Foreign Affairs Committee on May 16th, 2022

[The Chair, Liberal, Sven Spengemann]

Ms. Vanni, my apologies, but I'll stop you there, if I may, in the interest of time.

Thank you, Mr. Chong and Ms. Vanni.

We'll go to Mr. Sarai for five minutes.

Please go ahead.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you, Chair.

Ms. Vanni, I want to commend you and your organization. It has a very impressive record given the number of lives that are saved with the small amount of investment for the prevention of tuberculosis and malaria. You save millions and millions of lives in the long run, so I really commend you and your organization. I'm very proud of Canada's contribution towards that. It's something we're all very proud of.

You mentioned that COVID had an effect that changed things, perhaps in your reach and delivery or in other factors. Can you elaborate on how COVID-19 affected your programming?

[Françoise Vanni]

Thank you very much for your kind words and for the question.

COVID-19 has impacted the programs in many ways. First of all on the offer side, health workers and community health workers were completely overwhelmed and under stress by the COVID-19 pandemic. Some of them were sick—we've lost many health workers—and/or couldn't access the health facility and/or could not cope with the level of demand.

That applies obviously to frontline health workers, but also labs were completely overwhelmed. That means that health workers or the labs that were usually used to fight tuberculosis, malaria or HIV were busy dealing with COVID-19 and could not cope with everything at the same time.

The other aspect is more on the demand side. For example, you had a lot of people who had a fever, let's say, in Burkina Faso. Having fever, they understood that they shouldn't go out from their houses and that they should not go to the health centre because it could be COVID and therefore they could contaminate others. There are contradictory instructions. For TB, similarly, if you cough you should immediately get tested and get treated, but if you cough and you have COVID you should stay home. It was very difficult for people to actually know what to do. Also lockdown orders prevented people from getting access to treatment or prevention services.

We've seen indicators go backwards very significantly in HIV testing, which was very badly affected. TB testing and treatment were very badly affected as well. Malaria resisted a bit more because programs and actors on the ground managed to adapt, for example, the way they distributed mosquito nets. They went door-to-door and therefore such programs were more resilient to COVID-19, but TB and HIV were very badly affected because of those different factors.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Are there broader ramifications for malaria infections that happened as a result of the increased malaria outbreaks?

[Françoise Vanni]

Malaria also got worse. I mentioned the increased deaths, which means basically a child dies from malaria every minute as we speak, which is not acceptable really. We've gone backwards on malaria as well.

The countries where malaria incidents are the highest were not hardest hit by COVID. Also the map of COVID-19 has impacted some countries more than others. Malaria may suffer from a couple of things. One is the ODA risk where money goes to other priorities, including COVID-19, but perhaps forgets other priorities that still kill millions of people, including children around the world.

The other one would be an illusion that because there is now a new vaccine, it's fixed. It's not because, as I said, the vaccine has an efficacy rate that is still modest. It needs to be deployed alongside other tools like bed nets, prevention programs and so on in order for us to be able to drive numbers down.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Were you able to assist with COVID vaccinations at the same places just because of your experience in giving vaccinations? Was there any coordination between the COVID vaccinations and your own organization with tuberculosis and malaria vaccinations?

[Françoise Vanni]

That's interesting because we did work very much in coordination and indeed we were one of the founders of the ACT-Accelerator, which is the coalition that brought together all the global health agencies like Gavi, the Global Fund, WHO and others. They really came together to mount an entire end-to-end response to COVID-19, including all the different tools.

The Global Fund has taken a leadership role in everything but vaccines because Gavi is taking care of that part, including through the COVAX mechanism that you know about. We haven't been involved in vaccines ourselves, but we've been focusing very much on tests, diagnostics, treatments, oxygen, protective equipment, laboratory strengthening and all of those things. The coordination was there, but it's not that the Global Fund itself was involved in COVID vaccination campaigns per se.

[The Chair, Liberal, Sven Spengemann]

Thank you very much, Mr. Sarai and Ms. Vanni.

Go ahead, Mr. Bergeron. You have two and a half minutes.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

Ms. Vanni, you said that Canada was the sixth-top donor to the Global Fund and had a seat on the board. It's quite telling and troublesome, then, that the Global Fund isn't really aware of Canada's access to medicines regime. The regime was the centrepiece of Canada's strategy to help developing countries combat the AIDS epidemic by providing them with access to medicines.

You talked about a pool of medicines provided by the fund's donor countries. Does Canada contribute to the pool?

If so, what medicines does Canada contribute to help combat the three diseases globally?

[Françoise Vanni]

Thank you.

I will look into Canada's regime and get back to the committee with an answer.

What I was talking about was a pooled procurement mechanism, not a pool of medicines contributed by donor or non-donor countries. Through the mechanism, the Global Fund is able to proactively negotiate with labs and suppliers of the various health products we need. Those products are then made available to countries in accordance with their requests. Countries determine their own needs. The Global Fund uses a funding mechanism based on each country's own priorities in combatting the three diseases. Countries seek out use of the mechanism, and we provide them with the medicines requested. It's not a pool of donated medicines. Rather, it's a pooled procurement framework to negotiate better prices for high-quality drugs.

I hope that answers your question, Mr. Bergeron.

[Stéphane Bergeron, Bloc, Montarville, QC]

Yes, definitely, Ms. Vanni. Thank you. Also—

[The Chair, Liberal, Sven Spengemann]

Thank you very much, Mr. Bergeron. Sorry, but you're out of time.

Madam McPherson, please go ahead for two and a half minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you, Mr. Chair.

This has been so fascinating. Thank you.

I have a quick question.

Knowing that COVID-19 is a new pandemic, which we have heard many times is going to be with us for the long term, is there any discussion about the Global Fund looking at including COVID-19 in the HIV/AIDS, tuberculosis and malaria bucket?

[Françoise Vanni]

That is an excellent question.

At the moment, we continue to deliver our COVID-19 response. Thanks to Canada's support, and other donors, we have been able to deploy an additional $4.3 billion to countries to help them fight COVID-19. That is ongoing.

Funding needs, by the way, are not covered for the COVID-19 response coordinated by the ACT-Accelerator coalition, as I mentioned.

When it comes to the Global Fund's long-term intent, the common strategy remains to focus on AIDS, TB and malaria, because that is our mandate. That is why we were created, and we really need to meet our commitment there.

However, it also includes the recognition of the Global Fund's role in pandemic preparedness. It's beyond COVID, in a way, recognizing that during the COVID-19 pandemic, the very same infrastructure and systems and networks that the Global Fund has been able to support in countries to fight AIDS, TB and malaria were the ones that countries used to respond to COVID—exactly the same community of workers, labs, supply chains, data systems and so on.

In that sense, the decision made by our board was not so much, let's continue with COVID, because it isn't something that we can foresee. We will, if needed, but it is isn't something that we can foresee scientifically.

However, the board has agreed that we should play a more deliberate role in helping the world get better prepared for future pandemics—leveraging our investments in health systems. In that sense, the $18 billion target that I mentioned includes an investment of an estimated $6 billion in health system strengthening, which means essentially helping those countries get better prepared for pandemics. That is what health systems do: respond to the current pandemic battles and prepare better for what may come.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

We've heard that from so many experts on how to deal with COVID-19, so thank you very much.

I think that's all the time I have.

[The Chair, Liberal, Sven Spengemann]

Ms. McPherson, thank you very much.

Mr. Duncan, welcome to the committee. Five minutes go to you, please. Go ahead, sir.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you very much, Mr. Chair. It's good to be joining the committee today on an interesting and important topic.

I want to ask some of my questions pertaining to the financing model. I have a couple of questions on that.

In the replenishment, as it's noted, over 90% of the funding that helps the fund comes from governments, but there is an amount there from private sector foundations. In your replenishment, can you speak to the role that those private aspects have? Is that something you're looking to increase as well? I look at that from a synergy perspective of the performance-based model that you have and transparency in terms of the inspector general in the system you have. Are you seeing more of an uptake or interest in that when it comes to funding opportunities as part of this replenishment? Is the private sector done at the same conference as well?

Perhaps you can address those first.

[Françoise Vanni]

Indeed, in terms of the funding model, we do have more than 90% of our resources coming from governments or sovereign donors—93% exactly at this point in time. The rest does come from private sources. In that space, we have a long-standing partnerships, and we also have very high ambitions for this replenishment.

We are ambitious because COVID-19 has demonstrated to everyone, including the private sector, how important it is to invest in health systems and prevent outbreaks from becoming pandemics, as we've seen with COVID-19 and the COVID-19 crisis.

To respond to your question, there is indeed more momentum. We are very ambitious with two or three things with the private sector. One is targeting and mobilizing philanthropists, high-net worth individuals, and asking them to step up and to fight against the three diseases. We already have a few engaged with us, including the Gates Foundation and others. We want and expect more contributions from that angle.

We are also mobilizing the private sector and particular corporations for their know-how and bringing them onboard to bring particular innovations, tools and capacities they have to help us accelerate our work and drive innovation in particular areas where we are finding bottlenecks and we are not as impactful as we would like. For example, data management is one area where we have a number of partnerships with the private sector to help us leverage change. In that space also, the supply chain space, bringing private sector experience is very, very helpful.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Can I ask if that is part of the replenishment conference then? I'm assuming that the private sector foundations are invited there, and that's where they make their pledges. I would assume from your answer that there would be a mix of cash contributions, commitments or pledges, but also in-kind contributions as well. Could you speak a little bit about that?

[Françoise Vanni]

Indeed. There are two ways in which private sector partners can contribute. They can contribute directly in cash towards the $18 billion, and we very much hope to get such commitments, not only at the conference itself but before that, and the team is already working on securing early pledges in the coming weeks, hopefully. There are also pledges of what we call “innovation partnerships”, namely, bringing know-how to the table. That can also be announced at the replenishment conference. Those are very, very welcome. They do not contribute to the $18 billion, though, because they do not bring cash; they bring something else, but it's very, very valuable and can be announced there as well.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

I didn't start my timer, so I apologize, Mr. Chair. Cut me off when you—

[The Chair, Liberal, Sven Spengemann]

You have about a minute, Mr. Duncan.

Please go ahead.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you.

We raised the issues of where some of the demographic concerns are with regard to HIV infections. One thing you talked about and a few colleagues have alluded to in their questions is focusing more on preventive measures, as you've acknowledged.

Could you break down perhaps where this should be done? Is it with education? You've talked about raising awareness via education, but also perhaps maybe more on the medical side. Here I am thinking of prep and medications and different things along those lines. What type of balance or direction do you see the majority of that preventative funding or effort going towards to reduce the number of new infections? Is it mostly via education to raise awareness, or is it purchasing medications that could help prevent infection rates from rising?

[The Chair, Liberal, Sven Spengemann]

Please give a brief answer in the interest of time, Ms. Vanni. Thank you.

[Françoise Vanni]

That's a fascinating question. The mix will differ from country to country. Essentially, prevention takes education, and awareness in particular, in highly vulnerable populations. This is where you need community leaders and you need peer-to-peer education. You don't need a formal doctor going into those populations. You need a particular approach, in that sense.

You also need tools. You need tests, tests, tests, and in that sense, you need self-tests, for example. We need to scale up self-testing. This is one of the lessons we learned from COVID as well. These tools are really important, as is all the treatment, obviously, including prep.. There is still a lot to be done in that space.