10:00 A.M. EDT
Real Audio of Briefing
MR. DENIG: Good morning, and welcome to the Washington Foreign Press Center. Welcome, also, to journalists at our New York Foreign Press Center.
I'm very pleased this morning to be able to welcome back to our podium, Dr. Randall Tobias, the Global AIDS Coordinator in the U.S. Department of State. He has just recently returned from a trip to Germany and Africa and will give us a briefing on how we're making progress in Africa under the President's initiative to combat HIV/AIDS.
Ambassador Tobias will have an opening statement to make and after that will be very glad to take your questions. Ambassador Tobias.
AMBASSADOR TOBIAS: Thank you very much. It's good to be back here this morning. I represented the President at the inauguration of President Mbeki in South Africa, and as part of that trip, visited a number of AIDS centers in South Africa and spent about two and a half days in Ethiopia and two and a half days in Mozambique.
So I wanted to take advantage of the opportunity to simply update you on where we are and on some of my impressions from that trip, and then answer any questions you may have.
As we all know, HIV/AIDS is a global emergency that is requiring a global response, and that is exactly what we are trying to do here. President Bush announced in his State of the Union Address in January of 2003 the President's Emergency Plan for AIDS Relief, which is a $15 billion, five-year program to try to help address the ravages of AIDS.
In 2003 alone, three million people died from the complications of AIDS. Five million became newly infected during that same period in time. Estimates are that about 40 million people worldwide are currently infected with AIDS and that number is growing dramatically.
So it's extraordinarily important, both from a humanitarian point of view, as well as for a variety of other reasons, that the world community come together as we are doing here in the United States and begin to more aggressively address this issue.
The President's $15 billion plan over five years will devote $9 billion to 14, soon to be 15, focus countries that are among the hardest hit in the world. Twelve of those countries, 12 of the 14, are in Africa and two in the Caribbean. And together, those 14 countries represent 50 percent of the world's infections.
Five billion dollars of the $15 billion will be going to continuing bilateral programs that the United States operates in about 100 countries around the world. And then $1 billion of the $15 billion is slated to go to the Global Fund, and fund that the United States helped to start. We've contributed about 40 percent of the pledges to date to the Global Fund and it, too, is an important part of our overall strategy.
The President has directed that our programs will provide support for anti-retroviral treatment for two million people; support in a variety of ways directed to prevent seven million AIDS deaths over this five-year period that otherwise would occur; and to provide care to ten million people, palliative care to people who are in the final stages of this disease, and care to the orphans and vulnerable children who are really left behind by this disease in some very dire circumstances; large, large numbers of families in these hard-hit countries where the head of the household may be 12 years old or 11 or 10.
We'll maintain our commitment to the rest of the world beyond these 15 countries in a variety of ways, including helping countries develop plans and strategies and encouraging leadership in each of those countries to really step up to address the problems.
Let me give you a brief status report. I'm pleased to report that in just the first seven months since my confirmation in October and less than four months since receiving our first appropriation from Congress, we're really making rapid progress. The last time I was here, I was here to tell you that in March, we got the first $350 million disbursed, and part of what I had the opportunity to see on this trip was that money actually being put to work. And I'll come back to that in a moment.
But there are still a large number of challenges facing us, the first and most compelling being the lack of infrastructure to provide HIV/AIDS support in these countries. The great shortage of health care professionals, doctors, nurses and others who can provide support and care and treatment; and the lack of physical infrastructure to provide the means by which these health care professionals can deliver their support.
There are a number of things that are happening to address this. Certainly, the leadership in the countries are increasingly speaking up and getting involved. I met with the heads of government in both Ethiopia and Mozambique and was very pleased with the activities that they are engaged in.
One of the really pressing issues in all of these countries is the issue of stigma associated with HIV/AIDS. And I think addressing stigma is probably as much a leadership issue as it is a money issue. And so one of the things that I did in both countries was to get tested, to go to one of the HIV/AIDS counseling and testing centers that we are funding. The way that process works is that you go in, you are assigned a number, and your name is then sealed in the files and the only thing that is visible is this number so that you have total -- there's total confidentiality about protecting your results. But I had the local media with me to give them the opportunity to see how the testing process works. The next day, I was participating with the Mayor of Addis Ababa in Ethiopia, dedicating a new counseling and testing center that the President's Emergency Plan is funding. That is part of a hospital that's operated by the city of Addis Ababa. And I challenged all of the community leaders who were at this event to do what I had done the day before: go get tested, and tell somebody that you got tested, and tell them to tell somebody else that they got tested, and so forth. That's how we will begin to get rid of the stigma.
I was very pleased when the Mayor of Addis Ababa, who followed me on the program, got up, made his remarks, and then said, I'm going to follow Ambassador Tobias' example and I'm going to get tested right here today. And he proceeded to go back into the testing facility with television cameras and print media around, which was very visible in the media in the next day or two in Addis Ababa.
But that's the kind of leadership that we really need to encourage that I think is beginning to happen and is certainly going to make a big difference.
I visited a treatment clinic in South Africa run by an organization called Right to Care that is a recipient of the funding that has come out of this first round of funds and they are rapidly expanding. I had the opportunity there to speak with about five AIDS patients who are getting the benefit of this program, one of whom, a young woman who had been a runner and had been quite ill and is now back on her feet enough that she's begun to do distance running again. So that was very, very encouraging to see.
I visited a couple of prevention programs focused on youth. In these particular cases, these are young people who are going around to schools putting on plays that dramatize the prevention messages that they're seeking to get across to other young people about the importance of delaying the age at which they become sexually active, even the importance of reducing the number of partners when people are sexually active. And the peer pressure, the acceptance, if you will, by young people when other young people are telling them, this is the kind of thing, kind of behavior to embrace, clearly is making a difference.
In both Mozambique and Ethiopia, I visited home care programs where volunteers are going to some very depressed locations where people live literally on dirt floors, in huts with dirt walls, tin roofs. And in each case, there was an AIDS patient dying there on a mattress in that -- in each of those facilities, with volunteers providing help and medication for pain and nutrition and that sort of thing. But it really brings home, on a very personal level, the impact that this is having.
In one case, in one of these houses, there was a young five-year-old girl who was the daughter of the woman who was dying. And the volunteers were trying to determine what was going to happen to this young girl who was about to become an orphan. But I came away convinced that, as daunting as the task is, that the President's Emergency Plan is beginning to make a difference, that there's a lot of excitement and enthusiasm about beginning to get this launched.
I expect that in the next few weeks, we will be getting the second round of funding out, and that will total something approaching another $500 million. So we're really off to a very fast start here and it's, again, it's good to have the opportunity to be in Africa and visit the programs that are the recipients of this money, and see the human beings that are benefiting from this and see what is beginning to happen.
Well, with that, I'll be happy to answer any questions that you may have.
MR. DENIG: Okay. As usual, I'll ask you to use the microphone and identify yourself and your news organization. Let's start up front with Charlie.
AMBASSADOR TOBIAS: Charlie.
QUESTION: Charlie Cobb with allAfrica.com. Not so long ago -- right here, in fact -- General Wald, the Deputy Commander of EUCOM, made the point that the AIDS pandemic in Africa in general, and in South Africa in particular, was having a radical impact on the strategic planning of EUCOM in Africa. I'm wondering whether that conversation came up in South Africa on your trip and whether or not you're now thinking, now that Africa has been ratcheted up to an area of strategic concern, whether or not there is a conversation going on now about addressing that particular problem.
AMBASSADOR TOBIAS: Well, first, let me say that I have not met General Wald personally, but I run across his statements and his activities with some frequency and I have come to admire him greatly. I, in fact, sent him an email earlier this week.
But he is an example of the leadership that is emerging, not only in our own government but elsewhere, to really address this problem as it needs to be addressed from a variety of areas.
We have a program in South Africa where we are supporting a treatment program that the South African military is using to treat their own people. They have a very high infection rate within the military. Without wanting to get too far into broad generalizations, I think it's generally understood and generally accepted that the -- that there are very high incidence rates in what are sometimes referred to as "mobile" men: mine workers, taxi drivers who are gone for long periods of time, truck drivers, and people in the military. So the militaries in these countries tend to have a higher infection rate.
And while the President's program really had its roots in the President's own humanitarian feelings about this -- and I have never heard the President describe this program in anything other than humanitarian terms -- but the fact is that it's pretty clear that the impact that HIV/AIDS is having around the world is already in some places and increasingly will be a security issue. It is sowing seeds of hopelessness, which is the basis for unrest, if that's not addressed. And clearly, in some countries, it is impacting the ability of countries to mobilize their defense forces.
So I think General Wald is exactly correct and I look forward to working with him.
MR. DENIG: Okay. Let's go with the lady up front here. Please use the microphone.
QUESTION: Susan Ellis from Washington File. Can you tell me the 15th country that will eligible for the President's plan?
AMBASSADOR TOBIAS: No. (Laughter.) We're in the process -- we have gathered input from all over the government. I'm looking actually, at the moment, at about 39 countries that would be potential candidates for one reason or another. We're consulting on exactly how we ought to move forward with that. We've been, really, kind of consumed with getting the first money out the door, that -- we haven't gotten closure yet on that. But I'm hoping that within the next few weeks, we'll be in a position to select and announce the 15th country.
MR. DENIG: Yes, sir. Next gentleman.
QUESTION: David McAlary, Voice of America. As I'm sure you know, that the high infection rate among women in Africa, particularly South Africa, stems partly from the issue that they don't have control over their own sexual, that many are the victims of abuse and forced sex by their partners.
In the President's program, one of the strategies it supports is the ABC program, and many people -- always be faithful, wear condoms, and abstinence -- but many women's activists say that this is not going to work for women who are forced to have sex and, therefore, become infected by infected partners. In light of that, can you support the ABC program or is there something different needed for these women?
AMBASSADOR TOBIAS: The ABC program is really the heart of the platform for our prevention efforts. But nobody ever said the ABC effort is all there is and is enough. One of the other elements of our strategy is to encourage strong national leadership and encourage the development of a cultural and a policy context that's needed to address these issues. In some countries, there are things that need to be done with respect -- in a legal sense, with respect to women's rights, women's inheritance rights, the power that women have to get help from the police and go to court when they are abused and taken advantage of. There are cultural practices that need to be addressed. In some rural areas in Africa, it is very common that when a woman's husband dies, that she is fundamentally sexually inherited by the brother, a brother of the -- of her husband who died. And there is a sexual cleansing rite that takes place and on and on and on. And these issues have to be addressed. The ABC approach, which is really directed at our prevention efforts, does not get specifically at those issues. We need to get at those issues in other ways. But they are very, very important parts of our strategy.
QUESTION: Are you getting at those issues in other ways? And could you --
AMBASSADOR TOBIAS: Yes, yes. And I think where it has to start is that the leadership, at all levels, but starting with the seniormost national leadership in every country, really has to step up and say, we have a problem in our country. AIDS is a big issue facing us. We have to address AIDS and here are the things that we're going to do about it.
And increasingly, we are seeing that happen. And in those cases, there needs to be recognition of exactly the issues that you are describing facing women, and an identification on a country by country basis of what specifically do we need to do here to address that problem. We are both urging and encouraging the need to address those kinds of issues, because they are very, very important.
I was in a rural area of a country back in December -- actually, this was in Kenya -- where the infection rate among young women between 14 and 19 was 24 percent. The infection rate in young men 14 to 19 in exactly the same area was four percent. And this is largely attributed in that area to forced sexual relations between older men and younger women, and, again, with a lot of cultural roots.
So these are things that are the reality in a number of the places where we are working and they have to be addressed.
MR. DENIG: Okay. Back to Charlie.
QUESTION: Although President Bush plans to increase the funding to the Global Fund, or at least contribute, I think it's what, $1 billion over the next five years --
AMBASSADOR TOBIAS: That was the original plan.
QUESTION: Yeah, the -- Kofi Annan has said more than once that really that fund needs, over the next seven to ten years, anywhere from 50 to $100 billion. That $1 billion looks fairly small in that context, and I can't help but wonder whether or not there are some problems you or this Administration have with the Global Fund. And would you speak to that, as well as assess the Global Fund.
AMBASSADOR TOBIAS: Well, the Global Fund is intended to be just that, a Global Fund, not a United States fund. And yet, the United States, which helped launch the Global Fund, currently accounts for about 40 percent of the pledges into the Global Fund. I might add to that that in 2003, the money that the United States Government provided for international HIV/AIDS support was greater than the total of all of the rest of the world's governments combined. In 2004, if the rest of the world stays at the 2003 level, and I certainly hope that's not the case, but in 2004, with the beginning implementation of the Emergency Plan, the United States Government will be spending about twice as much as the rest of the world combined.
So we're doing a lot of that through our bilateral programs. We're doing a lot of that through the Global Fund, but we also need to get the rest of the world to step up to this.
With respect to the Global Fund specifically, it's an important part of our strategy. If I'm going to a country like Ethiopia, for example, and maybe looking at a $100,000 grant to an organization there directly from the Emergency Plan, or I'm looking at $100,000 from the Global Fund, of that $100,000, 40,000 is U.S. money because we're paying 40 percent of it. But if we can get the same thing done by leveraging our 40 percent, combined with dollars from other organizations, then our money can go further.
So the whole purpose of the Global Fund is to get other people to contribute. So far that hasn't happened to the degree that we'd like for it to. Now, when you're talking about what Secretary General Annan said, he's exactly right. This $15 billion that the President has committed over five years is not going to cure AIDS in the world. It is the largest commitment that any country has ever made for any health care initiative. It's the largest humanitarian effort that the United States has done since the Marshall Plan. It's huge. But it's not enough.
And so I think we need to keep sort of a separation between what is the total magnitude of the problem, what is it that we're able to do right now, and how much of that is the United States doing versus how much is the rest of the world doing. And we really need to get the rest of the world to step up to this, and then over time, clearly, it's going to take much more money. But right now, it's the building of the leadership and the infrastructure, the physical infrastructure and health care personnel that are really the biggest inhibitors in getting this thing moving.
QUESTION: I mean, do you foresee a time in which the Global Fund will get anywhere near the kinds of numbers Secretary General Annan is talking about? And in terms of other countries' contributions to the -- of money to the AIDS campaign, how do you see it, other countries proceeding in the kind of bilateral way that the United States is, or in a multilateral way through the AIDS fund?
AMBASSADOR TOBIAS: Well, I am hoping that more countries -- more and more countries will do what the United States is doing, and that is both, that they will engage in bilateral programs, but they will also support this very important multilateral program.
The Global Fund, which is a startup effort, unlike what we're doing in the United States -- we've been at this almost 20 years. People tend to view the United States being brand new with bilateral HIV/AIDS programs. We've been at this for 20 years. We have people on the ground, we have experience, we have relationships with organizations.
And what's new about the Emergency Plan is the creation of the role that I have as the first United States Global AIDS Coordinator to bring all of the activities of the United States together under one umbrella. But we really couldn't get the kind of money that we've gotten out the door as quickly as we have if we weren't able to build on this 20 years of experience.
The Global Fund, on the other hand, is two and a half years old. And so the Global Fund has been raising a lot of pledges, raising a lot money, but it's taking the Global Fund more time to begin to get money out the door and into programs.
So I think what Kofi Annan is talking about is the need to raise more money downstream, and clearly that need is there. But the near-term need for the Global Fund is to get their programmatic activities in place and get more money out the door more rapidly. And they're working very hard at developing those capabilities.
MR. DENIG: Let's take the gentleman in the way back, please.
QUESTION: Hi. David Coetzee at Southscan. The U.S. got and has had quite a bad press in the last few weeks or in the last month over the Gabarone conference on treatment drugs. It seemed that the U.S. was taking a position against generics and in favor of big pharma. And that's the way it was written in a lot of the papers in, for instance, Ethiopia or in South Africa.
So I am wondering if you could explain what exactly the position is, vis-à-vis generics and the label drugs from the big pharma companies.
And as an addendum, really, it's just an add-on to Charlie's earlier question, I wonder if you could let us know what the -- what your perception is of the awareness in the African countries you visited about what is going to happen to their state's capacity as AIDS deaths start to hit their administrations, whether you see an awareness of that coming up.
AMBASSADOR TOBIAS: Let me take the second question first and say that I think it varies from country to country the degree of the awareness of the magnitude that AIDS is going to have. Even as recently as a year ago, I think there were -- when I first came to this, there were government leaders who either didn't recognize or weren't willing to talk about the economic impact, for example, that AIDS was already having on many countries.
I'm seeing more openness and more desire to identify the things that need to be done, much more eagerness to embrace the kinds of help that is coming from what we're doing, what the Global Fund is doing and others. And I think this will feed on itself. I think as more and more African leaders step up and are much more visible and talk about this and talk about the problems, then that will either encourage or, for whatever reasons, motivate those that aren't to be doing the same thing. So I think -- we're not there yet, but I think we're on a path.
Unfortunately, there has been a lot of inaccurate information on the drug issue, and I think it's, in large part, because there have been some very active lobbying on the part of those who have economic interests associated with what are referred to as generic drugs but really aren't.
In this country, when we think about generic drugs, what we are talking about is a prescription that a physician writes that you can take to your local pharmacy and get it filled, and if it is a drug that has availability of both a generic drug and a drug that originally came from a research-based company, whichever you get, the fact of the matter is you know that either one of those drugs are exactly, precisely the same. And the reason that you know they're the same is because there is a process in the United States whereby the Food and Drug Administration approves in exactly the same way, with exactly the same processes, the way in which these drugs are put together, the way in which they're manufactured, all the scientific data that stands behind that, and so forth.
When people refer to generic AIDS drugs, there really aren't any that fit that mold. These are really copies of drugs that have been approved by regulatory authorities, but the copies themselves have not been submitted to any regulatory authority or approved by any regulatory authority.
Now with the relatively limited presence of treatment up to this point in time, the risks associated with that, if there are any, have been relatively containable. But we're about to scale this whole treatment effort up in a very, very massive way, and we have to be sure that we're getting it right. So our position is not that these copy drugs are bad, it's that nobody knows because they have never been reviewed by a stringent regulatory authority.
And so our policy at the moment is that we're requiring that the programs that we fund use drugs that have been approved by a stringent regulatory authority. And I might add that we're having no trouble at all getting adequate supplies of those drugs and getting our programs scaled up, while, at the same time, we're working together with the World Health Organization, UNAIDS, the Southern African Development Community and others to try to identify appropriate processes whereby the people in Africa who will receive these drugs have assurances that these drugs are safe and effective, just as people in the United States do.
I think it's totally inappropriate to have a policy where there are good drugs in the United States and drugs that people view are good enough in other places in the world, that the drugs need to be good and safe and effective every place. It's interesting that this is an issue that, in talking with people in Africa who are involved in these programs, they are much, much more focused on the issues of infrastructure and people and the capacity constraints than they are on the drugs, because right now, they're able to get drugs, for the most part, in the programs that are able to do treatment. But there is so little treatment going on because the capacity doesn't exist. And we've got to do both of these things over time.
The availability of drugs over time is going to become a huge problem. The capacity of the pharmaceutical industry globally to produce the quantities of drugs that are going to be needed, as we scale up this program, is an issue that will need to be addressed.
But right now, our only interest is ensuring the safety and effectiveness of the drugs we acquire, and with that assurance, it will be our policy to acquire the drugs wherever we can get them, at the lowest possible price for which we can get them, but I want to be sure that we're going to do good and not harm.
MR. DENIG: Let's go to this side here, again, please.
QUESTION: (David McAlary, Voice of America) I'd like to follow up on that question. The WHO supposedly has an oversight process that it says ensures quality, safety and effectiveness of these generic drugs. Are you saying you don't have faith in that?
AMBASSADOR TOBIAS: No, I'm saying the WHO -- I think you're misquoting the WHO. I would refer you to the WHO's own website on their so-called prequalification program. It has been characterized inaccurately by some as a regulatory process, and it is not. It was not intended for that purpose. And rather than my tell you what the WHO's process is, I'd just refer you to their website.
But it serves an important function. We're working very closely with the WHO on this. But we need something that is more akin to a regulatory process where we can have assurances and be able to assure patients that these drugs are safe and effective.
QUESTION: (David McAlary, Voice of America) I have another question.
AMBASSADOR TOBIAS: Okay, sure.
QUESTION: And it's a totally different topic. At the Center for Strategic and International Studies, right now, as we're speaking, they're having a day long forum on the ways -- best ways to respond to the emergency situation. And one of the panel's examines the proposal by Phil Nieburg, formerly with CDC, to create an emergency response mechanism within the Office of the Global AIDS Coordinator.
Can you tell me what that's about or if there is any such inclination to do that?
AMBASSADOR TOBIAS: Well, I've been working very closely with the people at CSIS on a number of subjects. I've spoken to several of their meetings, and I think they have a great deal to offer.
I do not know the details. I know, in general, what this particular subject is. I don't know the details yet of what their recommendations are, and I'll look forward to seeing that. So I think it would be inappropriate for me to speculate on what that might be.
One of the goods things about Washington is that whatever issue you're involved in, and certainly this issue of HIV/AIDS, there are a number of very knowledgeable people and organizations around who are willing and interested in helping and are providing input and information that I find very useful, and CSIS is certainly one of them.
MR. DENIG: Any final question?
(No response.)
Okay. Well, thank you very much, Ambassador Tobias.
AMBASSADOR TOBIAS: Thank you very much.
MR. DENIG: Thank you, ladies and gentlemen.
