entities, and we have.

Mr. Morales: So I'd like to transition to the future now. You've been a leader in vaccinology for quite some time. Could you share with us your vision of the future in this area, and what are some of the key insights that you'd like our listeners to take away from this conversation?

Dr. Fauci: Yes, I think the future of vaccinology is very bright because the technicological advances, particularly in the arena of genomics and the spinoffs of genomics will give us the opportunity to develop vaccines not only against important infectious diseases -- I mean, if you look at the three big global killers right now in certain countries in the developing world, more than 50 percent of the people in a particular society die either of HIV/AIDS, tuberculosis, or malaria. We don't have vaccines against any of those three great killers.

We also have a number of other infections that we need to develop vaccines against, and there are even non-infectious diseases, such as certain cancers, where there's a very important effort to try and develop vaccines. So the future of vaccinology is challenged by a lot of important goals that we need to fulfill. That's the sobering part of that, that they're very important and serious challenges.

The good news is that the technology that we're involved with right now is opening up doors for us that we never imagined would've been opened years ago.

Mr. Morales: So we're catching up. (laughs)

Dr. Fauci: We are indeed.

Mr. Morales: That's great. So you're a phenomenal spokesperson, and in this conversation we've used a lot of big words that would confuse most people. I'm interested -- what's your strategy in explaining science to laypeople, and to what extent do some of these new social networking technologies assist you in getting some of this message out?

Dr. Fauci: Well, I -- the rules that I use when I talk to the public about science is don't try to impress anybody with how smart you are. Just try -- just be clear. (laughs)

Mr. Morales: (laughs)

Dr. Fauci: People really need to understand what it is that you're talking about. So speak in common, plain English. Don't beat around the bush. Say what it is that you want to say. And if it requires an explanation, make it brief and make it clear and make it accurate. So I use the terminologies precision of thought and economy of expression. Know what it is that you want to say, and say it in as few words as possible.

Mr. Morales: Now, last year you were honored with the Presidential Medal of Freedom. So I'm curious, what advice would you give to someone out there who perhaps is thinking about a career in medicine or perhaps a career I public service, or maybe both?

Dr. Fauci: Well, my advice to a person is that you need to do what feels good for you, and you should at least give a consideration for and think about the possibility of biomedical sciences in the form of something related to health, either as a physician, or as a physician-scientist, or as a pure scientist, because the rewards of doing something in a public service way for mankind -- you can't pay enough for that. That's a feeling that is a very, very wonderful, sustaining feeling about feeling good about yourself.

So if there's any possibility that a young person is interested in pursuing a career in this particular area, namely health, I strongly encourage that person to at least pursue and investigate whether or not that is something that you really want to do with yourself. It's not for everyone, and I don't think that if you don't do it that there's something (laughs) wrong with you. But if you have any inkling or tendency to want to do that, you should at least pursue it and see if it's for you.

Mr. Morales: That's a wonderful perspective. Thanks. Unfortunately, we have run out of time. I want to thank you for fitting us into your busy schedule today, but more importantly, Tom and I would like to thank you for your dedicated service to our country, both as a physician, a researcher, and as a public servant.

Dr. Fauci: Thank you. Thank you very much. It was very good to be here.

Mr. Morales: This has been The Business of Government Hour featuring a conversation with Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Diseases. My co-host has been Tom Romeo, IBM's public sector, general government industry leader.

As you enjoy the rest of your day, please take time to remember the men and women of our armed and civil services abroad who may not be able to hear this morning's show on how we're improving their government, but who deserve our unconditional respect and support.

For The Business of Government Hour, I'm Albert Morales. Thank you for listening.

Announcer: This has been The Business of Government Hour. Be sure to join us every Saturday at 9:00 a.m. And visit us on the web at businessofgovernment.org. There you can learn more about our programs, and get a transcript of today's conversation. Until next week, it's businessofgovernment.org.

Anthony Fauci Interview
04/26/2010
Dr. Fauci was appointed Director of NIAID in 1984.

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