Transcript: Global Fund 10th Anniversary Media Conference Call

January 27, 2012

Media Call on the 10th Anniversary of the Global Fund to Fight AIDS, TB and Malaria
January 26, 2010, 10:00 pm ET

Moderator: Joanne Carter, executive director, RESULTS

Operator: Good morning. My name is Tanya, and I will be your conference operator today.

At this time, I would like to welcome everyone to the Global Fund 10-Year Anniversary conference call. All lines have been placed on mute to prevent any background noise.

Operator: Thank you. I would now like to turn the call over to Joanne Carter, executive director of RESULTS and RESULTS Educational Fund. Please go ahead.

Joanne Carter: Thank you, operator, and thanks, everyone, for joining us today for today’s briefing on the 10th anniversary of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The last 10 years as a global fund have proved to be one of the most successful efforts in the history of public health.

Millions of lives have been saved in some 150 countries. But projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is a devastating and unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap.

We’re calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We’re also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.

Today, at the World Economic Forum in Davos, two key donors cast votes of confidence with their checkbooks: Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami, and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the fund’s impact and effectiveness and a challenge to other donors to step up.

Earlier this week, the Global Fund also announced two important changes regarding its leadership. The board appointed a new managing director for a one-year term, and the executive director announced that he will be stepping down effective mid-March.

In just a few minutes, you’ll hear from two speakers who have been instrumental in the Global Fund’s success over the last decade. Dr. Tedros Adhanom Ghebreyesus, who served as the chair of the board of the Global Fund from 2009 to 2011, and who is minister of health in Ethiopia, has been at the forefront of putting the Fund’s resources to work to save lives. And economist Jeffrey Sachs, of Columbia University’s Earth Institute, who was one of the original catalysts and architects of the Global Fund.

But first, let me just say a few words about this particular moment in the Global Fund’s history. This week marks 10 years since the Global Fund opened its doors. Its achievements over the last decade have been extraordinary. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that’s up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing over two-thirds of donor financing for TB.

As someone who’s worked on this issue for well over a decade, I can tell you that before the Global Fund, donor financing for TB was minuscule, and TB patients and programs were dying from neglect, and that has changed.Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25 percent globally in the last 10 years, and malaria deaths have been halved in some African countries.

But these gains have not been earned by doing business as usual. In fact, the Global Fund is business unusual. For 10 years, the Global Fund has been on the cutting edge of innovation and effective aid delivery. The Global Fund empowers the countries and communities that benefit to determine how the aid is best used. In the country, ownership is complemented by rigorous accountability, unmatched transparency. The U.K.’s Multilateral Aid Review found the Global Fund among the highest-rated institutions offering strong value for money.

And the next decade holds remarkable promise. In particular, new evidence demonstrates that early initiation of AIDS treatment can massively reduce the spread of the virus to uninfected partners. This finding was named the 2011 breakthrough of the year by Science magazine and has actually allowed public health experts to credibly plot the end of the epidemic.

But just as science is telling us we can end AIDS within the next generation, making funding for scale-up for treatment and other proven prevention more critical and impactful than ever, this opportunity is jeopardized by the decision to halt new Global Fund scale-up opportunities until 2014.

The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries’ capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we’re not just in danger of slowing progress, but actually reversing it.

The U.S. and other donors can fix this situation. If the U.S., the UK, and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases and propping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.

So we’re calling on the U.S. to host this meeting. We strongly believe that if the U.S. hosts this emergency donor’s conference, other donors will join in. If we convene it, they will come.

The Obama administration — from Secretary Clinton, to the president, to Ambassador Goosby, our global AIDS coordinator — has reiterated its commitment to the Global Fund and to fulfilling the U.S.’ pledge. By doing this and by exerting U.S. leadership globally through convening an emergency meeting, the U.S. can lead the way in reversing this devastating setback.

The Global Fund has a decade-long track record of impact and innovation in the fight against AIDS, TB and malaria, but these diseases won’t wait around for the world to sort out its financial challenges. Now, if we don’t advance against these epidemics, we’re now moving backwards, and we don’t want that to happen.

I’m now going to turn the call over to Dr. Tedros, the minister of health in Ethiopia, to talk about the impact of the Global Fund in Ethiopia and why it is such a crucial mechanism. Dr. Tedros has really led the way, as I said, not only on the board, but really in implementation in Ethiopia.

Dr. Tedros, if you could say a few words about the impact of the Global Fund and the importance of funding for scale-up now.

Tedros Adhanom Ghebreyesus: Thank you so much, Joanne, for this opportunity. Thank you so much, also, other participants of this call, including my good brother, Jeff Sachs.

As you know, seven, eight years ago in Ethiopia, when someone was asked to be tested for HIV, they would refuse to be tested, because knowing your status at that time, your status of HIV/AIDS means equivalent to a death sentence.

So you can imagine where we started. And very few people actually had access to treatment, and those who can afford it only.

But after the advent of the Global Fund and PEPFAR, now we have more than 70 percent of those living with HIV/AIDS in Ethiopia getting treatment. And every year, close to 10 million people get tested willingly because they know they can get treatment. And as you know, Ethiopia is one of the countries whose incidence of HIV/AIDS declined by more than 25 percent.

But not only HIV/AIDS, even malaria declined by more than 50 percent, and also TB prevalence has declined. I think this created hope for many individuals, many families, and the hope of individuals and families means a hope for the nation.

And I can truly tell you that the past 10 years has been an extraordinary year for 10 years of solidarity that was unprecedented with extraordinary achievement. What we believe is, the past 10 years, we have built a very good house of solidarity.

The Global Fund is not just [about] getting money, but the money was really of good quality, effective aid, because it was flexible, because we were using the money based on country priorities, because it was a predictable five years agreement, because it was performance-based and accountable.

So not only money, but it was effective money. It was effective aid. And from the beginning, it was well-designed. And as you know, the architects are my friends, Jeff Sachs, and Kofi Annan. Of course, all the advocates of HIV/AIDS, malaria, and TB played a great role. And all the political leaders, also, rallied behind in order to make this happen. And as I said earlier, this has been an extraordinary 10 years of solidarity.

But now the sad part is that solidarity is in crisis — that extraordinary solidarity is shattering before our eyes. The reasons are, as many of you know people say “it’s because of the financial crisis” and “because Global Fund has problems, money is embezzled.”

Of course, there was a problem. Money was embezzled from Global Fund. But I don’t think this is different from any other project we had other than Global Fund. But the good thing was, Global Fund itself identified the problem and fixed it. So it should have been congratulated, instead of punishing it.

If the reason is financial crisis, I think that solution should not be short-sighted. We have to go for long-term strategies and we have to really take care of the house that we have built. The danger of this short-sighted action is few people will be on treatment, meaning HIV is on the retreat now, but it will be on the increase, and that’s what we may see.

And not only that, people were comfortable until now, but when we say no more new people on treatment, we’re bringing back the death sentence, and people will not be happy to get tested, because they will say, “What for?”

But the damage is even beyond that. I don’t think there is anyone who would not ask when his house is burning, because there is that solidarity in the house we built the past 10 years, and we are achieving greatly. But the action is we had to really think strategically — not with short-sighted solutions — and we have to get into action immediately.

By the way, I’m really glad to hear that today in Davos, Mr. Gates had announced the 750 million U.S. dollars and also Japan, despite the tsunami and all the flooding in Thailand, agreed to contribute the $800 million. This is really good news. But all partners should really follow through, and I really agree that there should be an emergency meeting before the July meeting in the U.S. And we have to renew our commitment, because what we have invested the past 10 years, we shouldn’t really lose it.

I believe from my heart that aid is not charity. It’s not. It’s an investment for the betterment of our world. And we have to really take care of that and keep our solidarity for the betterment of our world. Thank you so much for this opportunity again. And thank you for this advocacy, especially RESULTS and my friend, Joanne, for having this call. Thank you so much.

Joanne Carter: Thanks so much, Minister Tedros. And folks will have a chance to ask you questions, as well, in a few minutes.

Now I’d like to turn the call over to Jeffrey Sachs for some opening comments and just noting that Jeff is actually boarding a plane, so will be sort of in transit, but appreciate you being on this call, Jeff. And I know you’ve got a bit of time, so I welcome your remarks and then we’ll take questions.

Jeffrey Sachs: Thanks very much, Joanne.

And thanks very much, Tedros, for making the Global Fund such a success, not only in your personal leadership in the fund, but as minister of health of Ethiopia, showing how money properly invested has decisive benefits in improving the health and well-being of the society. And Ethiopia is a great demonstration of this.

The Global Fund, in short, as you’ve heard from two eloquent speakers, is working. It’s a remarkable institution. It has changed the history of poor countries, especially in Africa, but not only in Africa, during the past decade. It has saved many millions of lives. It has protected hundreds of millions of people from disease.

It showed how every skeptic 10 years ago who said you could not treat AIDS in Africa, you could not get ahead of the epidemic, you could not control malaria, because bed nets would not be used, and every other myth that was said has been proved wrong.

So this is one of the world’s success stories, and we need to champion it. Since the financial crisis, governments have cut back on spending in general, but many have found it convenient to cut back on spending on the world’s poorest people. This is, of course, a double tragedy. Often waste goes unattended, but because the poor don’t have a voice, they don’t get heard, and we have had, therefore, cutbacks on these highly effective, very inexpensive, but crucial lifesaving interventions that the Global Fund is funding.

And that’s why we had the call today. There is a crisis: the Global Fund is functioning, but it did not get in its donor replenishments an adequate amount of money for the period 2011 to 2014. And as a result of that, it actually suspended what they call Round 11, which was supposed to take place in 2011, and because of that, many programs in many countries are now in peril.

This is against a backdrop in which tremendous progress has been made and even more progress can be reasonably expected if the programs continue.

I could talk about all three diseases, but let me just say closing words about malaria. Malaria is one of the major killers in the world, especially in the tropics and especially in Africa. It’s one of the most recalcitrant diseases, in that the mosquitoes are absolutely stubborn and lethal, and one has to have a sustained fight to make progress against these killers.

But the fact of the matter is — and it’s absolutely remarkable and historically unprecedented — malaria deaths in Africa are down by about 40 percent compared to a decade ago, thanks to the leadership of the Global Fund.

I was counting on Round 11 to finance the scaling up of the community health workers, those front-line village workers who help to treat malaria in the villages. And, again, Minister Tedros is one of the pioneers of using such extension workers for effective community-based care in Ethiopia. We need Round 11 so that this great cutting-edge army of village workers who can control malaria, AIDS and TB are out there doing their job.

And that was the main purpose of Round 11, in my opinion, and it’s why it is so essential that we have these continuing funding rounds of the Global Fund so that countries like Ethiopia can continue to build their local health systems for effective control.

The actions that were announced today, especially the steps by Bill Gates and by Japan, are heartening. The commitments that were reaffirmed by the United States on December 1 on World AIDS Day by President Obama, Secretary of State Hillary Clinton, and Ambassador Eric Goosby, that the U.S. would honor its $4 billion over three-year pledge to the Global Fund, are heartening, but the bottom line is, when will Round 11 get underway?

If this is delayed, this is devastating. This is the indicator that I’m watching. I want Round 11 to go forward as planned, because governments in the poorest countries were depending on that for the scaling up of their fight against these diseases. They’ve made a lot of progress. They’re out on the front lines fighting, and they need the continued ammunition of bed nets and medicines and diagnostics and community health workers to get the job done. And we can’t leave them out on the front lines without the armaments that they need to fight these diseases. That for me is the bottom line.

It’s progress today announced in Davos, but we need real results. We need Round 11 reinstated within the coming weeks or very few months so that we can continue on to ultimate success against the three diseases.

Thanks very much.

Joanne Carter: Thanks so much, Jeff.

Operator: Your first question comes from the line of David Brown from The Washington Post.

David Brown: Hi, Dr. Sachs and Minister Tedros, I missed part of the call, so I think you probably addressed this, but can you just repeat, please, how much difference the $750 million contribution that the Gates Foundation announced today will make? And is that going to allow a reinstatement of Round 11, perhaps?

Jeffrey Sachs: Joanne, do you want to go through the numbers?

Joanne Carter: Sure. To start, so the Gates Foundation $750 million announcement, very key, through this promissory note did two things: One is, it’s about $250 million above what was originally expected from New York, so it’s additional resources, and then through the promissory note makes those resources potentially available as needed. So it’s an important endorsement, and additional resource. Jeff, you can say more to this or Minister Tedros — in and of itself, it’s not enough to launch a new round, but it’s a really important signal and a really important start.

And, again, to just reiterate: Japan, that was not new resources, but there was a real question about Japan’s ability to meet that full and much larger pledge that it had made in the last replenishment, given its emergency. So it’s a great model for other countries, including those like Italy and Spain, who are facing financial crises, too.

Jeffrey Sachs: David, one of the reasons that Round 11 was suspended was the feeling that the $4 billion from the U.S. was not reliable enough or that it would come with a delay, stretching between the 2013 period and into 2014, perhaps even later.

President Obama indicated on December 1 that, from the administration’s point of view, the U.S. is good for this money. But what I think is really needed is the president and the Congress together, right now, very clearly, to say that the U.S. is good for this money.

And my view is that this is a perfect issue for an agreement at Washington, which is typically elusive, because this is utterly bipartisan. This scale-up of U.S. efforts started under President Bush. I hope that President Obama and President Bush together and Speaker Boehner and Majority Leader Reid could all come forward and say, “We’re on. This is a U.S. commitment. This isn’t administration versus Congress, Democrats versus Republicans. This is an American commitment.” This would make a huge difference, because one of the things that held the fund back was the lack of clarity and, indeed, even acknowledged internally by the U.S. that some uncertainty about if and when and how much and by what time the money would actually come.

And the president has been very strong that the U.S. will be good for this, but let him come with the congressional leadership right now to absolutely demonstrate unequivocally that the board should move forward and reinstate Round 11. And I think this is in the president’s hands, because I’m sure that he would be joined by President Bush and by the leaders of both houses and in both aisles, in fact, of Congress, because this really is an American issue. It is not a divisive issue.

David Brown: Are you saying that President Obama should actually call specifically for the reinstitution of Round 11?

Jeffrey Sachs: Absolutely. This is essential. And I’m not absolutely sure whether they realize how essential it is, because this is core to the practical timetables of dozens of countries. I know it, because I’m working with those countries. They were shocked at the suspension of Round 11.

They’re in the process of trying to scale up community-based delivery of malaria control. And all of a sudden, what they were counting on for a year in the budgets disappeared. And so this is devastating right now. And everybody is in suspension until this gets reinstated.

And that’s why I’m not sure the board fully appreciated the ramifications. I don’t know whether the president of the United States does. But absolutely this has to get back on track immediately if we’re going to achieve the goals that these countries are on target to achieve.

Joanne Carter: And I would just add that this is about American resources. And as we’ve said before, it’s about American leadership. And so this is the moment where President Obama can also very powerfully leverage U.S. leadership by calling for this emergency donors conference before the international AIDS conference, so that there’s an opportunity for donors to come together to actually fill this gap so we actually can move forward with a funding opportunity in 2012.

Jeffrey Sachs: And, Joanne, if I just might add just to amplify that and to clarify, the U.S. on its own needs to be completely clear that it’s good for the $4 billion on time and that the Global Fund should count on that, because that makes a huge difference.

And then with that, the United States is also in a superb position to call on others at least to do the same and for others that have not yet been donors to join in as donors, because there are many, many others who should be coming in on this at this point.

Tedros Adhanom Ghebreyesus: By the way, to add to that, maybe to the question specifically, the last replenishment, the target, the minimum target was $13 billion for the Round 11 to proceed. But the outcome was $11.7 billion only. So there was a shortfall of $1.3 billion.

So what was pledged by Mr. Gates today will not be enough, because from almost all contributors, there is an expectation to increase, to give beyond the pledge. So not only should we, you know, pay after the pledge, but also to increase in order to at least have the minimum $13 billion to launch the Round 11.

So the whole idea is, we shouldn’t wait or accept until 2014. We shouldn’t wait until 2014. And we should have the Round 11 on time, and this crisis meeting could help reinstate the round, because many countries were shocked, because [in] Ghana no one expected it, and everybody was taken by surprise.

Thank you.

Joanne Carter: Thank you. Operator, we can take the next question.

Operator: Next question is from Ann Goland with British Medical.

Anne Gulland: Hello. Yes, Anne Gulland from the British Medical Journal. I was going to ask the same question as your previous caller, but Dr. Tedros just talked about this $11 billion that you got in the funding round, so what is being done with that money? So the money that you did that was actually pledged, how is that going to be used?

Joanne Carter: I can perhaps start, and then others can speak to the real impact of that. But I think, in part, because of the success of the Global Fund, and the success of prior rounds, like Rounds 8 and 9 that allowed for massive scale-up, in particular of malaria, which is really why we’ve seen this kind of impact that both Jeff Sachs and Minister Tedros talked about. Because of those prior rounds, a significant amount of the money in this replenishment period is going to the second stage of successful grants. So they’re a continuation of existing grants.

So when that $11.7 billion came in, which again was lower than even the lowest hoped-for funding scenario for maintenance, it left no room if any donors had problems or stepped back, and so now we’ve seen, because we’ve fallen below that level, the board made the decision to cancel Round 11 with devastating consequences.

So in a sense, it’s a reflection of the success that resources were going for renewals, but now we’re faced with a situation where there’s potentially — unless this gets reversed by donors putting money in now, we’re actually in a situation where we might not see any money for scale-up until 2014, and that will be devastating.

Joanne Carter: I mean, David, one thing I would say is that the real — the next number of years of the Global Fund is going to be led by a very exciting, bold, new five-year strategy. And I think something that didn’t come out of the November board meeting in Accra, what did come out was this cancellation of Round 11, ironically, at that same board meeting, the board very enthusiastically endorsed this new five-year strategy, which looks to save 10 million lives and avert somewhere between 140 million and 180 million new infections and to build on the existing strength of the Global Fund to do that, and then also approved a comprehensive transformation plan for the fund to further strengthen and kind of build on the reforms and the strengthening that already have been happening with the institutions.

So I’m not trying to sidestep the question, but to say that really what’s driving the next years of the fund is that set of strategy and transformation that’s already underway, which there’s broad board commitment, and there’s a new general manager who will be in the short term supporting the actual implementation of that.

And I think the only other thing I would say is that the institution, you know, is — from my experience of being on the board — and Minister Tedros could say more about this — you know, it is the sum of all of those partners that are committed to the institution that are actually driving forward the — you know, the strategy and the — and this further strengthening of the fund that can take place.

So I feel like that’s what’s going to actually determine the future of the institution, and that’s what partners around the table are excited about.

Minister Tedros, I don’t know if you would add anything?

Tedros Adhanom Ghebreyesus: I think that’s good. I agree. Thank you.

David Brown: Well, I’ll just cut right to the chase here. Is any of the current problems with, you know, lack of new contributions, lack of fulfilling old pledges, is any of that attributable to poor management by Michel Kazatchkine, “Kazatchkine”?

Joanne Carter: Well, so I would say my answer to that would be no. If you actually look at where the gap is now, and the reason that we started the replenishment with $11.7 billion and that we’re facing this gap where we don’t have resources for a new funding round, so part of it is what Jeff and Minister Tedros talked about, one, that because some of the pledges going into that replenishment were weak, and we only came up with $11.7 billion, we started lower than we hoped even for the lowest funding scenario. So that really left — again, there was really no margin if countries had to suspend pledges or there were problems, so you started at a low level.

Second, a few countries, like Spain and Italy, didn’t pledge as was hoped and also are in arrears because of their financial crises. Again, I would say Japan’s an amazing model. Japan just committed to its full pledge, despite the fact that it had a tsunami and a nuclear crisis.

So — and then, third, as was mentioned, there was concern in the forecasting about not being able to fully predict that the U.S. would come through with its full $4 billion pledge. I think we have very encouraging signals from Secretary Clinton and the president and Ambassador Goosby, saying they are fully committed to that, but that’s actually the reason for the shortfall and a few other very small amounts from other donors.

So, you know, that’s where that comes from.

David Brown: But did the U.S. ever say it wasn’t going to fulfill its pledge? I…

Joanne Carter: No. Just to explain — no, I think, in fact, what I would say is we have gotten — again, to reiterate, very encouraging and strong support from the key folks in the administration. Again, the president, Secretary Clinton, Ambassador Goosby all committed to fulfilling that. But as you know, about — you know, what’s been the challenge with the U.S. process is the administration makes that pledge, puts that in the president’s budget, and then it’s — you know, it’s a process with Congress to actually decide the appropriation.

And while the administration for 2012 had actually asked for $1.3 billion, the appropriation was a flat-line of $1.05 billion. So I think it’s the challenge of working to overcome that to fulfill — to fulfill the pledge. So it was not the administration stepping back. It’s that the forecasting, given the U.S. process, essentially was more conservative in terms of what they felt like they could absolutely predict, which created part of the — significant part of the gap for a Round 11.

David Brown: OK, thank you.

Joanne Carter: Thanks very much. Minister Tedros, I don’t know if there’s any final comment that you would want to make in this situation?

Tedros Adhanom Ghebreyesus: No, I think I have already said a lot. So thank you so much, if there are no more questions.

Joanne Carter: OK.

Tedros Adhanom Ghebreyesus: But one thing that I would like to maybe say is, during the recent meeting where we have honored President Bush, I think one of the recommendations also focus on domestic resources.

So why I’m advocating for, you know, donor support, I think countries, especially developing countries, should also try to contribute to the cause and increase their domestic resources.

So that’s also one of the calls we’re making. And that’s what I would like to reiterate. This is something that we should really do it together and, you know, take our own homework, you know, on all of us. So that’s what I would like to emphasize.

And one of the good outcomes of the Addis Ababa from December 4th to 8th, to really focus on domestic resources, also, in order to ensure the sustainability of what we have.

Joanne Carter: Thank you, Minister Tedros. And I think that’s an incredibly important point. It did come out of the ICASA [International Conference on AIDS and Sexually Transmitted Infections in Africa] meeting and the commitment to countries, as well, mobilizing your own domestic resources. I think there’s also a powerful way that the Global Fund has worked with middle-income countries to ensure that there needed to be co-financing, and I think there are smart ways to look going forward how we can even further enhance that as a part of the model.

But thank you very much. And thanks to everyone who was on the call. And we’re also glad to follow up, if needed, after the call. So if folks have follow-up questions or want to be in contact with any of the speakers, you can contact Blair Hinderliter, and that is at (202) 783-4800 x126. Thanks very much, everyone, and have a good day. Thank you.

Tedros Adhanom Ghebreyesus: Thank you. Thank you, Joanne. Thank you, everybody. Thank you.

Joanne Carter: Thank you.

Operator: Thank you. This concludes today’s conference call. You may now disconnect.

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