and infectious diseases discussed pandemic threats. toics included initiatives develop universal vaccines for , and influenza, and how new gene sequencing technologies could play a role in the development of vaccines. this is an hour and 15 minutes. >> we can go ahead and get started. i want to welcome everyone here today to the breakfast. my name is elizabeth, and i lead the health care practice here in washington, d.c. have thispy to continued partnership with the alliance for health policy, so together we can advance knowledge of key health policy issues. today's topic is just that, pandemic preparedness.

one of the most important challenges we face is preparedness for a pandemic outbreak of an infectious disease. there is no one better to speak to that than our speaker today, y fauci. thank you for being here. i know this will be an interesting discussion. i would like to turn it over to sarah dash, the president and ceo of the alliance for health policy. >> good morning, everybody. thank you for being here. i am president and ceo of the alliance for health policy. for those not familiar, we are a nonpartisan organization dedicated to advancing knowledge and understanding of health policy issues. apco worldwide for this series. thank our speaker

today for being here. as we will undoubtedly talk pandemic 10018 flu years ago killed more than 50 and 100people globally, years later, the world continues to contend with the risk of novel influenza out rates as well as other outbreaks that reached pandemic scale. while this year's flu season made headlines for its severity, its impact was nominal compared to a pandemic flu outbreak. we are pleased to have dr. auci.ny f policyiance for health does not usually get to introduce rock stars, but as far as health policy goes, this is a man who barely needs any introduction.

program onversees a topics such as hiv/aids as well as diseases of the immune system. he also serves as one of the key advisors on global infectious disease issues. she was one of the principal architects of the president's emergency and for aid relief, which has saved millions of lives. we are thrilled to have you here. is going to get background, and then we will be able to get into a q&a and discussion. dr. fauci: it is a pleasure to be with you here this morning. to run through some slides to give you a bit of a background, and then leave it open for discussion on this or anything else you would like to discuss that is related to it. i am going to start off with the concept of pandemic preparedness. , both seasonalza

and pandemic, serves as the prototype for pandemic preparedness, even though you can have a pandemic with other types of diseases, usually respiratory diseases that spread the. -- spread rapidly. the thing i would like to discuss is how we separate seasonal and pandemic influenza, but we should think about them as one. hopefully it will become obvious why i say that, and what i show you will hopefully convince you of that. when you look at the artificial separation of seasonal and pandemic influenza, seasonal --luenza is hardly cryptic highly predictable and highly unpredictable. the highly predictable part is that we will have an influence outbreak for certain every single winter in the northern hemisphere, and in the southern atmosphere they will have it in their winter.

since seasonal flus change very little from season to season, there is always a degree of residual background immunity in the population. that is critical to why seasonal flu is not a pandemic every year. let's take a look at the numbers and the unappreciated mortality with influenza seasonally. in the united states, if you sideat the left-hand there are 56,000 deaths per year, up to 700,000 hospitalizations. globally is on the right-hand side. the economic costs are substantial, about $10 billion in direct medical costs, and an indirect costs, about $87 billion per year. the thing that lulls us into complacency with the flu is that thee it occurs every year,

cumulative mortality and more ability over a period of years is quite substantial, and we will get to that in a bit. this is a very telling slide, because if you focus on the red that started off with the beginning of the flu season and worked its way up, it was paralleling the purple line, which was 2014-15. 20 14-15this season, was the worst year we had in about a decade. when i say worst, it is because the cdc has only been carefully want to taking it with -- quant itating it with metrics. our recorded in real guestss opposed to total , which is an extrapolation after-the-fact. look at what happened at this

point. instead of turning around, this we were inknew serious trouble, because it started to do this, and only several weeks later did it finally reached its peak. now it is on its way down. bottom line is, with regard to , this season is unquestionably one of the worst, if not the worst. we don't want to declare it the worst until after the season, but this was a really bad year, and that has jolted us into telling you something i am going to discuss in a few moments. iscontrast, pandemic flu completely unpredictable. people used to say there are cycles in pandemic flu. there are no cycles. what does pandemic mean? pandemic as opposed to epidemic means it is widespread, number one. number two, it is a new virus,

new in the sense that the population has never experienced this particular virus, as opposed to seasonal flu, where maybe you did not see the same h3n2 last year, but one this year is very similar to it, and you have cross-reactivity. , almost no one in the population has had any prior experience except maybe the real people who may have experienced something 40, 50 years ago. -- theyeard, the 1918 called it a spanish flu for some reason, which we can discuss later, but it had nothing to do with spain. there were about 15 million to 100 million deaths. reason that is important, 50 million to 100 million deaths in 1918, when the population is 1/3 of what it is now, means a lot of deaths.

the important thing is that, for a single season, this is the most cataclysmic public-health health event in the history of our civilization. if you look at cumulative deaths of small parts -- of smallpox and cumulative apps of measles, there are a lot more than this, but to have it happen in one season and a half, we have never seen anything like that, which tells you of the threat and importance of respiratory born diseases that have the capability of spreading readily but also have high mortality. to think about seasonal and pandemic flu as interconnected with each other. what do we do when we respond to influenza? here at nih, we do basic and clinical research, ultimately to develop countermeasures in the form of diagnostics, therapeutics, and vaccines. vaccines are the most important

medical tool. publicly there are health tools -- watching your hands, social distancing, getting out of crowds when you but vaccinesreaks, are clearly the most important. . have three points i make i jokingly refer to it as the fa uci three. concerned about my discontent with where we are he's influenza. i will go through these ,ndividually, starting with current seasonal influenza vaccines are not consistently effective. further, go one second i have to give you my statement so i don't get into trouble. it is always better to get vaccinated than to not get vaccinated. you have a 10%, 20% effective

vaccine, it is still better to get vaccinated than not. let's take a look at the numbers. if you look at the efficacy, the effectiveness of vaccine over the last several years, at best, the influenza vaccine is 60% effective. thereeally bad year when is a mismatch, it is about 10% effective. me?is that disturbing to because when you're dealing with vaccines historically, take a look at some of the big killers. measles is 97% effective. polio is about 95% effective. yet the best we can do with influenza is 60%, and at worst it is 10%. the next thing that bothers me, pandemics do occur, and the response after-the-fact is usually not effective, and that

relates to how we make vaccines for flu, which we will get to in a moment, because it is really time-honored on the one hand and antiquated on the other hand. i will explain. you will remember this. this was with the swine flu of 2009, the h1n1. what did we get wrong through no fault of our own? march, just like we have for you today, we are in march. you saw the curve going down. something unusual happened in 2009. as the curve was going down, in california and mexico, we started to see people getting sick with an influenza that was really strange, because no one had seen it. it did not type according to tie things. -- according to the typing.

everybody was focused on china and the far east for the next pandemic, and we were seeing in infectionsand mexico of humans with a brand-new virus that we had not seen before. that was one on thing. the second odd thing was that it was in march, when flu season was supposed to be over. the bad news is we've got a problem with a new virus. the good news is we have time to make a new vaccine. as we get to the summer, it is likely the virus is going to cause a pandemic for the following winter. what do we do? we found out bad in april, it did not stay in california and mexico. why? because respiratory born viruses , with the way they travel, never stay in one lace. it always circulates globally.

this was highly predictable, but it was still only april. what happened? before the appropriations subcommittee and said, it is april, it may take six months or so to make a vaccine. you have to grow the virus in eggs to make a vaccine. explaining april, may, june, july, august, september, we are good. we will have it in october. we know influenza does not generally start happening until november or december and peak in january. as the children came back to school, what happened? in septemberbreak instead of january. the blue line is where the red line should be, and the red line is where the blue line should be.

the red line is the percent of illnesses, which came in september and peaked in october, just about the time that the meanse was ready, which that the vaccine, although we made it reasonably quickly, was still too late for the pandemics. that's what i mean when i say , and evenmics occur under the best circumstances with the technology we have today. continue to chase after potential pandemic outbreaks. what do you mean by chasing? it started off in 1997, then 2003, then 2005, the famous age five in one, the bird flu -- h5n1, the bird flu. it did not efficiently spread

from human to human, but it was a 35% to 40% brutality when it did get to a human. we decided to make a vaccine, so we spent hundreds of millions of dollars, in fact, billions of dollars, to prepare ourselves for the pandemic. never turnedh5n1 into a pandemic. we stockpiled the vaccine, but we don't have a pandemic. we realized there are more of these, the most recent of which was h7n9, which is still smoldering around. andade a vaccine for it, you can see in 2013 we said, wait a minute, this is another bird flu jumping from chickens to humans and is killing humans. it is not spreading efficiently from human to human, but we can't take a chance. we've got to make another vaccine, so we invested another

few hundred million dollars to make a vaccine against the h7n9, and everything was fine. in 2014,mini outbreak 2015, 2016 and what happened in 2017? the virus that emerged was so in a very small way, that it was not protected by the vaccine that we made in 2013, which means what? that we have to make another for he for age -- 7n9. that's what i call chasing after a pandemic. you have to do it, because you can't ignore it. there are two challenges that overlap. the first is how we produce vaccines. egg-based vaccines, which means you have to grow the

vaccines in eggs. it takes about six months. we made an improvement by saying, let's go from eggs to cells, which was a modest improvement, but you still have to grow the virus, which tells us maybe we should do something more predictable and consistent, and that is dna technology. this is the flow sheet of what i make acribing, that you decision in february or march, and deciding what you are going to do -- like our right now it is the end of march. make a decision in februarywe already t what is going into the vaccine for next season. we are now making that vaccine. the horse is out of the barn. the six months, seven months that it takes to have it ready, things can happen. what can happen? antigenic mismatch is a the six months, seven months well-known cause of the decrease in seasonal vaccine effective this -- effectiveness.

in other words, we make a decision in february or march, we start making the vaccine, but for theses circulating six months that it takes. it may mutate, so by the time you have to vaccine ready, the virus is a little bit different. that's what happened in 2014 and 2015. we made the right choice of what virus to put in the vaccine, but the virus changed as we were making the vaccine. matchbout years where the is a good one, where you make a decision, you decide on a virus, and the virus does not change? what possibly can go wrong? well, in 2016-17, something did go wrong. the very process of growing the virus in the egg fooled us. what do you mean by fooled us?

virus, youe right put it in the egg to grow, and in order to grow well in an and, the virus has to adopt to egg growth. so it mutates, which is understandable. to bad news is it happened mutate at that part of the molecule that is responsible for inducing a protective response. this is what is called an accidental mismatch, or an isogenic mismatch. the virus in the environment did not change. the virus that went into the eggs changed, another stumbling block. although we have gone from toased -- egg-based cell-based, the ultimate goal is incumbent technology -- were competent dna technology. dna technology.

these are some of the vaccines that will replace needing to grow the virus, and that is things like dna and rna vaccine platforms, viral vectors, nanoparticles. these are all things that don't require growing virus. finally, there is the strain specificity versus the universal coverage. we wrote a title -- an article titled "chasing seasonal influenza." in june ineeting rockville, maryland, and we reported on the proceedings of , and we just , inntly published online february, our strategic plan and

research agenda to develop a universal flu vaccine. there are a number of targets for universal flu vaccine. the common denominator is you to make a response against the part of the virus that does not change from season to season. vaccine thatke a induces a response to a part of the virus that does not change. these are several of the targets. sake of an example, this isn't the only one, i'm going to take out the hemoagglutinin molecule. as shown here, it has got a head and a stem. when i show audiences, think of theoccoli with a head and , or a mushroom.

there is a big difference between those components. which the vaccine is directed to make an immune response, those red dots are kinds of mutation. the head mutates a lot from season to season, and really changes when you get a pandemic. if you make a response against the head and you happen to hit it right, good here you are good to go. but from season to season, that theges, which is exactly reason why each season we ask you to get a flu shot every year.we don't ask you to get a measles vaccineevery year -- every year, or a polio vaccine, but we do ask you to get a flu vaccine every year. if you look at the dark blue part, the stem, that does not change. --y few limitations

mutations. one of the many strategies is to induce a response against the stem region. one of the ways you do that is by molecular biology techniques. you don't have to grow the virus. this is just sequencing the virus, taking the gene out, making it express hemagglutinin, and removing the head, stabilizing the stem, and putting in on something like a theparticle, and then have body make a response against that particular component. very quickly, therapeutics. there are a number of therapeutics for influenza. m2, unfortunately, most of the viruses now are resistant to that. the ones that you know are known as tamiflu and others. right now, for example, there is a new drug that has been

developed by a japanese company that works by a different mechanism. i want to geten more money for basic research, but since none of you are going to give me more money, i will tell you anyway. [laughter] this is a drug that was developed in japan that is against a different part of the virus replication cycle. the way they got to that was nih-funded ago, an investigator actually determined in. we science publications, what the mechanism is. in the company came along and made a drug that may be promising. just another shout out for basic biomedical research. also, there are monoclonal antibodies being tested against protective, a preventive standpoint, and a therapeutic standpoint. let me stop there and use it to

throw it out for discussion. i always throw this slide out there because it it reminds us that emerging infections have been around forever, they are here now, and will always the the around. if there is ever the mother of perpetual challenges, it is certainly influenza. let me stop there and i'm happy to answer any questions. >> thank you so much. go ahead, introduce yourself. >> [inaudible] outbreaks became bad in september when all the kids went to school. the kids in sleep away camp's all got it in august angela. -- and july. camp had doctors and nurses on the public health call comparing notes every day. the reason i know this is because my kid was one of the

kids that got sick. did you all go back and make contact with these camps as they were working with this disease alsl summer? >> we didn't at nih, because that's not what we do. that would likely be the cdc. i'm not sure they did. when it started to occur in oh myber, we were saying, goodness, we were hoping it would not happen, but it did. a follow-up question, could you briefly describe the role of cdc, andur agency, and other federal or state agencies that are funded? dr. fauci: that is a commonly asked that reasonable question. the agency, the overrating

umbrella agency is the department of health and human services. within that, you have the nih, , the secretary for preparedness and response, and other components of hhs. when you think about pandemic preparedness, the cdc, they are the disease detectors. disease -- monetary disease, protect disease. that's why we have the intelligence service that goes out when you have zika or ebola. job is to do the basic and clinical research to understand the disease, describe it, and develop countermeasures, or do the research that allows pharmaceutical companies to ultimately make countermeasures,

like do the basic research on vaccines, basic research on therapeutics, basic research on diagnostics, and then collaborate with pharmaceutical that.ies to do the fda is a regulatory agency to make sure all this is done in the appropriate way. it is really quite synergistic. we work very, very closely with the cdc. whenever there's is an outbreak like this, it always involves -- that's why during ebola and zika, you saw them together talking about that. >> and when you showed the maps of the outbreaks, are those models that the cdc creates? dr. fauci: yes. >> thank you. do you have a question? nih top a lot about moving away from the egg-based system. how long do you think we will keep doing this, a system that's not particularly effective? what do you think gets you there?

dr. fauci: that's a good question. the a combination of science proving that the other methods work. for example, if you look this year, we have one candidate that is using the molecular dialogical technique -- biological technique. that is the vaccine. only about 3% of the vaccine doses were of that type. the overwhelming majority were of egg-based and lesser amount of cell-based. the first step to answering your question is that have a few platforms that prove they are as good or better than the egg-based, and i don't think there would be much of a problem to prove that. can use scalep is

that up to be able to make doses people?million plus although there were many weaknesses in egg-based, there are massive factories that make millions and millions of doses. will bedo that, then it an interesting little dance that will occur of, how do we convince the companies to pull out from what they have been doing in a time-honored trial basis over the years that they feel comfortable with, and substitute another thing that will require a different kind of a plan, a different production? that latter of the three steps is probably the most problematic. it is sometimes difficult to get companies that have long investments in doing it a certain way that sort of works, even though you think you can do better. that will be the problem. the first step for us is to

prove that these different platforms work well. >> i have a question. why was this year's flu so bad? from your perspective, why did we have so many cases? dr. fauci: two reasons. one is that it was a dominant h3n2 strain, which from the actor.is a bad whenever you talk about strains that are going to be in a situation where you would have complications and more hospitalizations, more mortality, h3n2 is a bad actor. the second thing is that if you look now at the statistics that have come out from the cdc, in all, all the vaccines the age groups was about 36% effective. specifically for age three and effective. only 25%

if you have a bad actor virus to begin with, and a vaccine that's only 25% effective overall, then you've got a real problem. that's exactly what we had. the numbers are different with age. whiche reason or another, is complicated, children from six months to eight years did better. their effectiveness overall was 59% against h3n2. bad virus, that vaccine, not very effective. back to just to go ebola and zika recently, can you update us on where we are now in terms of vaccines for both ebola and zika? are we making progress on that? dr. fauci: that's a good question, i'm glad you asked it. there are about half

a dozen reasonable candidates for a zika vaccine. the one that we developed at our vaccine research center was a dna vaccine, which is plasma that you stick the gene of whatever protein you want to have an induced response. we are now in a phase two study in several countries in south america, mexico, the caribbean, .lorida, and texas that's the good news. i wouldn't even say sobering but, because it's not bad, there's not a lot of zika out there to show that it works. datae accumulating safety so that if there is an outbreak next season, we look at what is called an efficacy signal. if there is no outbreak, we can -- that him you know data together with the other data to prove this works in

animals. then we are working with the fda. you never want to jump ahead of the fda. they need to make their own decisions, but the fda is at least willing to discuss the possibility of an accelerated approval based on the safety and animal data. we are well into that. things are moving well. you don't read about in the newspapers because there is no zika rou -- around right now. with regard to ebola, we had one vaccine that was shown to be effective in a trial that is not really designed to definitively show effectiveness. right now, there's a trial going on in west africa comparing the adnovirus vector data.e, accumulating

the short answer to your question is that we are on the road to a vaccine for both of those, even though you don't hear about it anymore because we are not in the middle of an outbreak. >> ok. i saw three questions going around. do you want to go ahead, from my left, down the road? shannon? did you want to start? [laughter] >> i am shannon. i was interested in hearing about access and affordability if wems of vaccines and see a vaccine for ebola or zika, are you concerned about people being able to afford those things, and who would be targeted? the second question, are you an opioid vaccine,

actually a fentanyl vaccine? i don't know if there is any cross over there. how would you target for that vaccine and how would you know choose? any certain population, and how would you ensure they could afford access? dr. fauci: so you have gone beyond my memories scope of being able to remember all the questions. [laughter] ok. that's all right. now -- it'sright interesting you asked the question, because we have been going back and forth with nidasals with night -- about collaborating in a really immunological aspects, particularly vaccines, for opioids. the answer is yes, we are doing that. secondly, it depends on the epidemiology of who you would

vaccinate, and certainly people who are at risk for developing addictions, you would want to do that. that's the first thing. but that is a very complicated way to figure out the profile. regarding access and cost, i really can't comment on that right now. i could comment about the accent -- access and cost of the zika, but not yet for opioids because we are not there yet. ebola,gards to zika and we have a policy that whenever we partner with a company that cdc, federal funds, if we get involved in any aspect of the development of a vaccine, that thature vaccine will be made available in a reasonable way to the people we tested the vaccine in. when we do this in west africa, , andin liberia, guinea

it has to be affordable. we had agencies that would make repurchases. i don't really have a concern that we will have a vaccine that will be out priced for the people who need it. both for zika and ebola. those are the kind of arrangements that you make with the companies. you don't have a situation where they are out priced. issue, and this gets to your fourth question, you make a vaccine, who do you give it to? it's very interesting. that is one of the reasons why we have such a problem getting companies to make an investment for a vaccine that doesn't have a set group of people who unquestionably would get the vaccine, such as we give with childhood vaccines, where everybody gets measles, mps, everybody mu

gets hepatitis. thing about zika, it would depend on the epidemiology. . right no, you would -- there is no zika right now. if there was a chronic outbreak of zika in south america the way we do with dengue fever, you would certainly want to vaccinate children or young adults of childbearing age. tose are the ones you want protect. if you talk about south america, i wouldn't do it now, but if we had a smoldering low level of zika, i would do that. the other would be for travel related. take the people around this room. professional people who might go to south america on an assignment, and you may be at the age where you might want to get pregnant, you can see that as a travel related vaccine to

go to when area like that. but you wouldn't vaccinate everybody in florida and texas or you have a couple of cases of zika. it's just not worth it where you have 200 cases and 60 million there.goin living the ratio is not worth it. those are the people you would target. >> thank you. >> another question? >> thank you. just to be clear, what do you see as the most likely answer as far as improving the efficiency -- efficacy of the flu vaccine. is that the universal flu vaccine or one of the other nimble alternatives? dr. fauci: that's a good question, and that gets back to the slide where i showed seasons with the arrows that connect back to each other. we definitely need to make a oneer seasonal influenza,

that even if you get the right match, it is potent enough to give you 90% efficacy instead of just 60%. in the realm of just seasonal loan, you want -- seasonal alone, you want to get that one. closely related to that is the issue of universal. what you want to do is get a better one for seasonal, but you would like to make your seasonal vaccine one that is making you respond against that part of the virus that doesn't change, which, parenthetically, would actually be a universal vaccine. as you are making the seasonal flu vaccine better and better, you are actually working your way toward the universal flu vaccine, because one of the ways to make it better is to make it so that the response is against that invariable part of the

virus that's not going to shift, drift, excuse me, from season to season. they really are very connected. that's why i tell people we shouldn't think about this group will develop a better seasonal flu, and this group will develop the universal vaccine.it's all going to work together. >> may i ask a quick follow up question? in addition to the efficacy of the vaccine itself, but is the impact of vaccination rates on the overall morbidity and mortality? it's always better to get it rather than not to. without a doubt, there is a lot of mathematical formulas that show that if you have a certain percentage of the is --lation that population that is vaccinated, you can get a degree of immunity

that would compound in a positive way the effectiveness of the vaccine. we vaccinate about 150 million people in the united states. there are about 380 million people in the u.s. we are not anywhere near where we should be for universal influenza vaccinations, not a universal vaccine, but universal vaccination.the more we do that, the better protection . >> thank you. another weston. -- another question. >> congress right now is considering the reauthorization, and i was wondering what resources you thought would be useful for that legislation to help with the development -- >> the acronym -- pandemic action act. dr. fauci: the act is much more

towards what we have in the department, the assistant secretary for preparedness and response, which is a component aspr, involved in part partnering with companies, need.to dowhat you from a public policy standpoint it doesn't directly relate to us as the research component that does the research, but it is clearly involved in the overall preparedness. it is critical if you want to have a comprehensive comparative that you get reauthorization of the bill. >> and the techniques, incentives, or anything you think would be important in that bill to motivate the research you are doing? dr. fauci: one of the things we don't do is we don't comment on pending legislation, sorry. [laughter] >> ok. i know that darpa is working

on jean editing and addressing infectious disease, and military medicine in the army is working with this. are you working with this at all? dr. fauci: we have a number of collaborations with darpa. we continued to over the years. they have a different kind of a mandate. they come in very high risk, very high reward. if it doesn't succeed right away,, you are done, you are out. we do more of the long-range one. so they have the first above the response and then you take it? >> it goes both ways. we do some of the fundamental research, and darpa uses it to get the quick, big stuff, and then we take that big stuff to implement. it's a pretty good arrangement. >> anything that you are working

on together right now? dr. fauci: not really. thank you. just a follow-up on what you told shannon about access and affordability, looking ahead to a more effective seasonal vaccine or a universal flu vaccine, are you confident that those will continue to be affordable like the current vaccines are? the administration talks about ,he shift towards value-based which could potentially be more expensive. for something that could be as blockbuster as a universal flu vaccine, is there an exclusive licensing arrangement that you do, in some cases, that would be appropriate? dr. fauci: you are asking sort of two separate questions.

let me answer the one that is more crystallized to answer. the whole issue of an exclusive licensor. when you hear about exclusive licenses, there's always almost a knee-jerk response that if you give a company an exclusive license they are going to gouge the public because they have an exclusive license. but that really is not always the case. when you are dealing with the development of a countermeasure, there's not a great incentive for companies to get involved one ofcine work is not the most popular areas of endeavor for pharmaceutical companies, which is the reason why you only have a handful or so of companies involved in vaccine research. even though exclusive license may seem like it's risky that things are going to get out of control, often that is the only way you're going to get a company to make the financial

risk to even get involved in vaccine development. that i have not seen a correlation at all between an exclusive license to accompany, and a company taking by makingof it an exorbitant price, in the area of vaccines. i have not seen that in vaccines. i haven't seen that scenes that were exorbitantly expensive because the company had an exclusive license. and you think that is more effective for the seasonal flu or universal flu vaccine to require the license? no, it's a good question, but there really isn't a linear relationship. you don't know how effective it is at the time you are getting the license. and we make a discovery license something to a company that develops it, we do the

licensing before we know how effective it's actually going to be. we know what the efficacy and a trial is, but we don't know how effective it will be in the community. >> thank you. to comment on what i think your second question was, the rhetoric that wealue-based care are hearing from pharmaceutical companies, that maybe we should only pay for drugs if they work.does that model make any sense with vaccines, and what would it look like? i'm curious what you think about that. dr. fauci: what i think about it is probably irrelevant, because i don't get involved in that. i would like to give you my opinion of value-based or not, but my only concern is to develop it so it can be used. i can give you an opinion, but since i'm a public figure, my opinion might be taken out of context.i will tell you about it over a beer . [laughter]

>> thank you. >> i have a question about the fine line. do you have any sense of when we might get to a universal flu vaccine, any timeline on ebola or zika as well? dr. fauci: you like multiple questions. [laughter] ok, we will take one at a time. exact when you are talking about universal flu vaccine than talking about a zika or ebola, for the following reason. there is still a lot of discovery left in developing a universal flu vaccine, whereas we already have a solid candidate for zika and a couple of solid candidates for ebola. you can predict timeframe why is that if we get an outbreak next year, and this vaccine is reasonably effective, we could

probably have it in two or three years. you can't say that with universal flu vaccine, because when you are dealing with the necessity for discovery before you can actually make a product, since the discovery is unknown when you're going to get it, it isn't like a bridge. you get the equipment to build a bridge. you don't know when you will get the answer to the discovery part. having said that, it is not going to be, today we don't have a universal flu vaccine, and then tomorrow we will. it will be an iterative process. that will be improvements on various versions of it. i tend i can to describe it as universal flu vaccine 1.0. it means you make a vaccine that will prevent against all the

subtle changes that will occur. that i would call universal flu vaccine 1.0. it really isn't universal for all the flues. then you go to universal flu which may be for all of the current flues. i think the home run is many years out. the first version maybe five years out.

that is the most troublesome right now. [indiscernible] dr. fauci: we do that right now. did you get vaccinated? >> i sure did. [laughter] we are already vaccinating people with more than one flu vaccine in each shot. the component in the year 2023 will be universal, but not quite yet for the h one and one.

>> so the universal flu vaccine would not necessarily eliminate the need for an annual? dr. fauci: i'm glad you asked that question. th,re is a thing called bread which is all of the flues, than there is a thing called durability. they are two different concepts. get a vaccination that covers all the flues for one year. once you get that you start working on durability, than you may have one that lasts for 10 years. for example, tetanus. say you should get tetanus shot every 10 years. because of the durability.

i hope that we are going to be able to get away from a yearly flu vaccine. i doubt, very seriously, if it is going to be one vaccine or two vaccines and then you are done. i do not think it will be that way. >> quite an important public education on it. thank you. does anyone have another question? go ahead. [indiscernible] be careful of the difference. i am glad you brought that up. it is often innocently misinterpreted. when you say how long it will take to prove that a vaccine works is often a different vaccine of when that

will be in a vial of to give to a person. there is usually a gap of several years. you have to do all of the appropriate testing. i would say, with the zika vaccine that is being tested in a phase two trial, if we get an outbreak of zika in the summer of the southern ,emisphere next year, like 2019 and we show that there is an efficacy signal, that would be two years. a year to analyze it. from now you will know that this vaccine does or does not work. when will that vaccine be ready to give to people? maybe an additional two years or three years. washe other main question

how did you know what you're going to spend the increase on? there are certain aspects of the budget that are earmarked. the rest of it will be distributed among the institutes for fundamental basic research. a proportion, like the other institutes did, over which we have total discretion as to what we are going to do with it. amount got an earmarked for universal influenza vaccine.

it caught the attention of congress and they want to help. in a bipartisan way they are always very helpful. they have given us an extra amount of money to develop a universal flu vaccine this year. >> how much? $40 million. >> [indiscernible] dr. fauci: you know, i am sure, how the appropriations process works. for2018 budget also called a sharp cut in the nih. congress budget superseded that, and the president signed it. it is an interesting thing going on.

congress is increasing, and ultimately that it signed by the president. it depends on which side you are looking at. yes, the 2019 presidential budget does call for a cut. what we going to get into thousand 19 i do not have any idea. >> [indiscernible] can you give us a window into what you are working on? dr. fauci: we put out, a couple of years ago, a strategic plan for microbial resistance. fromvolves everything cheerleading to the work of developing a pipeline of drugs, modulating the immune system by vaccination or a variety of other ways to prevent or

ameliorate infections that you would otherwise be worried about. manipulating microbial anti-toxins, in other words not going against the bacteria itself but toxins associated with the bacteria. the interaction between host and pathogens. everything from fundamental research to actually developing new drugs. then we have a whole clinical trial process we are doing things like the repurpose thing of old drugs we have not used usede, that have been not and a long while, to see if they are now effective. we have a whole strategic plan and agenda for that. [indiscernible]

dr. fauci: yes. if you're asking is there work on looking at commonalities , a molecule of some sort i inhibit hold classes of bacteria, the answer is yes. we are working on that. that is referred to as broad-spectrum. but it really is not broad-spectrum. it is mostly within a class of bacteria that you have a molecule that can essentially block everything within that class. >> we have time for a couple more questions. >> [indiscernible] there are a lot of areas that the military medical community is also working on, such as anti-bacterial resistance.

how much are you working with the army and maybe grab some of army medicines money? i never work towards grabbing other people's money. put that on the record. i can give you a non-facetious that myo questions historicallye always worked closely with the department of defense. examples, thegent hiv vaccine trial in thailand was a close collaboration with the military hiv program. zika that we started with the zika vaccine was with the walter reed army institute of research. the work we do with malaria is with the department of defense. we, over many years, have been

closely collaborating. they're one of our closest collaborators. >> can i ask you, we have been talking a lot about diseases that unfortunately are household names now. ebola, zika, the flu. what about preparing for the unknown? what about that next thing? can you speak to that a little bit, and what are your thoughts on that? dr. fauci: that is a very good question. when you're talking about preparing for the unknown, there are two ways of doing that simultaneously. different groups embrace one or both of those. the first is to try and anticipate what that new thing is going to be, and preemptively make a vaccine, therapeutic, or diagnostic. an organization

and decided they want to go after that. way that we concentrate more on is what we call developing and perfecting but for technology. in other words, vaccine platforms that are not against but can be readily adapted to pathogen x.. for example, if you perfected the dna platform technology and you know how to use it, then a , toase x comes along , you insert it

into that platform and you save six months already. instead of china to guess what pathogen it is going to be, you perfect your responses to that pathogen. that is a we are doing very aggressively right now. >> thank you. any more questions? you said your whole career you have been fighting infectious disease and making enormous strides. switching gears a little bit. what kind of advice would you have for people who are entering the field and want to work in this field? again, i obviously have a personal prejudice towards it. itself hasl, science to be one of the most exciting things that you could possibly do. for young people who are interested in getting into it, i

would suggest to them and encourage them to follow that desire. infectious disease is one of the reasons why i picked infectious diseases. there are certain characteristics about it that are exciting in general, and that fit in with my personality profile. it is something that is acute. you can do something about it. it kills people. you can prevent it. you can treat it. and that is not just provincial, it is global. encouragement,y is to just confirm that the hasd of infectious diseases to be one of the most exciting things. even though it is enormously stressful.

turns out to be one of the most exciting things you can do. when you're dealing with a formidable foe in the form of infectious diseases that has an amazing potential impact in a negative way, such as with an outbreak, or in a positive way, that you can do something about it. people whocourage are thinking about this to give it serious consideration. >> thank you. you talk mostly about diseases that spread naturally. terrorism or man-made diseases that affect people? our preparedness for the release of microbes is very

much incorporated into our approach towards naturally occurring microbes. it really is the same thing. the same platforms, the same surveillance, the same ability to develop countermeasures, the same collaboration with the cdc and others. i often say, and i will say it here, is that to me the worst bioterrorist is nature itself. because if you look at what nature has done to us compared to bioterrorism, it is not even close. last question. i wondered if you could talk about that in terms of the epidemic. in terms ofything

education and awareness, helping to push any interventions that could help curb the increase in infections? dr. fauci: because of opioids? >> yes. closely inwe worked our area that relates to prevention among injection drug users. clearly, the kinds of of infection with hiv and people who are exposed because of the use of drugs that started off with opioid very clearly things that we do. we do not primarily due opioid work, what our work in hiv certainly overlaps in that area. inside -- a site from the

opioid epidemic, which have a comment hiv trajectory? you know, as some of i've spent the last 36.5 years working on hiv. if you look at the medical advances, particularly in the arena of treatment, it is really nothing short of breathtaking what has happened from the when i first started seeing them in the summer of 1981. the median survival of people with advanced disease was somewhere between eight months and 15 months, which means 50% of patients would be dead in a year. as the years went by and we single drugs, and now ifbinations of drugs, someone comes into the same

clinic i saw them in 1981. let's say 25-year-old person recently infected, and i put combination, i can predict to them that if they take their medicine every day they will live an additional 50 years. that is clearly one of the most important medical advances in memory. something as dramatic as that. the science has been fantastic. what we have right now is an interesting situation. vaccines would be the nail in the coffin of hiv. apart from vaccines, if you look at what we have now, have more of an implementation gap than a scientific gap. there are formulas to show that since we know that if you treat and bring theiv

virus to below detectable level, it is almost impossible for that person to transmit the virus to somebody else. if you do some simple math, if you'd the erratically could identify everybody in the , and bring the virus wouldetectable level, you and the epidemic because those people would not be able to infect anybody else. even in the absence of a vaccine, theoretically you could end the epidemic. but theoretically is a far cry from reality. we are at that very interesting point in the epidemic where we

already have the tools to have a much greater impact than we are having. one of the greatest things our was ay has ever done program created by george w. bush. now 13 million lives have been saved by that program. that is very impressive. >> thank you. i think on that inspirational note i want to thank you for joining us today. i want to thank apco for their partnership in this series. thank you all for coming. before we close, if you have a minute to fill out your evaluation form for quality data purposes we would appreciate it.

again, thank you. [applause] >> c-span's washington journal live every day with news and policy issues that impact you. radio up friday morning talk show hosts from around the u.s. share their thoughts on the direction of the company. be sure to watch c-span's washington journal live at 7:00 eastern friday morning. join the discussion. night, former economic

adviser to president reagan and two the trump campaign. he talks about how he helped guide the tax bill passed in late 2017. we have coverage of the leadership program of the rockies. that is friday at 8:00 eastern here on c-span. >> for nearly 20 years, in-depth on book tv has featured the nation's best-known nonfiction writers in live conversations about their books. this year, and a special project, we are featuring fiction writers. join us live sunday at noon eastern with walter mosley. he has written over 40

critically acclaimed books and mystery series. we will be taking your phone calls, tweets, and facebook messages. sunday, live from noon to 3:00 eastern on book tv. on c-span two. commissioner advocated for better food labeling, dissing sodium levels in food, and increasing his agency's role in improving public health. during the came national food policy conference in washington dc. this is just under one hour. >> good morning everyone. i am delighted to introduce, as our first speaker, dr. scott. gottlieb. he is a physician, a policy