the republicans have some problems but i think it will come down to, besides georgia and pat robertson kansas, it will be those four democratic seats in purple states, kay hagan in north carolina, jeanne shaheen in new hampshire, mark udall in colorado, and the open seat in iowa. we think there is about a 60% chance that republicans get the majority. keep in mind, there are close races. don't be stunned of democrats held onto their majority but the odds are pretty good that republicans will. for the first time in my life, i have done first you are actually done this in 10 minutes and 30 seconds over. inc. you all very much. from thee picture center for strategic and international studies. this afternoon, health officials

will discuss progress made in the work to combat hiv. one of the speakers is dr. anthony felty, the head of the allergy and infectious diseases department. it should get underway shortly here on c-span.

>> once again, we are waiting for the start of a program of health officials working to combat hiv. we would hear from dr. anthony fauci, the head of the national of allergies and

infectious diseases. in the meantime, the city press in africa is reporting that preparatory work is well underway to license an hiv vaccine in south africa. if all goes well, the follow-up trials are set to begin january, 2017, and could be used for general use by 2019. this was revealed by glenda gray at the hiv research for prevention conference that is taking place in cape town.

>> waiting for the start of this gathering of health officials, a discussion on progress made in creating a vaccine to combat hiv. all of the panelist, we understand, are in the room to ,y clipping dr. anthony fauci head of the national institute for allergies and infectious diseases. as is hosted by the center for international -- for strategic

and international studies. it should get underway in just a moment. >> while we're waiting for this discussion on progress made and creating a vaccine for hiv, we will go for -- go to this morning's washington journal about the midterm elections. host: miss taylor, good morning.

as it stands right now, give us your condition of the u.s. senate after tonight and tell us what factors into that thinking. >> a recurrent series of meetings focused upon technologies and their evolution and new opportunities and new tools that can be quite important in a number of different areas of global health. this is a terrific way to kick this effort off. it is really the brainchild of my close friend and colleague, todd summers. thank you, todd, for bringing this together and getting us rolling. and i want to thank our colleague who has worked very hard to pull all the pieces together.

welcome, and i will turn the floor over to todd and we will get on our way. >> thanks, steve, and welcome to many of the new digs here. .e are really happy to be here many of us in the room have been working on hiv for some time. -- like me, is past it is past my third decade and we want to move onto something else. we hope for an end to this epidemic. hiveally wanted to focus on vaccines and give you a sense of where we are in the research pipeline, what it is you are likely to see, when you will see it, and what it will look like. -- thet are the impotent potential impact it will have on the epidemic. happy to starty

this off with dr. tony fauci, who many of you know is head of iaid and has been a stalwart champion of vaccine research, among many of the other responsibilities he has leading our nation's hiv research agenda. grouchy -- dr. fauci, thank you very much for coming here. i am on the board ofavac, so a bit of a conflict of interest there. margie mcglynn is here with us. she runs the international aids vaccine initiative. it is one of the project -- product development partnerships that is focused on bringing together multiple sets of actors to accelerate the development of an hiv vaccine.

it will be a great opportunity to hear from her and what she sees in her perspective. we will have about 30 minutes ar dr. fauci to give us presentation, plenary talk, and the mobile moved to mitchell war and for about -- mitchell war in for about 10 minutes, and then margie mcglynn for about 10 minutes as well. and then we'll open it up to the panel for you to engage them in questions and answers. i will moderate that. it is a good chance for you to engage with them on discussions around where we are with hiv research and how it fits in. dr. fauci, over to you. thank you again for coming. [applause] >> so i can advance my own slide? there you go. thank you. thank you very much, todd. it's a real pleasure to be here with you today.

i will talk about the issue of the role of an hiv vaccine. i want to start off by putting ofo perspective the concept why we really do need an hiv vaccine, despite the -- the spectacular successes and really historic successes that we've had in the last several years in the arenas of both treatment and prevention. let's take a look at the background and then i will get into the nitty-gritty about where you are with a vaccine. you are aware of the most recent aiders from unh -- u.n. that keeps it on a shortlist, less than a handful of pandemic that our so the location has had to face. showing 39ning -- 78 million

infections, 30 mind million deaths, 359 million million people living with hiv, .nd 1.5 million it is getting better, i would say, but it is still something that is very difficult to accept. we have 1.1 million people living with hiv, and importantly, about 16% to 18% don't know that they are infected. we've had over 600,000 deaths. the number that keeps bothering me for decades is that there are approximately 50,000 new , fortions every year decades. that is the most unacceptable statistics that after all of our prevention modalities -- and it is a good example of the disparity in our society, because 12% of our society is african-american, and 50% of new infections are among african-americans, mostly gay

african-american men. use,, it is a disease of but i don't want to get into that right now, because i want to move on. decades of on extraordinary accomplishments in science. i could spend half an hour on each of these here. the ones that really come to mind are those extraordinary advances in treatment, which started off if you think of the history -- todd was mentioning that he was involved in the very beginning. i began with hiv a week and a onf after the wmmr came out june 5. i've been doing it ever since. it was a time when we did not know anything, i mean, what the virus was to now over the years developing treatments to where we have more than 30 fda which haveugs, completely transformed the lives of hiv-infected individuals. we are at the point where we can outht now say with

putgeration that if you can someone on antiretrovirals relatively early in the course of their infection and they stay on their drug, let's say, a 25-year-old hiv-infected man or woman, you could look them in the eye as i do when i see them in my clinic three times a week and tell them that if they stay on their drug, they will project -- you can project that they will live an additional 55 years. it is one of the most extraordinary competence in biomedical research and translation. now we have implantation in lower middle -- lower and middle through fundses and philanthropies to the point that when i first went -- not the first time, but when i was sent to africa by president bush to try to scope out the pep for -- have far program, they were less than 13% receiving therapy.

there are 13.6 million deaths averted little willie -- globally since 1995. we have a bunch of combination preventions. some are really easy that we knew about even before we knew it was hiv. and is, condom use, needle syringe exchange. and now we have medically related interventions like circumcision, mother to child transmission, microbial prophylaxis, and a very important treatment as prevention, which can prevent them more than 95% to transmitted to another individual. , startings us to talk a couple of years ago at the aids conference here in washington, d.c. and when hillary clinton came to the nah -- nih a few months before.

we can talk about a world without aids. i guess, when you say that, given everything we have, one can ask yourself why do we really need a vaccine? i will tell you why. let's take a look at the current , whether it is essential, and what the pathway is. the current status, the projection in the absence of an hiv vaccine, you can do -- and ical models always worry about mathematical models. i'm in the middle of an ebola mathematical model that is not helping out very much, but that's another story. i'm sure steve will think of another session to discuss that. but the projection is that if , we have about 35% decrease since 2005 in d eaths. and when you look at the new infections, it's about 38%

decrease since 2001. that is pretty good. if you look at the mathematical model, depends on how much you implement what we already have. let's say, we don't have a vaccine and we take all the things that i put on the preventions lied and every thing i told you about treatment. really to blue to green means how you increase the implementation of these modalities. if you really put a full-court press on and pep far get funded the way it should and the global fund does what it's supposed to do, you can actually see that implementation. , is a vaccineay essential to the aids pandemic accor i wrote an article about this in february of this year, of 2014. a little bit about some of the things that i mentioned in the new zealand journal of medicine article. the reason i believe it is necessary is that if you look at some of the challenges that we hiv aidst ending the

pandemic in the absence of a vaccine, you have to look at the reality that despite all of these great results, there's a thing called the care continuum. i don't want to spend time, because i've spoken to similar audiences about that. we don't do very well and when access to the system, retention in the system, and adherence to therapy. and when you look at the country, we are doing really badly about the number of people who are hiv-infected and the percentage of those who are in the health-care system that stay in the system, get on therapy, stay on therapy, and drop their viral load to the point where they do not infect anybody else. we have a long way to go, even though we are doing very well. then there is the social and cultural barrier. i could spend a lot of time on that, but i won't. such as the lag of

implementation. one example is circumcision. circumcision now, if you look at the numbers, it started off at effective and5% long-term follow-up, it's about 73% effective. i cannot imagine if i had a vaccine that was 73% effective. we would be celebrating it on the front page of the new york times. and yet, we don't implement it very well. there is also stigma. that. know about the legal impediments, homosexuality being illegal in a large number of countries, which is just mind-boggling when you think about that. there are a lot of things that are impeding our ability to get --ending the hiv aids hiv-aids. the other with thing that is apparent to everybody, that is, the whole idea of human nature and recidivism. again, becauses i've shown it before, because it's a great example of when you are interested in infectious diseases that seem to go away

and then do not. malaria is one. the measure of malaria parasite providence -- prevalence in 1983,ar from 1957 to there was a program where there -- indoor residual strain spraying that reduced the parasite from 76% to less than 5%. the officials involved in their great wisdom decided they were done with malaria and zanzibar, so they stopped. then look what happened to the curve. it went right back. one of the things that i'm concerned about is this mathematical model that we always talk about. i'm afraid that even the best of circumstances, if you just take the green line that goes down, and i say 2000? 2000 with a question mark because i'm afraid to say.

when you start with a low level of infection in the numbers look good, i'm afraid we will have a rebound. my conclusion is that the only way to durably control and end the aids epidemic is to end the vaccine -- is to have a vaccine. i think we can do an incredible but ifwithout it, you really want to nail it, then you need to have a vaccine. let's talk about the effective path of a vaccine. i break it up into three parts -- years of disappointments and unexpected success and the way forward. the years of disappointments i can relate to. cliff lane and i actually did the first vaccine trial in 1987 with agp 167 unit candidate. with a gp 160 sub unit candidate.

if you vaccinate somebody with an envelope of teen -- envelope they will be resistant to infection. but hiv is smarter than that. the history is truly one of frustrations. first, we started off with the b-cell approach. wrong, because the body doesn't like to make neutralizing antibodies against hiv. and as i'm bored to show you in a minute, less than 20% or so make it, and they usually do it after one or two years of infection, when it's too late. and virus.ue microbe no other virus axis wake. -- no other virus acts this way. .bola is terrible but you make a good response in the room -- a good immune response and it's clear.

-- wouldt be the case that were the case with hiv. we didn't. trials, we did trials -- we did trials and trials with vectors. it's available both of them. there was no protection. ofn the field got a sort lapsing confidence and said, we can't prevent infection. let's try to at least suppress viral replication. so they switched to a t-cell vaccine, which nobody imagined would prevent infection, but it might suppress viral load. that did not work either. in fact, one of the studies showed that it actually made the visuals more susceptible to individuals made more susceptible to infection once they were vaccinated. i use the example of why we should not be distributing and ebola vaccine before would prove that it actually worse, because we might wind up making people worse. but again, that is another

story. ok, unexpected success. you've got to get lucky sometimes. we did an impure trial of a poxvirus vector with an insert --a bunch of viral moments viral components followed by a protein boost, and that is what 44, or theer to as rv1 now famous thailand trial, which showed a 31% efficacy. that is not ready for prime time, but it was a very important study. it was important, because it is that asove the concept marginal as it is, you can actually prevent infection with a vaccine. it was an enormous proof of concept. what are we going to do that? it is very interesting, because for those of you who are not involved in following this -- i don't expect anybody to follow it that closely -- but it was an

interesting fundamental philosophy of how you approach a vaccine. that is when i get to the last thing, the way forward. doingabout what we are over the next several years as two major buckets. approach, and44 the other is a-based vaccine design, or trying to develop a broadly neutralizing antibody. the cousin we found something very interesting with the rv144. blowupproach, this is a -- if you look at the bottom of the slide, i blew it up. .hat is the hiv envelope trimer that is the antigen that you want to use. and if you really want to get into controlling antibodies, you've got to prevent -- present the trimer in its stable form to the body so it can see it. but we were not that sophisticated ears ago.

what we did is we took a monomer of that trimer -- again, trimer means three components. you pull one out and in. klee injected it into -- and you him. iricallyimpur injected it into people and we found out that among those 31% who were infected, they had an immune response against a particular epitope that was in v2 region of the envelope. that means it's one of the parts of the envelope. the changes from strangest rain. we identified the anybody, and then only by extrapolating saywards that -- did we that is the site that you really want to make an antibody against. we threw it in and said, ok, that is the immune corollary.

now what do you do? is 31%e something that effective. you say, let's amplify it. and you amplify it by increasing the strength of the response, namely how much antibody you make. theincrease the breadth of response. can it be broadly against multiple strains? and you increase the durability. does it last for a year or two, or maybe three or four? kept goinge of rv144 down as you got further from the vaccination. and you do that by sticking with the products, but now doing multiple boosts, modifying the vectors, and adding attachments. ns.agime you are not changing the concept. you just want to do better than you did it before. and what we're doing now on

africa is we are working to find out if we have done anything different between those in thailand and those in africa. in the thailand city, if you vaccinate them with a similar you vaccinate the africans with a similar regimen thai, it reacts similarly. which leads us in parallel -- you know, the title of the slide is "alternative strategies and ," and that iss structure-based vaccine design, namely trying to develop neutral antibodies. let me rip you what i said before. the first time we took an envelope, we had no idea what we were looking for in their -- in the immune response. but we injected it and found out what it was and said, let's

amplify that immune response. and you structure-based vaccine design, it's exactly the opposite. and let me explain. this is the trimer again. you go to a whole bunch of hiv-infected individuals and you they are making broadly neutralizing antibodies. and if so, to what are they making it against? as opposed to throwing it in and finding out. if you take these individuals, these 20% of individuals who make rod neutralizing antibodies and you clone -- who make broad neutralizing antibodies and you , you canse cells identify five parts of the trimer that are actually the targets of neutralizing antibodies. now we know what we want to induce. -- andare taking that those are the antibodies.

those squiggly things. .nd they have names and numbers now the antibodies recognize the .pitopes so the challenge now is to take those epitopes on the trimer and present it to the body in a way that makes the antibodies that we know are neutralizing. in other words, we are saying, here is what i want you to make a response to, instead of take this and who knows what you will make a response to. that is called structure-based vaccine design, to get a neutralizing antibody. and when you do that, you have to understand what is called b-cell lineage. in other words, can you cope the b cells -- coaxed the b cells to do what you want them to do.

why am i throwing that out before you got out because in natural affection -- before you? he cousin natural infection, that is not happen readily. the b cells do not like to make a broadly neutralizing antibody quickly. how do we know that? is 20% of people do it and it takes them two years to do it. and --ot to maybe fully fool the immune system. how do you do that? there was a study that was reported by a collie, a fellow named bart haynes, who many years ago was a fellow in my laboratory at nih and he's now at duke. he followed someone who was infected and they knew they were infected really early. so what he did, he followed the evolution of the antibody mutation with the evolution of the virus mutation.

if i had a pointer, i could go through that. but look at my attack in with my hands italian backwards -- background and i will tell you. [laughter] the antibodies come in and the virus makes a response. againmutates and mutates and the antibody keeps following that mutation to the point where it is such a great antibody that it is now broadly neutralizing. the only trouble is, it's too late for the patient, because they already have so much virus. the neutralizing antibody is not going to do anything. but what it told us is that if you selectively present to the b cell a changing, evolving, immunogen, you can actually coaxed it to make a broadly neutralizing antibody. and that is exactly what the philosophy and the strategy is right now.

this is natural infection. and on the bottom, to get an and that is the trimer i'm showing -- to vaccinate someone over a time frame, maybe to boost or three booths to get a neutralizing antibody. those are the two fundamental approaches that will be taken. one, capitalized on the fauci -- on the rv144 with the results of your peers is him -- of pure impiricism. and the other is the opposite of that. it is totally structurally-based and planned. we know that t cells are important not only in suppressing virus after infection, but this is a complicated slide -- but if you andt off in the upper left

andelps to make cytokines also helps to kill the hiv. up theary, by scaling current prevention and treatment modalities, hiv incidences in death, i can tell you, will continue to decrease in the and numbera vaccine two, achieving a vaccine is a timely and sustained end to the hiv and aids pandemic. i have just described a clear and scientific pathway toward an hiv vaccine. and if we integrate non-vaccine with vaccine prevention modalities, then and only then do i think we can ensure the end

of the hiv-aids pandemic. and as i said in the article that was published, the only guarantee of the sustained end and to get where we want to go so that when we put up the last slide it will be a meaningful slide, namely, that we will have a world without aids. thank you. [applause] >> i think if we give laser pointers on the end of your fingers, we will all be in great shape. [laughter] avac and onen runs theheir jobs is to bring audience induces discussion -- into the discussion. one of the things we asked mitchell to do was to talk a little bit about how you generate the kind of advocates you need so that dr. fauci and

his team have adequate resources, but not getting too far ahead? we keep running on. one of the things mitchell has to do is to figure out how to get people excited enough that they keep the money flowing, but not so excited that they get ahead of our progress. [applause] >> we will see if it's magic. by magic is being introduced a board member. the harder thing is following dr. fauci. we talk about being a translation organization, scienceing very complex and competent issues into the science. field, we often see people become carp -- compartmentalized. here asrrassed to be up

the advocate for the translator, when i think dr. fauci is an advocate and a translator as much as any of us. we often forget that. if we learn anything in the 30 plus years of this epidemic, is that when these constituencies come together it is true for hiv and it is certainly true for evil as well. i will certainly try to -- four ebola as well. i will try to write in advocates response to all of that. i went back in time. years has an annual report on this and i went back seven years ago when we did a bit of a soundtrack in the research for vaccine. "we arehe least likely nowhere" by the talking heads. and in fact, if you go back to 2007, there was a sense that we were investing in working hard and making no progress. andperhaps, as we had more

more vaccine candidates out there, it seems sometimes that if you did not know we were going, any road could take you there. and there was a shooting in a lot of different places, but not quite clear where we would take it all. as i reflected back in preparing for today, what i'm struck by is what are marketable exciting time we are in right -- what a remarkably exciting time we are in right now. i guess it all depends on when you start counting come and i to starte you not counting too soon. but i think we are in one of the most exciting moments scientifically, and more broadly in terms of the vaccine and how we will get there. week, 1500 people gathered in cape town, south africa for the first ever hiv and prevention conference. i will spend a few minutes talking about why there wasn't easy as him and excitement there. i woke up on monday or tuesday morning to google celebrating

salk'ssault -- jonas 100th birthday. it just reminded me of how important and powerful vaccines are, and how transformative that is. and what would have been his 100th birthday last week is a power of a the vaccine and why no disease will be fully eliminated without one. was unfortunately not there, but he did a great visitation via video. that all ofint out these topics are catalogued and webcast. it was one of the most invigorating meetings we've had in quite some time. but it was in a context that i did want to frame a bit. in the of you may know,

last several months, we've been engaged globally in this conversation globally about the so-called 90-90-90 targets. and it's not just one target, but multiple. as you know, every aids conference and every report has a new theme, a new slogan. this one is 90-90-90. that 90% of all people should be diagnosed, that 90% should be on treatment, and that 90% of those on treatment should be virally suppressed also because we know that if people are virally suppressed, they live longer lives and they also do not transmit the virus. as you saw just before me, there is a huge challenging getting that many people tested, that many people treated, and that many people virally suppressed. of the target is no less important. and i want to highlight that is critical.

in the global community, whether you are talking u.s. epidemic or globally, we should be striving toward that. but i want to highlight that i don't think it is enough. as we talk about a global end to the academic -- the epidemic and whatever timing you are looking at, 99% suppression is fundamental. only if we complete the entire cycle there. rights --tion, human this epidemic does not end with biomedicine alone. we know that and we need to act accordingly. this is really where i think there was a lot of excitement in cape town last week, and in the field generally in aids vaccine. i will not test you with your eyes. i trust that you know everything that is there. basically, what you see are a range of different approaches that you've heard described already. the reason i put this appear,

and the reason i do challenge you to come to terms with it is that as advocates, as policymakers, as anyone working on the epidemic, to know the issues at heart to bear in terms of what is happening and -- to know the issues at heart they in terms of what is happening in the field and we can do. and i want to highlight about rv144 years ago, science is a process as everyone knows and yet we had this tantalizing result five years ago. for many in the community who desperately want an aids vaccine the question is, what happened? five years ago. where is it? but it is a huge challenge to boost that well beyond 31%. what this tries to do is lay out a series of different pathways, approach, but4 also a range of other different candidates. the bottom line is, we don't know which one of these will work. some in common nation.

the challenge is how to articulate that and get people to invest in it. if there were a single pathway forward to a single definitive act that we could invest in and get the result and move on, that would be a relatively easy equation. but it's not that at all. we want to spend a few minutes talking about money. at the end of the day, as exciting as the science is, it takes money. this is work that we've done in the last decade in partnership with others to track investments not only vaccine, but but across all biomedicine are mentioned. something doesn't look quite right in 2013. we saw a tremendous increase over the late 1990's and early 2000. and then it began to plateau and decline in the past couple of week -- couple of years. it won't surprise you that the orange bars u.s. federal government assistance, primarily through the nih, but also to the military research program that and the u.s. agency

for international development. you can see that the u.s. government is a major investor in this endeavor. and last year, about $828 million invested. that is a number that is a fascinating test people. these presentations and there are people who say, we invest $828 million and we don't have a vaccine yet? and there are other people who say, that is all we are investing? it all depends on what else you do in this world. analogy.ordinary back to the polio experience. to the or member back days of franklin delano roosevelt and his attorney collecting dimes in the march of dimes for polio. and we take great pleasure knowing that there were two polio vaccines invested in, but at its height as the money was collected, only about 10% was invested in polio vaccine research and development.

the other 90% was in public education and in care and support. i would or do -- i would argue as you think about $828 million, if you puth or not that in a global context? iney needs to be spent, and fact, increased to meet the ambitious target of treatment and prevention delivery. we cannot not invest in aids vaccine research. it really is the long-term to finally sustain the end of the epidemic. to show you the nih at the top, not surprising. and bill and linda gates foundation on that second -- and melinda gates foundation on that second line. the decline made very little difference overall. when those big nevers stay big

and stay significant in their investment -- when those numbers stay big and stay significant in their investment, -- we do need to invest in what is called p5 strategy. this is the partnership to build on. we have to chase that lead. will we do better than 31%? we don't know, but you cannot not explore that. we also have to look at a range of other ideas on that slide previously that begin to highlight there are other ideas. will they work echo we don't know -- will they work? we don't know, that is why we do the clinical trial. but all of the work around a structure-based design, around all of these broadly neutralizing antibodies that have clever codenames for what they are, each of them needs to be pursued and in quite a diderent way than we

before. how do you translate that novel idea into a vaccine candidate into a clinical trial? when you walk the halls of today, of the meetings the scientists are beyond excited. but how do you capture that into communities where the trials are still a number of years off? we need to invest in all of those. and deliver what we have today, but continue to develop the tools we need for tomorrow. that is a fairly consistent theme from what you heard before me, and undoubtedly after me. i want to hear what one other piece -- give you one other piece of information in why keeping up alive in the aids vaccine is so important. we have to keep alive this scientific promise that we have. but we have to be honest about the timeline. and there is no benefit in falsely promising that a vaccine will be licensed anytime soon.

we don't actually know. i'm always a believer in under promising and overdelivering. i think that is really important as we think about these timelines. because we have to prepare funders,ers, and prepare them for the incredibly challenging trials to come, but also prepare them to invest in the fruits of that research will we get it, and act on the positive results as we are doing with rv144. as we are doing all this were to deliver what we have today and think about the trials for tomorrow, the one other piece that i think is so very important is that the clinical trials of tomorrow will undoubtedly be more challenging than they were in the past. as hard as the science has been and as frustrating as some of the results have been, the future trials will undoubtedly become more complex, because we will be learning from the trials in south africa where we are scaling up male circumcision,

where we are providing oral preexposure prophylaxis, where we are providing microbicides. two different candidates will have the next year. and if they are positive, women will have access to those. hope when we embarked on this in late 2016 and early 2017, i hope that the incidences are going down. it may cost more money, but it is essential that we do the right thing in providing these people everything we know they can use, but still recognizing that their contribution the vaccine trial is to get us what intervention,e and that is, a vaccine. inc. you very much. [applause] -- thank you very much. [applause] >> thanks, michel. we will now hear from margie mcglynn. she spent 26 years, i believe, at merck.

one of her jobs was to leave -- leader their adverts -- was to leave their efforts on trials. it's a really great opportunity to hear from someone who has been involved in industry and has taken a moment of her life to help us on an aids vaccine. margie, thank you for coming. >> thank you, todd. to mitchell's point, it's very difficult to first follow such an esteemed scientific leader, who's also an advocate, and an esteemed advocate who also knows a lot about the science. they are terrific colleagues to work within this field. i think the task at hand calls for the best of all disciplines to step forward. lead --nization that i let's see, i don't have the

right sides appear. here we go. the organization i lead is called the international aids vaccine initiative. are familiar with partnerships. and there were anywhere between 13 to 15 depending on how you define the term, of these types of organizations that were started primarily from the mid-1990's through the early 2000 and they were started .ecause of market failures but there were some diseases especially affecting the poorest countries in the world where there were not enough incentives for commercial organizations to step forward and develop a vaccine, or to develop a treatment or a diagnostic test. a market necessarily failure. i really believe there will be a commercial market for an hiv vaccine. although the road has been difficult and different companies have invested at different times along the road. and i can tell you when you get burned by a significant investment, as certainly merck

was with it, the step trial, it causes companies to take a step back and say, ok, i'm going to wait until there's proof of concept. i think that is a good way to think about the role of an organization like iavi. how can we help facilitate the advancement of the science to there? i will talk more about that in a moment. dr.a little bit bolder than fauci. i put years down on my graph is a but a model is only as good as the assumption that goes into it. there's only one thing that we can say for -- say about this model is that it's wrong, but it's demonstrative. there are a few things i would like to point out about this model. let's look at the purple line. that is the una's s enhancedid investment framework. some of your murmur the

aids pution where un forward a modeling tool that answer the question that if we and100% enrollment modeling, what can we achieve? ids will admit this was aspirational. it was -- it's the best we can do with what we've got. by 2070, we make it down to half a million new infections a year. that is extremely optimistic, for many of the reasons dr. foutch he -- fauci went through. launch date of 2027. because i always answer the vaccine, once we have a -- if we can give you proof of concept, i can give you the

vaccine within 10 years. but proof of concept means you have a candidate that has shown the ability to prevent infection, or significantly control viral load. and i don't believe we are there yet. as we had a hint of that at the rv144 trial. but i think we can get there and the metrics will tie you that we can get there within a 10 year timeframe. -- the metrics will tell you that we can get there within a 10 year timeframe. partners,g with other we looked at alternative scenarios. happened?e green line that is, we stay at the current trend and we are funded where we are now, $19 billion a year, and we continue to have it acceptance of uptake every year? then you'd have a more significant impact of a vaccine. chances are, we will be somewhere in between. because the can do better than we are doing today and there is and strong funding support

very strong moral support throughout the world. we showed a 50% scale up scenario. on the far right, you can see the cumulative number of new infections that will be averted over this timeframe for those different scenarios. whether it is 16 million or 42 million, that is a lot of lives being saved and the huge burden of illness and the huge burden of cost being avoided. clearly, all of those -- all of us should maintain the commitment that we have, the excitement that we have for what a world without aid could look like. and as dr. fauci said, a vaccine making that happen quicker, but more importantly, sustainably. of the models i would like to show you look at other new prevention technologies. and again, the purple line shows the enhanced investment framework. we then show the down, which i think is red.

if you were to add on preexposure prophylaxis, that is, you take an uninfected individual who has a relationship with an infected themn and you prophylaxi with antiretrovirals. been problems with that for reasons i will not go into today, but a few were to overcome the objections to adopting that, in cape town last week we heard a lot of enthusiasm for purchase to be able to do that. you could see the additional the client. if you independently took the investment framework and added on treatment as prevention, that is, treating early to significantly decrease the likelihood that person will infect a partner, you could then go down to the green line, a little bit under 400000 and -- 400,000 new infections a year.

if you do all of those in combination with the approaches that were available when the investment framework was developed in 2011, you can get down to under 50,000 new and then youyear can seriously say we will bring about the end of aids and we will have an aids free generation. what does it take to do that? it takes being resolved, something you've heard so much about already. it takes sustained funding. and a comment on funding, i was looking at the chart that mitchell showed and thinking about my day that merck. once you start to move through a development cycle and start to get some really promising results, which is where i think we are with a broadly neutralizing antibodies, and certainly with the rv144 results, your spending escalates dramatically. it may go up two or three fold. the fact that we are down 15% is

weren't -- is worsened by the fact that we really should be increasing exponentially. to maketo work hard sure that story is heard. and we are ready to move forward the organization i laid was developed because global experts came together and said we really need an organization that is so late dedicated to the development of an aids vaccine that can help work with the different parties out there and ensure that happens. some european government and the gates foundation is the largest foundation donor and we have other smaller foundation donors as well. the role we try to play is what i would call the translational space. we do not have the research

expertise you would see in the public sector such as n/a a id. when those discoveries are there but we have our laboratory capabilities. we have conducted over 20 phase one trials, primarily in africa and one in india. we have an house individuals primary from industry data able to advance candidates coming from other researchers to help to turn the promising discoveries into actual vaccine candidates. we also have a clinical trials network. the primary vendor for that is usaid.

they also fund some of the product development work as well. through the network we have been able to make a lot of contributions in the at the dvr a -- epidemiology. we utilize those centers to help us gather at the centers -- samples of the hiv-positive patients to contribute to the ultimate vaccine product and of activities.on we have nine clinical trial centers in five african countries area of program to help build a greater extent the scientific leadership coming from africa to help hold the infrastructure for the next major global health threat that you merges and certainly has a lot of ancillary benefits within africa. our real goal is to get the critical concept. we are not equipped to bring a vaccine to market. as an organization we are not

equipped to do that. we will need a major farm or pharmacompany -- major or vaccine companies. pharma companies will be there. are already reviewed your advertisement in the early stages of research. primarily j&j and a little bit of lack so. i believe as we get to the proof of concept, that we will have helpated partners who will us with some massive building of manufacturing capacity that will be needed and the massive adertaking and launching program like this in over 120 countries of the world but will need it. been a long, winding road but there are other vaccines that have taken longer.

there is a chart that showed that took 40-50 years to get to market and i would like to point to the number for polio. ask the question, what if we had given up on the polio vaccine? imagine what the world would be like today. let's all move together with the result we will not give up on an hiv vaccine. we are absolutely committed it is going to happen. it is going to happen in our and it will happen well .e have the same director fortunately he is in great health and out jogging every day . any support you can provide to make sure the resolve continues will be for a good cause that we can all save on -- although a few proud of leaving to the an aids freehind, world. thank you. [applause]

thank you to our donors as well. >> >> misses a chance for you to have questions an analyst for the panelist. we look around to take questions. i would ask you give us your name and organization. one thing that came out is the stick to it of nesta attention. ness of to it attention. there is eradication of the polio virus. you have seen

spurts of energy. of congressman porter and others at the bowling of the nih budget. almost as if you paid for that later pricing the flatlining of the budget. certainly that results in the budget. how do we keep the energy going and the escalation fact that we need to see in financing in terms of political energy? >> he certainly spent a lot of time in congress and maybe you can help us understand. >> i am more desperate to hear the answer. i think part of it is capturing the success. we do have a challenge where we have the success from 2009. in enormous amount of work has happened since then. it is hard to describe.

i think we need to get better at articulating very promising things that have been happening and articulating what we need to do. hard as the science is, i do not think we should ever assume the delivery part is easier. as hard as the sciences, delivery will be harder and i think we need to prepare for that. he is seen aids prevention options already that science princess excitement. on the vaccine side, we're anticipating where we are in the specific things we should be expecting for the foreseeable future. >> no new money for anything. i only say get out there and make all of the arguments you want. there is no new money for anything, literally.

the budget has been flat. it's likely under the circumstances will stay flat. shouldes not mean you not continue to try to advocate for important things. argue money in the global fund in some respects is more important that as important because we have a scientific challenge. scientific vaccine that is still in the -- in the discovery phase as opposed to the implementation phase. not to avoid the question but we can always use more money. i am always arguing for more money. pay creaserease the of where we're going. it is no guarantee. right now we still have scientific challenges so we need to do the best we can with the

scientific challenge. when we get to the implementation, then we have to put the full court press on. the difference with polio is polio vaccine is a really easy they were very good friends of mine, but it is really easy, you just need to do it. why is it easy? 90 plus percent of people infected with polio to find. a very small percent do poorly. everyone recovers makes a beautiful immune response. all you have to do is induce it. the implementation is a problem. why haven't we eradicated polio after all of these years? it is an implementation issue. a are dealing with hiv is implementation problem.

people say why do you put so much or how come you have not put enough? i think we need to continue to push hard to make vaccine a high priority. >> i hear you say it is as much science. >> it is. you have to convince donors to continue to support it. you have engaged -- engaged in on theo put the money table. how do you make the case in the ever-changing world of washington, d.c.? rex absolutely. you need data and need to show modeling like what we showed today. especially when a lot of people think we have an hiv vaccine. interesting how we all

went back to reeducate the audience. about what to talk will the impact be? how will it affect total funding? if you look at total treatment costs for hiv estimated at 19 billion globally, as you start to see the implications of the vaccine, how does that come down? we show a little bit of that data in cape town last week. the lines start to cross. donors contributing hundreds of millions talking about national governments contributed in -- contributing hundreds of millions to help treat hiv, they have to have a long-term view if they cannot invest millions of dollars, that is what we are asking for here.

you can actually see the total treatment line come down over time. it is all about data and covering the story and getting them to realize what the implications will be if we are successful. isi am smiling because today election day and you had to worry about shareholders focused on quarterly profit. the timeline in the city is probably shorter than a quarter. the fact is this is an argument you need to keep making over and over again. why don't we open it up for questions? i want to go to the back of the room. >> i am with the american college of inventive medicine and center for naval analysis working ancestors and -- version general of the navy. fascinated by a new kind of vaccine.

how do we prepare to approach that social challenge and behavior change? people are still rather poorly trained to take the vaccine cap go >> that is a very good question and hope it is not multiple multiple. if you mine in on the science of it, you want to trigger a cell that is one that recognizes him as the taupe that will get to the maturation you want. i will try to explain it.

the higher the affinity or more power the antibody has to mind onto hiv, the more you leave all mutatee and tehhe genes until they build up a really tight affinity. we know the really good anti-bodies are highly you tatian no. the reason they are is hiv just keeps replicating and on starting the immune system. leads to anybody that is a really good one. how do you do that with the vaccine? that is the challenge. you have to be able to give it in a form that it doesn't take seven booths to get their. if it does, it may be scientifically interesting that a nonstarter and it comes to a vaccine. you try to fashion it in a way

that you need maybe one or two to get there. you have to capture the cell that only requires a couple of iterations. when you get to six and seven, it is not practical. you are right on target with your questions. >> overall effects. any other responses. couple.t we do a with john bailey hopkins. moran.ion for mr. i want to build on the analogy to polio. and ask about the legal pathway.

this goes back to the episode about he would sooner patton a son. think about the difficulties in the late 1990's with intellectual property, even though we are in this world with hepatitis c, we see significant barriers with access to the new antivirals. terms ofng about the the predevelopment partners you talked about and the conditions in terms so we can ensure the price of the vaccine is such that uptake is not limited and we do realize the promise inherent to the vaccines. start on the critical issue. we consider it a public good. we will also want to ask is

really central to the work we need to do. we do have intellectual property on any discoveries that we are involved in. we do get involved in licensing biotechnologyh companies but a clear access provision. we have margin right if they are not able to bring it to the world's poorest countries. we could in fact take that back and find a developing world manufacturer. it is quite possible the vaccine may make -- make it through the priceline that have come out of the work from various researchers involved. he said it is especially true if it does not have developed world potential. this did not prevent infection and stimulated response to

control infection. approach we were taking is how did it take approach to build capacity and you will likely find that in the south and a country like india. you can do it at a much lower cost. we have artie had discussion with much of the lower faction in the organizations. >> the one thing i would add is i described $820 million invested annually, you were not missing on this slide. from financial perspective quite

different. that is not to say they are not actively engaged in the profit. -- theeline is aced prime is based by the vaccine company. the boosters following from novartis and other large pharma companies. they are investing time and resources and opportunity and some money but the lion share is the gatesm foundation. so when it shows efficacy, we hope, the question will not only be the end for novartis but the funders. public sector in philosophical of make their it is a public could. it is probably not the original polio vaccine but we would isect given the lion share being born that there should be an equitable and very fair price for it. >> we have arrangement.

>> when we get to licensing agreement, we make sure that is part of it. can i also add points about the recent successes of coffee -- gavi. they have been able to bring a vaccine that prices under five dollars per disc for hpv vaccine and under three dollars for perists for rotavirus -- dose for rotavirus vaccine. some of the additional models we will put on the website as soon as we finalize this a bit more. we have looked at the cost regiment in the range and they cost about $30. -- king at the modeling as expert in the fourth row and we looked at whether that would hit the bars that policymakers would

consider very cost effective and low and middle income countries. if we are able to hit that mark, we had a very cost-effective regiment and those are the costs we model. rightsly we need the licensing agreement, is there is a for-profit company that gets involved. like the strategy i put in place , we had tiered pricing and that merck, no profit pricing strategy and i am proud to say being under five dollars for the hpv vaccine was because of that. other companies do not use the terminology but the lowest price theretty post to just cover manufacturing cost i believe. if there is an arrangement, a licensing deal with the manufacturer, you would expect they would set the tiered pricing. in order to take on the program to bring it into the world and the poorest countries, it has to

hit that far. , the foundererkley negotiate very hard to get those prices down as well as possible. thank you very much. i have two quick questions. first, margie, usaid as the development agency is generally interested in seeing africa lead the way. maybe you could share your vision a little bit about how it has and will engage africa and that endeavor. first, i wondered if you could mention how these an about-face -- and our bodies will be used in potential experiments having to do with passive antibody transfer. being done as proof of concept to determine what the level and breadth of what you would need when you induce it. we know if you passively

transfer antibodies you cannot only treat but prevent infection. that means you take an about-face. click you -- you phone them and make a whole bunch of anna -- antibodies and infuse them to prevent them from being infected or if they are infected, to treat. not a particularly good approach toward treatment. we have one pill of three drugs that can do it better than an about-face. it is being considered in clinical trials for prevention. if you can give it intramuscularly, you could have pretty good protection. this these that are ongoing right now, like trying to determine what level of antibodies you need to have protection, you could gauge what you need to induce the vaccine. brett, death and durability.

depth and, durability. i did not say much around preventing infection. it seems like controlling infection. >> the goal of antibody is to prevent, not control. --found to your question onto your question, i did prefer a little bit this in my talk that we've been involved in africa for 11-12 years now and have seen tremendous growth in the intellectual capacity of contributing to the science and we're really trying to build upon the momentum that has been established. our principal investigators involved in africa that are very well educated and trained professionals do not want simply to be a receptacle to the vaccine coming out of the u.s. in europe and protested

their population. they have a lot of insight and capability they can contribute to identifying the essential components of the vaccine. some of the work done at smaller scale. some of the epidemiology, infection,acute identifying immune components. very basede response upon the virus they are exposed to? we have a program going on right consultation with many of the investigators in africa and other partners that we have around the world where we are looking to build further on that, looking to place even more studies to increase , as well as to increase training, not by building a new training. we are both a lot on clinical practices, laboratory practices,

hundreds of employees as well as others that have been trained. mitchell's organization has been very involved. how can we help with postgraduate education? some of the universities that have set up the programs, how can we do that so we can further evolve the scientific career of the tablet and keep them within ?frica the last thing i will mention is for the investigators to be able to submit proposals that will be a scientific review board that will pick a most compelling proposals. they have great ideas and there are scientific experiments that within centers. that program is being launched this year as well. >> you work a lot to develop partnerships with institutions in africa and asia, trying to build skill sets.

>> this should be critically developed by the vaccine? when we started trial or or expand to south africa or uganda or southeast asia, we always do it with the intent that when they leave they will be able to do it themselves. we go in and go out but have been doing that for some years now. we have a clinical trial network both vaccine, prevention and others that is totally internationally now and southeast asia and southern africa and south america.

>> at the end of the cape town all of this has contributed to building the expertise. >> you have worked a lot to make sure civil society and the countries is also fully engaged and supportive of and holding to account the research going on. how is that going? >> it is going well. in a torrent. running clinical trials is not easy. one of the most exciting parts of the meeting last week was that it took based in south africa. that was done quite strategically. outside of the u.s. the infrastructure and the leadership coming from south africa is an herald.

. -- unheard of. the community is deeply engaged. that is surprising given when you look back at the history of up from aic, sending treatment aspect perspective. what is interesting is everyone wants to make a vaccine. that is the easy part. the challenge is how we ensure there is a responsiveness and what is happening scientifically on the ground. people want to know the research is happening but what about precision? where is the access? where is the trial? it is a question of how you really inspire and develop trust in the research enterprise at vaccines butt run how do you build the relationship so the community will support science but has expectations of what science should be able to deliver.

>> i am heidi ross. this touches upon what you were saying. what do you think the efficacy ?f this are we looking at the silver bullet or a vaccine that combined with prep or combined to the 100%?s us how do you communicate that effectively in the community who hears vaccine and thinks it is the silver bullet? that, ie you answer think several of you touch about this is about combination. that it starts to result in a high level of preventive and the -- benefit. how do you find an effective vaccine or does it get hidden behind the other interventions? >> i would love to search for a

magic bullet. if we are searching for the magic elect, we should pack up and focus on something else. i do not think there will be one. that is a realistic attitude. do know from the time trial of 31% efficacy. often thrown about as 50%. every regulatory agency would number guess.nt i think it plays out in two ways. i was saying the future clinical trials will be complicated. background ofther prevention but produced the level of new infections. vaccines will have to work harder but does not have to be perfect. the number of infections to prevent lower.

the other interesting thing is there was a presentation last week about a trial looking at a combination of micro bolt vaccines. it was from a couple of monkeys. they are always fascinating and important but not here to prevent infection in monkeys but in humans. and that a combination of microbicide with the vaccine of monkeys was shown to be much more effective. combination prevention is what we will work towards. whether it is a vaccine or introduction of 50% effective vaccine. >> 31 is not been enough.

i agree with mitchell. we know we have prevention but the issue of human nature and lack of adherence to that. highlye to pick out the population and efficacy to offer them things like microbicides. the day human nature will win over and there will be people who will get infected and hopefully you will get enough people in this ready. >> i will be a little controversial for my background introducing other vaccines and looking at the barrier to vaccine adoption.

i introduce hpv vaccine and have 100% efficacy. the common strains included in the most common out there. the insuredg at population because you either have private insurance or was covered by the vaccine for insurance program. the threet up take in dose regimen in less than 40% of teenage girls. a lot of barriers. i think we will see it in some of the developing countries as well. strive we really need to for 65-70%. i would hate to go to market was 50% effective. i think you will have all sorts of barriers put up. we also ran scenarios and i talked about the cost of effective barrier or target that you need to reach.

the policy may -- policymakers and payers, there may be a high risk population that when you just immunize that population may be 50% is good enough and combined with other approaches but i think to really get local uptake of the vaccine, widespread acceptance, we have to push the envelope. something out with more 50% but we keep working at it to get to the 75% barrier. >> lemmie tell the population that if i had a 50% vaccine i in a vaccinate them all microsecond. you go to the district of south africa and you look at pregnant women between the ages of 23 and a 44% prevalence of hiv infection.

i will take the 50% vaccine and take it so fast -- i would agree with you on that. >> one of the questions that will come out of this is who pays for all of this? long agol fund not too and got 12 billion or less than 12 billion and was trying to get 15. increases.they if you start increasing these things, how do we do that? or two we have to focus on the interim or while we're waiting to go back up, the hotspot areas? to refine these kinds of populations where the population makes more sense tried to do it everywhere at the same time? >> i disagree. that 50% is good but 50% is not good for vaccinating everyone who has some fear they

might be infected. if we get a vaccine that is 60% effective, i do not think we will have a problem in getting that paid for it to be quite honest with you. preventing an infection versus lifelong interbranch revile therapy is huge. you look at a lot of groups that will pay for that. a lot of thinking keep me up at night but that doesn't. we use the term combination prevention. it is not throwing the kitchen sink all the time. a lot of talk about hotspots. go where the epidemic is. i think we're getting much smarter in the community to figure out where we need to be

with which interventions. they are going to be different. i think we need to be clear about that. we clearly have to be more efficient. how do we take the tools again and ensure they are reaching the right people at the right time. >> hi. formally with psi. be a sneak preview of your next talk, but how has the reemergence of ebola and attendant hysteria in this country as some might call it, how does that compare to the early hiv scare in haiti, san francisco in central africa and there was not a name for it?

part two, how will you be competing with ebola on funding? you talked about flatlining funding levels and three, our there economies of scale in the field for public awareness campaigns for both conditions? >> i will take the first one. if you go back to the very early 1980's, you will have the evolution of what turned out to be an incredibly historic epidemic pandemic. not to americans have been infected with ebola, both of whom directly and to regularly -- deliberately in a self-sacrificing way care for the ebola patient. those are the only two people that have gotten infected in the

united states. >> it would've been nice back in the 1980's when i would say we have a real problem here, we probably have more infections you can possibly imagine. [applause] there is an article in the new -- there is an article in the times" and he called it epidemic of epic proportions. up the plate,ks it does have a negative déjà vu all over again field to hiv in the early days. information is really powerful though. is there an opportunity to take the attention being paid to

tola and leverage that regain the attention on the investment that lacey need to be made? i know we did some work on the global health security agenda. frankly, we got it pretty limp response from washington. a week later we had ebola. >> i try to leverage. there are interesting numbers out. they saye been now 4951 but let's say 5000 people have died from ebola since the beginning, probably more. a month or so ago it was 3000-4000. i -- when i slammed the magnitude of the problem, yesterday 41 hundred people died

of aids. yesterday 5700 people were infected. people died of aids. compare that with what is going on with ebola. i am not downgrading the concern you have about a serious disease but when you think about of magnitude and how the public to that, every single day 4100 people die of aids. you get kind of numb to that. it is not the thing that is getting people excited. when you want to really put attention on things that really need more attention, you can say take a look at this. we have an ongoing problem. i use the attention we're getting with ebola to say we're getting this attention, how about the same sort of sustained attention for other great killers?

to thee was another part question that was the ability to do public information campaigns and economies of scale where they are able to lead -- at least in terms of basic capacity building, save practices and hospitals, something that we could do that is trying to leverage information around ebola to leverage hiv risk? >> different ballgame. i think geographically we need to remember where hiv and ebola is. the three countries infected are not major hiv communities. i do want to talk about the nigerian response bolding on platforms. eighth investment in nigeria and the gates foundation in nigeria allowed them to quickly come on top of the academic. -- epidemic.

made thingsepidemic far more dramatic. separateme something that health systems matter. we know that. from omaha,y nebraska. powdered now than i ever thought i would be to watch the clinic. we are under investor there and i think it will make a big difference. having a health system that can deliver is critical. one of the reasons why the leveraging is don't say we will not invest because we have enabled outbreak. we should be doubly down on investments because it is the single best investment in the history of global public health. i think we need to be seen in that regard. mitchell, you have gave voice

to an important comment that the defense against ebola could have been incredibly explosive but was largely donor funded. from then formally sureistration, we are not -- we want to put money into ebola the coming year so stop pestering us. sure the vice president said that in response to a question and answer time in boston, which is rather unfortunate. members of congress are talking a whole lot right now about an emergency supplemental. it is important work that the dod is conducting clinics. not exactly a shortage of

funding at the moment. nonetheless, members of congress talking about putting their stamp on it. sustained members of congress says there are doing a year-long running for 300 thousand dollars after $600 million worth of cuts. not really a question. >> kind of the washington question. there is a lot of momentum around the health system. we will put our shoulder on that. as confident as you are, you can see this is a place where you start training for one thing and offer another. i what i hear you say is we need to add on top of what we are are really doing the cost of getting an hiv vaccine out and that will

be important now in terms of financing. one of the reasons we want to do the session to help people like heidi who have to go back to the hill and explain these things understand that while it will offer rate opportunity, especially in combination with other things, it will not result in a tremendous amount of savings. he will have to invest to achieve those savings. it is a hard argument in the city to make, especially when it comes to foreign aid. i know question and then we will close out for the day. great. i want to thank the panel is for coming here. thank you for leading off the series. thrill to have you here as always. thank you for having me here. thank you very much for coming and sharing with the civil society. thank you for coming. i think all of us here have some work to do. for feedback for future events like this.

if you have ideas around this technology, we are happy to hear them. we will look for e-mails for great suggestions. thank you all for coming. have a good afternoon, and don't forget to vote. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014]

>> throughout campaign 2014, c-span has brought you more than 130 candidate debates from across the country in races that will determine control of the next congress. tonight watch live election night coverage to see who wins, who loses in which party will control the house and senate. coverage begins at 8:00 eastern with results and analysis and you will see candidate victory and concession speeches and some of the most closely watched races throughout the country. throughout the night and into the morning we want to hear from andbut facebook calls tweets. campaign election coverage on c-span. has a map showing when the polls are closing around the country.

i did on our facebook and twitter pages. the first polls close at 7:00 eastern on the east coast and the last poll closes at midnight in alaska. what to expect when they start closing from this morning's "washington journal." y of virginia. how do you take tonight activities on this election day? >> well, i think the republicans are going to have a good night for a great night. we do not know whether it is good or great because there are some very close races. at the crystal ball operation the university of virginia, we go ahead and allocate all the seats. and we have the republicans likely to win 53 senate seats recounts have gone off. and democrats holding 47, as the current line. we think republicans are going

to do quite well, but there are some very close seats. whether this kansas, where i alaska -- or iowa or alaska. >> we hear a lot about paths during this process. do you see anything trending? looked ntially, we have at the polling and all the background information we can data we can ll the gather. that ve a set model presents us with the general outlines of what is likely to happen and real events. i would simply say that if you are watching the senate you obviously t, start by looking at new hampshire and north carolina. held by tes are democratic incumbents --

and tor jeanne shaheen senator kay hagan -- they are kind of the democratic firewall. been a bit ahead -- they were once well ahead, now just a bit ahead of their republican opponents. they end up falling, then indicates that there is a more republican surge than expected. and that will mean a number of senators will grow -- even beyond the 53 we have outlined. if, however, they are able to hold down the fort and able to think election, then i you're talking about more modest totals for the republicans. if the democrats are able to mobilize the vote today to a much greater extent than expected, i think the first it will really be in georgia, for example, where you race for senate -- the republicans a bit ahead,

but the possibility of a runoff. i think it might also show up in the state of kentucky where is running for reelection. i expect them to win, but you have to look at the margins. be some are going to early signs and we will all be following them together as we move across the country. >> a lot of people are looking at alaska. why is that? >> alaska is an interesting case. one term democratic senator who won by just a few thousand votes six years ago against a crippled republican opponent. it is a republican state. it is a solid republican state. they will occasionally elect a democrat. he has run a textbook campaign with only a few errors. has organized like mad -- the outlying villages -- it is a tremendous organization. he has done everything you can

do as an incumbent if he doesn't win -- it is more of a case of which direction this particular election is moving in. it is rather the general atmospherics of 2014. >> when it comes to other such as iowa -- a lot of people saying it is close -- do you see the same factors will t favor into it? >> starting out a year ago, i think that most people expected i want to stay democratic. and i what has clearly been leaning democratic, looking at the past election returns. so bruce braley was thought to have an excellent chance to win. a number of errors

on the campaign trail and i think it has cost him dearly. and the republican nominee has run a good campaign. she has projected a solid image. sides as camped on both of her self. i think she is likely to win, but it is close. the last call out of their up by polls showed her seven points. i think it is closer than that. >> and midterm level, it is rare that we have so many races that are so close? >> this is a larger than usual number of close races. i actually counts nine on the senate, 11 gubernatorial contests that are close. it is not enormously greater, though. normally in a midterm year, you have 36 gubernatorial races and easily one third will be highly competitive. that is about what we have.

senate contests -- it can be as as five and six at this stage in the campaign, but i would not call this -- i would call this more competitive than usual. you have mentioned it -- as far as gubernatorial races are concerned -- wwhat the ones to watch? other others to watch? >> i think everyone is watching florida. republican governor scott and his predecessor who became an independent, now a democrat -- that is very, very close. the latest polls given eyelash lead to charlie crist, but it is so close that i do not think the polls can point to the winner. that one would be read at the top of my list, but even

of the small states have fascinating contest. you look at maine, for instance. just like four years ago with a conservative the tea party republican -- who won four years ago aagainst two liberal opponents. well, he has to liberal opponent again. now, the structure of the race is a little bit different and to have crats seem better chances, but it is a close contest between the democrat and the incumbent. couple of other things. i know it is not a closely was hed race, but it mentioned a couple times today. they're in virginia, the senate race between mark warner and gillespie. your thoughts on that? >> we rate every senate race all through the year. we never had that as anything

other than democratic. you the margin -- maybe it is just a few points. this is a competitive year and a purple is still competitive state, but i can tell you most of the republicans at the highest level will be shocked if gillespie beats warner. i think warner will end up winning. as the crystal ball is concerned, what is your history in terms of midterm elections? >> i'm delighted to say our accuracy rate is higher than 90%. we call every race -- 98%. we call every race. we call every gubernatorial, senate, and house races. obviously, when you call all 507, you are going to be wrong sometimes. but we do it because it is fun and we think that is the fun of the process. our leadership certainly agrees

with us. >> that is larry, the director for politics at the university of virginia. also mentioning the crystal ball that takes a look at things. if people want to find out information about the crystal ball, where can they go. >> interesting to watch the .egal debates it demonstrated some of the ineptitude of the neocon proposition that in the beginning of any war the

president is the ultimate abilityof the countries to go to war. >> i would like to commend airing the information from the writers on greece and the military. it was excellent information. andave death levels international -- depth and nuance. that ptsd can climb and can be trylved if you continue to various interventions. history onamerican c-span is one of the best