The AmFAR Report

single individual or group of
individuals can be expected to
know enough about all the highly
complex scientific and technical
aspects of AIDS research in all the
disciplines they involve, so as to
be able to direct fundamental
research activities. This, however,
does not mean that better coordination and novel collaborationsbetween individual researchers,
between various NIH institutes
and between government, industry and academia - cannot be
improved, nor that the intensity of
the overall effort and its fruitfulness and cost-effectiveness cannot
be considerably enhanced.
Research activities should, as
heretofore, be supported on the
basis of both their scientific merit
and relevance to the goal of the
overall program. They should be
closely monitored by a relatively
small group of outstanding
experts in various disciplines
under the direction of one person,
so that promising leads, gaps in
knowledge, duplications of effort,
as well as emerging needs for,
resources - whether these be
needs for expertise, collaborations,
equipment, facilities, special
reagents, or financial means - be"
rapidly identified and attended to
by the Office of AIDS Research.
'3. The Office of AIDS Research
must be strengthened.
An office of AIDS Research (OAR)
was established in 1987, ostensibly
to promote coordination of the
national HIV/AIDS 'esearch
effort. This office is currently
headed by Dr. Anthony Fauci who
is also the Director of the National
Institute for Allergy and Infectious
Diseases (NIAID). He is, in
addition, an investigator personally in charge of the research
program of a large laboratory, and
he frequently is a spokesperson in
congressional and public forums
on behalf of the governmentsponsored AIDS research pro
gram.

If the Director of the OAR is
truly to be in charge of either the
national research effort, or else the
major part of it, namely NIH AIDS
research which now includes also
behavioral research, he/she must
be able to dedicate full attention
and full time to the task, and must
be free of conflicts of interest. He/
she must also be empowered with
considerably more independence
and authority than the current
Director.
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4. Mode of OAR operation.
With regard to the OAR:
(i) We recommend that its
Director continue to be an outstanding senior scientist, but that
he/she be one who can dedicate
full time and effort to oversight
and coordinating responsibilities,
working with the assistance of a
small group of appointed senior
program analysts, namely active
scientists and clinical investigators
with expert knowledge in various
aspects of HIV/AIDS research,
assisted by supporting personnel.
Program analysts would participate in the review of federal
programs.
Together, they would constitute the Office of AIDS Research.
(ii) Ideally, the OAR Director would have oversight authority on all agencies involved in

AIDS research, within and outside

the NIH, and the authority, vested
in him/her by the President
himself, to shift financial or other
resources between such agencies
(such as terminating or initiating
programs). He would be a strong
advocate for the program as a
whole before Congress. This broad
responsibility would require the
creation of a new line of authority,
by-passing and superseding that
of the Director of the NIH. The
position of Director of the OAR
would then pr6bably be at the
level of Under-Secretary of HHS.
Alternately, the OAR could
remain in the office of the NIH
Director. The OAR Director would
then report to the NIH Director
and have oversight on only the
NIH AIDS research program at
the pleasure of the NIH Director;
he/she could likely obtain information about HIV/AIDS research
carried out by other agencies but
would be able to coordinate the
total effort only through adjusting
the NIH effort, with the approval
and consent of its Director. Even
with this more limited authority,
the Director of the OAR could
considerably strengthen overall
AIDS research because the major
portion of that research is under
NIH control.
(iii) Either on his or her own,
or with the NIH Director, the
Director of the OAR will report to
the Director of the National AIDS
Program (possibly, as mentioned
above, a member of,the
President's Domestic Council).
Nevertheless the Director of the
OAR would have final authority
on matters pertaining to the
content and budget of the national
program of. HIV/AIDS biomedical
- basic and clinical - and
behavioral research.
(iv) Within the shortest
possible time following the
establishment of the strengthened
OAR, its Director will assess AIDS

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