following that, prime minister david cameron answers questions from the house of commons. >> this week on "q&a," our guest is dr. anthony fauci, director of the national institute of allergy and infectious diseases. he addresses the challenges involved in running at institute, and how his staff work at new disease outbreaks. he also talks about his upbringing, family, how he got into medicine, and his relationship with different presidents at the time. >> dr. anthony fauci, director of the national institute of allergy and infectious diseases, how many years? >> 30, 30 years. >> in those 30 years, did you

ever have a feeling that something was going to get away from us in one of these crises or diseases? >> not that it was going to get away from us, but it was going to be a lot more serious than anyone anticipated. when i first started seeing and taking care of hiv infected individuals, before we even knew that it was hiv, in early 1981 the winter of 1881 and 1982 -- it was very unpredictable and no one knew what was happening. i was concerned that many people in and out of government considered this just a fluke of --among gay men but the way i saw it evolve and following it it was quite scary.

unfortunately my concerns were well-founded, because it turned out to historically be today one of the most devastating historic pandemics that we have ever experienced, that sell -- that civilization has ever experienced. >> when did you first recognize this? was there an ah-ha moment? >> there was an ah-ha moment, he -- it was the summer, and the cdc puts out a weekly mortality report, which is almost a pamphlet that gives you a heads up on diseases, or an outbreak of this, and it reported on their june 5th, 1981 mmwr, five men from los angeles who presented with a very unusual kind of pneumonia that you only see in people with a very suppressed kind of immune system.

and i said, wow, why all gay men? they were supposedly completely healthy other than that. i thought it was a fluke and i put it aside. and then the next mmwr appeared on my desk at the nih, and now they said 26 men, not only from l.a., but also from san francisco and new york, have this strange pneumonia, but a strange cancer that you see with people with this immune system that is suppressed, and it was all in gay men, and i thought whoa, this is really bad. i had no idea what it was. it looked very much like it was an infectious disease. when you look at these patterns, it seems to have been spread by sexual contact, and that is when

i really had that combination of an ah-ha moment and anxiety, this is really going to be bad and i made this transforming decision of my career, i decided i was going to stop what i was doing, rather successfully for the previous nine or 10 years, and devote myself completely to studying what i felt would be an enormously difficult disease. and it unfortunately turned out that that was the case. >> i remember that people were mad at you, people in your own operation. who got mad at you for what reason, that you took gays in? >> it was accommodation, first of all in a well-meaning way, my mentor who had cultivated me in science and academics thought i was being foolish throwing away a very promising career in one area of medical research to go

after something that they thought was going to disappear this is just a fluke, it is going to go away. later on, as i began to take a leadership role, in not only the research, but when i became director of the institute of the national institute of allergy and infectious diseases in 1984, there were people that were concerned, and i would say bordering on being angry with me, it it it was clear -- that it was clear that i wanted to put more research in it. i wanted to get more government resources, i wanted more government research, and it was clear that we needed to embrace the gay community, the activists, to see what was going on in the trenches. there was a lot of resentment toward me on that, resentment on part of the scientists, because they thought i was going to divert resources away from other

areas of infectious diseases and i was arguing, i don't want diverge -- to diverge resources i want new resources. as i argued in front of the president as to why we needed more resources for the disease. so that was that area of resentment. and then the activists playing a major role in some of the decision in policy making in a research program was completely foreign and antithetical to many scientists. at the time, scientist that we do not need to involve the community, and i did not think that was a good idea because the community had a lot to offer. they were suffering from an unknown disease, the rigidity of the regulatory process as far as getting drugs approved, like experimental drugs that showed efficacy, that was all a changing paradigm and we had not experienced that before. >> we will come back to some of this, but i want to get to -- we

have seen a lot of you over the years, and i want to talk about your own background, your own life. first, when did you make a decision and why when you decided you wanted to be available to the media? there are 27 institutes at the national institutes of health, and i can maybe name one or two others, why did you decide to do that? >> it became clear to me that the particular discipline that i was dealing with, emerging infectious diseases that would generate a lot of concern on the part of the public, that could be hiv-aids, that could be pandemic flu, that could be ebola, it is clear now with the ebola crisis, it became clear that the public needed to understand just what these issues meant to them personally and to the nation and the world. and i was perplexed by seeing it

that scientists had shunned the way from trying to explain things in plain english the way that people could understand it. there was a culture back then when i first started doing it that scientist either did not want to be bothered with the press or getting involved or when they did, they spoke over people, as opposed to trying to get people to understand. i made a decision along time ago that a, it was important for the government to understand, and if you want the support of the congress and the administration, you have to be understood and you have to be in the public eye, otherwise it could just slip under the radar screen, and as it turns out, that was the truth. that was one of the reasons that much attention was paid to it. >> you have a boss? -- do you have a boss? >> in science, technically speaking, the federal branch of

the government that i am technically in, the president is technically the boss, and the department of health and human services, so the secretary is the next level of the boss, and then there is the nih where you have an nih director, so technically speaking, that is the boss. so we you are in science and public health, there is very little of that boss tells somebody to do something in that you might see in another endeavor. it is more of a collaborative discussion and an intellectual deciding what is the best direction to go in. technically someone is administratively your boss but in reality, it is more of doing the right thing and the best thing and the most appropriate thing.

>> your is the two's budget for the year is what now? >> about four and a half billion dollars. >> how many people are involved? >> about 1800. >> physically where are you located? >> bethesda, maryland. it is about five and a half miles to washington, d.c. >> the first doctor in your family was your father, he was a pharmacist. tell us about that. where were you born? >> i was born and raised in brooklyn, new york, in the benson-hearst section, which was back then and maybe even now, if you took an aerial photo, it was ethnically divided, it was the italian-american section, the irish section, the african-american section, the puerto rican section, and i was in an italian-american section called benson-hearst. my father is a first generation, his father was born in italy, he came to the united states at the

turn-of-the-century, at the turn of the 19th and 20th century and my father was raised early on in the little italy section of new york in manhattan, and moved to brooklyn, and our family was raised in brooklyn. he went to columbia university college of pharmacy and became a pharmacist, and that is what he did for all of his life. >> so that is how you got the name doc. >> yes, back then, many people called a pharmacist doc, and many people who did not have the time or not want to make an appointment, they would go to a pharmacist and explain the symptoms, but my father never overstepped his bounds. if somebody needed to see a physician, he would say go to see a physician. but sometimes he could take care of the minor ailments of that they would have. >> mom, what was your mom's

background? >> she went to hunter college in new york city -- she went to hunter college in new york city, she got married very early interestingly, my mom and my dad got married right out of high school, and as soon as they had, as soon as my mother gave birth to my sister who is three years older than i, and me, she became a homemaker for her full life. >> the jesuits taught you, high school, holy cross, in manhattan, what does it mean to be talked --taught by jesuits? we hear about jazz with all the -- about jesuits all the time. >> it is great, they complain intellectualism with discipline. not smacking you are around, but intellectual rigor and how you

handle yourself as a person and a human being. i think they had a major influence on me and what i did. it does not mean that people who don't go into public service are doing anything lesser with their lives, but they tend to have, i would not say a pushing, but a leaning towards something about what you do is towards public service. what i did going into public service, or at least a part of my life, but it was an interesting combination of concern for mankind as well as a good intellectual rigor. >> when did you want to be a doctor, can you remember the time? >> i think it was early high school. i am very interested in people. i am very much of a people person. it is part of the jesuit

training, very steeped in classics and humanities. so when i went to jesuit high school, we took four years of green and four years of latin, and romance languages and agent -- ancient history, and the holy cross, which is another jesuit school, it is a college, i took a kind of hybrid, premed course, it was called, almost an oxymoron, ab greek-classic premed. you took enough science to get into medical school, and the idea about when i wanted to become a doctor, i liked science, i liked discovery, i liked the challenges of science, but i also so much liked mankind and the humanities that it was just a natural fit. where do you put science and people in the same bucket? to me that was medicine. >> who was an early mentor?

>> probably some of the very young jesuits in regis high school. in the jesuit training it is a , long, long training before you become a jesuit priest. so you would have people called scholastics, who were not priests, but they dressed as priests, and they were highly intellectual and highly nurturing of what you wanted to do. >> you did an interview with "science" magazine back in 2003, and they said "dr. anthony fauci works 14 hours a day, jogs for

lunch, eat dinner with his family after 9:00, and continues working until bedtime where he sleeps for four and a half hours." how much of that is true? >> i say that it still is, fortunately or unfortunately, i don't do it as a drag i do it , because i like it and i am energized by what i am doing. fortunately, likely through the creativity of the tolerance of my wife, who also works at the nih and is the chair of one of the departments there, the department of clinical bioethics, that we erase -- we arrange our schedule when we were growing -- when our kids were growing up, that it is not particularly difficult to eat dinner very late at night to read i preach that two people. the only way that we could be as a family every single day is when i could come home at a quarter to 9:00 or 9:00, and my children would get out at 3:00 and most of them would play

sports, they would have a snack, and they would wait, and then i would come home and we would have dinner together, and they would either study or go to bed, and then i would go into my office and work until midnight and they go to bed and get up at 5:00. my eldest is 28 and she is a phd student in clinical psychology at boston college, she graduated from harvard and taught in the inner-city minority areas in new york city and in washington, d.c. and went for further graduate training, and now she is in a phd program. my middle daughter is 25, and she is a first-year medical student at the university of pennsylvania, and my youngest just graduated from stanford as a computer scientist, and she is working in san francisco for twitter. so she is a computer geek! >> please tell us the story of meeting your wife. [laughter]

>> well, i had been at the nih for about 10 years or so, and i just happened to have made a trip to china for a meeting, for a scientific meeting. while i was away, the nih began the beginning -- the nih hired a nurse who was a clinical nurse specialist. my wife started off as a nurse before she got her phd in ethics. she came to the nih and i did not even know she was a new nurse because i was away for that week. and one of my new patients was a person from brazil who only spoke portuguese. and my wife had just come back a few months earlier from two years with project hope in brazil, and she was totally fluent in portuguese. so as i was talking to the patient, i wanted to tell the

patient to go home, they had to go rest, they could not do activities, he was just recuperating. and i told him that i needed somebody to translate. and there was this new nurse who just came back from brazil, she can translate. so i told her that he needs to do a, b, c, d, and e. she spoke to him in portuguese and i found out later that he told her to tell the dock that there -- doc that there was no way that i was good to do that i am going to go to the copacabana, and she was horrified and she did not want to say that, so she turned to me and said he said fine, he is going to do that. i did not know, i believed her. and when i looked at her, she was a very attractive young nurse and i thought she was very interesting, i was single, so i went back to my office and a few days later, i told the head

nurse, could you tell that nurse, miss grady, to come to my office because i want to talk to her? she thought she was going to get fired because she thought i had found out that she had misled me about the patient, so she went to my office completely petrified that she was in trouble, and she sat there looking very nervous, i could not figure out why she was nervous. so i look to her and said, you know, i did not realize that you had come here until last week, would you like to go out for dinner sometime? she about fell right to the chair, and she said of course i will. [laughter] and we got married a year later. >> in the same interview, they asked you the question in the "science" interview, are you a man of faith? let me read you what you just said. "broadly and generically, i am not a regular church attendance. -- church attender.

i have evolved and left the roman catholic religion to someone who tries to keep a degree of spirituality about them. i look at myself as a humanist and i have faith in mankind." is that accurate? >> totally accurate. >> what is that say about the jesuits? did they talk you out of the church? >> no, but they are more aligned with my principles of humanity and doing the best that you can't. i think that there are a lot of things about organized religion that are unfortunate, and i tend to like to stay away from that and think more in terms of the principles that i learned from the jesuits, from the catholic religions, the principles that i run my life by. but the idea about the organization of religion is not something that i is hereto very -- that i adhere to very much. >> the national institute of allergy and infectious diseases

is responsible, what is the broad scope for it what are those 1800 people doing? >> they are planning and researching all infectious diseases as well as certain diseases like autoimmune diseases. >> what is an infectious disease? >> and infectious disease is one that is caused by a microbe that is transmissible. we know that hiv is caused by the virus hiv, influenza is a virus that is every year for current, and sometimes you get a pandemic that is very serious, malaria, tuberculosis, childhood diseases, respiratory diseases sexually-transmitted diseases. all diseases that are caused by a microbe that hopefully you can

prevent or treat. >> let me ask you a question what is a microbe? >> it is an organism that has an ability to replicate and transfer from one person to another, so bacteria can live more freely, viruses need to get into a cell to live. >> so as we look into the world as an outsider generalist and we see the cdc, you see your institution, the nih, who is in charge? >> no one needs to be in charge. each has their own goal. take the department of health and human services. the three most commonly recognized organizations that have to do with health and research are the cdc, the nih, and the fda. the cdc are the disease detectors, they tracked down new

diseases, they are very active with the ebola outbreak right now in west africa, they are very active when you have a flu season or an outbreak of west nile fever. the nih is pure research. so when there is a disease, what we do at my institute when you are thinking about infectious disease, is we understand how that disease evolves, we develop drugs, we develop vaccines, we do prevention modality. we do the research that allows you to intervene. the fda is the regulatory agency. they monitor drugs and interventions, and that is within our own government. when you go globally, the who is kind of like a global cdc, what the cdc is for us. they sort of coordinate health globally throughout the various nations.

>> let me show you some video that you probably have not seen for a long time. this goes back to 1998, it is very quick. it is from the debate with george herbert walker bush. >> there is nothing corny with having sports heroes, they are out there setting the pace. i think of dr. fauci, you will probably never heard of him. he is a fine researcher, a top doctor at the national institutes of health. he is working hard on aids. >> that is 1988. do you remember that? >> yes i do. >> what do think about that? >> i did not see the debate, i was out of town coming in on a plane. and when i walked into the

lobby at the nih people started , clapping like this. [laughter] i said, what is this all about? they said, what do you mean what is this all about? the president called you a hero. i was totally surprised. >> did you know him? >> oh well, very well. i had the great privilege of getting to know president george h w bush from the time that he was vice president and when he was getting ready to run for president, he wanted to know about the strange disease called aids. unfortunately, the reagan administration, of which he was a part, did not i believe use the bully pulpit enough about calling attention to aids. george h w bush felt that this was important, so while he was

still vice president, he came to the nih and wanted to meet me. he said he wanted to meet this person, dr. fauci, show me around. and i spent a considerable amount of time with him introducing him to my patients and talking to him about what hiv is, and we struck up a friendship. it was one of those great honors that fall into your lap. and when we finished, he invited me to the vice president's mansion for lunch and receptions , and then when he became president, it was wonderful because i had direct input to him. he would call me up and i would be invited to lunches. and even after he left the presidency, he would write me notes and sent me a nice letter on my 60th birthday joking around, saying that i can't believe you are 60 years old. he is a wonderful human being. >> how many presidents have you known personally?

>> essentially all of them to a different degree. i knew president george h w bush very well. when president clinton came in i got to know him, not on a personal friendship where he would invite me over, but got to meet with him and i could talk with him and meet with hillary clinton when she was first lady, and then afterwards she became senator of new york, and then secretary of state, no doubt about that, eight years of that. and they went george w. bush came in, i had met him originally when he was a staffer at the white house with his father. and we struck up a very good relationship, and i think that was one of the reasons why he sent me to africa in 2002 for the purpose of determining the feasibility of developing a program that might transform hiv-aids in the developing world. so i got to be quite close with

president george w bush, related not only to the fact that i knew his father, but the fact that he took a very keen interest in a global hiv-aids, and allowed me to be one of the architects of the program that is now transforming hiv globally, the president's emergency plan for aids relief. and luckily now that president obama is quite interested and quite amenable to getting involved and solving problems that i am involved with, i have had the great privilege of meeting several times at the white house and at the nih with president obama. so i have been very fortunate that the presidents of the united states have been extremely amenable to listening to and helping out with the problems that we face vis-a-vis

research. >> you are clearly the most visible except for dr. collins who runs nih. how many presidents have asked you to be the director of the nih? >> george h w bush two or three times and i said no, and he was great when i said no, he said that he understood and he said continue to do what you are doing. when president clinton became president, his staff asked me if i was interested, and they said i had heard i would be a very good -- i explained to him that even though this would be a great honor, i don't even want them to ask me because i don't want to have to say no. so i took my name out of the hat. and george w. bush became president, he specifically asked me, and again i said as i said to his father, that although this is a great honor and a

great position, i think i could contribute more to the nation and to the arena of biomedical research by staying in the position as i am now. >> you still see patients? >> absolutely. >> how often? >> two or three times a week. we do rounds, i don't want to be the primary physician the way that i was before i became director, that would not be fair to the patients, because i have so many responsibilities. i go around all year long for the last several decades. >> what would you say to your fellow doctors about the way they should treat a patient? >> well, there are a lot of approaches to a patient, one is first with great respect. you have a real privilege as a physician of having someone put into your hands their health

their pain, their suffering, and sometimes even their lives, so you have to take that very, very seriously. it is not just another job. i don't want to get too melodramatic, but it is a calling. it is a certain level of profession that has with it extraordinary responsibility. so that is the first thing i would impart on physicians young physicians when i asked for advice. the other thing is to listen to your patients. very often if you listen to what the patient is telling you, you get a real head start on what is going on with them. >> what would you like the patient to do in relationship to his or her doctor? >> try to be, but it goes back and fourth because it depends on what the reaction of the dr. is to the patient, but try to be as

to the doctor. -- as an open to the doctor. but you do things that are important that are extremely important in the doctor's formulation about what is wrong with you and needs to be done with you. >> who you are at 1990 in a town hall meeting. >> in the 1990's, we will be seeing some revolutionizing at how we will look at the treatment of hiv, is the end of the 1980's has created the concept the you will see in the 90's, mainly treating people early on before they develop full-blown disease, prophylactic development to stop opportunistic infection. we have the goal to convert hiv infection into a chronic manageable infection, whereby you can test someone, counsel them, and treat them with a combination of drugs early

enough on in the course of infection so that you might have a situation like many other chronic diseases, where there is feasibility and a comfortable life span. >> 25 years later, what happened? >> it happened. we have drugs right now that we give to people who are hiv-infected, and i could show you the dichotomy in the early 80's if someone came into my clinic with aids, their median survival would be 6-8 months. that means half of them would be dead in eight months. now, if tomorrow, when i go back to rounds on friday, and someone comes in to a clinic who is 20 plus years old and who is relatively recently infected and i put them on a combination of three drugs and a cocktail of highly active antiviral therapy, i could look them in the eye and say, we could do mathematical models and say if you take your

medicine regularly, you can live an additional 50, 5-0 years. knowing that if you are going to take your medicine you could live essentially a normal lifespan, just a few years less than a normal life, that is a huge advance. >> 1991, a very familiar face stood up. i am going to run the video and ask you what impact this particular announcement had on this whole discussion. >> because of the hiv virus that i have, i will have to retire from the lakers as of today. i just want to make clear first of all that i do not have the aids disease, and i know a lot of you want to know that, i have the hiv virus.

my wife is fine, she is negative, so there is no problem with her. i plan on going on and live for a long time, bugging you guys like i always have, so you will see me around. >> so do you know this man? >> i do, i have been on panels with magic, education panels talking about hiv, because he is an example of someone who was caught early before he got sick. he was put on therapy and he is fine. i was on a panel last year where he and i were asking and were receiving questions from the audience and a moderator. >> by the way, do you ever have someone call your office and say i want to see dr. fauci? >> yeah, they do all the time. >> what happens? >> if it is in the realm of what we do, i bring them in, and the

nih has to fit into a protocol and many of the people who call directly to fit into the protocol, and we actually do take care of them. >> the interesting thing about the job that you have is that the government has decided, and i don't take a lot of people know this, that you are so important in the work that you do, that they pay you a lot more money than they pay the vice president of the united states. they pay you more than they pay the chief justice of the united states. the last figure i saw was $335,000 a year, correct? >> correct. >> how does that happen in this town? >> in the nih, when you have positions that are difficult to recruit for they have special exemptions where they can make the salary be flexible within a certain range that is not a typical gs level, you go in and

you are typical gs-14, gs-15 level, and it is not permanent they can take it away. for a time they will pay you a certain amount. there are several of us in the nih where we are in that category, where we would make more than we would make it a government slot. >> has money ever mattered to you? >> no, not at all. in the federal government when you have someone as visible as i am, i would go to a meeting and the speakers would get thousands of dollars a piece, i get nothing, you just don't want any semblance whatsoever of a conflict of interest. >> in 2003, you testified for -- testified before the senate

about another subject. >> the pathogenesis means how does this microbe have a pathological effect? that is what we are going to find out when we study the virus. we are not sure if the virus is causing all of the damage within the lungs of the individuals, or if it is getting together with a normal immune response, but in some cases the immune response causes damage. certain type of immune responses can actually make the pathological effect worse. we have seen that in some cases with respiratory viruses, in some cases with measles. it is important to hammer down the pathogenesis. >> do you remember, of course you remember sars, but how do you talk to a group like this? the average person gets lost. >> you have to make sure you are

understood, and i have a very important goal that you don't want to impress people with your razzle dazzle knowledge, you just want them to understand. >> what happened to sars? where is it now? >> sars essentially disappeared. we isolated the virus we made a , vaccine which was pretty good in an animal model, and then pure public health measures suppressed it and it went away. it was one of those diseases that are very common, which is a disease that is fundamentally an animal disease, and it jumps species from the animal to the human. and sometimes it is trivial and nothing happened and one person gets infected, it sometimes it adapts itself to the human, and

it spreads from human to human. that is what sars did. once you suppressed it, you essentially stopped it, because the next one that jumped into humans did not have the capability of spreading easily from person to person. so we dodged a bullet with sars, we did. >> since 1978, you had 440 major lectureships, 30 honorary degrees, did any of those numbers go up? >> the degrees when up to 38 or 39. >> where do you find time for all of this? >> like you said at the beginning, i really don't sleep much. >> about four or five hours? >> it is not the healthiest thing in the world, but when you physiologically get used to it you get used to it. and that is it, and you wake up and you are fine.

>> and where do you find time for all of the lectureships? >> i tend to do lectures that are important in their impact, and i really do honestly do know -- do no boondoggling. i won't do that. if there is a national meeting where you are going to impart important information to scientists, i may or may not do that, i pick or choose enough so that i am not so often away from my office so i lose effectiveness. i am very, very careful about not over traveling. i do something that you can do in one day, i fly up and i come back in one day. i don't go at to a meeting at a ski resort and give a talk and you stay there from three to

five days, zero to do that. it is just in and out. and when you do that, you can be pretty economical for your time. >> back in 2005 you were talking about another issue. >> importantly, the virus has evolved to be able to jump from chicken to human. it is still very, very inefficiently. it is very rare, we have had one or two cases, where it is confirmed to go human to human. so it is still a virus that has not been able to assume the capability to become a real classical pandemic, but when you see this smoldering activity going on, the migratory word -- the migratory bird and it is , not just southeast asia, it is russia, it is kazakhstan, never talking about turkey, and the birds are not going away, so the

condition that would be amenable to a pandemic or not resolving themselves. in fact they are getting worse. that is also a reason for the accelerated current activity. >> what happened to bird flu? >> well, it went away. so, over the last few years there have been these blips of a virus that is fundamentally a bird or another animal virus that jumps to a human, but it doesn't adapt itself to easily go from human to human, so you will see cases of h5n1, things that are not human viruses, they are fundamentally animal viruses, and they will jump. the thing to be concerned about, will evolution allow it to adapt itself to all of a sudden saying, i like being in a human and transfer more and more? it just stayed at a very inefficient way from bird to

human rarely going from human to human in any meaningful way. >> i'm going to read the first paragraph of a "new york times" article, this is by denise grady. "an unusual method for producing antibiotics may help solve an urgent global problem. the rise in infections that resist treatment with commonly used drugs and the lack of new antibiotics to replace one that no longer work." i know you know this story, it is this drug, and the author -- >> the author was dr. kim lewis. our institute funded the research and this is another example that the national institute of allergy and infectious diseases funded the research, but we give grants to very competent scientists, like

the scientist in this question so we did do it. so we do have our "fingerprints" on it. if we continue to have a problem of microbe becoming more and more resistant, we could get in trouble. so the things that could be treatable become untreatable that is a problem. when you have a new class of antibiotics that could be countering the emergence of resistance, that is something you want to look into and that is something we're going to do. >> did you know before this article came out in "nature" magazine -- >> oh yes, when they publish something, they have to write it up, they have to submit it, it

gets reviewed, revise, so we knew about it before it hit the press. >> how much money does your institute spend a year on research? >> on research, we spend the entire four and a half billion dollars and on microbial research, we spent several hundred million dollars. >> let me ask you what is an antibiotic? >> it is a substance whose main purpose is to suppress or kill a microorganism, typical one if you have the very common cause of pneumonia or a middle ear infection is a microbe. so if i have pneumonia and i am given penicillin, which is the

classic type of antibiotic, it will ultimately destroy the bacteria in my body. >> but the point of all of this that we were just talking about was that if you become resistant, is there a point in someone's system where they are resistant to all antibiotics? >> no, no, it is not the person who is resistant, it is the individual microbes that is resistant there is no such thing , as you or i walking around saying, wow, we are resistant to antibiotics it is the , microorganism that we could get. we had a problem recently at the nih were a microbe that was resistant to almost all antibiotics, we were able to

track it down and sue presse but whether it was in you, or me, or people -- and suppress it, but whether it was in you, or me, or people in the hospital, they would not be able to fight it. >> who determines how long you stay there? >> you get reviewed by an outside committee that reviews you and determines your effectiveness, and if it discovers you are not effective, you step down. >> someday there could be a new director of your institute and she says, tell me what i should look out for, and we are not talking medicine, we are talking politics. as the head of this institution for over 30 years, what would you tell them? >> in the face of politics policy, and medicine, the thing that i have found to be very effective is to be consistent be totally honest, and don't

tell people things that you think they might want to hear. tell them the truth that is based on evidence, because even though politicians, be they in the administration or the congress, may not be happy with what you tell them because it disappoints them, they will respect you if after a while it is clear to them that you are telling them the truth based on scientific evidence. so that is the one thing that i would emphasize to anyone who follows me, that that is how you can be successful in getting good science to drive policy. >> what do you tell them about dealing with congress? >> be clear. don't try to razzle-dazzle them, don't talk down to them, don't feel that because you are a scientist you are so superior that you can talk over their heads. don't talk in an esoteric way so that no one has a clue of what you are talking about.

you've got to have that balance to you can make a person feel like they've really understand what you are talking about. they will like that because people like to learn. they will respect you for being able to explain it to them. >> there was a time recently when there were media and the politicians screaming that we did not have control over ebola. you were out talking a lot about ebola. how does that look now? >> from the united states' standpoint, it is very good. we had a person who did not know he was infected, and that created a tremendous degree of concern and panic. what happened is that people extrapolated what they saw on

the front page of the newspapers with all of the deaths and suffering in africa and thought that was going to happen here. and what we try to do, and what i tried to do in front of the national audiences, is say that we are taking this very seriously for sure, but given our health care structure here and the ability to suppress the spread through identification, isolation, and contact tracing this is not going to happen in the united states like it is going to happen in west africa. we may get a case or two, like we did, but we are not going to have an out-of-control outbreak. there is good scientific evidence for why that is the case, and people believe it, and as it turns out, that is what happened. there is no ebola, there may be a case that comes in, that we are going to be able to handle it. >> the flu. a lot of people i know got a flu shot, and people over 65 have gotten a double dose.

lots and lots of money was spent on the flu vaccine and it did not work. >> well, it is not working optimally, that is for sure. each year you make a calculated guess based on information that you gather over what is circulating towards the end of the season and what is going on in the southern hemisphere. >> who makes that guess? >> who, in correlation with other agencies. the world health organization. they have to make that decision in february of the prior season, because in order to start manufacturing the influenza vaccine, it takes about six months, so by the middle of the end of the summer, it is ready and you start distributing it in the fall, and it is ready for the winter season.

by the time this decision was made for the 2014-2015 season, they thought that this particular strain would be one type. as soon as they started manufacturing the vaccine about one month later, it became , clear that the virus was drifting, and that means mutations and drifting, so that by the time you got to the flu season, the majority of the strains did not match what was in the vaccine. that is the bad news. the somewhat comforting news is that you can still get good benefit from vaccination even though there is not a perfect match because there is what is called cross protection. so if i get the strain that is

not the extent one of circulating in the community, i can still get a certain degree of protection. i might not be protected against getting infected, that i could be protected against serious disease or hospitalization. >> to ever get the flu shot? >> i do. >> do you ever get the flu? >> i got the flu in the mid to late 70's, and i was as sick as i have ever been, but i have not gotten influenza in several years now. >> as you sit at your desk every day, what is your number one concern way out there? >> my number one concern way out there would be emerging infections that have to be spread by respiratory fruit. influenza is something that bothers me a bit, and the real priority that we are working on right now at my institute is to develop what is called the universal influenza vaccine.

a universal influenza vaccine is something you can take once or a couple of times in your lifetime and it will cover all of the strains of influenza, see you don't have to play this testing -- playlist guessing game each year for you have to change her vaccine or maybe every year or two, and keep getting vaccinated every year. if you can get a universal flu vaccine and you get it a few times, the way you get a measles vaccine, and you are forever protected, or a polio vaccine and are forever protected. >> how close are you? >> it is foolish to say we are going to get it in x number of years, but there are things that make me think that in a reasonable time, we may have a universal flu vaccine. >> we only have a couple of minutes left. toughest decision you ever had to make?

>> well, one of the toughest decisions, and i had a few, was when i made a decision during the early years of the aids pandemic to bring the activist community into our deliberations, because most of the scientific community including my own staff, were totally against that. they said the activist would be disruptive, that they would get in the way of what the scientific approach would be and i got to know the activists very well, i became friends with many of them, and to this day some of them are very close to me. >> larry kramer? >> yes, i still see larry, i am friends with larry, and i still see them and interact with them, i insisted that we bring the activists into our deliberations. and i made that decision knowing that there was going to be a lot of pushback, from the administrative community, but it

was the right thing to do. in some respects it was not a tough decision. it was a decision that had some repercussions for me, because people were thinking that i was selling out to the activists when i was saying absolutely not, they have a lot to offer. it is to our detriment not to bring them into the process. >> dr. anthony fauci, 30 years plus director of the national institute of allergy and infectious diseases, we thank you very much for your time. >> very good to be here. >> for free transcripts or to give us your comments about this program, visit us at q&a.org. programs are also available through our podcasts.

[captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> if you enjoyed this week interview, here are some others you might like. wayne frederick of howard university. alfredo hinojosa of johns hopkins. you can watch them all at www.c-span.org. >> monday night on "the communicators," we look at the newest development in the technology industry for 2015. we met up with our guest at the consumer electronics show. gary shapiro, president and ceo of consumer electronics. mark fields of ford motor

company, and fcc commissioner michael o'rielly. >> not to sound too grandiose but we are talking about transportation problems. driverless cars, safeguards. fuel production, hunger. you know how much water to use. health care. it is exploding here. sensors that give information to your doctor. and safety. safety in the home, safety of everything. exploring things remotely. you are taking a lot of problems that perplexed us and we are reducing them in the future. >> a great opportunity for us as a company to highlight innovation by talking about our next generation system.