Foreign Affairs Committee on May 31st, 2016

[Svend Robinson, Senior Specialist, Parliamentary Affairs, Global Fund To Fight AIDS, Tuberculosis and Malaria]

I am going to add a couple of very brief words, Mr. Chairman, first of all to say that it is a pleasure to be back in a committee with you as a former colleague over a number of years. I had the great privilege of serving as a member of Parliament for a little over 25 years, 15 of those years with the honour of serving on the foreign affairs committee. I have always thought it was the best, so congratulations to all of you for the opportunity to serve on the committee.

Christoph has told you a little bit about what the Global Fund is about. I have had the great privilege and honour of working with the fund and coordinating our engagement with parliamentarians around the world for almost eight years. When I meet with other members of Parliament, I use Canada as a role model of effective engagement across party lines on an issue that is about saving lives and promoting human rights and respect for people around the world.

As Christoph said, I really just want to take this opportunity to thank you. I think we have appeared a total of six times before this committee over the past few years. This will be my last opportunity to appear before the committee, as I am moving on from the Global Fund at the end of July.

It has seen the solid support of members of Parliament across party lines.

I see Dean Allison, who has been a great supporter, not just here in Canada but also working hard with the global TB caucus. There aren't a lot of votes in your constituencies for these issues; you are doing it because you believe in it passionately.

Peter, as a former minister himself, who is very supportive as well.

Robert, as you know, Hélène Laverdière has been present since the beginning with regard to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Of course, there are colleagues on this side of the House as well, and the wonderful announcement. My final engagement with the Global Fund will be in Montreal on September 16 at the replenishment conference that Canada will be hosting and, with a 20% increase, following in the steps of the predecessor government.

Mr. Chairman, it has been a great privilege to work with members across party lines. I want to thank you for your leadership and for this opportunity to share a few words about a pretty special organization globally that is saving lives and that Canada is playing a critical role in leading.

Thank you.

[The Chair, Liberal, Bob Nault]

Thank you, Mr. Robinson and Mr. Benn.

We have about 25 minutes for questions.

Mr. Allison and Mr. Kent, go ahead.

[Peter Kent, Conservative, Thornhill, ON]

Thank you very much, Mr. Chair.

Thank you, gentlemen, for your services. Thank you for a wonderfully effective fund in working to contain and perhaps one day eliminate AIDS, TB, and malaria.

I would like to broaden the discussion a little. We are told by Canada's National Advisory Committee on Immunization that in fact HPV is the greatest and most common sexually transmitted viral infection in the world today, and that approximately three out of four sexually active Canadians, three-quarters of the population, in effect, will be infected by HPV at some point in their life, in many cases with a minor manifestation, but for many more, for a large number of women, cervical cancer, and I have had a brush with the serious cancer that manifests in men.

In Canada we have, since the federal budget of 2009, jump-start funding across the provinces for HPV vaccinations for young girls, grade 7 and up. The provinces are acting on new advice from immunization experts around the world that boys should be immunized as well.

Is there any consideration that the Global Fund, given its effectiveness so far in countering the three original diseases, and given the new knowledge about HPV globally today, might consider broadening its immunization work?

[Dr. Christoph Benn]

That's an excellent question.

First, you're absolutely right. Human papillomavirus is very important globally, particularly because of the effect on women, as it increases the risk for cervical cancer. This vaccine is made available globally, which again is a huge development. Fortunately we don't have to do that, because our colleagues at the vaccine alliance, Gavi, are doing that.

That is indeed one of these new developments. In previous decades it would have taken a long time before you would have a new vaccine that would be made available not just in Canada but globally. That's exactly what has happened over the last decade or so. In this case, through Gavi's making this vaccine available globally and through the Global Fund, we can basically make all the latest drugs, whether for HIV, tuberculosis, or malaria, immediately available to those in greatest need. That is the big revolution, if you like, that had not been possible before.

Therefore, I'm happy to tell you that, yes, the vaccine is being made available. It is financed through our colleagues at Gavi, and it is complementing the investments of the Global Fund. That shows you there is a lot of progress in global health that was not possible just a couple of years ago.

[Dean Allison, Conservative, Niagara West, ON]

Dr. Benn and Mr. Robinson, it's great to have you guys back at the committee.

I only have a chance for one question, so it will be a very short one, and hopefully I'll get a very long answer. The chair won't cut you off.

I think of transparency, and the great things about your organization in terms of what you do. We come under pressure for the dollars we give to multilateral organizations, not knowing how they work and whether they are effective and transparent.

Would you talk to us very briefly about the thought process in terms of the importance of transparency for you in how you choose and work with a country all the way through the process of self-sufficiency? At some point you're hoping the governments of the day that you're helping will be able to move into something self-sustaining. Would you take us through the psychology of where the Global Fund is in terms of how they choose and get people to self-sufficiency?

[Dr. Christoph Benn]

I'm very happy to. Thank you so much for that question.

First, when the Global Fund was created, we made transparency one of the major principles that we wanted to implement in a new way. In that sense we've been quite radical in terms of transparency.

All the information is made public on our website about where and to which programs our money goes, the results achieved and, an important factor, where we find that things are not going well. It's quite unique. Actually, there is an international aid transparency index that many organizations report to. There was a report a couple of weeks ago, and the Global Fund, again, came out as one of the five most transparent organizations in development. We take that very seriously and not with any complacency, because we believe transparency is also a key to accountability. Unless there is transparency, you won't have accountability for how the money is being spent at the country level.

You have to report on what is happening with your money in positive terms and with the results. Also, when you find examples where there is mismanagement and so on, we make that public as well, because part of the accountability at the country level is that there have to be consequences. If money is misused, we ask for the money back, and we are getting it back and we are reporting on that, as well.

Transparency, I think, is absolutely key for development finance. Also, the technologies we have in terms of what we can now make available digitally provide these opportunities to go as far as we can in terms of transparency.

[The Chair, Liberal, Bob Nault]

Thank you, colleagues.

Mr. Miller.

[Marc Miller, Liberal, Ville-Marie—Le Sud-Ouest—Île-des-Soeurs, QC]

Thank you, both.

First, Mr. Robinson, I want to thank you for your service. You've lasted longer than most of us will. Your principled stances on LGBT rights, medical assistance in dying, and the environment have inspired a great number of parliamentarians in this current wave and, I would venture to say, regardless of political affiliation.

Mr. Benn, we discussed this earlier at lunch, but I want to provide you with the opportunity to say this on the record. Again, TB is sort of the forgotten child and, in terms of spreadability, and in my mind, perhaps the most dangerous threat to eradicate, particularly given the challenges in implementing what we discussed of getting into prisons and getting awareness into poorer areas.

What are the challenges you face, whether they are eastern bloc countries or others in getting that implementation and getting the proper prophylactics or awareness into those areas of difficulty?

Just for the record, I want to say that the conference will be in my riding, so I would encourage you all to come. That's the one political point that I....

[The Chair, Liberal, Bob Nault]

Political announcement follows.

[Dr. Christoph Benn]

I'm really happy that you're all drawing attention to tuberculosis, because it has been around for such a long time that it doesn't have this sense of emergency, such as HIV/AIDS has had, or now all this talk about Ebola and Zika. Sometimes they forget the chronic emergencies that have happened for a long time, and TB is probably the most important of those.

TB is a disease that is affecting the poorest and the most vulnerable around the world. Now, who those poorest and most vulnerable are might differ from country to country. You mentioned, and we discussed it a little bit, the particular challenge of TB in prisons, but you know I also mentioned the particular challenge of TB in the mining industry. TB affects miners disproportionately because of their living and working conditions. TB is generally associated with how and where people live, and how and where people work. To address that you need to design specific programs.

We now have special programs for TB in the mining industry, particularly in southern Africa and in the communities in which the mines operate. We've also had some programs in many countries, particularly in eastern Europe and central Asia, for TB in the prisons. We call prisons the breeding ground for resistance, because it's particularly in prisons where people are poorly treated, often insufficiently or incorrectly treated, and that's exactly what leads to the very dangerous multi-drug resistant tuberculosis.

You can address that only if you support those countries and encourage them to invest particularly in health care in the prisons. It's possible, but it's a conscious decision, and often the government.... You will understand that prisoners are hardly constituents that matter for many politicians, but they matter when you want to address this disease.

We have a number of examples of where this has been addressed specifically through program support by the Global Fund, also in eastern Europe, also in the Russian Federation, because that is where you have the most dangerous forms of the multi-drug resistant tuberculosis.

[Marc Miller, Liberal, Ville-Marie—Le Sud-Ouest—Île-des-Soeurs, QC]

You stated that you're a funding agency, and I talked about implementation. What are the specific actions you take with more recalcitrant partners to get the message out?

[Dr. Christoph Benn]

I'll go a little bit more into how we operate.

The first innovation that the Global Fund created was that in any country that we support, we ask the country to create a country coordinating mechanism. That was quite unique. This means they have to create a roundtable by the government, but also the civil society and private sector have to come together and then decide on what the priorities are for the country and what the strategy will be, and they submit their proposal.

In some countries—not all—it's important to say it's not just the government, that it's a country mechanism. It's often the civil society that is working in these prisons and that is putting these issues on the table. We encourage them to do so. It doesn't mean that we want to overrule the government, if you like, but we are asking any country that is submitting a proposal to the Global Fund to come together in a coordinated fashion through these country coordinating mechanisms. That is exactly what has happened in Russia and in other countries.

It's through this mechanism, through this roundtable, that we receive the proposals for programs in prisons and in other particularly vulnerable settings.

[The Chair, Liberal, Bob Nault]

Thank you, Mr. Miller.

Mr. Aubin.

[Robert Aubin, NDP, Trois-Rivières, QC]

Thank you, Mr. Chair.

I want to thank both of you for being here with us this afternoon. I want to extend a very warm welcome to Mr. Robinson.

It's as though you made it to the National Hockey League while I was still in the minor leagues doing my homework, when you were a player.

In listening to you, I drew a parallel, and I would like you to tell me if it makes sense in terms of the study we are doing currently on countries of focus.

You are fighting a very long-term battle against three diseases in particular: AIDS, malaria and tuberculosis. At the Global Fund to Fight AIDS, Tuberculosis and Malaria, you must nevertheless have the necessary flexibility to respond to urgent requests such as the recent Ebola outbreak, or Zika; we do not yet know everything about that one, such as how widespread or serious it could become.

With the budget you have at your disposal, how do you balance this long-term permanent work that produces results, and the leeway you need to react to epidemics that occur periodically?

[Dr. Christoph Benn]

I can start, and Svend, you may want to add to that.

In a sense, we at the Global Fund also had to struggle from the beginning with this kind of challenge between an emergency response and a sustainable, long-term response. When we started 15 years ago, HIV/AIDS was considered a global emergency that required a very urgent response, but at the same time, you have to respond in a way that is sustainable because, for example, as most of you will know, when you put somebody on treatment for HIV/AIDS, it's lifelong. It's very effective. The people have an almost normal life expectancy today with this treatment for AIDS, but they have to take the drugs every day.

You have to have a long-term perspective in that, and when the world is faced with new emergencies, such as Ebola, or now Zika, and so on, we don't have a direct mandate for that but what we did, for example, in west Africa was to provide those countries—Guinea, Sierra Leone, Liberia, for example—which were affected by that maximum flexibility through the funding of the Global Fund because many of the measures you have to put in place to contain and control an Ebola outbreak are very similar to what you need to do to contain AIDS or malaria. Actually, the major differential diagnosis for Ebola was malaria, so we were increasing our funding for the malaria control while also strengthening efforts enabling health professionals in those countries to take the required precautions for this disease.

We often have to balance that and also make sure that the work continues to focus on what is really the major infectious disease, if you look at the impact, and to keep a focus on that.

Svend, do you want to add to that?

[Svend Robinson]

I would just add that in addition to the three diseases, a very important priority for the global fund is strengthening health systems themselves. Obviously, it's important that we provide bed nets to help to prevent malaria, and provide ARVs for people who are living with HIV and so on, but increasingly, we're looking at ways to strengthen health systems themselves.

One of the exciting things that I was hearing from members of parliament in western Africa around the time of the Ebola epidemic was precisely that in terms of the infrastructure that had been put in place through Global Fund-supported programs, initially to support people who were living with HIV, TB, and so on, they were able to use those same resources and in many cases, the same health care workers, to then respond to Ebola very effectively, because they worked in the community, they worked in the villages. They had the respect of the people in the villages and the trust of the people in the villages.

I think increasingly we're hearing from our partners in countries in Africa and Asia and elsewhere that yes, we need to tackle these three pandemics, but at the same time we have to do more in terms of strengthening health systems themselves. In Ethiopia—and Dean, I know, was in Ethiopia—we've done a lot in terms of supporting primary health care centres, and while they do a lot on the pandemics, they also support people generally in communities.

I think more and more we're looking at that because it enables us, when there is an emergency, whether it's Zika or Ebola, to effectively target some of that training and those resources to those areas as well.

[The Chair, Liberal, Bob Nault]

Monsieur Aubin.

[Robert Aubin, NDP, Trois-Rivières, QC]

Given the success of the Global Fund to Fight AIDS, Tuberculosis and Malaria, I wondered if the 2030 Agenda for Sustainable Development objectives changed anything in your approach, or if they only changed the economic lever allowing you to ask each of the partners to be more generous.

[Dr. Christoph Benn]

No, it has changed also the approach somewhat. Obviously, the move from the MDGs to the SDGs has been very important for the Global Fund as for many other organizations. Fortunately, we were working at the same time on our new strategy that the board just approved a month ago for the next six years. We just approved a strategy in the SDG context, in the SDG era, that takes into account both how we can help countries to end AIDS, tuberculosis, and malaria—as we are mandated by the SDGs—and, as Svend said, now follow a specific objective of helping countries to build resilient and sustainable systems for health.

This has become one of the four pillars of the new Global Fund strategy and I think that's directly related to the request, if you like, from the SDGs and the different focus. We need to keep focused on what we've been doing quite successfully while we also help countries to build those systems and promote and protect human rights, which is another very important component of this new strategy, because without the kind of environment where human rights are respected, you cannot implement and run effective health programs.

[The Chair, Liberal, Bob Nault]

Thank you, Mr. Aubin.

Mr. Levitt.

[Michael Levitt, Liberal, York Centre, ON]

Thank you, gentlemen, for being here and providing an update and illuminating us on the work of the fund. I have to say I was not fully aware of the depth of the work that's been done over the long term. To hear about past work as well as the commitment to the future is heartening. I'm proud to be a part of the government.

It will come as no surprise that gender issues have been a focus in this committee and in Parliament. In fact, the previous study we did was on women, peace and security. I want to go along that line. Does the fund conduct gender-based analysis in its decision-making processes to routinely analyze the gender dimensions of the three diseases under its mandate, and the public health responses to them?

[Dr. Christoph Benn]

I'm glad you raised that point because it is indeed very important.

The Global Fund has been doing gender analysis for many years. The board approved a gender equity policy in 2008, which is a long time ago. This is one of the elements that has received much more focus in the new strategy, and for a very good reason. These three diseases, but HIV in particular, have a huge gender focus. With respect to HIV, one particular area of concern is the extremely high infection rates we are still seeing, particularly in southern Africa, among young girls and women. They are affected quite disproportionately in comparison with young men. We know that unless we address that effectively, we will not be able to end HIV as an epidemic.

I mentioned TB and drug resistance as one of the challenges. With HIV, though, the challenge is clearly the very high infection rates among young women.

We now design, together with those countries and many other partners, and Canada is one of the key partners, programs that are able to directly address the needs of girls and young women. There is also a very clear link, by the way, to education. One of the most effective ways to prevent these infection rates is to provide education.

With every year you keep girls in school, particularly in secondary school, you see that the risk of HIV infection goes down. It is one of our absolute priorities, not only the focus on gender and specifically designed programs, but also the link between health and education because that is one of the ways to address that effectively.

[Svend Robinson]

If I could just add as well, in addition to the very high sero prevalence, particularly among adolescent girls in sub-Saharan Africa, there is another serious concern. That is the very high levels of HIV among certain concentrated populations, particularly men who have sex with men, gay men, and transsexual populations in some Asian countries. We see sero prevalence levels of 15% to 25%.

In many cases, in the countries we're talking about, populations are criminalized. This is the situation in Uganda and a number of other African countries. The Global Fund is literally the only source of funding for organizations in those countries that are working to counter the devastatingly high levels of HIV. Nigeria just passed some very repressive legislation, but the Global Fund has been able to work out an understanding with the government that this is a serious health issues, in addition to a human rights issue.

I was just in Vietnam with a group of Australian MPs. We met with people from the LGBT community who said the same thing, that this is the first time that they have actually had an opportunity to do peer education through programs that were supported by the Global Fund. Minister Bibeau was in Vietnam and had an opportunity to meet with some of those folks as well. That is another area, and you are absolutely right that the gender issue is critically important, but we also want to make sure that human rights are respected across the board.

[The Chair, Liberal, Bob Nault]

Mr. Fragiskatos.

[Peter Fragiskatos, Liberal, London North Centre, ON]

Thank you, Chair.

My colleague Mr. Miller talked about his riding. Let me say that any time you want to have a conference in London, Ontario, let me know and we'll be glad to host you.

I note that global deaths from tuberculosis declined by 41% between 2000 and 2014, and yes, there is a continued need to be vigilant on that front. Malaria deaths dropped significantly between 2000 and 2014, by 48%. These are stunning figures.

Canadians, I think, would want to know what accounts for that success. Are there particular factors you would point to?