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Date: Fri, 16 Nov 2001 09:48:17 -0500
From: Africa Action <[log in to unmask]>
To: [log in to unmask]
Subject: Africa: Global Health Fund

Africa: Global Health Fund
Date distributed (ymd): 011116
Document reposted by APIC

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+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +economy/development+ +security/peace+ +health+

SUMMARY CONTENTS:

This posting contains excerpts from the keynote speech by Malawi
Vice President Justin Malewezi, at the Africa Consultation Forum on
the Global Fund to Fight AIDS, Tuberculosis and Malaria. The full
text of the speech is available in the archives of the "Break the
Silence" E-mail Forum, available on http://www.hdnet.org/home2.htm
or at http://archives.hst.org.za/bts, along with ongoing discussion
on the Global Fund, with many African participants. The Brussels-
based Transitional Working Group settting up the Fund has a web
site at http://www.globalfundatm.org

The posting is preceded by a short update note from Africa Action.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

Africa Action Update Note

Developing countries and non-governmental groups are critical of
many aspects of the joint statements agreed at the conclusion of
the World Trade Organization ministerial summit in Doha earlier
this week. But the combined impact of activism, public outrage,
and the determination of developing countries led to a significant
breakthrough with the key declaration that the existing trade
agreement "can and should be interpreted and implemented in a
manner supportive of WTO Members' right to protect public health
and, in particular, to promote access to medicines for all." For
full text: http://www.ictsd.org or http://www.wto.org

The declaration failed to include a clear statement explicitly
authorizing export of generic medicines to countries without a
manufacturing capability of their own. Moreover, after its initial
shock, the pharmaceutical industry is already trying to claim that
nothing has changed. However, the text represented an unprecedented
victory for the stance taken by African and other developing
countries. It clearly paves the way for more agressive action to
make lower-cost drugs available. Whether this happens now depends
primarily on political will and resources, both in key countries
that have hesitated to act and in international agencies, including
the new Global Fund.

For "can and should" to be turned into reality, African countries
and non-governmental organizations must mobilize to take full
advantage of the opening offered by the Doha declaration. And they
must demand adequate resources and guidelines be given to the
Global Fund, including support for global bulk drug procurement
mechanisms that can further lower prices while maintaining quality
control.

-----------------------------------------------------------

Republic of Malawi

Statement by The Right Honourable Justin Malewezi, Vice President,
delivered at The Consultation Forum on Global Fund to Fight AIDS,
Tuberculosis and Malaria

November 12-13, 2001
Le Meridien Capital, Lilongwe

Office of the Vice President, P.O. Box 30399, Lilongwe 3, Malawi
Tel:(265) 788 444; Fax: (265) 788 362; E-mail: [log in to unmask]

3. Every minute we have been sitting in this room, ten people have
died of the three diseases HIV/AIDS, Tuberculosis and Malaria.
This translates to 15,000 people a day. This is not only appalling
and tragic, it is scandalous. It is scandalous because we have the
knowledge, the technology and the resources to address the
challenges posed by HIV/AIDS, Tuberculosis and Malaria, but have
not yet mobilized sufficient political will to prevent and treat
these diseases in a comprehensive manner and on a scale
commensurate with the devastation facing the human family. The same
vision that fuelled our struggle for freedom in Africa, the same
vision that mobilized every nation after the Second World War to
sign the Universal Declaration of Human Rights, it is the same that
is now needed to fight and conquer the triple threat from HIV/AIDS,
Tuberculosis and Malaria. ...

5. Nowhere has the impact of HIV/AIDS been more severe than in
Sub-Saharan Africa. The region with less than 10 percent of the
world's population is home to 70 percent of people living with
HIV/AIDS. The HIV/AIDS pandemic will kill more people in Africa
than all the casualties of all the wars of the 20th Century
combined. AIDS is devastating Africa - AIDS is destroying our
hopes, our lives and our future. AIDS has a uniquely devastating
impact on development and is at the centre of a global development
crisis. AIDS kills young adults in their most productive years
leaving grandparents to bring up their children. AIDS reduces life
expectancy. Child mortality and poverty are projected to increase
fuelling a secondary pandemic of orphans throughout the region.

6. The HIV/AIDS pandemic in Africa has been described as a
"catastrophe in slow motion" and as a "development and security
crisis". While these descriptions capture the devastating impact of
the epidemic, they do not bring out the urgency and immediacy of
the danger facing Africa and, indeed the whole world. Nor do the
statistics capture the tragedy of lives destroyed. Every day we are
burying our children, our sisters and brothers, our workmates, our
leaders, our teachers, doctors and other professionals. In the
suffering and death of our brothers and sisters, we face grief
beyond words and sorrow beyond tears. We cannot stand by and watch
while our people are dying. The HIV/AIDS pandemic is the greatest
threat to our future - it is an emergency and requires an emergency
response by the international community.

7. Although these health problems often originate in contexts
related to poverty, they have also become a major obstacle to
reducing poverty itself. Increased investment in health is a
critical challenge for our future as health is a fundamental human
right. The burden of disease in Sub-Saharan Africa stands as a
stark barrier to economic growth and therefore must be addressed
centrally in any comprehensive development programme.

...

11. As you discuss and consult on the Global Fund to fight
HIV/AIDS, Tuberculosis and Malaria, I would like to address six
issues.

12. First, the HIV/AIDS pandemic is a threat to global security.
Although Africa is the epicentre of the AIDS pandemic, AIDS is
growing throughout the world. In the growing populations of India
and China, AIDS is gaining ground with close to four million people
already infected. The number of AIDS cases in Russia and Burma are
also increasing. If AIDS takes a deeper root in India, China and
other countries that have a combined population of more than two
Billion, the resulting carnage could far exceed that of the current
tragedy in Africa.

13. We are part of a world community. The recent appalling
terrorist attacks in America were shattering and have been
condemned worldwide. Thousands of lives were destroyed and families
devastated. The tragic events of September 11th have altered the
world fundamentally and a new Global Alliance has been forged to
fight international terrorism. We need the same political will,
unified resolve and resources to fight disease.

14. AIDS threatens to fundamentally destabilize the world. This
latter concept was formally recognized in the UN Security Council's
first debate on AIDS in January 2001. The debate also marked a
shift in the concept of security from the absence of armed conflict
to a wider definition of human security encompassing the
fundamental conditions that are needed for people to live safe,
secure, healthy and productive lives.

15. A whole generation of children are growing up without their
parents. The current estimate of 13 million AIDS orphans is
projected to increase to 40 million within the next decade.
Children are growing up deprived of the most basic human rights of
family, education and confidence in their future. Many are
condemned to live their lives in poverty and are vulnerable to
abuse. Apart from the tragedy of every life not lived to its full
potential, the orphan crisis is breeding ground for conflict and
disintegration of the very fabric of society. This is a security
risk.

16. The second issue I would like to address is the key constraints
to addressing challenges posed by HIV/AIDS, Tuberculosis and
Malaria. HIV/AIDS and other infectious diseases affect Africa
exceptionally, but Africa's ability to respond to the unique
challenges posed by HIV/AIDS is limited by the following
constraints: -

17. The first constraint is that GDP growth rates have consistently
been below the six percent growth rate that is required for Africa
to achieve sustained economic growth and poverty reduction. It is
also important to recognize that the HIV/AIDS pandemic itself
undermines growth prospects. AIDS erodes saving and investment by
both individuals and Governments. ,,, Conservative estimates for
Africa suggest that the reduced productivity and costs associated
with the AIDS pandemic alone are equivalent to more than 20 percent
of GDP. These figures do not include the external effect of the
disease on families, communities and enterprises.

18. The second constraint is the debt burden of US$206 billion and
debt service obligations of around US$13.5 billion per annum. Debt
remains a pervasive obstacle to Africa's capacity to invest in
economic infrastructure; it also diverts resources from the fight
against poverty and HIV/AIDS. In the majority of African countries,
we spend more on debt service annually than on education and health
combined. In the words of a recent UNICEF report "To spend more on
external debt than on social services when hundreds of millions of
children lack access to basic education, primary health, adequate
food and safe drinking water is not only morally wrong, it is also
economically senseless. Hunger, disease and ignorance have never
been a foundation for rapid and sustained economic growth"

19. The third constraint is that levels of official development
assistance (ODA) to Africa have declined substantially over the
past two decades. By 2000, real per capita inflows were less than
one-third of the level reached two decades earlier. Only the Nordic
countries of Sweden, Norway and Denmark and the Netherlands have
met the target of allocating 0.7 percent of GDP to official
development assistance. The average ODA/GNP ratio of the developed
countries declined from 0.33 percent in 1992 to 0.24 percent in
1999.

20. The fourth constraint is that Africa has faced a long-term
decline in the terms of trade and Africa's share in world trade has
declined substantially. Furthermore, Africa has faced extreme
volatility in export prices and difficulty in accessing Northern
markets. After the Uruguay Trade Round, it was estimated that the
new agreements would lead to an increase in global income of some
US$212 to 510 Billion. However, Africa did not share in the
benefits of global trade. Africa experienced a net loss of US$1.2
Billion per year. This reflects the fact that global economic
policy making occurs in a world of grossly unequal economic and
political power. ...

23. The third issue I would like to address is the need for a
comprehensive approach to HIV/AIDS covering prevention, care and
treatment. It is a paradox that for the majority of diseases in the
world, it is accepted wisdom that disease prevention, care and
treatment should be addressed in a comprehensive manner as
prevention and treatment are complementary and have major public
health benefits. None, for example would question the wisdom of
treating Malaria, Tuberculosis or indeed any other common
communicable disease. Indeed with the exception of childhood
immunization, no major disease control programme focuses on
prevention alone. However, it was only this year that consensus
emerged that there is need to provide comprehensive treatment for
HIV/AIDS.

24. Until a few years ago, HIV infection led almost inevitably to
an early death from AIDS. However, in the mid 1990s the HIV/AIDS
community saw a scientific breakthrough with the introduction of
anti AIDS drugs. These regimens have resulted in a reduction in HIV
levels in the blood often to undetectable levels and lead to a
markedly improved immune function in HIV infected individuals. Anti
AIDS drugs have transformed HIV infection into a chronic condition
that frequently remains without symptoms for years. Moreover with
the ability of these drugs to dramatically decrease viral
replication, the chance of transmitting the virus has diminished
correspondingly thus reducing rates of mother to child transmission
and reducing death rates.

25. The picture of continued improvement in the prevention and
treatment of AIDS in high-income countries is in marked contrast to
the situation in low-income countries. Sub-Saharan Africa in
particular has been unable to effectively control the epidemic.
This has been so because HIV/AIDS programmes in Sub Saharan Africa
have not been comprehensive in approach to cover prevention, care
and treatment. ...

When these therapies will become available the lives of HIV
positive people will be prolonged thus also reducing the number of
orphans. People will also be more willing to go for testing as
access to treatment reduces the stigma associated with HIV/AIDS.
...

29. The fourth issue I would like to address is the need to invest
in public health as the foundation of human development and
economic growth. Low-income countries, especially countries in
Africa have far lower life expectancy and far higher mortality
rates than the rest of the world. ...Improvements in health
translate to higher rates of economic growth and reduced population
growth. The world needs to implement such a comprehensive and broad
programme.

30. This will require high-level political commitment in the
developing and developed world. The investment would be repaid many
times over in saved lives, enhanced economic growth and global
security.

31. The fifth issue I would like to address is the need for
countries themselves to determine their priorities for investment
by the Global Fund. We in Malawi are close to finalizing our
proposal to the Global Fund. The proposal has been developed over
a period of six months and is based on extensive consultation
within Malawi and with international experts. ...

32. May I suggest five key principles for the operation and
governance of the Global Fund.

i) The countries themselves should develop proposals that they have
authored themselves independently. Countries are best placed to
determine the appropriate balance between the three diseases and
the balance between prevention, care and treatment. ii) The
resulting proposal should be subject to scientific and public
health scrutiny by a panel of independent experts serving as an
independent advisory group to the Global Fund. iii) Funds should be
disbursed as grants not loans. iv) Build in a clinical and
operational research component into every programme so that the
lessons learned from scientific research should be applied in the
programme and that international best practices should be
developed. v) Developing country governments should be adequately
represented on the Board of the Global Fund.


... The Malawi Government proposes four actions for consideration
by the international community.

38. First there is need for faster and deeper debt relief. We
endorse UNCTAD's proposal for a "comprehensive assessment of the
sustainability of African debt". An independent body that would not
be unduly influenced by the interests of creditor nations should
carry this out. Consideration should be given to the suspension of
debt payments by all African HIPC countries until a final agreement
is reached on debt reduction. This initiative could make a
significant contribution to growth and poverty reduction provided
that it is combined with additional financing on grant basis to
fill the external financing gap.

39. Second we call on the international community to fully finance
the Global Fund for HIV/AIDS, Tuberculosis and Malaria to the
required level of US$10 Billion per annum as a matter of urgent
priority.

40. Third, we call on the intentional community to increase
international aid in order to invest in health as the foundation of
economic development. We call on the international community to
increase levels of ODA by 0.1 percent of GDP in 2002 in order to
invest in global health. In the longer term, we endorse Article 83
of the United Nations General Assembly Special Session on HIV/AIDS
Declaration and ask the international community to increase aid
levels to the agreed target of 0.7 percent of GDP and to increase
the proportion of aid directed to the poorest countries.

41. Fourth, we call on the international community to mobilize
global science for the benefit of the poor. There is need for a
significant investment in further research into safe and affordable
HIV vaccines and their delivery including methods to prevent mother
to child transmission and to improve our understanding of factors
that influence the epidemic and actions that address it. ...

In conclusion, Mr. Chairman

42. People are suffering and people are dying. A whole generation
of children are growing up without their parents, condemned to live
their lives in poverty. Tens of millions of people have died of
AIDS, Tuberculosis and Malaria. This is a new holocaust. Without
serious action now, tens of millions more will die. Every single
death is an indictment on our consciences. The HIV/AIDS pandemic
threatens world security. How long is the world prepared to wait?
How many tens of millions more have to die before we address this
situation seriously? ...

The international community must invest in health as the most
urgent priority and allocate a minimum of 0.7 percent of GDP to
overseas development assistance. Such an investment is required
if we are to meet the human development targets agreed at the
Millennium Summit. We need to make essential drugs and vaccines
available to the worlds poor. Every nation has signed the Universal
Declaration of Human Rights. It states that all human beings are
equal in rights and dignity. The Universal Declaration of Human
Rights places a moral obligation on the international community to
invest in human development. I am not asking for charity, I am
asking for justice.

44. We do not need further intellectual debate about whether to
focus on prevention or treatment. We have to do both. We do not
need further debate about cost-effectiveness of focusing on
principal communicable diseases or HIV/AIDS. We have to do both. We
do not need further debate about whether health sector reform
should precede a significant increase in investment for health. We
have to do both. ...

45. Now is the time to take action. Now is the time to invest in
health. Now is the time to translate our commitments into reality
and fully finance the Global Fund. Humanity demands that we do not
delay or prevaricate or find excuses any longer. Let us build an
international alliance for justice as the foundation of a lasting
peace. ...

************************************************************
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