Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

Mark Masselli: This is Conversations on Healthcare , I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret we ar e seeing an accelerated response to the zika
pandemic. The Center for Disease Control and Prevention has deployed teams of
investigators to north - eastern Brazil, the epicenter of the outbreak of the mosquito borne
virus.

Margaret Flinter: And they are re ally trying to determine if it is the zika virus could it be
possibly be other additional causal agents that have led to the spike in babies born with
microcephaly.

Mark Masselli: Teams are going to door to door interviewing women who have been
exposed to zika during their pregnancy. The data needs to be collected methodically so
public health officials can be armed with the best intelligence on the outbreak and the
risk assessment.

Margaret Flinter: Well this is really what we call basic classic epidemi ology Mark and
it's got to be done but understanding the nature of these disease outbreaks and the
specific outbreak is something that our guest today is quite expert on.

Mark Masselli: Dr. Anthony Fauci is the Director of the National Institute for Aller gy and
Infectious Disease. He led the global effort to uncover the cause of the AIDS epidemic.
His department is working in concert with the CDC and the World Health Organization
to get a handle on the zika virus which still has so many unknowns.

Margar et Flinter : And Lori Robertson will also check in, she is the managing editor of
FactCheck.org and is always on the hunt for misstatements spoken about health policy
in the public domain.

Mark Masselli : But no matter what the topic , you can hear all of o ur shows by going to
chcradio.com.

Mark Masselli: And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter because we love hearing from
you. Now w e will get to our interview with Dr. Anthony Fauci in just a mo ment.

Mark Masselli: But first here ’s our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these healthcare headlines. The World
Health Organization has issued several new guidelines associated w ith the ongoing zika

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

virus pandemic affecting a large swathe of South and Central America. Evidence is
mounting between the link between zika infection in pregnant women and babies born
with severe birth defects including but not limited to microcephaly, abnormally small
head and brain development. And for anyone who travelled to the affected region being
advised to avoid donating blood for at least to 28 days upon return, incidents of a
neurological disorder Guillain - Barre disease is also being linked to zika exposure.

Zika is expected to exact the $4 billion economic toll . The federal government and the
insurance industry released on Tuesday an initial set of measures of physician
performance that they hope will reduce th e glut of conflicting metrics doctors now must
report. The measures are intended to make it easier for Medicare, patients, insurers
and employers to assess quality and determine pay.

America’s Health Insurance Plans or AHIP which represents most insurers said it was
encouraging insurers to add these into contracts it strikes and renews with doctors and
hospitals. Sometimes doctors have to report multiple measures assessing the same
things such as, how many patients ’ diabetes improved because each insurer has its
own metric .

A RAND report has borne out what is long been known the military’s health programs
falls far short of properly addressing behavioral health issues affecting active service
members, a vast majority of soldiers who get diagnosed with PTSD or depression
receive at least one talk therapy session according to the study, but the system faces
difficulties ensuring the patients continue with treatment either by continuing to see a
psychotherapist or following up with the doctor after being presc ribed medication. The
RAND study examined medical records were close to 14,000 soldiers diagnosed with 1
or 2 other conditions of those about 15,000 had PTSD, 30,000 had depression and
6,000 had both. About 1 in 3 patients newly diagnosed with PTSD got t he appropriate
follow up care after starting treatment, the soldiers with depression less than a quarter
had been competed those four visits. Meanwhile only 40% of patients who are
prescribed medication followed up with their doctor afterward. I am Maria nne O'Hare
with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Dr. Anthony Fauci, Director of the National
Institute of Allergy and Infectious Disease at the National Institute of Health which
oversees research of broad spectrum infectious diseases. Dr. Fauci served as the key
advisor to the White House and The Department of Health and Human Health Services
on global AIDS issue as well as the global preparedness for emerging infectious
disease. He earned his medic al degree from Cornell University Medical College. Dr.
Fauci welcome to Conversations on Healthcare.

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

Dr. Anthony Fauci: Good to be with you.

Mark Masselli: You know it's fair to say American know you as our expert on infectious
diseases, you have made s ubstantial contributions to the HIV AIDS research as well as
other infectious diseases. But the most recent is of course the outbreak of the zika virus
which is the mosquito borne pathogen that’s been showing up in South and Central
America . The outbreak has sparked a coordinated effort between your organization
CDC and the World Health Organization and others, why is there so much concern
about the zika virus and how dose it differ from other mosquito borne infections?

Dr. Anthony Fauci: Well in general the zika virus went in and affects an individual is a
relatively mild infection characterized by a couple of days of fever, a rash and some
conjunctivitis. However, most recently with the explosion of cases in Brazil there has
been the realization that i t is very very likely a strong association of infection of pregnant
women with zika and the occurrence of congenital abnormalities in the fetus and
newborn particularly a type of congenital abnormality called microcephaly which is a
small head and brain du e to either underdevelopment and/or direct damaging effect of
the virus on the brain of the baby. And individuals who are not pregnant, anyone, there
is now the realization that there is an increase in the incidents of the syndrome called
Guillain - Barre w hich is autoimmune disease that attacks the peripheral nerves and can
under extreme circumstances lead to difficulty in paralysis and breathing and even
death. But the most important thing that’s driving the concern about zika is the effect on
congenital abnormalities in women who are infected during pregnancy and that’s the
thing that’s causing a great deal of concern in South America particularly in Brazil.

Margaret Flinter: Well Dr. Fauci like so many public health threats that emerge , people
are scrambling I think to learn and to understand and to know more , but a new piece of
information that seems to have thrown an another big source of worry into the equation
is reports of human to human transmission in uterine partner to partner, c an you talk
with us maybe a little bit about what are the hardest regions at the moment and how it
spreads and what sort of threats does it pose to the United States?

Dr. Anthony Fauci: The hardest hit regions, South America particularly Brazil,
particula rly the north - eastern section of that country, but also other South American
countries like Colombia and Venezuela as well as the Caribbean. Now it is spread by a
mosquito bite that is the overwhelmingly predominant way that this is spread. We have
seen in this country imported cases, someone who might get infected by being bitten by
a mosquito then travels to the United States and gets sick so I would not be surprised if
there are in the future local mini outbreaks of local transmission. Similar viruses like
dengue and chikungunya which are both spread by the same type of mosquito have
been in the Caribbean and South America for long time and then every once in a while
you get a little cluster of a mini outbreak in the United States particularly in the s outh -

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

eastern gulf coast states and we have seen small mini outbreaks of both dengue and
chik u ngunya. They have been very well controlled by accelerating mosquito control, but
we should not be surprised if we do see this little mini outbreak. There has be en the
description of a couple of well - documented cases of sexual transmission namely
someone who got infected, came back and then infected their partner who never left the
country and we don’t know how often that occurs, it's doesn’t look like it is a ver y
frequent event but we do not know that. And for that reason the CDC have
recommended that when man who might get infected in South America and maybe
come home, that they should practice safe sex particularly pregnant woman. So if you
have a wife that’s pregnant or a girlfriend that’s pregnant and you are a man, the
recommendation is to use the correct and consistent use of condoms

On the other hands the recommendations by the CDC is that if you are a pregnant
woman in the United States and you are think ing of travelling to the region and there are
over 30 countries that have now been designated in the Caribbean and South America,
the recommendation is that you strongly consider not travelling to that region until the
situation gets clarified.

Mark Massel li: Dr. Fauci it's sort of an interesting pathway to this crisis, zika was picked
up in the 40s , what happened in the development of this disease that we missed, is it, or
do we have our eyes on zika earlier?

Dr. Anthony Fauci: So it's first recognized in a monkey in 1947 the first human infection
was documented in Africa in 1952 and then zika kind of stayed under the radar screen.
And then in 2007 there was the first really major outbreak, there was a major outbreak
in the Isla nd o f Wayag [PH] in the Pacific Ocean and then over a period of few years
from 2007 to 2012 and beyond it worked its way through French Polynesia and in 2015
it hits South America with a massive explosion of cases. And very likely, because the
people in S outh America particular Brazil had never before been exposed to this zika
virus so they were a population that had no background immunity, it does not like they
have any major molecular or genetic change in the virus tha t caused it to explode this
way but we are still working on trying to find out if there is anything different about the
virus, to the virus that was in Asia and then across the Pacific

Margaret Flinter: Well Dr. Fauci I would like to talk for a moment about what happens in
your research co mmunity in times like this. Your organization has a very robust
infrastructure for mobilizing research protocols in quick response to outbreaks, you have
also responded to malaria , to dengue fever , to Ebola, what has the research community
learned from th ose experiences that inform the research approach to zika, how this
global network of scientist working together on this and what the best prospects are for
controlling the outbreak as well as for a viable vaccine?

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

Dr. Anthony Fauci: Well the experience t hat we have had emerging infections that go
all the way back you know in recent memory to HIV AIDS, few other diseases that you
mentioned tell us that we need to be essentially perpetually prepared having a global
health security network to be able to pick up with surveillance these infections when
they occur so that they don’t get out of hand and you wind up behind the eight ball as it
were before you even get started. Number two, is to develop the technologie s to rapidly
move to develop what we call coun termeasures in the form of sensitive and specific
diagnostics, therapies where possible and importantly for diseases like this vaccine.
And that’s exactly what we are doing right now at NIH and NIAID is rapidly trying to
develop a vaccine for zika and to do that as quickly as possible in the same way as we
very quickly got the ball rolling and got a vaccine for Ebola when the Ebola outbreak
was at its peak. So our main job right now is to get better diagnostics and that would
probably not take too long.

N ow the other things that one does in an outbreak like this and this is more is to do
good vector control, in other words control the mosquito vector which is Aedes aegypti ,
a very very difficult to control mosquito bites all the time inside, outside, it's a very
difficult mosquito. So a lot of effort has to be put into controlling the mosquito by
larvicide s, insecticide s, getting rid of standing water where the mosquito breeds a nd
when people are in those regions , to cover themselves and protect themselves with
insect repellent . So it's really rather a compr eh ensive effort to address this emerging
outbreak.

Mark Masselli: We are speaking today Dr. Anthony Fauci, Director of the National
Institute of Allergy and Infectious Disease at the National Institute of Health since 1984.
He oversees research on a broad spectrum of infectious diseases, I would like to know
your thoughts on what we really need to be prepared in terms of dollars and there were
some concerns earlier about the Ebola outbreak that we were n’t there fast enough, but
you have talked today about we need to be vigilant, we need to have surveillance, the
basic science need to be in place. So specifically what's the President asking for in
research, what's the larger need to really be vigilant and surveilling public health?

Dr. Anthony Fauci: With regard to zika the President in order to allow a coordinated
response among multiple agencies of the US Federal Government has requested of
Congress a $1.8 billion supplement to a 2016 budget in order for us to be able to do and
continue to do what we are doing right now because the m onies that we have either at
the NIH or the CDC or the FDA, for the most part are committed to things that are also
very important. So if you are going to take this extra bit of effort which is considerable
to address a serious threat like zika you are go ing to need more resources and for that
reason President Obama has asked the Congress for this supplemental amount of
money. But in the long run you have to develop a global health security network to be
able to have connection among countries throughout the world with surveillance

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

communication to be able to detect and respond as rapidly as possible to threats that
are either suspected of occurring or that are completely surprised and unexpected the
same way that zika was. So you have to make the long te rm investment both in basic
and clinic al biomedical research. For us that means developing better technologies for
vaccines and diagnostic so that you could respond very rapidly and not have a delay of
a couple of years in responding to something that is exploding in front of you the same
way that zika is right now or currently. And then there is the ability to move rapidly the
way we are moving right now with zika and that’s the reason why the President asked
for this extra money.

Margaret Flinter: Dr. Fauci you know when these things happen, they happen at the
level of community and have the potential to just overwhelm, even a pretty good public
health or primary care or acute care infrastructure and we have been hearing reports
the incidents of Guillai n - Barre maybe small but it doesn’t take much to overwhelm a
small hospital. And I wonder if you can comment on how the public health community
can mobilize to also help support the intervention and the response at that level?

Dr. Anthony Fauci: We learne d that lesson with Ebola and that is one of the important
components of an adequate response is what we call sustainable infrastructure at the
local level. One of the reasons was, it was that explosion of cases of Ebola in West
Africa was that the medical infrastructure was barely existent . And when we had the
need for identification, isolation and contact tracing it just was not there. You have to
have an ongoing building up of what we call sustainable health systems so that when
you get an outbreak like this the community involve can at least begin to respond and
you mentioned the situation with Guillain - Barre in some of the smaller South A merican
countries that don’t have the kind of infrastructure that you need it can become very
very challenging for them. And it is a challenge because we still do not have globally
the kind of health systems infrastructure that are required to respond at the local level to
these kinds of outbreaks.

Mark Masselli: Dr. Fauci I can just imagine Americans this summer making a run on
mosquito repellent, and I am wondering, am I more worried about dengue or zika or am
I more worried about mosquitoes? How do I protect myself , and I am sure there is
people who are thinking about going Olympics who might not do that but for the average
person what do we worry about?

Dr. Anthony Fauci: In the United States there are low - low levels of diseases like West
Nile and so me of the encephalitis that are spread by mosquitoes but we don’t have
large overwhelming outbreaks of mosquito borne diseases such as malaria and dengue
and other diseases like that because of our climate and because of the fact that we
have reasonably go od mosquito control. But as far as we care concerned in the United
States mosquito es are more of a nuisance than anything else which you have to be

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

concerned about is that if you are going to a region in which there is not only a lot of
mosquitoes but the re is a prevalence of disease like what we saw starting in 2013, there
was chik u ngunya in the Caribbean so people who will go into the Caribbean on vacation
you know have to have some concern because chik u ngunya was really quite a
prevalent in an outbreak in the Caribbean islands. The same now with South America
and that’s the reason why The Centers for Disease Control and Prevention are making
a strong recommendation to pregnant women that they seriously think of not traveling
there right now until it get s taken care of. So depending upon where you live
mosquitoes can be a little bit of a nuisance or a real threat to your health, it really
depends geographically distributed.

Margaret Flinter: We have been speaking today with Dr. Anthony Fauci, Director of the
National Institute for Allergy and Infectious Diseases of The National Institutes of
Health . You can learn more about their work by going to nih.gov or follow their work on
Twitter and all of their latest a lerts @NIAID. Dr. Fauci, thank you so much for your work
and for joining us on Conversations on Healthcare today.

Dr. Anthony Fauci: Good to be with you.

(Music)

Mark Masselli: At Conversations on Healthcare , we want our audience to be truly in the
know when it comes to the fact s about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org , a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you g ot for us this week?

Lori Robertson: Several members of Congress have written to government officials
about the zika virus outbreak in Brazil and a suspected rise there in the number of
microcephaly cases. But we found some politician s overstated what's known about the
outbreak.

Sen ator Kirsten Gillibrand claimed that, o ver 4,000 babies in Brazil have been born in
the last year with microcephaly , that suspected case is not confirmed. As of January
29, Brazil Health Ministry reported 4,180 suspected cases of microcephaly but only 270
were confirmed . The remaining cases were either under investigation 3,448 or
discarded that’s 462 cases.

S en ator Richard Blumenthal said those 4,000 cases in Brazil “have been linked to the
outbreak of the z ika virus.” , b ut only six of the 270 confirmed babies with microcephaly
had tested positive for z ika. Health officials say evidence strongly suggests a link
between z ika and microcephaly but they also emphasize the link hasn’t been
scientifically confirmed.

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

Doctors in Brazil began noticing a possible increase in microcephaly cases around
August 2015, as reported by the New York Times. The z ika virus likely spread to the
country roughly a year earlier.

Microcephaly is normally thought of as a rare neurological condition , where an infant’s
head is substantially smaller than the heads of other children of the same age and sex.
However, the condition often signifies a deeper problem , abnormal brain development.

There is plenty of concern among groups such as the World Heal th Organization and
the Centers for Disease Control and Prevention. But the concern in part arises from a
lack of knowledge about z ika and its potential causal link to microcephaly. For more on
what’s known about that possible relationship and the cases in Brazil so far, see our
website at FactCheck.org and that’s my fact check for this week, I am Lori Robertson
Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players an d is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversat ions highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Currently about two million
people around the world are suffering from end stage renal disease or acute kidney
failure. There are basically two options for these patients kidney transplants which are
costly and severely lacking in available donor kidneys or dialysis, also costly as well as
time - consuming, requiring patients to undergo blood filtering treatments at medical
facilities lasting up to five ho urs per treatment, costing about $90,000 per year.

A Montreal teen science project just may pave the way for another solution. Anya
Pogharian, developed a portable home dialysis kit that cost about $500 to produce far
less than the $30,000 dialysis machin es currently in use. Her idea inspired by her high
school internship working at a Dialysis Center in Montreal.

Anya Pogharian: Even have to make your way to the hospital which is a problem for a
lot of patients, it's not necessarily easy to go three time s a week to the hospital
especially because maybe limited mobility.

Mark Masselli: Pogharian says hundreds of hours of research led her to build a
prototype of the dialysis machine which is about the size of a typical gameboard but
pumps and purifies blood just as large scale dialysis machines do. Her invention has
earned her numerous awards and scholarships and the attention of one of Canada’s

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases

key hematology labs. She hopes this device can be developed throughout the world,
e specially Third World countries where significant percentage of the population doesn’t
have access to either transplant surgery or dialysis .

Anya Pogharian: 10% of patients living in India and Pakistan who need the treatment
cannot afford it or can't have it and anyway it's not accessible so that’s really what
motivated me to continue.

Mark Masselli: A relatively cheap, portable, easily assembled dialysis machine that
could alleviate the cost and treatment hurdles of ongoing dialysis, keeping patients
hea lthier longer, allowing them to be treated at home, now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broa dcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.