Joint Foreign Affairs Committee - 2nd April 2008 - Global Pandemics: Discussion with Global Fund.

Joint Foreign Affairs Committee - 2nd April 2008 - Global Pandemics: Discussion with Global Fund.

Senator David Norris: I welcome our distinguished guest. In response to one of the points, I would say that a number of us are involved with parliamentary representatives who support the UNFPA. We have a grouping here that is very effective and assists in debates by providing us with efficient and detailed briefings which are very useful. Many of us support this initiative.
I noted the same trends as my colleague, Deputy Michael D. Higgins, with regard to funding. It is worrying that the United States plays such a relatively insignificant role and also frequently, under the Bush Administration, attaches conditions of a moral nature, which is completely regrettable in a scientific area and an area which deals with the treatment of human beings. While there may not be time for the professor to address this issue given that there is so little time, there is a worrying development in regard to TB. The Chairman referred to our national history with regard to TB but now as a by-product of AIDS there is the development of drug resistant TB. If time permits I would appreciate a comment on that issue.
My final question and comment is the business, which a number of colleagues have raised, of gender equity and so on, but they neglected to mention the other rather coy phrase “sexual minorities”. I wonder how many sexual minorities there are. Is there a wonderful efflorescence of sexual minorities? I can think of one in particular, homosexual men, gay men. I have had experience of going to the meetings of the interparliamentary union in India and being the only person to raise there, about ten years ago, the question, which was a time bomb. I discovered that in the previous year the first national conference on AIDS had been held in the Ashok Palace Hotel and it excluded by police force women sex workers, or as we used to call them, prostitutes and gay men, who wanted to take part.

Many of us here have the privilege in northern Europe of being able to speak openly about these issues. There is a real political difficulty in the east, in Asia and in Muslim countries. We owe it to these people to indicate our very strong support for gay men who, certainly in the west, were simultaneously attacked as being the principal mechanism of transmission and then ignored. The professor should know of our strong support. I doubt if any of my colleagues would dissociate themselves from that.

Chairman: The professor does not have to answer all those questions.

Professor Michel Kazatchkine: If I were to do so we would be in session for many more hours. I will run through a few of them. I thank members for raising so many important points. I will answer a number of points raised by Deputy Higgins about contributions. He is correct in suggesting one should examine the figure per capita as much as absolute numbers. It is true that the US has made an unprecedented effort with regard to AIDS with the $15 billion for the President’s emergency plan for AIDS relief, PEPFAR I, programme and President Bush’s request for $30 billion, which is now being considered by Congress and the US Senate, for the PEPFAR II programme. When one examines the percentage of GDP the US gives to development, it is far below the mean European figures. As Europeans we can be proud of the effort of Europe, which is supporting close to 65% of Global Fund funding. Many EU countries have committed to increasing overseas development aid towards 0.56% and then 0.7% of GDP. Ireland is among the high donors. I measure this as the percentage of overseas development aid that goes to Global Fund, which is 2.65% in Ireland’s case. The highest donor gives 3% of overseas development aid to Global Fund and the mean is approximately 1.9-2.1%. Ireland is among the strong donors.
China is investing in bilateral efforts, particularly in infrastructure and with regard to malaria. It is not linking with the multilateral groups on the ground and with Global Fund but these developments are recent and we must build relationships. China is a small donor to Global Fund, giving tens of millions but receiving $440 million from our portfolio in China.
I look forward to the next three years as years when the contributions Global Fund receives from rapidly emerging economies will increase. We are targeting fundraising efforts at the Chinese Government, India and Russia, which is the best example. Russia has been a beneficiary of Global Fund to the extent of $270 million. Last year, Russia decided to reimburse all the funds it has received by 2010. I would like to use that model to address China, India and Brazil. The patterns of donors will change and the growing economies in Asia will be represented in Global Fund donors.
I thank several members for raising the impact we have. This is where the advocacy of members is needed. Some may say that since there is impact and people hear marvellous results about malaria, they do not have to worry anymore about AIDS and other diseases. This could lead to complacency but we need the opposite attitude. Here is a global issue that the world is coming together to tackle. We are making significant progress but let us eradicate malaria and make an impact on tuberculosis. It is amazing that the world is still confronted with an increasing epidemic of tuberculosis in 2008.
Deputy Ardagh referred to philanthropists. There are two ways in which they invest money. The main investment of Mr. Gates and Mr. Buffet is in technology or research, upstream investment. However, at the Toronto AIDS conference two years ago, Bill Gates committed €500 million to the Global Fund. He is giving us €100 million per year for the next three years. I am in close contact with Bill and Melinda Gates and their foundation and hope its work will expand with the Buffet money. Their key investment is in the area of future technology.
A question was raised about the spread of AIDS. Several years ago, we were concerned that AIDS could spread throughout the world if we did not deal with it urgently. It is now fairly clear from an epidemiological perspective that two types of epidemic exist in the world. The first is the African, or I would even say the southern African, epidemic, which is a generalised epidemic of unbelievable scope. Next week I will travel to Swaziland, where one person in three is infected by HIV. In the rest of the world, epidemics are concentrated among, for example, intravenous drug users or homosexual men. We should be able to stop these epidemics because we can access these people for treatment fairly easily. However, the issue of how we deal with southern Africa is very difficult to address, particularly in respect of prevention. I do not think there is any hidden or unknown aspect to the progression of the epidemic.
With regard to the point made on multi-drug resistant tuberculosis, not only is the AIDS epidemic extremely worrying in southern Africa but now we are also concerned about the tuberculosis epidemic and resistant tuberculosis. HIV-AIDS and tuberculosis are linked because people whose immune systems are compromised by AIDS are particularly vulnerable to tuberculosis. We now see the spread of multi-drug resistant tuberculosis in eastern Europe and Central Asia. The Global Fund is currently the only funder of resistant tuberculosis prevention and treatment. I recently visited Georgia to open a new facility for multi-drug resistant tuberculosis. We are the only provider of multi-drug resistant tuberculosis in the world. The support of this committee for our activities in that regard is therefore very important.
I was asked about administration but I am unclear on the question. The Global Fund is extremely cheap from an administrative perspective. We are spending between 4% and 6% on overheads. We have a comprehensive funding policy so that, whenever we approve a programme for €10 million or €100 million, we immediately put that money aside in the bank so we are sure there is no risk to continuity. That money goes to the World Bank, which invests it, and the returns on our investments pay our administrative costs. Every euro that Ireland contributes to the Global Fund goes to the developing world. We are proud that Geneva does not retain a single euro.
Several questions were asked regarding the feminisation of the epidemic, which is currently a major issue in southern Africa. The risk for a young woman to acquire HIV-AIDS is about six times that of a young man. That means prevention must include education for young women, although obviously it must also focus on men. There are limits to what we can do. One can educate, court or inform as much as possible. When these young women are confronted with poverty and violence there is no way to respond for them. If they have to sell sex for money because they are hungry, no education effort will help. Some members spoke about the socio-cultural context. These diseases cannot be separated from the overall context of the fight against poverty and for human rights.
I should address some remarks by Deputy Noonan and others on audits and how we can be accountable apart from the five-year evaluation. We are the only development funding agency that works according to a performance-based funding model. When we sign a grant with a country, that country sets a number of objectives, for example by three years it wants to reach 20,000 people with anti-retroviral treatment. The country will aim to reach 5,000 people in year one, 10,000 in year two and 15,000 in year three and request annual budgets accordingly. We will disburse the first tranche and will not disburse the second tranche before objective one is reached and we see how the money related to that objective is spent. Every six months - or every three months for countries we examine more carefully - our principal recipients give us reports on the programme achievements and the budget that has been spent.
We also have independent auditors in countries, usually accounting firms such as KPMG or PricewaterhouseCoopers, which we subcontract. Every six or three months these people send us a similar report to the one we request from the principal recipient. If the two reports are consistent and if the programme achievements have been achieved I disburse the second tranche. If there is inconsistency between the two reports, we investigate. One of the members mentioned the risk of corruption, of which we are very conscious. A few months ago The Irish Times published a report on a country I cannot name, and which was not named in the newspaper because it is the subject of a police investigation. The report was on some of the Global Fund’s money being used inappropriately in an African country. That report was correct. From time to time I receive such evidence. Because of our legitimacy, because we are global and our board comprises donors and recipients, public sector and civil society, the Global Fund is the only board with the strength and legitimacy to tell a country we are discontinuing the grant. For a bilateral country it is difficult to suspend bilateral efforts because bilateral efforts often have some political visibility purposes. I will stop here.

Chairman: We must wind up because we are going to be put out, never mind Professor Kazatchkine.

Professor Michel Kazatchkine: As members may know, we have suspended grants in Ukraine, Uganda and in a few other countries and are threatening some countries with temporary suspensions, so we have strict control over corruption. Let us keep our fingers crossed. We have been doing reasonably well, particularly if one thinks of the very large flows of money through the Global Fund.

Chairman: I thank Professor Kazatchkine. People are mostly concerned about where governments receive money directly and wish to ensure it gets through to where it is needed. We have visited various places and seen audits being conducted, even by our own officials. It is an issue which is raised in the media and elsewhere.
The delegation is very much on top of its brief, as is very obvious to everybody present and clear from the presentation made and replies given to questions. We all agree that if there is to be an impact, it must not lead to complacency. That is very important. We must aim for total eradication. We are all much more aware of the great work being done by the Global Fund in combating the scourge of AIDS, malaria and TB. Coping with the challenges posed by these pandemics is not an easy task but it is welcome that the delegation is focused on the issue.
Professor Kazatchkine is to be congratulated on the work he has done in his first year as director of the Global Fund and we wish him every success with his future plans. We will communicate and keep in close contact with him. We will also follow up on the invitations mentioned. I again thank the delegation.

The joint committee went into private session at 1.42 p.m. and adjourned at 1.45 p.m. until 3.30 p.m. on Wednesday, 9 April 2008.