2:00 P.M. EST
Real Audio of Briefing 
MS. ARCHIBEQUE: Good afternoon, and welcome to the Washington Foreign Press Center. This afternoon we have with us Ambassador Randall L. Tobias, the Global AIDS Coordinator at the Department of State. He'll be talking to us today about the Five-Year Strategy for the President's Emergency Plan for AIDS Relief.
I would ask that, if you have not already, please turn off your cell phones and pagers. Thank you.
Ambassador Tobias.
AMBASSADOR TOBIAS: Good afternoon. In his State of the Union address a year ago, President Bush called for an unprecedented act of compassion to try to halt the ravages of HIV/AIDS around the world.
The President committed $15 billion over five years to address the global HIV/AIDS pandemic, more money than has ever before been committed by any nation for any health care initiative. $9 billion will go to new programs to address HIV/AIDS in 14 of the world's most affected nations, with a 15th country to be added some time in the next few weeks.
These countries, together, account for more than 50 percent of the world's HIV/AIDS infections. $5 billion will go to provide continuing support in approximately 100 nations where the United States currently has bilateral HIV/AIDS programs. And $1 billion will go to support our principal multilateral partner, The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Today, President Bush's vision becomes a reality. Just four and a half months after we'd launched the Office of the Global AIDS Coordinator, and less than one month after Congress appropriated the funds for the President's Emergency Plan for AIDS Relief, $350 million, the first release of funds, is today going into the hands of service providers in the focus countries.
This money will go to scale up programs providing antiretroviral treatment, prevention programs, including those targeted to youth, safe medical practices programs and programs to provide care for orphans and vulnerable children. We expect to be funding several national safe-blood programs very shortly.
These target areas were chosen because they are at the heart of the treatment, prevention and care goals that are the focus of President Bush's plan. The programs of these specific recipients were chosen because they have existing operations with people on the ground; they each have a proven track record; and they have the capacity to scale up their operations and to begin having an immediate impact.
Our intent has been to move as quickly as possible to bring immediate relief to those suffering the devastation of AIDS. By initially concentrating on scaling up existing programs, that is exactly what we believe we will be able to do.
With our next round of funding, we expect to place additional focus on also attracting some new partners who can bring expanded capacity and innovative new thinking to this effort.
With just this first round of funds, an additional 50,000 people living with HIV/AIDS will begin to receive treatment. And that will nearly double the number of people currently receiving treatment in all of Sub-Saharan Africa.
In addition, prevention-through-abstinence messages aimed at young people will reach about 500,000 additional youth, and resources will be provided to assist in the care of about 60,000 additional orphans.
In addition to announcing today this first round of funding, we are also submitting today to Congress, a comprehensive, Five-Year Strategic Plan for the President's Emergency Plan for AIDS Relief.
This strategic plan will guide us in deploying our resources to maximum effect. We will be concentrating on prevention, treatment and care, the focus of the President's Emergency Plan.
In the focus countries, over the five years of the plan we intend to provide treatment for 2 million people, to prevent 7 million AIDS deaths and to provide care to 10 million who are infected or in some other way affected by the disease in the focus countries.
We are not starting this initiative, this effort, from a blank sheet of paper. Rather, we will be capitalizing on the existing strengths and capabilities that already are present in the United States Government; that is to say: We have established funding and disbursement mechanisms already up and going; we have two decades of expertise in fighting HIV/AIDS around the world; we have a field presence and strong relationships with host governments in over 100 countries; we have well-developed partnerships with nongovernmental and faith-based and international organizations, whose role it is to deliver HIV/AIDS programs.
And we are implementing, not a new bureaucracy, not a new major organization, but rather, a new leadership model to direct all of these existing capabilities -- a model that will bring together under my direction as the United States Global AIDS Coordinator, all of the programs and all of the personnel of all of the agencies and departments of the United States Government who are engaged in fighting HIV/AIDS around the world.
This strategic plan is built on four cornerstones: One, rapidly expanding integrated prevention, care and treatment services in the focus countries by building on existing successful programs that are consistent with the principles of the plan, as we have already done with the $350 million that I've just announced.
Second, we will be identifying new partners and building new, expanded capacity in order to sustain a long-term and broader campaign.
Three, we are -- we will be encouraging bold national leadership around the world, and encouraging the creation of sound, enabling-policy environments in every country for combating AIDS and mitigating its consequences, and doing all we can to help leaders around the world to do that.
And fourth, we will be implementing strong, strategic information systems that will provide vital feedback and input that can be used to direct our continued learning and our ability to identify the best practices, to determine what is working so that we can fund more of that, and what is not working so that we can stop funding that and put our money into programs that work.
Within this framework, we will strive to coordinate and to collaborate our efforts to respond to local needs which will be different from country to country, and which will differ within regions of countries, and also to ensure that our efforts are integrated with the host governments' strategies and priorities. It is not our intent to come with the answers, but rather to come with help that complements what each country wants to do and feels in necessary and appropriate to do in their own circumstances.
In addition, we intend to amplify our own worldwide response to HIV/AIDS by working with international partners, such as UNAIDS, the World Health Organization, the Global Fund, the World Bank, nongovernmental organizations, faith-based organizations, companies in the private sector and others, all of whom can assist in engendering new leadership and bringing new resources to this fight against HIV/AIDS.
There is no doubt that this is one of the greatest challenges of our time, and it's going to require constant and concerted commitment from everyone if we're going to have a chance to defeat it. I think the limits of what we can accomplish in eradicating AIDS and its consequences are defined only by the limits of our collective moral imagination.
What inspires me the most as we embark on this effort is the remarkable self-help already underway in fighting HIV/AIDS in some of the most under-resourced countries and communities in the world. These are places that have responded in whatever way they can to help fellow members of their own communities.
I hope that with our support that we can amplify and sustain their efforts to combat the devastation of HIV/AIDS. And that is why getting this first wave of funding released today is such an important milestone.
Before I open the floor to questions, I simply want to say how grateful I am to work for President Bush, who is so committed to defeating this HIV/AIDS pandemic, and for the support of Secretary Powell and others who are spending an enormous amount of time and energy helping us all get focused on this initiative.
The President's leadership has facilitated the speed with which we are responding to people in need. And that commitment, I think, will ensure that our success has a greater chance; success that, in the end, will be measured in lives saved, families held intact and nations moving forward with development.
And now I will be pleased to answer your questions.
MS. ARCHIBEQUE: If you would please, state your name and news organization before you ask the question.
Go ahead.
QUESTION: Jim Loeb, Interpress Services.
I'm a little confused. In the fact sheet, it states that you intend to -- or we intend to increase our pledge to the Global Fund by $1 billion over five years. Now, the way you broke it down is that there is $1 billion for multilateral initiatives, in general, including the Global Fund, out of the $15.
AMBASSADOR TOBIAS: Yeah.
QUESTION: So I need some clarification.
AMBASSADOR TOBIAS: Okay. Let me see if I can help. When the President announced the Emergency Plan a year ago, it was to begin with fiscal year 2004 funding, and that funding was appropriated by the Congress less than a month ago. And so that would be the first money, you know, going out under the Emergency Plan. And included in that is $1 billion. And so when I'm talking about increasing the pledge by $1 billion, I'm really talking about the $1 billion pledge that's included in the Emergency Plan. That would be spread out over the five years.
Now, in the meantime, more money than the $200 million that the President requested was appropriated in this year's Congressional appropriation, so there's actually $547 million going to the Global Fund this year.
QUESTION: But that doesn't count in the $1 billion total. Is that correct? Does the $547 -- are we already halfway, more than halfway there, or --
AMBASSADOR TOBIAS: Well, that remains to be seen. The President proposes and the Congress appropriates. And it's entirely possible that Congress will continue to appropriate more. I can't predict that. But it will be at least a billion dollars.
I should add, just for your general understanding, because I think there has been a good deal of misunderstanding about the relationship between the Global Fund and the United States Government programs -- and indeed I'm often asked questions that sort of sound like we're trying to compete with each other, nothing can be further from the case --President Bush, in fact, made the first $200 million contribution to help start the Global Fund.
Tommy Thompson, the Secretary of Health and Human Services, is Chairman of the Board in the Global Fund, and the Global Fund will be a very important element of our overall strategy, as indicated by this $1 billion out of the $15 billion, total.
MS. ARCHIBEQUE: In the back.
QUESTION: Patrick Jarreau, the French daily, Le Monde. Could you help us with the appropriation process? Because how much has been actually appropriated by the Congress until now?
And second question: I understood that the global plan, which is $15 billion, included already appropriated $5 billion. Is it right?
AMBASSADOR TOBIAS: Yeah. Money is appropriated under our system annually. So we can look to the future with some expectation about what's going to happen, but the money is actually not there until it's appropriated; and that takes place on an annual basis.
The President indicated that he would make a commitment for $15 billion over five years, and therefore, if one got to the end of the five years and looked backward, one would see that he had requested on annual basis, amounts of money that would total $15 billion beginning in 2004.
Now, a lot of people took the 15 divided by 5 and assumed that that would be $3 billion a year. That was never the intention, because in a number of countries we have to build the infrastructure. We have to get people in place. We have to build the capabilities in order to begin, for example, to do the treatment.
So in the first year, it was $2.4 billion that has been appropriated, and that will continue to increase. So, obviously, in some of the latter years, the annual amount will be greater than $3 billion. Does that help?
QUESTION: Yes. And the second question: What is new money?
AMBASSADOR TOBIAS: Okay.
QUESTION: I mean, as opposed to what has already --
AMBASSADOR TOBIAS: Well, when we talk about new money and old money, we're really -- it would probably be less -- it would probably be more explanatory to describe it as new programs and old programs.
Before the President announced the Emergency Plan for AIDS Relief, the United States Government, on an annual, ongoing basis, was funding HIV/AIDS programs in about 100 countries around the world, and the total of that funding, annually, was about $5 billion.
We've swept all of that into this program. And so of the $15 billion, $5 billion represents those programs in those countries that have already been going on; and then $10 billion represents money above and beyond the programs that have been requested in the past. And the $10 billion then is broken down between $9 billion for the so-called focus countries, and $1 billion for Global Fund.
MS. ARCHIBEQUE: The gentleman from India please.
QUESTION: Paresuram from the Press Trust of India. Could you please look at page 86, item 47, item 47-India.
AMBASSADOR TOBIAS: Page 86?
QUESTION: Page 86, item 47-India.
AMBASSADOR TOBIAS: Yes, okay.
QUESTION: I find that India gets -- will be getting bilateral aid under USAID, Health and Human Services, Department of Defense and Department of Labor. I was wondering whether it is possible to translate it into actual dollar figures?
AMBASSADOR TOBIAS: Into money? I'm not able to do that today. One of the reasons that President Bush created the position of having a central Global AIDS Coordinator is that we've had a number of programs in the United States Government scattered around in different pieces, but they've never been under integrated leadership. And so as we pull these together, we're also pulling together information about them. I'm sure that the information exists. It just exists in a number of different places and we'll be in the process of pulling that together in the weeks ahead.
MS. ARCHIBEQUE: Nneoma from South Africa, please.
QUESTION: Thank you. I'm Nneoma Ukeje-Eloagu of This Day newspapers, Nigeria and South Africa.
I was wondering if the numbers here are the total of treatment for all 15 countries or if this is for in each country? So you have two million HIV-infected. Is this total number of --
AMBASSADOR TOBIAS: Oh, that will be -- our objective is to provide treatment for a total of 2,000,000 people at the end of -- by the end of the five-year period in the focus countries, in the 14, soon to be 15, focus countries.
QUESTION: Any idea which country would be the 15th?
AMBASSADOR TOBIAS: Well, in the appropriating legislation that the Congress passed recently, the Administration was asked to select a 15th country. The criteria that the Congress applied was that it's to be somewhere other than Africa or the Caribbean, which is where the first 14 are.
I've had my plate full, so to speak, getting this strategy put in place, and so that's about the next major decision to come to and I would hope to get that done in the next few weeks.
MS. ARCHIBEQUE: The gentleman up front here, please.
QUESTION: Andrey Filatov of ITAR-TASS news agency. Is Russia included in the list of the countries that will receive help?
AMBASSADOR TOBIAS: We have a number of relationships with Russia. We have a bilateral program from USAID. You can see that on page 86. And the Department of Defense must have some program there. I don't know the details of that.
MS. ARCHIBEQUE: Go back to Nneoma.
QUESTION: Thank you. I was wondering, with the troubles in several of these countries going on now, how do you plan to administer the program Haiti, Uganda, there's so much happening.
AMBASSADOR TOBIAS: Well, it's interesting. With all the turmoil going on in Haiti -- we, in fact, I was told yesterday, have a very good working relationship with whoever in the Haitian Government is overseeing their program and our people have been meeting this week in Miami to continue their planning for what's going on there.
We'll just have to handle that on a case-by-case situation as we go forward. Obviously, this is a disease that's not going to stop when there are other issues around and we need to find some ways to keep all this going, and in some places it will be easier than others.
MS. ARCHIBEQUE: Okay. Do you have another question? Okay. Back to Jim.
QUESTION: Jim Loeb again. Still on the Global Fund, I mean, when you say there's a substantial percentage, it's like less than seven percent or it's around seven percent. I know when Frist and Lugar and other internationalist Republicans first seized on this idea, they suggested a 50/50 split. Now I know it's up to Congress and I know that you serve at the pleasure of the President, but there seems to be a perception, and this will further it, that the United States wants to be unilateral in this as in so much else.
AMBASSADOR TOBIAS: Well, yeah, let me help you with that.
QUESTION: Let me just --
AMBASSADOR TOBIAS: Yeah. Okay.
QUESTION: Let me just finish one other point. If the $547 million that was appropriated for this year is counted against the billion, I assume that the President's request will be something on the order of $100 million a year. And if the United States -- or if the international community and the U.S. contribution toward joint-endeavors or multilateral endeavors continues to be at, say, one-fourth, at a minimum, I mean, the Global Fund is going to be bankrupt in no time at all. And I'm just wondering what's realistic about this.
AMBASSADOR TOBIAS: I'm not sure I follow the last part of your logic. Let me put some facts on the table. In 2002 and 2003, the United States Government's contributions to international HIV/AIDS was equal to the rest of the world, combined.
In the 2004 budget year, if the world of the world stays flat, and I certainly hope they do not because one of our objectives is to try to get more and more donor governments to realize the magnitude of the need here, but just as a starting off point, at least, if all other donor governments stay flat in 2004 and give the same amount they did in 2003, then based on what the United States is doing in 2004, our total contributions to international HIV/AIDS will be twice as much as the rest of the world, combined.
So it's kind of hard to say that the United States is not doing its share. Secondly, I think there is this perception that the Global Fund is kind of the old, established organization and what we're doing here through the office of the United States Global AIDS Coordinator is new. And that's actually kind of a reversal of the facts.
The Global Fund has been in business for about two years. The Global Fund, I think, is off to an excellent start. But they are, nonetheless, a relatively new organization just getting started. They have identified the need -- a lot of needs, and have made a lot of potential grants. But by the same token, they're having the same issues that the United States Government and other governments are going to have in actually getting the money deployed on the ground because of the need to build the infrastructure.
The United States, on the other hand, has almost 20 years of experience with people on the ground, mechanisms in place, funding mechanisms, monitoring mechanisms and so forth. And what's new is that we're bringing that all together under unified leadership in one place under the Global AIDS Coordinator.
But there are things that the Global Fund can do more effectively in more places than we could ever do under bilateral programs. But on the other hand, we're going to be much more involved programmatically with our bilateral programs than the Global Fund is. These are two very different models for approaching the issue.
But I want to make very clear that the Global Fund is not some organization off on the side someplace. The United States made the first contribution to it. The Secretary of Health and Human Services is the Chairman of the Board. I have people in my organization who are very involved in the Global Fund and we view the Global Fund as a very important partner going forward. But we also view the arrangements that we are making directly with each host government as something that's also a very important aspect of the way we will approach this.
QUESTION: I mean, my impression of the idea of the Global Fund was that it would take best practices on the part of many, many aid agencies around the world that have been dealing with the AIDS crisis for quite some time, and that the idea was to be able to disburse, to obtain and disburse funds very quickly with a minimum of bureaucratic overhead. I mean, one big problem is that grassroots clinics that get AIDS funds from different sources all over the world have to fill out different forms from all over the world, taking an enormous amount of time and resources.
And now, by the United States insisting on an overwhelmingly bilateral approach to the problem, it seems to me it just risks compounding those kinds of costs when the whole point of the Global Fund was to reduce, if not eliminate them, in view of the fact that this was an emergency.
And I have to say that it really does give the impression that, as in questions of war and peace, the United States just continues to insist on having its own way, and despite the fact that the Chairman of the organization is the head of HHS in the United States.
AMBASSADOR TOBIAS: I think that's more an editorial than a question.
QUESTION: No, no, no, it's a serious question because I think --
AMBASSADOR TOBIAS: No, no, I understand that.
QUESTION: You have to -- as the Ambassador; you have to deal with that.
AMBASSADOR TOBIAS: I understand that. But the question does come with a point of view. And what I'm --
QUESTION: I'm not -- I'm not --
AMBASSADOR TOBIAS: No, no, I'm not debating you. I'm just stating a fact.
QUESTION: Okay.
AMBASSADOR TOBIAS: And I think that the model that the Global Fund is using is not necessarily a model that can get money out as quickly as bilateral programs can. You make an excellent point about the problem that can clearly occur if all of the donors do not find ways to cooperate and collaborate.
As the President of one country in Africa said to me, "You know, the good news is that lots and lots of donors are coming to our country to help. The bad news is that lots and lots of donors are coming to our country to help and they're hiring away our best people, and we, you know, we've got to get things harmonized."
I've met with the head of the World Bank, with the head of the World Health Organization, with the head of UNAIDS, some of them multiple times, talking about one of our top priorities, which is to see if we can provide some leadership in all of this, all of us together, to get some harmonization around certain things that we're all going to do.
For example, can we all agree to -- and we're very much headed down this path -- can we agree to the same monitoring and evaluation mechanisms so that every country isn't imposing a different set of standards requiring a country to use scarce resources to respond to those standards?
I just don't want to get drawn into a debate about the Global Fund being good or bad and bilateral programs being good or bad because they're not good or bad, they're just different. And I think taking a bilateral approach, arguably, gets sort of the middleman out of the middle in some of the things that we're doing where we're dealing directly with the ministry of health and other officials in a host government to respond very directly and very quickly to the needs that are there.
But there are certainly other things that the Global Fund can do that I think are very, very important. And I think we are all finding conflict here where it really does not and should not exist.
MS. ARCHIBEQUE: Do you have a final question? A question from the gentleman in the back.
QUESTION: Thank you. Yashio Hotto, Aera, a Japanese news magazine.
AMBASSADOR TOBIAS: Yes.
QUESTION: You mentioned that $9 billion goes to prevention and treatment and care services in 15 different countries. And could you expand and explain specifically for the treatment? And I know that many of the AIDS drugs are very expensive --
AMBASSADOR TOBIAS: Mm-hmm.
QUESTION: -- in many countries -- and the developing countries cannot afford for the AIDS drugs.
AMBASSADOR TOBIAS: Well, the price of AIDS drugs has been coming down dramatically, and more and more companies are manufacturing AIDS drugs. I'm often asked, and let me just put it out here that our policy will be to buy drugs that are safe and effective at the lowest cost that we can provide them or that we can find them, whether they come from brand name pharmaceutical companies or generic companies.
And we are working with an effort that's being co-sponsored by the World Health Organization and UNAIDS and the Food and Drug Administration here in the United States and the Southern African Group -- and I'm sorry -- I've forgotten the initials -- that is a body that establishes standards and principles for the selection of pharmaceuticals to ensure that they're safe and effective. These organizations are all coming together to try to help establish some principles that should be used in making those selections.
But as the price comes down, and as we get processes in place to make these decisions, I think the debate is very likely to move from one of price to one of supply. It's going to be very important that the pharmaceutical companies have a willingness to invest the capital that they're going to need to do in order to have the manufacturing capacity in order to generate a steady, uninterrupted supply of high quality drugs.
Because as you may know, once someone starts on this treatment, this is an every day, the rest of your life treatment. It's not like someone starting cancer treatment and maybe getting into remission, and then they have to be monitored. This is every day for the rest of your life, and so we have to have a sustainable long-term plan here.
But the question that you've asked really highlights, perhaps, more than anything else, what's new, what's different about President Bush's Emergency Plan for AIDS Relief, because historically, the focus on AIDS has been very much a prevention focus. And, in fact, there has been a lot of debate over the years about prevention versus treatment.
This is an integrated plan, integrating all of the elements of prevention and treatment and care, and to some degree, it's hard to draw hard lines between those. For example, people who are under treatment and begin to get better are seen by their neighbors, and that causes people to think, "Gee, maybe I'd better go get tested and see what my situation is. And maybe if I'm infected, maybe when the time comes, I can get on treatment."
Whereas, people have been very reluctant, in many cases, because of stigma or a whole lot of other reasons to get tested, but also because, in many cases, it's just been seen as hopeless. Without treatment, if you get tested and you know your status, it's simply a death sentence. Well, it doesn't have to be that way anymore. And that's why treatment is such an important element of this plan.
MS. ARCHIBEQUE: I'll take one short question, last question.
QUESTION: A short one. It's a very short one. Paresuram of the Press Trust of India. Getting a broad overview of the problem -- and getting a broad overview of the problem, and whether from your perspective, the AIDS situation worldwide is getting better or worse?
AMBASSADOR TOBIAS: Well, right now, I think the situation is getting worse, but I hope it's on the verge of getting better. Why do I say it's getting worse? In 2003, just as one trend indicator, perhaps, around the world, 3,000 people died; 5,000 new people were infected. Every day -- it's hard to imagine -- but every day, the equivalent of 20 fully- loaded Boeing 747's -- just think of what your reaction would be if you were reporting a story that today, 20 fully-loaded Boeing 747's crashed, killing everyone on board, 8,000 people. That's what happens every day, day after day after day. That's the number of people that are dying around the world from AIDS.
We've got to get to the point where our prevention programs are sufficiently effective, that fewer and fewer and fewer people are going to need treatment. At the same time, we need to take care of and respect those people who are ill. We need to address the needs of the orphans and the families that have been impacted by this, and we need to provide treatment for those people who are infected, but now, because of the availability of these drugs, can really, under the right circumstances, live a healthy and productive life, for as far into the future as anyone can see.
But we won't really get the problem under control until we stop the increase in the infections. And I see great hope. I don't know how much, if any of you, know about my own background, but I spent all my career in the private sector and had retired and was having a wonderful time with my grandchildren and doing other things. This is not what I planned to do at this stage in my life.
And the President asked me to take on this role, and I spent a lot of time thinking about it and became convinced that this is the most important opportunity I've ever had in my life. I wouldn't be here if I didn't think that we have a real opportunity, all of us, the United States Government, the Global Fund, the World Bank, the United Nations, the World Health Organizations, all of the governments in the world who can help, we have an extraordinary opportunity here, and I think interest and energy is beginning to be mobilized.
More and more countries are speaking up and speaking out about the HIV/AIDS situation in their own country. More and more countries that are in a position to do so are joining the band of people who are donating to all of this.
But it's a very daunting task as we look to the future, and there is much, much, much that has to be done, and it's going to be very, very difficult. But I think in my lifetime, we're going to see this get turned around. And I'm really very hopeful of that. And if I didn't think so, I probably wouldn't be standing here.
MS. ARCHIBEQUE: Ambassador Tobias, thank you for joining us to discuss this important topic, I appreciate it, and thank you all for coming.
AMBASSADOR TOBIAS: Thank you all very much.
