Foreign Affairs Committee on May 16th, 2022

[Stéphane Bergeron, Bloc, Montarville, QC]

I'm delighted to hear it.

[Françoise Vanni]

You're right. The devastating effects of the COVID‑19 pandemic on AIDS, tuberculosis and malaria have been well-documented. In fact, we have lost ground in the fight against the three diseases, which we have invested so heavily in over the past two decades.

It is true, however, that some positive things came of the COVID‑19 pandemic. As just mentioned, the investments required led to innovation, so the momentum generated by the pandemic sped up the development of vaccine technologies and other breakthroughs. Obviously, that gives us tremendous hope, since vaccines have yet to be found for all three of the diseases we target, even though they have been around for decades.

The potential for new technologies to be deployed—like mRNA vaccines, as you mentioned—and the fact that a number of labs are now exploring those possibilities are very positive developments. As you know, clinical trials are complex undertakings that often take many years, so we will have to wait and see, but we are cautiously optimistic.

One piece of positive news, however, is the World Health Organization's recent recommendation of the first-ever malaria vaccine. That is one more tool in our malaria toolkit. Of course, it has to be used in conjunction with other tools because it doesn't have a high enough efficacy rate to allow for indiscriminate use. In any case, there is progress in the fight against malaria, and it could help us step up efforts in the next few years.

[Stéphane Bergeron, Bloc, Montarville, QC]

Speaking of drugs and vaccines, in the late 1990s and early 2000s, Canada adopted Canada's access to medicines regime with the intent of making HIV/AIDS drugs available to developing countries.

I'm not sure whether you've heard of the regime, but since its creation, only one country has tried submitting a request through the regime—Rwanda, in 2007. It says a lot that only one country has sought to use the regime. Recently, an initiative involving Bolivia and COVID‑19 also proved unsuccessful.

Is that an effective way for Canada to make drugs available to countries in need?

Should we instead focus on waiving the patents for AIDS, tuberculosis and malaria drugs to pave the way for new medicines and expanded distribution?

[Françoise Vanni]

Thank you for your question.

I don't know enough about the regime you mentioned.

Nevertheless, generally speaking, the Global Fund partnership is an excellent tool, because we can sit down with the board and talk about which tools are working and which ones aren't as effective in relation to implementing countries. Those partners can also help us adjust our mechanisms.

I don't know the situation with the specific regime you brought up, but on our end, we have set up something I think is very useful, the pooled procurement mechanism. Through the mechanism, we are able to provide high-quality medicines to the countries we invest in and support, to prevent the use of counterfeit drugs or products that do not meet the necessary quality standards. Of course, the mechanism also gives us the ability to negotiate prices. The Global Fund's scope of activity gives us some influence so that we can bring down prices, whether for AIDS, tuberculosis or malaria drugs, or COVID‑19 antigen tests.

Our pooled procurement mechanism makes it easier to access quality-assured medicines at lower prices. As mentioned earlier, it also helps mitigate corruption risks in the supply chain.

[The Chair, Liberal, Sven Spengemann]

Thank you, Ms. Vanni and Mr. Bergeron.

It's to Ms. McPherson, please, for six minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you, Mr. Chair.

Ms. Vanni, I would also like to thank you for joining us today. It's such a pleasure to have you here. I want to thank you and your whole team for the incredible work you do around the world.

I think what I'll start with is just that we're, of course, very happy that the Canadian government did have the replenishment of $930 million for the 2020-22 period. Of course, that period is ending now. We are looking at the replenishment of the fund. What do you require from Canada? What is the timeline that you would like to see that happen within?

[Françoise Vanni]

Thank you very much for your kind words.

We are at the moment implementing the funds that we raised in the sixth replenishment. It's not over, and thank you, Canada, again, for your very robust pledge. Implementation is ongoing. Indeed, we have never deployed as many resources in the past. It's really been a scale-up of the Global Fund supports for low and medium-income countries in the fight against these three diseases, let alone COVID.

That being said, this year we aim to raise at least $18 billion ahead of and at the pledging conference, which is being scheduled by President Biden for September in New York, the date still to be seen. This money would be made available to countries. We will be negotiating the grants next year, 2023. Then they will be implementing such grants in the period from 2024 to 2026. This is how it works. We raise money in one year; we negotiate for one year; and we implement in the following three years, more or less.

With regard to the mobilization on the Canadian side, we thought it would be really interesting to explore the IAS conference as a potential platform for Canada to express its commitment and potentially announce its pledge. That would set up the momentum and show the commitment ahead of the New York pledging conference later in September.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

What amount would be needed from us? This is an opportunity for you to speak to the Parliament of Canada. What would you like us to pledge? What would that number be?

[Françoise Vanni]

Thank you.

In fact, what I tried to explain at the beginning is that the $18 billion target represents an increase of 30%, roughly, compared with the sixth replenishment. That 30% is not because we have suddenly become more expensive. In fact, we have very low operating costs. For your information, 5.2% is our level of operating costs; so it's very, very low. The increased target is because of the COVID-19 knock-on impact on these three diseases. This 30% increase is what our funding needs are. This is what we expect our major donors to consider as a potential pledge this time.

As I said, what is happening is that the U.S., as the host, but also as our largest donor, has already committed that 30% increase, with a commitment of $6 billion. If we want to unlock the $6 billion from the U.S., we need to find the other $12 billion. This is why it's so important that all of our major donors step up. If they don't, we won't be able to find the $12 billion and therefore will leave the U.S. money unavailable on the table.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

I think we can all agree at this point in time, coming out of COVID-19, that this is not a situation we want to be in. Realistically, the quicker Canada can make that pledge of 30% more than the 2020–22 pledge, it would be really really extremely helpful to the organization and to saving the lives of countless people around the world.

I have a concern, as somebody who has worked in international development for some time. We have heard that the countries will be allowed to use their vaccines as part of the calculation for official development assistance. This would mean that there could be less money within that pot for actual development work going forward. Knowing where we are and knowing the gains we've lost over the past two to three years, it would be devastating for development around the world, particularly with the food shortages we're seeing out of Ukraine and many other contributing factors.

Can you talk a bit about what that would look like if ODA was reduced because vaccines were included in the calculation?

[Françoise Vanni]

That's a very daunting question, because what we are facing at the moment is a false dilemma. On one hand, we're going to stick to our 2030 targets, the long-term sustainable development goals, for which we need sustained funding from donor countries, and also sustained commitments from implementing countries. On the other hand, we have crises that we need to urgently respond to: COVID-19, Ukraine, Afghanistan and many others. This is a false dilemma, because if we jump into responding to one crisis after the other—you could add the climate crisis to that list—at the expense of sustaining of the long-term investment that is needed to reach the targets, what we will be doing is laying the groundwork for future crises.

If we think about the 2030 targets as our compass, we really need to make sure that this ODA funding or other funding mechanisms—I don't know which ones at this stage—are at the right level to address both challenges at the same time. Otherwise, we will go backward. Indeed, we already are going backward. Going backward is much more costly. It costs more in lives, but also in dollars.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Yes.

Mr. Beasley from the World Health Organization said that we will pay a thousand times more if we don't deal with this appropriately now.

Thank you so much.

[The Chair, Liberal, Sven Spengemann]

Thank you very much, Ms. McPherson.

Thank you, Ms. Vanni.

Colleagues, we have time, because everyone adhered to the time limits very closely today. Thank you. We have time for a full second round.

The first allotment is for five minutes to Mr. Chong. Please go ahead.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Thank you, Mr. Chair.

Thank you, Madame Vanni, for appearing in front of our committee.

The Global Fund is looking for $1.2 billion over three years from the Canadian government for its replenishment. Is that correct?

[Françoise Vanni]

Yes.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Have you had discussions with Canadian government officials about this replenishment, the $1.2 billion request?

[Françoise Vanni]

Not only have we had discussions with the Canadian government, but the Canadian government sits on our board. We are always discussing it with the board member and others, including through our governance.

We have basically discussed in depth the strategy of the Global Fund. The strategy was designed and approved by our board. The strategy says we stick to our 2030 targets and to our commitments—to our mandate, if you wish—to end AIDS, TB and malaria by 2030. Based on that, we've calculated the funding needs over the next three years in order to be back on track to reach those targets. Those calculations were made by technical partners, not by us, based on their global plans.

That gives us the $18 billion target for the Global Fund, which represents a 30% increase. This was discussed with the Canadian board member and the Canadian government as the basic requirement in order to get back on track.

To give you an idea, that $18 billion still leaves $28 billion unfunded in the global plans to end HIV, TB and malaria by 2030. It's not a very ambitious target. It leaves a lot of funding needs still unmet if we are to meet the 2030 targets.

Yes, we have discussed that, but we have, obviously, not come to a conclusion when it comes to the Canadian commitment.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

You indicated that Canada's board member is supportive of the overall strategy, including the $1.2-billion request from the Canadian government. Is that correct?

[Françoise Vanni]

Canada adopted the strategy alongside the other board members. We haven't had a formal discussion yet when it comes to the target.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Okay, so we don't know if they're going to support this request.

[Françoise Vanni]

We don't know yet. We will need all of your support for that.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Yes. Thank you.

You mentioned that while there's been a significant decline in HIV/AIDS mortality in recent years, there hasn't been a commensurate decline in HIV/AIDS infections.

Can you tell us what challenges there are in trying to reduce infections?

[Françoise Vanni]

That's a very good question.

That's the beauty of innovations, right? When we found the antiretroviral treatments and were able to make them available equitably to all people who needed them, we made a huge step forward in the fight against the disease. Where we are struggling is indeed in stopping new infections from happening. Obviously that means we will always have a large population of people who would need ARV treatment for life going forward, and this is not a good prospect.

The key challenges are discrimination, criminalization, gender inequity, poverty and vulnerability. These are all factors that drive new HIV infections, very clearly. This is why I was referring at the beginning to our investment in breaking down barriers to health and our focus on gender.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Could you elaborate a bit more on something you mentioned earlier? There seems to be a disproportionate number of adolescent girls in sub-Saharan Africa who are being infected with HIV/AIDS. Could you tell us why that is?

[Françoise Vanni]

Yes. Actually, the majority of new infections in Africa come from adolescent girls and young women. Between 15 and 24 years old, they are twice as likely to get HIV compared with their male peers. As I said, vulnerability factors include gender-based violence, early marriage, not going to school and things like that.

This is why we have focused our investment in the 13 countries where new infection rates for HIV are the highest in Africa. It's essentially the southern part of Africa, if you wish, where we have multiplied our investments and very much focused on that area of work. We are keeping girls in school and making sure we give them the possibility to have their own businesses and be more empowered economically so they can exercise more and more control over their lives. We also support organizations that provide peer-to-peer counselling among adolescent girls and young women. These sorts of activities go very much beyond the biomedical interventions, if you wish. We are very much working across health, education, economic development and youth engagement to reduce the new infection rates. We've managed to decrease those rates by 41% over the past 10 years in those 13 countries.