Foreign Affairs Committee on May 16th, 2022

[The Chair, Liberal, Sven Spengemann]

Good morning, honourable members.

Welcome to meeting number 21 of the Standing Committee on Foreign Affairs and International Development.

Pursuant to the motion adopted on May 5, the committee is meeting to discuss the Global Fund to Fight AIDS, Tuberculosis and Malaria.

As always, interpretation is available through the globe icon at the bottom of your screens, and for members participating in person, please keep in mind the Board of Internal Economy's guidelines for mask use and health protocols.

I would like to take this opportunity to remind all meeting participants that screenshots or taking photos of your screen is not permitted.

Before speaking, please wait until I recognize you by name. When speaking, please speak slowly and clearly. When you are not speaking, your mike should be on mute.

A reminder that all comments by members and witnesses should be addressed through the chair.

We are pleased to welcome our first witness this morning, Françoise Vanni, director of external relations and communications for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Madame Vanni, you have a five minutes for your opening remarks, after which we will proceed to questions from the members. The floor is now yours. Please go ahead.

[Françoise Vanni, Director, External Relations and Communications, Global Fund To Fight AIDS, Tuberculosis and Malaria]

Thank you very much, Mr. Chair and members of the committee, for the opportunity to testify before you today.

My name is Françoise Vanni and I lead the external relations and communications team at the Global Fund. I had the honour to testify before this committee three years ago in the context of the sixth replenishment of the Global Fund, and I'm really grateful to have this opportunity again today as we run our seventh replenishment campaign for the Global Fund.

Let me start by expressing my gratitude on behalf of the Global Fund and our partners around the world for your long-standing support and leadership in the fight against HIV, TB and malaria and in global health more broadly.

Canada is a founding donor of the Global Fund and has always been one of our strongest partners. Our fifth replenishment, hosted by Canada in 2016, was the most successful ever at the time, and Canada was our sixth-largest donor in 2019 in Lyon when we broke that record by raising $14 billion for the sixth replenishment. This was made possible by the strong, consistent support we have received from our allies in the Canadian Parliament, so thank you.

In addition, in 2020 and 2021, Canada supported the Global Fund's COVID-19 response to assist over 100 low and middle-income countries. The Global Fund is now the primary funder for all the non-vaccine components of the COVID-19 response, including tests, treatments, medical oxygen and personal protective equipment for health workers, among others.

The Global Fund recently marked our 20th anniversary, and the programs we fund have helped save over 44 million lives since our creation in 2002. Also, the combined death rate from the three diseases has been reduced by more than half in countries where the Global Fund invests. This is proof that global commitment combined with community leadership can force deadly diseases into retreat and advance the 2030 sustainable development goals.

Over the last couple of years, of course, the impact of the COVID-19 pandemic has been devastating, particularly for the most vulnerable. For the first time in the Global Fund's history, key HIV, TB and malaria programmatic results declined. Malaria deaths, for example, increased by 12%, which is about 69,000 more deaths, the vast majority of them children under five in Africa. It could have been much worse without our agile response, but it's still devastating, and even more so knowing that these diseases are preventable and treatable.

The direct cost of the war in Ukraine is another major human tragedy, and its knock-on impacts on lives and livelihoods around the world will also be severe. They include food crises, energy crises, debt crises and so on. These will, again, disproportionately affect the most vulnerable—those already most exposed to HIV, TB and malaria.

In that context, the Global Fund's seventh replenishment this year is crucial. We need to raise sufficient resources to regain lost ground and get back on track in the fight against HIV, TB and malaria towards the 2030 targets, while also building stronger systems for health that ensure countries are better prepared for future pandemics, which we know will come.

Our target for the seventh replenishment is to raise at least $18 billion. This is an almost 30% increase from the previous cycle because of the enormous setback the world has experienced over the last two years. With at least $18 billion, our technical partners, the WHO and others estimate that we would be able to save an additional 20 million lives over the next three years and avert approximately 450 million new infections across the three diseases. The stakes could not be higher. If we do not provide the resources that are necessary, then we must acknowledge that we are essentially abandoning the 2030 commitments. This would be a tragedy that would cost millions of lives and harm economies in many low- and middle-income countries.

President Biden, who is generously hosting the seventh replenishment in New York in September, has already included a $6-billion pledge commitment for the seventh replenishment in his budget. U.S. law requires that every dollar the U.S. commits must be matched by two dollars from other donors. Without a similar 30% increase from other major donors like Canada, for example, it will be difficult to raise the remaining $12 billion needed to unlock the full U.S. pledge. Therefore, we are here today to seek your help to secure a Canadian pledge commitment that meets this target as we do not want to leave money on the table.

The Global Fund has proven to be an effective and agile partner in development, as well as in times of crisis, whether by supporting low and middle-income countries in their responses to COVID-19, or by ensuring the continuity of life-saving treatment for conflict-affected populations in Ukraine—or, indeed, in many other places.

It also a powerful tool to advance human rights and gender equity, which are at the very core of our strategy. We have, for example, significantly increased our investments for adolescent girls and young women to prevent HIV in 13 priority countries where HIV burdens are highest. In these countries, the number of new infections has dropped by 41% over the past 12 years. Also, in Global Fund-supported countries, the percentage of mothers receiving treatment to prevent transmission of HIV to their babies reached 85% in 2020 compared with 44% in 2010.

By focusing on breaking down human rights or gender-related barriers to health, the Global Fund ensures that no one is left behind.

Thank you again for this opportunity today, and I would be very happy to answer all of your questions.

Thank you so much.

[The Chair, Liberal, Sven Spengemann]

Thank you very much for your opening statement, Ms. Vanni.

We will now begin our first round of questions. Each questioner will have six minutes.

We will go to Mr. Genuis, please, to lead us off for six minutes.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you very much, Chair.

Thank you for being here, Ms. Vanni. I appreciate the opportunity.

My questions will focus on issues of maximizing fund effectiveness and understanding some of your internal processes along that line.

To start with, there was a report out last month from your inspector general raising concerns about fund allocations in Liberia. I wonder if you could just update the committee on what is happening in Liberia and what the response has been.

[Françoise Vanni]

We have, first of all, no tolerance for any sort of fraud or any misbehaviour across our programs. We fund programs in more than 120 countries, subject to three lines of defence. We have, obviously, our financial controls first. We have our risk department, which also oversees the allocation of the funds in countries. Then we have the inspector general, who is entirely independent, and when they investigate they we provide public reports. We publish all of their reports, and then obviously we take relevant actions and also publish the progress in those actions that we take in response to any misconduct that may have been identified.

You can find all of those reports from the OIG, as well as all of the responses made by the Global Fund, on the website. At the moment, I'm not on top of the details of the Liberia investigation, but this is the general process that we follow.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you.

I think it's certainly much to your credit that the inspector general identified these issues in Liberia, so I don't mean this to be a criticism at all of your overall work, but I wanted to raise the question. Maybe if there are further details, we would welcome them in writing.

You spoke about efforts to advance human rights and gender equality. My understanding of your model is that it's not based on country selectivity. You provide funding essentially to all countries regardless of their policies. How does not having a country-selectivity approach mesh with pushing on issues of human rights and gender equality, or at least how do the mechanics of advancing those things work?

[Françoise Vanni]

The way the Global Fund allocates the resources that our donors are providing us is through an allocation methodology that looks at the disease burden. Then obviously the countries that have the largest burden of HIV, TB and malaria get the most resources. Also, there's the economic capacity of the countries themselves to respond to the three diseases. This is the basic methodology through which we allocate our resources.

Then we have a strategy that guides the way we operate, and the strategy includes the understanding that in order to effectively fight against and end HIV, TB and malaria, we need to tackle human rights and gender barriers. Otherwise, we won't be able to end those diseases. That's part of the analysis of the determinants behind those diseases. In that sense, we push the boundaries, if you wish.

We work with local partners. The Global Fund doesn't have country teams or offices. We work with global partners, including communities, civil societies and other partners on the ground, to assess what are those human rights and gender-related barriers to accessing health care. We work with them to push the boundaries and ensure that if laws are impeding access, those laws need to be changed, or if the practice needs to be changed, then we work again with in-country partners to make sure that those are gradually removed.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you.

Just to clarify that point, it sounds like you engage in policy advocacy. You try to inform countries regarding a policy or other changes that are linked to combatting these diseases. If a country refuses to go along with you on some of those issues, will that impact their eligibility or availability for funding, or is it purely based on the earlier criteria? You mentioned that capacity and need determine which countries get which resources.

[Françoise Vanni]

We do have a performance-based funding model by which, indeed, a country that wouldn't be investing enough.... We ask countries to also invest in the fight against the three diseases. It's co-funding, so we have a performance-based funding mechanism.

When it comes to human rights and gender-related barriers, it's not a straightforward response, obviously, because, if we did have those as criteria, then we would leave a lot of people who need lifesaving treatment behind and put their lives on the line. It's more of a progressive approach, if you wish, trying to convince them and change, as I said, the policies and practice on the ground step by step.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

With respect to corruption, is a possible consequence for countries that misallocate funding that you might direct funds towards other countries, as opposed to them? Is that something that happens? Is that a potential risk for Liberia, for example, or are the funding determinations made purely based on whether those countries are prepared to make contributions financially and their capacity and need?

[Françoise Vanni]

We track funding requirements, and we push hard for that. We have a very good return performance in terms of differing requirements from countries.

When it comes to corruption cases, we have a series of instruments that we can use. One of them is that we can change the recipients of the grants, because we have multiple recipients. We usually have a principal recipient for, say, the malaria grants. In most scenarios, it would be the ministry of health. Then you would have sub-recipients, which could be civil society organizations, specific branches of the ministry of health or others.

Normally we take remedial action, but, depending on the gravity of the facts and whether no remedial actions are being taken by the recipients, we can change the recipients, but still with the idea of ensuring continuity of treatment for the people we serve. We try to find alternative routes.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you very much.

[The Chair, Liberal, Sven Spengemann]

Thank you, Mr. Genuis.

Thank you, Madame Vanni.

We will now go to Mr. Ehsassi, please, for six minutes.

[Ali Ehsassi, Liberal, Willowdale, ON]

Thank you, Mr. Chair.

Thank you, Ms. Vanni, for appearing before our committee. We're very grateful for the explanations you have provided.

I should say right off the bat that the results have been quite impressive. Since 2010, I understand that fatalities and mortality are down 47%, and we are the sixth biggest donor overall and the second biggest when it comes to tuberculosis, if I'm not mistaken. Most recently, there was a 16% increase in our replenishment, so thank you for all of the hard work you're doing.

I do understand, however, that, because of COVID, there has been a bit of a setback and you had to come up with a new strategy, a new strategy that incorporates greater considerations for equity, sustainability and innovation.

Even though I understand those terms in the abstract, I was wondering how that plays out on the ground insofar as introducing these programs is concerned.

[Françoise Vanni]

Thank you very much for the remarks. Indeed we are quite proud that together over the past 20 years we have saved 44 million lives. It's quite remarkable and humbling.

You're right that COVID-19 has been a shock for everybody—for countries, rich and poor alike, and for organizations and partners like the Global Fund. There are a lot of lessons to be learned. In a way, we were challenged but also lucky enough to be developing our new strategy for the next six years in the context of the COVID-19 pandemic. We were learning literally by the day and feeding the new strategy through all of those lessons that we were learning.

The new strategy reflects all of that, including the importance of community and people-centred health services. We've learned that very much through COVID-19. Without the communities on the front line and the community health workers on the front line, it's very difficult to fight a pandemic, whether this is an old pandemic like tuberculosis or a new pandemic like COVID-19. Communities and people are much more at the centre of the new strategy.

It's similar with equity. We've learned that no one is safe until everyone is safe. The most efficient way to respond to COVID was actually also the most equitable way to respond to COVID globally. We couldn't fix it somewhere and let it go somewhere else. Equity was very much at the centre of what we learned through the COVID-19 response and at the heart of the strategy.

In terms of innovation, we have also the ambition of being much faster at developing and scaling up the introduction of new products in the fight against HIV, TB and malaria. We've seen how transformative that can be and how fast that can be. When there is the political commitment, when there are various investments, and when there is a “burning platform”, as has been the case for COVID, innovation can be extremely fast and extremely transformative and just save lives. We will be investing much more in that space to accelerate progress on HIV, TB and malaria.

[Ali Ehsassi, Liberal, Willowdale, ON]

Thank you.

It's your estimation that the 2030 target that was set by the United Nations will be met, correct?

[Françoise Vanni]

At this stage, we are off track. If we continue at the same pace, rate and way in which we are currently going in the fight against the three diseases, we are off track. We were already slightly off track before COVID, but COVID-19 pushed us far, far off track.

There is the possibility of getting back on track if we take action now. If we don't scale up the investment and the innovation and the co-operation now and in the coming two or three years, then we will be off track. But if we do, we can reach the target, absolutely.

[Ali Ehsassi, Liberal, Willowdale, ON]

Excellent. That's great to hear.

In which region would you say progress has been most pronounced so far?

[Françoise Vanni]

Well, it depends; 75% of our investment is in sub-Saharan Africa, because this is where the highest burdens are and the lowest economic capacities can be found. We have seen progress across the three diseases and across the regions, but perhaps I would flag that the disease that was mostly left behind before COVID, and that most suffered from COVID as well, is tuberculosis. The innovations have not been as active as they could have been. The treatments are still the old treatments, etc. Innovation has not been sufficient in that space. There are a lot of challenges in the tuberculosis space. We saw that in the context of COVID as well. The two have been very much combined and have created more vulnerability for the countries with a high prevalence of tuberculosis, such as India, for example.

I wouldn't say that a region is doing particularly better than another one, but we do have perhaps more entrenched challenges in the tuberculosis space that we need to tackle.

[Ali Ehsassi, Liberal, Willowdale, ON]

Speaking of entrenched challenges, when it comes to HIV infections, just so you can elevate our appreciation of the many challenges you're contending with, could you tell us what some of those specific challenges are for HIV infections?

[The Chair, Liberal, Sven Spengemann]

In the interest of time, please give a brief answer.

[Françoise Vanni]

Yes.

Very quickly, with HIV the challenge is mostly on the prevention side. We've made a lot of progress on the treatment side. We are able to save people's lives and allow them to lead healthy lives with antiretroviral treatment. On prevention we need to scale up our efforts, mostly in two areas, one being adolescent girls and young women. This is where most new infections take place in Africa, at an additional almost 900 a week. It's massive. Then there are the key populations of people who are most particularly vulnerable to HIV, such as sex workers, men who have sex with men, and drug users in particular. This is where we absolutely need to focus our efforts.

Thank you.

[The Chair, Liberal, Sven Spengemann]

Thank you, Ms. Vanni and Mr. Ehsassi.

We now go to Mr. Bergeron for six minutes.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

Ms. Vanni, thank you for being with us today and for educating us on the importance of these three ongoing pandemics. Although they took a back seat to the COVID‑19 pandemic, they are no less deadly.

I listened carefully to your opening statement, and I was surprised that you gave the whole thing in only one of Canada's official languages. Feel free to answer in the language of Molière, if you so wish.

Mr. Ehsassi referred to the negative effects of COVID‑19 on the fight against AIDS, tuberculosis and malaria. I just mentioned it as well. Nevertheless, there is a positive side to the COVID‑19 pandemic, especially the development of mRNA vaccine technology.

In early 2022, Moderna announced that it would be conducting clinical trials of an mRNA vaccine for AIDS. We also learned that BioNTech planned to conduct a clinical trial of an mRNA vaccine against malaria this year.

Are you able to give us an update on how those clinical trials are going? Are any results available yet?

[Françoise Vanni]

Thank you.

I would, of course, be very glad to answer your questions in French.