Foreign Affairs Committee on March 20th, 2018

[Dr. Christoph Benn]

First of all, the U.S. has traditionally provided 33% of our total income, which means if we had a replenishment here in Canada of almost 13%, the U.S. at that point pledged $4.3 billion, or a very significant amount.

The answer to your question is simple, because we've always been exempted from the gag rule. Indeed, it's always introduced by Republican presidents, so we had many years under President Bush and we were never affected by that because we are deliberately exempted. There is a waiver for the Global Fund. Under Obama there was no problem, because it was reintroduced, but the same thing applied. It has not affected the funding for the Global Fund from the U.S., fortunately.

As we said, we are watching the funding from the U.S. very carefully, but not for that good reason.

[The Chair, Liberal, Bob Nault]

Thank you.

Mr. Sidhu.

[Jati Sidhu, Liberal, Mission—Matsqui—Fraser Canyon, BC]

Thank you, all three of you, for your testimony today. It's always a pleasure.

On the funding, 95% comes from donor governments. You did touch a little on private funding of a couple of billion dollars lately. What is the plan, going forward? Are you encouraging private partners to chip in more in the future, or do they just initiate on their own that they want to chip into this cause?

[Dr. Christoph Benn]

We actually encourage the private sector very actively, otherwise we wouldn't get what is now 6% to 7% of the total income from the private sector. As I said, it doubled the last time, and we are in the process of doubling that again.

The private sector is certainly increasing, and part of my team is working exclusively on the private sector. It is about financial contributions, but we should not see only the financial contribution. It's also the contribution they make in terms of improving the program funding. They provide a lot of their expertise, skills, and innovative technology that helps us to run our programs much more efficiently. Supply chain management, for example, is one area where we rely a lot on the private sector. They know best how to distribute goods and commodities. We have a lot of partnerships with the private sector to address that.

We are looking at both financial resources—and, yes, we have a plan to increase that—plus technology innovation from the private sector that we need to do our work even better.

[Jati Sidhu, Liberal, Mission—Matsqui—Fraser Canyon, BC]

How optimistic are you that the private donations will increase in the near future?

[Dr. Christoph Benn]

I'm 100% certain that they will increase. We have a number of private sector partnerships in the pipeline, so that's easy to answer.

I think maybe the question behind it is, to what extent? I do not expect the private sector to take over the billions of dollars in program expenses. There is a difference here. The private sector is not organized like the public sector. There is no G7, or any kind of political obligation. We can appeal to them, but it's always completely voluntary and it fluctuates sometimes, and you have a company that is doing very well, and the next moment it's doing less well.

For many years we had significant contributions from the extractive industries. When the prices were high, we got a lot of money from extractives. It's gone completely. Once the prices collapsed, they had no obligation. They said, “Sorry, guys. Next year you will receive nothing because we can't afford it.”

That's the challenge for the private sector; it depends on many different factors. Therefore I'm not optimistic that the private sector is the solution to all the financial challenges. But yes, I'm very confident they will increase.

[Jati Sidhu, Liberal, Mission—Matsqui—Fraser Canyon, BC]

It's good to hear.

My second question is on the targets set by the UN sustainable development goals to end these three epidemics—AIDS, tuberculosis, and malaria—by 2030. I was wondering how realistic that goal is.

You're saying that you're dealing with 11 million people around the world. Once these three are out of the way by 2030, what's the plan after? Do you have any goals?

Let's say that cancer is the new norm around now. Are you going to be taking over something else after 2030?

It's a twofold question. How optimistic are you that you will have dealt with all three by 2030?

[Dr. Christoph Benn]

First, it's important to clarify that we're not talking about a goal of eradicating these diseases. That's completely impossible with the tools we have. We would need completely different tools, like very effective vaccines that we currently don't have for these three diseases.

What the SDGs say is to end AIDS, tuberculosis, and malaria as epidemics. This is basically defined as the reduction by another 90% to a low-level endemic so that they can't reappear as epidemics. That's the goal. That's more realistic than what some people might associate with ending them. It's not the eradication. It will be difficult enough. My prediction would be, I think, in many countries we can achieve that.

Then there are countries where the political situation is so difficult, so bad, that whatever we do and whatever money we might have.... We will not achieve ending these epidemics in Yemen right now, or in South Sudan. It will be challenging from a technical but also from a political point of view.

I do expect by the year 2030 that the number of countries that require this kind of international support will have decreased. I think many countries by then will be in a position to take over those costs, and there will be a concentration on fewer countries. We will need to concentrate our efforts on the poorest, the most fragile countries.

By then it might be that the international community will say, look, with that freed-up capacity, please address other health issues. There is more attention now to non-communicable diseases and other diseases. That's a decision that our respective boards will make when the time comes. At the moment we are still very busy driving down the diseases that we have a mandate to address.

[Jati Sidhu, Liberal, Mission—Matsqui—Fraser Canyon, BC]

Thank you so much.

[The Chair, Liberal, Bob Nault]

We'll go to Mr. O'Toole, please.

[Erin O'Toole, Conservative, Durham, ON]

Thank you to our witnesses today for your work. I want to echo my colleague's comments. It's truly impressive what the fund has been able to do in 16 years in terms of bringing together governments, philanthropic organizations, and the private sector. In many ways it's setting a new model or a new standard on advocacy and treatment.

I'll tell you that one of the first emails I got from a constituent, Christine Smith, shortly after my election was on Canada's commitment to the fund and to fighting these issues. I think you're also raising public awareness and that's probably helping with the fundraising goal as well, so kudos.

I have an unusual question that's not in any way meant to be political, because I do think the non-partisan nature of support for the fund has been a good hallmark of many countries including Canada.

Malaria is, in particular, challenging because when aid or even militaries deploy, mefloquine has been used as a malaria suppressant or a drug to combat or resist, yet it's been highly controversial. I'm wondering about the fund's expertise with that disease. Are there alternatives—obviously avoidance is one—to combatting malaria that you're familiar with, which would provide insights for not just militaries but aid organizations and others operating in areas where there is risk?

[Dr. Christoph Benn]

Malaria is a disease that has been around for thousands of years and has often escaped our efforts to really suppress it. I think we've never before been as successful as we have been over the last couple of years to drive down malaria. I mentioned earlier in the lunch discussion that a country like Vietnam has seen a reduction of 99% of malaria deaths. That is a country where malaria was very important for military reasons when there was the Vietnam War and it was a heavily infected country.

I think the efforts to develop appropriate medication, but also diagnostic tools, have been going on for many years. At the moment we are using what is called artemisinin-based combination therapy. That's the standard treatment for malaria. It's very good. It's based on a plant and has actually been used in Chinese medicine for 2,000 years. It's the most potent drug we have right now. It works very well. It is cheap, and we can basically cure malaria within four days. What we are watching is that there is some increasing resistance to that. Therefore the research community is very eagerly working on alternatives to the current artemisinin product. I'm moderately confident that this will work. So, at the moment we have a very good tool. We also have new diagnostic tools that are very effective. You know, malaria diagnosis was very difficult for many years, using microscopy. Now we have a rapid serological test.

There have been innovations in my area, by the way, in TB and HIV as well. We need these innovations all the time on diagnostics and on treatment if we want to achieve our goals. I think, also, the commitment of the international community to the creation of a Global Fund has provided these incentives for industry to invest in research. We've seen much more research and new products coming on board over the last couple of years, not because we pay for the research but because they anticipate that there is a market now for these products, and they are right. So, it's a more healthy pipeline, let's say, of new products that are coming onto the market. However, it's always a race against time, particularly in terms of the growing resistance.

[Erin O'Toole, Conservative, Durham, ON]

You were talking about the decline of the resource sector and how the extractive industries, which have been big beneficiaries, quieted down when resource prices slumped. I remember reading a few years ago about a partnership with the New York Stock Exchange or the Dow Jones index or something on partnering with companies that make investments to the fund and other things in terms of a corporate social responsibility index, that sort of thing. Are those still things the fund is exploring with private sector partners.?

[Dr. Christoph Benn]

Generally we've learned and had confirmed by many CEOs with whom we talk.... What we are asking from these companies is not CSR. CSR is simply too small. It's a small kind of charitable budget, and that's not the magnitude that would help the Global Fund.

When we are successful with private sector partnerships, it is because they realize it's part of their business. That could be the extractors. They saw in the countries where they invest, where they have their mines, that their workers and their communities are heavily affected by the diseases, and then they gave us money.

This is not just charity; this is part of the core business. That's more and more how we are appealing to companies and, in some cases, quite successfully, so yes, this is part of that. Also, it's that they are more committed to the SDGs. They say that part of their mission as a company is to help achieve the SDGs, and the Global Fund might be the way to do that.

What we're also doing more and more is working with funds—equity funds, philanthropic funds. If they are, for example, investing in Africa, they might be interested in sharing some of the management and performance fees with an organization that helps people in Africa because that's what their investors and their stakeholders expect.

We had a pledge here in Canada at the replenishment of such a fund that is investing in Africa. We said we were looking for a partner where we could show to our investors that part of the proceeds are then reinvested in the social sector, in this case in health.

Those are the models we are pursuing with the private sector, but you need to appeal to their core interests rather than, if you like, charity kinds of interest.

[The Chair, Liberal, Bob Nault]

Thank you.

Ms. Vandenbeld, please.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you very much.

I want to join my colleagues in congratulating you on the work that you've done over the years. It's rare that we see this tangible impact over the course of a number of years, so I applaud you on your good work.

Thank you very much also for mentioning the feminist international assistance policy. I noted in our briefing note that about 55% to 60% of the investments you make benefit women and girls. I'd be interested in looking at women and girls less from the perspective of beneficiaries and more as contributors, in terms of the implementation, the design of programming. We know that outcomes are better when women and girls are part of the entire process, from the very design of the program, to how it's implemented, to how it becomes sustainable. Because it also involves more women and girls at the community level, the outcomes are better for everybody.

You mentioned the high prevalence of HIV amongst young women, and specific programs targeting young women, if the young women are part of the design of these programs.

[Dr. Christoph Benn]

First I have a couple of words on how the programs are designed. From the beginning, when the Global Fund was created, we said that this needs to be country-owned and country-driven. Regardless of gender, there needs to be a process at the country level that designs those programs. That's happening through what we call the country coordinating mechanisms. Every country applying to the Global Fund has to have such a mechanism, and that brings governments together in every single country, but also civil society, private sector, and so on.

We make sure that in every CCM, communities affected by the diseases are represented. It's a requirement. We wouldn't accept a proposal without that. There are always people living with HIV, people affected by TB, people affected by malaria in the CCMs. It often also means—and it is quite remarkable—that in many countries' CCMs, you would have representatives, let's say, of commercial sex workers at the table. I can tell you that is often surprising for politicians. Now, after 15 years, it's normal. They should be there, because our programs are designed to address their challenges. That's at the national level.

When you then go down one level to the actual programs, like the special programs we have in those 13 priority countries in eastern and central Africa, then it's even more of the case. We wouldn't design a program for young women and girls without them. It's their program, right? That absolutely is the case. We have a particular campaign called “HER: HIV Epidemic Response” that we launched recently, and that's exclusively for programs for women and girls in those countries.

At a national level and at a program level, we always involve the communities affected. That can sometimes, of course, be men as well. We want to have groups of men who have sex with men, the LGBTI community, at the table as well, where it's programs affecting them, but very specifically also women and girls.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you, that's very good to hear.

The other piece I'm interested in is the engagement with parliamentarians.

Obviously there is very effective engagement with parliamentarians here in Canada and in a number of donor countries. You mentioned the domestic capacity and the amount of money that's going to health budgets within the recipient countries.

I note that you have countries with lower capacity among the recipients. We mentioned DRC, and there are others, like Nigeria. There are also countries like India, which would have more capacity to be able to contribute through their own national budgets. In that case if you have more representative parliaments, you have parliaments that have representation from all groups, from women, you end up seeing more going to the SDGs, toward health, sanitation, and education.

Is there an aspect to your programming, or are you working in coordination with groups that specifically engage parliamentarians?

[Dr. Christoph Benn]

Very much so. That's the perfect opportunity to hand over to Svend and also Scott, for there is a lot about that.

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

That's an excellent question, Anita.

The answer is absolutely yes. A big part of my role with the Global Fund over the past decade has been engaging with parliamentarians, not just in donor countries, but also in the countries in which we partner.

We do that in a variety of ways. For example, we work very closely with a number of international parliamentary organizations. The Inter-Parliamentary Union is a very strong partner; we have a protocol with them. L'Assemblée parlementaire de la Francophonie, we work very closely with them; the OSCE Parliamentary Assembly; the Commonwealth Parliamentary Association.... We work there because it's a great way of meeting people who are active on these issues.

We engage directly at the country levels. For example, one of the last activities I organized was a meeting of 30 members of Parliament in Kenya, including the chairs of the finance committee, the health committee; all the key parliamentarians made sure there was gender equality, by the way, at that meeting. Sometimes they had to be pushed a little. A big focus of that—and we did a similar one in Tanzania—was very much on domestic financing. You are the elected representatives and you have to step up. There's a real obligation there in sustainability, human rights issues, gender equality; we've worked with them.

Finally, and very importantly, we're bringing parliamentarians to the countries in which we work, and engaging them with other parliamentarians. For example, I brought a delegation of members of Parliament from Canada and the U.K. to Vietnam; Brenda Shanahan, Don Davies, and Dean Allison have been very much involved in the past as well. It's great because they have a chance then to engage with parliamentarians in those countries and raise some tough questions, in many cases, about domestic financing, human rights issues, and so on.

Those are the main ways that we've engaged. I know Scott's looking forward to continuing that engagement in the future.

Mr. Chair, could I bootleg in for 30 seconds to say thank you for the great privilege? For almost a decade I've been able to work with you as parliamentarians across party lines. I sat on this committee for over a decade, a few years ago now. It's an excellent committee. To be able to then continue my work has been a great privilege. I point to Canada as a beacon, an example of the kind of cross-party solidarity that has really made a difference to the Global Fund. I can thank you for that privilege as well; it's been great.

[The Chair, Liberal, Bob Nault]

That's a good opportunity for me to tell everyone that our time with the Global Fund is up. We'll save Scott for another day, because he's going to be here next year telling us all the good things he's done. We'll have an opportunity to do that.

On behalf of the committee, I want to thank the Global Fund, Dr. Benn, and of course Mr. Robinson and Mr. Boule for being here today, and also for your great work. If you do a good job then a lot of lives are saved, so we very much appreciate all that hard work. It's important, as you've said, to make sure members of Parliament are engaged in a non-partisan way. This is very much one of those non-partisan files that I think we all agree Canada should and could play a big role in, and we hope that it continues to do so.

Colleagues, I'm going to suspend for a couple of minutes; we're going to go in camera. Everyone who doesn't have a pass has to clear out. We'll just go from there.

Thank you very much.

[Proceedings continue in camera]