It is such a pleasure and honor to be here with these two gentlemen. We will do quick introductions because you all know who they are. Dr. Anthony fauci served as director for the National Institute [applause] elizabeth National Institute of air and infectious to the from 1984 until 22. He advised seven u. S. President s and was a principal architect of the president s emergency plan for aids relief, or pepfar. Senator bill frist served in the senate from 1995 until 2007. The last five of those years he was the Senate Majority leader and let the passage of pepfar legislation. He is a surgeon who specializes in heart and Lung Transplant surgeon transplants. I want to give an introduction to pepfar. I learned about that in Public Health school. There may be a few of you who are a little bit young. Who are not as familiar with it. In Public Health school, it was in addition to immunization, it was the single biggest thing we could brag about in Public Health. It is 20 years old today and it pays for medication for people with hiv in more than 50 countries and it was passed during the presidency of president george w. Bush. It is the largest investment by any nation to address a single disease in the world and has helped save over 25 million lives. [applause] dr. Fauci, that was a barebones explanation of pepfar. Anything you want to add . Dr. Fauci you said it very well. It really involved from a concept that at the time that pepfar was conceived of and then actually developed, was in 2002, which was then made law. It was several years after the availability of truly lifesaving drugs. In 1996, that was a pivotal year where certain drugs completely transform the lives of people with hiv. In those countries and those societies in which drugs were available, it was completely lifesaving, to the point now, people who have these drugs available to them can lead almost a normal lifespan. The thought was over a period of time people in the developing world do not have the accessibility to these drugs or to prevention. And a number of elements in society, faithbased groups, myself and my colleagues who would go to africa, were thinking is it feasible to get drugs to these individuals, even though many people thought inappropriately that you cannot give a complicated drug regimen to africans in subsaharan africa, which was proving to be completely incorrect her with all the credit to president george w. Bush, when he sent me to africa, his exact words to me were, as a nation of great riches and opportunities, we have a moral responsibility to not let people die from a disease that is treatable merely because of where they were born and where they live. So go to africa and figure out. [applause] just figure out, is it feasible . If it is, is this something that is transformative and is that accountable . That is how it started. Elizabeth feasible, accountable. We are going to remember those words. Senator frist. Dr. Frist 20 years ago, i would just like to have a human face to what the world was like at that point. As elizabeth mentioned, i am a surgeon and for years went to africa to do surgery and medicine. In the 1990s and the 1980s. At the time in africa, in the hospitals there would be groups of patients dying of what we just did not know what it was at the time. We did not have the testing at all. It was called a wasting disease because there was nothing you could do. It was general, was infectious, this sort of immune response, but we did not know what it was. In the United States, we really progressed in terms of understanding hiv aids from the early 1980s. Gentlemen sitting next to me helped figure this out. In africa, if you visited there in the 80s and the 90s, you would notice that there was this halloween out of society hollowing out of society. You will not see people 20 years of age, 30 years of age. But you would see the grandparents and greatgrandparents taking care of the kids. We did not know why really. But this meant that you had society the people Teaching School would die, the civil servants. It was so hard to imagine at that time. This was not one country, but it was very far from what a person like george w. Bush would see, much less legislators in the house and senate. Most did not have passports. There were 3 Million People a year dying every year globally of this single little kg virus cagey virus that again he helped figure out. In botswana at that time in 1988, the average Life Expectancy was 39. I came to the senate in 1995. When i came there was not a doctor in the United States senate. That is the backdrop that we are coming through with a virus that in this country but globally was heavily stigmatized. For many people, they did not understand what this virus was. There was this stigma around all sorts of reasons. I will stop with that because what was done then, and we will talk about whether it could be done again, is what the legislative body that i became majority leader of, being the only physician, i had to beat against that backdrop, not fully known what the Great Success would be, but knowing what we had as resources and in terms of Global Leadership potentially to take on the most heavily stigmatized disease in the world. One being that was hollowing out countries in africa. Elizabeth this was not easy to put together and it was not certain it would happen. Can you explain how it happened and tell us some stories. Dr. Fauci i started off not as large as it turned out to be. One of the things we were trying to prove was what could we actually do feasibly . Can you really implement this in the developing world . At that time there was a drug that was used in a single dose to prevent mother to child transmission. If you gave a single dose to the mother during labor and a single dose immediately after birth, you can diminish by 50 but transmissibility. The transmissibility. The original plan was to see if we can do something in that area. Dr. Frist what you are hearing now in terms of this trip to africa, if it had not occurred, this would not have happened. The importance of the president sending his top science person. The president said you go. Is there something that could possibly be done. I just want to say historical. But keep going. Elizabeth did people know you were going . Was it public . Dr. Fauci they did not know what the purpose was. They thought we were doing a factfinding trip. So we went there and i came back. It was such an extraordinary experience. I came back with this plan for 500 Million Dollars for mother to child transmission. I presented it to the president and most of the cabinet in the roosevelt room of the white house. The president said this is really terrific. Lets do it. And i thought it was over. As i was getting up, the president comes to me, he grabs josh bolton and says this is fantastic, but it is not big enough. I want you to go back and give me something massive that would transform, not just mother to child, but the people that bill was talking about. The young people that were getting infected. I was sort of stunned. I said that is going to cost a lot of money. He said let me worry about the money. And he sent me back to the drawing board and that is when i put together the program, 200 Million People treated. It started off as a 15 billion Dollar Program over five years. We were trying to determine what were the countries that were going to be involved. What about in dieppe . About china . We decided it would be fundamentally lower Income Countries in subsaharan africa. From the time i presented it to him, i worked with the white house staff, people whose names you do not know, but they were the heroes of it appeared abe. They helped me over a period of months, i was not sure whether he was going to do it or not. I became persona non grata for a we be. Oeb. But the president was totally behind me. He announced it on january 28 of 2003. It was something bad took seven or eight months going back and forth. How many treatments, how many countries, what it was going to be. It shows you what the leadership of the president of the United States can do when he or she decides that something is going to get done. Dr. Frist so all of that was going on in the executive branch. It does not go very far when u. S. For 15 billion because that does not when you ask for 15 billion because that does not come from the executive branch. It was a handful, five or 10 or probably more. Dr. Fauci that was stressful because the president told me i do not want you to tell anybody. Dr. Frist the secretary of health and Human Services, great guy, i did not know any of this was going on. Here we have a president who was the leader, but his world is not disease, Public Health or africa. But he had a mission and a dream and he knows what america can do. That is what a leader is all about. On the legislative side, since nobody knew anything about what was going on. I started working with john kerry at the time and joe biden, we started working with a think tank and we put together an amendment that doubled funding in the United States senate. It was a huge success but a huge battle because i as a physician would bring back jews from africa pictures from africa. Karl rove and others that the time will look at them. John kerry and i got involved. In 1999 we introduced a bill called u. S. Leadership to address hivaids, malaria and tuberculosis. When we introduce the bill, it was me and john kerry and joe biden. We did the press conference together. None of us at that time ultimately the bill we introduced became the template to the bill once it was announced. All of this was going on about six months before the big announcement. But that was the template on the senate side. But nobody knew on the state of the Union Address in 2003 except tony and probably about 1015 people that the president of the United States was going to say i am going to make the single largest commitment of any country in the world against a single disease. Congress did not know it. About four weeks before, i was called to the red room. I knew something was up. There were about 14 people there. The president said, tell the leadership of the senate i am going to make this announcement. People said it is too expensive. The president said it is not going to be too expensive. My chief science advisor said it costs 10,000 to treat a patient, but if we call upon the spirit of the American People, we can get it down. Somebody said it has never been done before. He said that is exactly why we are going to do it. Nobody should be dying in another country if we could have therapy for it. Three weeks later he went to the state of the union. [applause] elizabeth during this time, when the secretary of health and Human Services would see you and go, working on Something Interesting . What would you say . Dr. Fauci it was uncomfortable, but you know. But when the president explicitly tells you something, i know what the hierarchy is. Elizabeth it seems like the key to making this work was bipartisan support, including from conservatives like jesse helms, who really turned around on this issue. Can you talk about that . Dr. Frist let me jump in, tony. Language in politics and everything is so important. We were very divided on this particular issue at the time. It was a huge hill to climb in large part because people did not understand. There was a stigma. We had ryan white here in this country, but the idea of taking taxpayer money overseas was just hard. It is hard even today as you know. So jesse helms, it is all coalition building. Pulling the very best out of people. This drug cost about one dollar. There were 10 million aids orphans in the world at the time. Jesse helms was the most iconic republican in the party. If jesse helms spoke, the Faithbased Community, the religious right, the evangelicals would listen. Jesse helms had written an article saying this is a morally corrupt disease, aids was. And we are not going to do anything that is going to support a disease centered around immorality. No excuses for it. But he also cared about young people, children, family, the family unit and people around the world. Bono from u2 was really helpful. He and i had worked together. He said i am faithbased. Why dont we go talk to jesse . Going into the room, because there are 10 million orphans out there and you care about orphans and the remarkable thing, because antifederal virals were young. Tony knew we could get it done. There were 23 Million People in the world who had this disease. But he knew with the power of the pharmaceutical industry, he knew that. But that is hard to tell anybody to inspire them. 10 Million People, one dollar can prevent an aids orphan. Jesse said, tell me more. Three weeks later, she went to a big evangelical event. Jesse helms said at the podium i am going to support every effort to get rid of the scourge of hivaids in the world. And when jesse helms speaks, the whole evangelical community sense we are going to come on board. I tell this story only because it is so easy today to be divided. And we can do it. We did then. They change the course of history. And all of a sudden we are able to pull people together. Dr. Fauci one other thing to compare the political situation back then and what is going on right now. It is really striking because back then you had diversity of ideological philosophy. You have the far right, the center right, the center, the centerleft, the progressive spirit there diversity, but there was not divisiveness. So we could do things together regardless if you are conservative, centrist or liberal. The diversity wasnt there, but they liked each other and they worked the diversity wasnt there, but they liked each other and they Work Together. If i am thinking back, could we have pulled something off like this mount . I do not really think so. I think it probably would be objected purely on the basis of somebody being on the others. So this is really in my mind a classic example of how important the ability to Work Together in government is because the result was 25 million lives had been saved because people had the will to Work Together for something that was a common cause. You talk about examples for other things. This was historically such a great example. You talk about republicans being very far radical right. This was george w. Bush, a compassionate conservative republican, who just made this happen. Elizabeth you mentioned feasible, transformable, accountable. That is the pepfar model. Can we apply it to other diseases . I think we can. One of the things bush was adamant about is he did not want to dump money onto a government in a particular government. She wanted to go through ngos. He knew there was a lot of corruption in some of these countries and nothing was happening. That is why he wanted it accountable. He wanted it feasible. He did not want pieinthesky. He said, can we do this . He wanted it not to be at the surface and atchts picked me at the margins. Elizabeth why cant we do that drfauci i think we can. There is no reason why we cannot translate the pepfar model for other diseases. You can probably do the same thing with malaria or tuberculosis. Tuberculosis is a disease that we forget about but it kills a lot of People Living here. There are a lot of massive global killers that if we put our resources on we can do it. Elizabeth lets talk domestically. If we can do this for 25 Million People, save those lives in other countries, there are people in the United States that cannot afford the drugs they need. Is there anything we can learn from pepfar . Dr. Fauci leadership from above and the will for people to get things done for the common good. It is not rocket science. That is all you needed. You needed a strong leader who said he was going to happen. When we were in that room, people were saying it was too much money. Do not worry about it. It just happened. You really need leadership and the support bipartisan support. Dr. Frist ive spent a huge amount of time talking to people and defining problems. There is no question that we can do this again. I was able to take four republican senators and four Democratic Senators to africa and spend seven days seeing culturally this halloween good hollowing out. We had the huge support of the American People in a bipartisan way to do that. We do have to build that support and have the leadership. If it is around health, comes back to science as well. Tony was able to take an insurmountable problem. This was so big. He was able to see that even though the cost is here, that the virus itself, he knew we could get it really took a sciencebased background and confidence that we have seen it play out more recently with covid. When it comes to health issues, trust in science is critically important coupled with real leadership. Global health is a tough issue. Right now we only spend about a quarter of 1 on global health. The American People do not know that. If u. S. Them, they say we must spend 20 . But we spend one quarter of 1 on global health. And this is probably the best example. 110 billion now because every president has supported it. It is an investment beyond just hiv aids or a single virus. He sends a message it sends a message that america is there for from a moral standpoint. It builds an infrastructure for all sorts of other Infectious Diseases because that money was used in such a smart way. There is no question. This is what i tell my people from tennessee who say my taxpayer money should go to my town. That healthy societies and stable societies around the world only made possible by American Leadership make us more secure at home and safer at home. It is the best model for that because it is not just the virus itself that we are taking care of. We are taking care of families, we have injected hope. These implications are things that are beyond what we anticipated initially. The American People have supported, the democrats have supported, the republicans and every president since then. [applause] elizabeth you mentioned jesse helms. He wrote an essay in the Washington Post and said his conscious was answerable to god. He said i am guessing my full of soon meeting him. I am mindful of soon meeting him. How important was the religious aspect and making pepfar happen . Dr. Fauci it was critical. The Faithbased Community was essential because they were doing other things in africa that were not necessarily related to hiv. They had been in that position of reaching out to the developing nations, including in southern africa. So to get the support of the Faithbased Community, which was very much aligned with president bush, and even though in general there was not that strong relationship between the Scientific Community and the Faithbased Community, this was a good example of coming together. They were supporting what we were trying to do. I think there were of the number of elements that made it happen. If you had taken out the Faithbased Community and might not have happened. It may not have happened. Dr. Frist you start with the Faithbased Community, in that day, condoms you cannot mention at all. You cannot mention condoms. Really important in terms of language and understanding. That was one of many different coalitions coming in there. The coalition out there of mainstream america, when bono came to see, he has an effective voice because people do not expect this kind of initiative from a rockstar. You got the east coast, you got l. A. And san francisco. But if you want to move the American People with your voice and we have to do that, the president can say anything he wants, but unless you get the support of the American People because we write the tax bills, you got to have the American People understand. I said, bono, that is good, but you need to come to where faith is you need to go to the heart of america. He said, what are you talking about . I said in this country for these big things, you have to go to tennessee, nebraska, iowa. I thought he would go away. He did not go away. He said in three months i am going to do a heartland of america tour. He spent 10 days on a bus going to iowa, nebraska, tennessee. When he was in iowa, he would stand up and people would listen to him. He kind of told a story from a faith standpoint. He said i hear you can grow anything and i am here with you to grow a great movement. All of a sudden, everybody stood up. Dr. Fauci one other thing we should mention is what the response of the African People were to what had been done. When you talk about soft diplomacy and you talk about winning over countries to appreciate the generosity and the spirit of the American People, it is amazing when you go to africa how cognizant they are of what our country has done, our president has done and the American People. I have gone to africa multiple times since we developed the pepfar program and it is truly remarkable that you will go wherever and people come over and thank you because of pepfar. It is an incredibly warm feeling when people come over to you, thank you so much, pepfar has saved the lives of people in our village. Dr. Frist on the faithbased thing, people did not realize most health care in africa was delivered through faithbased institutions. That is the way most health care was delivered. Government supported come up with 60 of it was delivered. Medicine and healing as a currency of peace. I want to introduce that to you because it is real. You do not go to war with somebody who was just saved the life of your child. We only spend one quarter of 1 in this country in order to have a huge impact. I am arguing that if you come into a community and you make family stronger and give them hope, it opens up worlds of future opportunity, economic prosperity, safety, security. People sometimes do not see the full impact in peoples lives and that translates up into communities and schools, and then up into the governance of the country itself. Hiv aids is one area. It has been a great platform in over 50 countries around the world. For the future, we need to look at it as a case study, at the same time we countries like china who were building highways going through these same African Companies and giving them other services that are there. If we can speak powerfully through this health and healing, which we have modeled here for the future, but we need to seize upon it as well. Elizabeth that is a beautiful note to end this section of the presentation. Now we will take questions from the audience. Here in the front row. I would like to say thank you for all the hard work you do. You talk about Health Equity around the world, but what about here at home . It feels like some of us are struggling to fight for Health Equity here at home. I feel like that translates to [speaking foreign language] we are playing saviors all over the world, but what about here at home . Dr. Frist it is not mutually exclusive. We are one the world. When we talk health, we are talking global. When we talk on Climate Change, we are talking the planet. We are talking here at home, i hope nothing that we said has implied we are not addressing the equity issues here at home. Dr. Fauci we have a real serious problem in our own country that you were alluding to and a bright light was shined upon it during the 3. 5 years of covid, where the disparities of health and the social determinants of health among different populations in our country has led to a very disproportionate disparity in the rate and incidence of severe disease. When you look at black and brown communities who have a higher incidence of obesity, diabetes, hypertension, chronic lung disease, but was the reason why if you got infected and you were among that population that you had a greater chance of being hospitalized and dying. So what i have been saying is that if ever something put right in front of us why we had a responsibility to address the social determinants of health, which are not going to be an overnight task. It took decades if not centuries that have led to this that we have a responsibility to not forget. It was with hiv the same thing. There was a disparity in health among certain populations. Let that be one of the many lessons we learned from covid that we need to address the social determinants of health. [applause] thank you for everything you have done throughout your careers. What was the political strategy of the Bush White House at the time of the pepfar program . I can understand the moral leadership, the health diplomacy, but this was in the advent of 9 11. We were entering two wars. Dr. Fauci i will let bill address that, but being right there up close and personally was not a political issue at all. It was an understanding of the profound disparity between the United States, which from 1996 2000 and 2001 and 2002 took a disease that was almost uniformly fatal and turned it into a disease, they called it lazaro the fact. People who would have died came out of hospice because they knew the Life Expectancy was almost normal. That profoundly affected bush. It wasnt like lets see what political chips we can get out of that. There is always something a little bit political in washington but that was not a driving force. Dr. Frist i was thinking as you were talking, i can honestly say i dont remember whether the political chips were put on a table in a way that was for or against it. Everything has politics, and had to overcome politics and the same issues today around abortion but in terms of a political advantage or disadvantage, the issues that were big for me were inflated. Elizabeth lets see from this side of the room. Thank you very much, it is an honor. This question is for dr. Fauci. He talked about science. We know the impact of Climate Change and Public Health, in a monumental way you were able to treat hiv area where do think this administration and community is going with Climate Change . Elizabeth 42 seconds very dr. Fauci didnt you just come from a conference on Climate Change . Obviously, its very clear. Its real, its a problem, we have to address it. The argument of whether or not its a scientific fact is ridiculous. We need to put that behind us. The nonsense that its not a reality, i think were almost there. Dr. Frist we are at a point where people are coming together for the first time. I chair the nature conservancy. Its a Planetary Health and human health going forward. I feel good but we have a long way to go. Its a big issue, probably the next Biggest Issue after hivaids, the American People and the planet have to come together. Elizabeth perfect. Thank you both. [applause] dr. Fauci thank you. Elizabeth thank you