Foreign Affairs Committee on Oct. 27th, 2011

[Mark Eyking, Liberal, Sydney—Victoria, NS]

Not only do some of these countries have some funds that could be available to you, I think they're probably more cautious of going with these multilateral organizations too.

[Dr. Christoph Benn]

That's right.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

They sometimes feel that they should go on their own to have their own stamp on it and then get more credit for it--that's debatable.

I'd like to ask a couple of questions on these hot spots, because your numbers look good when you look at the overall and how you're reducing some of these diseases. But there are still major hot spots that are either increasing or still very vulnerable. In South Africa, for instance, HIV is still.... I don't know if that is diminishing. Can you give me some numbers on that or on TB in the Congo area ?

Talk about those hot spots. How bad is it in these hot spots? Do you have any way of getting in there and doing a better job? What are our challenges and how should we try to overcome them?

[Dr. Christoph Benn]

South Africa, yes, is one of the countries that, like Botswana, had some of the highest HIV prevalences in the world. That's also going down, particularly among young people. There are statistics showing that infection rates are going down among young men and women. They used to be at 25% and they're now at 18%, so that's encouraging.

But they have hundreds of thousands of people already on treatment, and there are more to come who will need treatment. Again, most of that is now paid by the South African government itself. We are supporting them, but they have increasingly now made domestic resources available for that. South Africa, I would say, is generally on the right track.

But you were asking me where the biggest challenges are. I would say they are in some of the most populous countries, like the Democratic Republic of Congo and Nigeria, not just because of the poverty level but also because of the political situation, the instability, and the difficulty of reaching the people with the services.

In DRC Congo, there is hardly any health system. Ethiopia is equally poor, but Ethiopia has a kind of structured health system. Congo hardly has a structured health system, and that makes it very difficult for us to work there.

Similarly, in Nigeria if we are talking about the elimination of malaria, Nigeria will be one of the key countries. As to whether we can do it there, again, that's mainly because of the lack of the infrastructure and a functioning kind of government system.

We are working a lot with NGOs. That is also a very important point for the Global Fund. We work a lot with civil society and also with the private sector. In many of our countries, they help us implement these programs particularly where the governments are weak. That does help.

But I think the biggest challenge is where the structures are just so weak that it is difficult to reach the people sufficiently.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

Is it also difficult to have your workers in there? Is that a problem also?

[Dr. Christoph Benn]

You know, first of all, the Global Fund does not have any staff in these countries. That's one of the principles. We are a very lean organization. We are supposed to have just one headquarters, and we have no country staff. We are supporting national organizations, be it government or be it NGO. Having no staff there is not so much the problem, because we are basically empowering the national organizations to implement those programs.

[The Chair, Conservative, Dean Allison]

Thank you. That's it.

Thank you, Mr. Eyking.

We are going to start our second round of five minutes, and I will move to Mr. Dechert.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Thank you, Mr. Chair.

Thank you, gentlemen, for being here today.

Thanks to CIDA and Global Fund for all the tremendous work that you are doing to help people around the world with these diseases. I'm very encouraged to hear of the positive developments in the prevention and treatment of these diseases. On my own behalf and on behalf of the people I represent, I thank you for doing that good work.

I'd like to ask Mr. Samson some questions regarding Canada's role in the Global Fund. You mentioned that Canada is currently the sixth largest donor to the Global Fund. Can you tell me how that compares to the percentage size of Canada's economy in terms of the global economy?

[Paul Samson]

Canada's contribution equals four per cent of the total funds provided, which is a number that is pretty standard for what we're providing to various big organizations. It's considered Canada's fair share, if you will.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Where does Canada's economy rank in the listing of world economies?

[Paul Samson]

Well, it depends a little bit on how you define it with some of the emerging economies, but we're usually somewhere between eighth and tenth place, depending on how you measure it. We're a member of the G-8, and we're one of the largest economies, so we are right where we would be in terms of our share of four per cent.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Okay.

You mentioned that of the $1.5 billion committed, Canada has disbursed approximately $979 million so far. How does that compare with the disbursement of the other donor countries? Do you have that information?

[Paul Samson]

Well, one of the things about the Global Fund is that it is a very transparent process. When you go to their website, there is a very detailed document about who has pledged what and about tracking those commitments. Canada can safely be very proud about meeting its pledges. When we pledge something, we meet it. We have a perfect track record in that respect.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Perhaps Dr. Benn could provide us some information on that. How does Canada's performance compare to others in terms of actually providing the funding?

[Dr. Christoph Benn]

As Paul said, it is very good. Canada has contributed their pledged amount every year. Again, that is an important point, because until the year 2009 we had an excellent track record with all our donor countries. Usually we achieve more than 100% of pledges being converted into contributions.

Unfortunately, that has changed because of the economic environment. A number of countries now say they are simply not in a position to honour their pledges, and that is a very serious situation for the Global Fund, which goes back to this kind of predictability. It's not just the amount; it's also the predictability. If a donor like Spain, for example, suddenly announces that they can't meet their obligations, that's a big gap.

We really appreciate Canada's support, and Canada has been a very faithful donor in meeting their obligations, but the challenge is that the number of countries we can really count on is becoming smaller.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Understood.

Mr. Samson, you mentioned that as of September 2010, Canada has announced a further pledge of $540 million for the 2011-13 period, and you said that this is Canada's largest contribution to a single global health initiative. Is that the largest contribution in Canada's history?

[Paul Samson]

That's correct. That's Canada's largest.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

That's interesting.

Now, Dr. Benn, I was very encouraged to hear you say that there is potential for a new vaccine to treat or prevent malaria. Can you tell us a little more about that vaccine?

[Dr. Christoph Benn]

Sure. As you know, finding a vaccine against malaria has been one of the big public health goals for decades. There has never been a successful and effective vaccine against malaria, but trial results came out that showed a 50% protection. That's good. That's not ideal, because for a vaccine you normally want a 90% effectiveness, but for the first time, it shows there's promise.

If they can improve that further, in four or five years we might have a really effective vaccine on the market. Obviously the Global Fund would be happy to support it and make it available to the countries, because that could be the final tool that we need, in combination with treatment and prevention activities, that would really enable us to eliminate malaria on a sustainable basis. That would a huge success--an historic success, really.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

That sounds quite exciting.

So it's not ready yet, but you hope it will be soon. Do you have any idea of what the cost would be to the fund if it were to start vaccinating people in those target countries?

[Dr. Christoph Benn]

It's a little early to say that, of course, because we are a couple of years away from the real marketing, but the company already has announced that once it is ready, they would basically provide it at production cost. So they wouldn't make any profit from that vaccine. I hope that would mean that we could purchase a dose of vaccine for, let's say, around five dollars maybe, something that would probably be one of the best investments in international public health.

[The Chair, Conservative, Dean Allison]

Thank you, Mr. Dechert.

We're going to move over to Madam Laverdière.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Thank you very much.

Thanks to all of you, both for your presentation and for the excellent work that Global Fund and CIDA do.

You mentioned countries like Botswana that are taking treatment and prevention of these diseases into their own hands. I wonder if you could elaborate a bit on the need of these countries for affordable drugs to combat those diseases.

[Dr. Christoph Benn]

Affordable drugs are absolutely critical for all three diseases. The good news here is also that the prices for these drugs have come down dramatically. When the Global Fund was created 10 years ago, it was not only that we able to mobilize billions of dollars but also that the prices for drugs at that time were about $10,000 per patient per year. It was absolutely unaffordable with whatever kind of resources you would get.

Nowadays, we pay between $100 and $200 per patient per year for a complete treatment for AIDS, so that's a huge drop in the price. Similarly, the price of malaria drugs, the artemisinin-based combination therapy, has come down now to less than one dollar for the complete treatment that can cure malaria. For tuberculosis, the whole six-month drug treatment costs around $50.

These drugs have become much more affordable. This means that an upper-middle-income country like Botswana can now afford these themselves. But we need to continue to support lower-income countries like Democratic Republic of Congo, Ethiopia, Haiti, or many others. Otherwise, they would not be able to provide these drugs to their people.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

On the same subject, and specifically with regard to those lower-income countries, what role can Canada play to make getting access to these medicines easier? For example, there's Canada's access to medicines regime and programs like that. Could you expand on the subject?