Foreign Affairs Committee on May 11th, 2010

[The Chair, Conservative, Dean Allison]

Pursuant to Standing Order 108(2), we're going to be meeting with the director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This is meeting number 17.

I want to welcome Dr. Christoph Benn, who is the director of the external relations and partnerships cluster, and Mr. Robinson, who is no stranger to Parliament; welcome back, sir. We're glad to have both of you.

Dr. Benn, if you'd like to start, you have 10 minutes. Why don't you start with your presentation? Hopefully, we'll have equipment problems figured out by the time you're done.

Welcome, sir. The floor is yours. Take it away.

[Dr. Christoph Benn, Director, External Relations and Partnerships Cluster, Global Fund To Fight AIDS, Tuberculosis and Malaria]

Thank you very much, Mr. Chair.

Thank you all for coming. I'm really very impressed and gratified that there's such an interest in the Global Fund and what we have to share with you. Thanks for the invitation. Thanks also to Svend Robinson, who has been working with me in the Global Fund and who is very well known to many of you.

In fact, I was before this committee together with our then executive director Richard Feachem five years ago, in 2005. I know that a few of you were present at that time. That gives me an opportunity to describe to you what has happened over the last couple of years. I think it's a very impressive story.

The Global Fund was created in 2002, meaning that when I was here in February 2005, we were three years old. Now we are eight years old. The results of what has happened in that period of time are really quite impressive.

When I was here in 2005, the Global Fund had $6 billion in contributions from the donors. Now we have $22 billion overall from public and private donors. At that time, we had approved programs worth $2.4 billion. Now we have $19.3 billion worth of programs in 140 countries on all three diseases—AIDS, tuberculosis, and malaria.

However, the most important thing is what has actually happened with this money. Have we been able to achieve real results that are affecting the lives of people around the world?

Here are a few highlighted figures. At that time, 2005, we supported 50,000 people on antiretroviral treatment. Nowadays we support 2.5 million people on antiretroviral treatment around the world. At that time, we had helped countries distribute 2.7 million impregnated mosquito nets to prevent malaria. Up to now, we have distributed 104 million mosquito nets. At that time, we had provided treatment for tuberculosis for 250,000 people. Up to now, more than six million people have received effective tuberculosis treatment.

You can see the trajectory of the financial support that enabled countries to implement very impressive programs. It has been calculated conservatively that five million people are alive today who would otherwise have died already from these diseases, and the number is increasing by 3,000 lives per month.

Looking at the bigger picture for these three diseases, we are really talking about what we are achieving in terms of reaching the health-related millennium development goals. Very briefly, there has been very impressive progress on malaria. Among the three diseases, this is the easiest disease to prevent and to treat because, with the combination of bed nets and effective treatment, you can lower mortality from malaria by 50% or more.

That is exactly what has been happening. We have a number of countries in Africa—Ethiopia, Eritrea, Burundi, Rwanda, Tanzania—in which we see declines of mortality from malaria of 50% and more. It is so successful that not only do we believe, together with the World Health Organization and others, that we can reach the millennium development goal on malaria, but we might be moving toward the elimination of malaria as a public health problem in many countries around the world. That would be a major achievement, of course.

When it comes to tuberculosis, again there are declines in tuberculosis incidence in many countries. We believe we are on track to reaching the millennium development goal on tuberculosis.

The most complex of the three diseases is HIV/AIDS. While I said that we have 2.5 million people on treatment, that is a huge success. Ten years ago, hardly anybody in Africa was receiving treatment; now, 42% of all people in Africa with AIDS are receiving effective treatment. However, we still have a way to go to achieve universal access and a broader decline in mortality from AIDS, so we will have to redouble our efforts to reach those goals.

Let me say one word about the relationship between the three diseases and maternal and child health, because that is a very important topic. We applaud the Canadian government for putting it high on the agenda of the upcoming G-8 summit here in Canada, but we want to make the point that 51% of women in Africa are still dying from AIDS, tuberculosis, and malaria. They are also dying from causes that are directly related to childbirth; still, the diseases play the biggest role, and therefore we have a major impact on maternal mortality, directly and indirectly.

We are also providing support for contraceptives, for antenatal clinics, and for sexual and reproductive health. We already invest a lot into maternal and child health; in fact, we believe that 37% of all our resources go into child and maternal health. I think that is a very important point as Canada, together with the other G-8 countries, considers the way forward in making more progress on these very important issues.

Canada has been a very strong supporter of the Global Fund from the beginning. Currently, the vice-chair of the board is Dr. Loevinsohn, from CIDA. Canada is the eighth-largest donor to the Global Fund. It is currently providing $150 million per year.

We are in a replenishment period. That means that every three years the donors come together for replenishment conferences. The next one will happen in New York on October 5, under the chairmanship of Secretary-General Ban Ki-moon.

We have asked the donors to consider three scenarios that need significant increases in the contributions to the fund, increases of either $13 billion, $17 billion, or $20 billion. That's what the donors are currently considering, which means that increases are required. I'd say our major donors would need to increase by 50% if we want to maintain the momentum toward the achievement of the millennium development goals. We have a real chance and a real opportunity this year, but it would require a significant increase from our main supporters, including Canada.

There is good news from some donors. Japan has just increased its contribution for this year by 27% and the U.S. has increased consistently by 30% over the last few years, so we have positive signals, but we need this momentum.

I wanted to show you a short video that shows you some of the main supporters of the Global Fund. They helped to create the Global Fund and they still maintain support for the Global Fund. I would be glad if we could listen to a few key voices here.

[The Chair, Conservative, Dean Allison]

We're going to need a little bit more time, Dr. Benn. Although you see all these TVs around here, we're not sure where the VCR is. It's our first meeting here.

We'll show it at the end to wrap up, which will probably be another option as well.

[Dr. Christoph Benn]

That is fine.

[Paul Dewar, NDP, Ottawa Centre, ON]

How many Canadians does it take to turn on a VCR?

[The Chair, Conservative, Dean Allison]

They have to find the VCR first, Paul, and when we find that, we'll realize we have a DVD and we'll be in big trouble.

[Dr. Christoph Benn]

I know that technology never fails to fail, so I'm not too surprised.

I will conclude my remarks and we can go into the question-and-answer session. I'll be happy to look at the video at the end.

This, of course,is an extremely critical year, not just for the Global Fund but for development and health overall. This year we have the summit on the millenium goals in September, when all the heads of state will come together to review the progress over the last 10 years, and the G-8 and G-20 summits, which Canada will host.

That is absolutely critical. I think we are in a transition period. We are relying increasingly on emerging economies--the G-20--to also make their contribution. We are talking to all of them to encourage them to become either donors or more significant donors to the Global Fund as well, but we are really looking at the leadership role of Canada this year. It's a particular responsibility, I believe, that you have the presidency of the G-8 in 2010. We have the full support of Secretary-General Ban Ki-moon, who is very strongly engaged on these issues and very interested in health.

I think this is an opportunity that we should not miss. We've made tremendous progress, but we need to sustain this progress into the future. That's why it was so important for me to be here with you today and to discuss what more we can do, if we look into the future, to reach the very important but ambitious goals that we've set for ourselves.

Thank you very much, Mr. Chair.

[The Chair, Conservative, Dean Allison]

Thank you, Dr. Benn. We're going to get right to questions. As I say, if we're able to locate the DVD in the building, we'll wrap up with that.

I'm going to start with Dr. Patry and Mr. Pearson.

Go ahead, Mr. Pearson.

[Glen Pearson, Liberal, London North Centre, ON]

Thank you so much for coming. I think all of us want to congratulate the Global Fund. Personally I want to congratulate you, not so much for your success but for the success on the ground that you have been able to achieve. Many of us have been wanting to see this kind of development over the years, and I thank you for all your efforts in doing that.

I also want to you congratulate you on having Mr. Robinson here. He is a terrific representative to us, a real advocate. We're glad to see him with you again.

I have a question and I know that because of your vast experience you'll have a good answer. I think you partly answered it already. With Canada sharing and chairing the G-8 this year, and having the presidency of it, I was wondering what you think would be sufficient for Canada to donate towards this initiative on child and maternal health. I think you just answered; I think you said you would be looking for a 50% increase from the major donors. I wonder whether you could break that down for me a bit, if you don't mind, so that we can get a better understanding and handle on it.

Is that observation correct?

[Dr. Christoph Benn]

Absolutely, yes, Canada has a particular role this year. We are asking all our main donors to increase contributions by about 50%, but I would say Canada would have a particular responsibility. It's great that some G-8 countries, such as Japan and the U.S., have already moved ahead. The Europeans currently find themselves in a big crisis around the euro; nevertheless, we have strong supporters there as well and we are hopeful they will also increase. However, Canada would certainly have a lead role.

The Canadian contribution for the global fund helps us to maintain and expand all these programs to fight AIDS, tuberculosis, and malaria, but as maternal and child health is so much on the agenda for this summit, I think it's very important that Canada consider the Global Fund as the major investment that the G-8 and the UN together have set up. As I indicated, we have already invested a lot into maternal and child health. Rather than trying to think about a separate mechanism or a different channel, I think it would be wise to consider the Global Fund as the potential channel for this initiative, and I know that a number of other donors would look at it the same way.

We had an editorial yesterday in The Globe and Mail, which I read on the plane coming here. I was delighted to read it, as you can imagine, but I think it makes sense: why create something new if you already have something--the Global Fund--that most donors agree is not only effective but also efficient?

We work with a small secretariat, so we can assure that there is little overhead. All the money that Canada has donated goes to the programs, to the field. Because we work without country offices, we can cover our administrative costs from the interest we get from the contributions. There's an efficient model here that would be able to address the challenging questions around child and maternal mortality that have to be addressed in the future.

[Glen Pearson, Liberal, London North Centre, ON]

That's great. Thank you, sir.

[The Chair, Conservative, Dean Allison]

Mr. Patry is next.

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

Merci beaucoup.

It's a real pleasure to see you here. I remember in 2005 when Svend was a member of this committee. It's fabulous.

It's very interesting to see the progress that the Global Fund has made. You talked about 104 million mosquito nets and six million people treated for tuberculosis, and treatment of AIDS also. You said at the end that you want to maintain the challenge and you talked about three scenarios.

Everything you pinpointed this morning is about the treatment. What about the prevention? There's prevention for malaria, no doubt about it--there are the bed nets--but how about the prevention of AIDS and tuberculosis?

[Dr. Christoph Benn]

That's very important. The investment of the Global Fund goes equally into prevention and treatment.

By the way, it's not the Global Fund secretariat that decides that, but the countries. When the countries apply, they design their programs, and we simply finance them, so we don't actually influence whether the money goes into treatment or prevention, but it turns out that all the countries apply for almost equal amounts for prevention and treatment.

I mentioned treatment because it's often more appealing and easier to explain, but a lot of money goes into HIV prevention in terms of provision of condoms, information, and testing and counselling clinics. I could give you a lot of numbers on those as well. There have been more than 100 million testing and counselling sessions. They are a prerequisite for the treatment, but they are also important for prevention in letting people know about the infection so that they can modify their behaviour.

I can reassure you that as much money goes into prevention as goes into treatment.

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

With this prevention, do you see the number of people who have AIDS or tuberculosis diminishing?

[Dr. Christoph Benn]

Yes, we do. In the most affected countries in Africa, we see a decline of HIV prevalence. It's not as dramatic as with malaria, of course. You can't achieve that in a short period of time. As I said, with malaria, it's 50%, but in HIV, you now achieve reductions of 5% or 10%, which is great, because we are seeing a reversing of the trend of increasing infections.

It is the same thing with tuberculosis. We see a decrease in the infection rates in most countries, but there are two challenges that remain with tuberculosis that I need to mention. One is the multi-drug-resistant tuberculosis. We have problems in a number of countries with the resistant tuberculosis. It is extremely expensive to treat, but it's also extremely dangerous. That applies not only to countries in Africa or Asia, but also to countries such as Canada, or in Europe. Drug-resistant tuberculosis is one of the big global public health threats.

The other is the coinfection of HIV and TB. In countries where most of the people have a coinfection, it's more difficult to control both infections. In tuberculosis in general, yes, there is progress, but these are two really challenging areas where we need to redouble our efforts.

[The Chair, Conservative, Dean Allison]

Thank you very much, Dr. Patry.

Now we're going to move to Madame Lalonde, or is it—

[Johanne Deschamps, Bloc, Laurentides—Labelle, QC]

Mr. Chairman, I will be splitting my time with Ms. Lalonde.

You told us about major progress being made in the fight against malaria, tuberculosis and HIV. If we look at the summary that I have here on the Global Fund's achievements, we find that you are directly contributing to millennium's objectives Nos. 4, 5, 6 and 8. You talked about progress, and also about the importance of increasing funds by 50%. If I am not mistaken, all current efforts are interrelated and are aimed at also reducing maternal and child mortality. It is really necessary that everything be coordinated efficiently on the ground.

What is your strategy and how do you assess the needs of each individual country?

[Dr. Christoph Benn]

You're absolutely right. All the MDGs are interconnected, and I'm pleased you're mentioning MDG 8, because that's an effective development partnership. We would not be able to achieve the results on MDGs 4, 5, and 6--children, maternal mortality, and the diseases--unless we initiated a new kind of development partnership at the country level. In every country where we invest, we demand a round table, which we call the country coordinating mechanism, at which the governments, civil society, and the private sector come together to discuss the needs of the country, define together what the priorities are, and then submit their proposal.

That is not without challenge in countries where you perhaps don't have a tradition of a participatory democratic process, but this method has forced countries to develop this kind of partnership, and this clearly improved over time. You cannot fight these diseases or achieve other development goals unless you involve civil society and the private sector also. Governments today cannot achieve those results by themselves.

So I do believe that the Global Fund model also offers some interesting lessons that go beyond those diseases, actually, and affect the millennium development goals more broadly. That is certainly something that can be applied also in the future.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Thank you.

I welcome you and also Mr. Robinson, whom it is a great pleasure to see once again.

You said that you want to take advantage of the G-8 to improve results. Could you please elaborate on that?

[Dr. Christoph Benn]

The Global Fund has basically two origins. One is the UN; the UN Secretary-General at that time, Kofi Annan, whom I hope you will see in the video at the end, was really a big supporter of the fund. The other one has always been the G-8.

It started with the G-8 in Canada in 2000; then, at all the G-8s over the years, the Global Fund, the fight against the diseases, and the progress towards the millennium development goals have always been on the agenda. We are confident that this will not be different at the G-8 here in Canada.

The difference is twofold. First, we are obviously in the middle of this economic crisis, so that's new. It was much easier in years like 2005 or 2007 to achieve big increases in ODA and funding. It's more challenging in 2010. Therefore, Canada has this particular challenge of finding a way to maintain this commitment in the middle of this crisis. I believe the answer is only through these results. We can only get the confidence of the donors, in spite of the crisis, if we tell them we are using their money with accountability, with transparency, and with results.

The other difference in 2010 is, as I described, this shift towards the G-20. You are witnessing the first big transition from just the G-8 countries to the inclusion of countries such as China, India, Saudi Arabia, South Africa, and Brazil at the table.

That's also an opportunity for us. Interestingly enough, basically all these countries have received Global Fund funding over time, so here you have, suddenly, big countries at the table that can speak from their own experience: China, Russia, Brazil, Mexico. They can say, “Well, we know the Global Fund, because we have benefited from it”. We hope this will support our efforts and that Canada can manage this transition and now get broader support. We want these countries to contribute financially now. They are in situations that allow them to take over more responsibility. We are talking to all of them, but we would be happy to have Canada's support, as you will have the chair.

That's why I said it's a very important year for us.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

Have you received positive signs from countries that are getting help and that want to become countries that provide assistance?

[Dr. Christoph Benn]

Yes. I would mention in particular Russia and China. They have already made this transition, but we want to see an even bigger commitment. We would now also like to have countries such as India, Brazil, and so on come to the table, because it's a joint responsibility, after all. That's the world we are evolving into.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

When you work in the countries, you provide the funds, but you work with these countries and with NGOs. Are there groups that are primarily related to you?

[Dr. Christoph Benn]

Yes. About half of our resources go to the governments directly, and half of the resources go to the non-governmental sector, but the important point is that it's the countries that decide. It's not us deciding at the global level and picking an NGO here or an NGO there. Many are active at the country level, and they often have the capacity to implement. They are running clinics. They have procurement systems and distribution systems, so they can play a very important role. Therefore, we support them directly and we want them also at the decision-making table.

By the way, NGOs are also sitting at the Global Fund board making decisions. This is the first really participatory decision-making. I told you we have allocated $19.3 billion so far; this allocation is made by a board that divides participation and decision-making power equally between the donors and the recipients, both the governments and the NGOs. That is a particular dynamic, but I think it's very appropriate for the 21st century that we go into this more equal decision-making. It has worked very well, and not just from the perspective of the recipients: I think even the donors would say this has enriched our discussion and improved our decision-making.