Africa: Global Health Fund, 11/16/01

Africa: Global Health Fund, 11/16/01

Africa: Global Health Fund Date distributed (ymd): 011116 Document reposted by APIC

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Region: Continent-Wide Issue Areas: +economy/development+ +security/peace+ +health+


This posting contains excerpts from the keynote speech by Malawi Vice President Justin Malewezi, at the Africa Consultation Forum on the Global Fund to Fight AIDS, Tuberculosis and Malaria. The full text of the speech is available in the archives of the "Break the Silence" E-mail Forum, available on or at, along with ongoing discussion on the Global Fund, with many African participants. The Brussels- based Transitional Working Group settting up the Fund has a web site at

The posting is preceded by a short update note from Africa Action.

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Africa Action Update Note

Developing countries and non-governmental groups are critical of many aspects of the joint statements agreed at the conclusion of the World Trade Organization ministerial summit in Doha earlier this week. But the combined impact of activism, public outrage, and the determination of developing countries led to a significant breakthrough with the key declaration that the existing trade agreement "can and should be interpreted and implemented in a manner supportive of WTO Members' right to protect public health and, in particular, to promote access to medicines for all." For full text: or

The declaration failed to include a clear statement explicitly authorizing export of generic medicines to countries without a manufacturing capability of their own. Moreover, after its initial shock, the pharmaceutical industry is already trying to claim that nothing has changed. However, the text represented an unprecedented victory for the stance taken by African and other developing countries. It clearly paves the way for more agressive action to make lower-cost drugs available. Whether this happens now depends primarily on political will and resources, both in key countries that have hesitated to act and in international agencies, including the new Global Fund.

For "can and should" to be turned into reality, African countries and non-governmental organizations must mobilize to take full advantage of the opening offered by the Doha declaration. And they must demand adequate resources and guidelines be given to the Global Fund, including support for global bulk drug procurement mechanisms that can further lower prices while maintaining quality control.


Republic of Malawi

Statement by The Right Honourable Justin Malewezi, Vice President, delivered at The Consultation Forum on Global Fund to Fight AIDS, Tuberculosis and Malaria

November 12-13, 2001 Le Meridien Capital, Lilongwe

Office of the Vice President, P.O. Box 30399, Lilongwe 3, Malawi Tel:(265) 788 444; Fax: (265) 788 362; E-mail:

3. Every minute we have been sitting in this room, ten people have died of the three diseases HIV/AIDS, Tuberculosis and Malaria. This translates to 15,000 people a day. This is not only appalling and tragic, it is scandalous. It is scandalous because we have the knowledge, the technology and the resources to address the challenges posed by HIV/AIDS, Tuberculosis and Malaria, but have not yet mobilized sufficient political will to prevent and treat these diseases in a comprehensive manner and on a scale commensurate with the devastation facing the human family. The same vision that fuelled our struggle for freedom in Africa, the same vision that mobilized every nation after the Second World War to sign the Universal Declaration of Human Rights, it is the same that is now needed to fight and conquer the triple threat from HIV/AIDS, Tuberculosis and Malaria. ...

5. Nowhere has the impact of HIV/AIDS been more severe than in Sub-Saharan Africa. The region with less than 10 percent of the world's population is home to 70 percent of people living with HIV/AIDS. The HIV/AIDS pandemic will kill more people in Africa than all the casualties of all the wars of the 20th Century combined. AIDS is devastating Africa - AIDS is destroying our hopes, our lives and our future. AIDS has a uniquely devastating impact on development and is at the centre of a global development crisis. AIDS kills young adults in their most productive years leaving grandparents to bring up their children. AIDS reduces life expectancy. Child mortality and poverty are projected to increase fuelling a secondary pandemic of orphans throughout the region.

6. The HIV/AIDS pandemic in Africa has been described as a "catastrophe in slow motion" and as a "development and security crisis". While these descriptions capture the devastating impact of the epidemic, they do not bring out the urgency and immediacy of the danger facing Africa and, indeed the whole world. Nor do the statistics capture the tragedy of lives destroyed. Every day we are burying our children, our sisters and brothers, our workmates, our leaders, our teachers, doctors and other professionals. In the suffering and death of our brothers and sisters, we face grief beyond words and sorrow beyond tears. We cannot stand by and watch while our people are dying. The HIV/AIDS pandemic is the greatest threat to our future - it is an emergency and requires an emergency response by the international community.

7. Although these health problems often originate in contexts related to poverty, they have also become a major obstacle to reducing poverty itself. Increased investment in health is a critical challenge for our future as health is a fundamental human right. The burden of disease in Sub-Saharan Africa stands as a stark barrier to economic growth and therefore must be addressed centrally in any comprehensive development programme.


11. As you discuss and consult on the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria, I would like to address six issues.

12. First, the HIV/AIDS pandemic is a threat to global security. Although Africa is the epicentre of the AIDS pandemic, AIDS is growing throughout the world. In the growing populations of India and China, AIDS is gaining ground with close to four million people already infected. The number of AIDS cases in Russia and Burma are also increasing. If AIDS takes a deeper root in India, China and other countries that have a combined population of more than two Billion, the resulting carnage could far exceed that of the current tragedy in Africa.

13. We are part of a world community. The recent appalling terrorist attacks in America were shattering and have been condemned worldwide. Thousands of lives were destroyed and families devastated. The tragic events of September 11th have altered the world fundamentally and a new Global Alliance has been forged to fight international terrorism. We need the same political will, unified resolve and resources to fight disease.

14. AIDS threatens to fundamentally destabilize the world. This latter concept was formally recognized in the UN Security Council's first debate on AIDS in January 2001. The debate also marked a shift in the concept of security from the absence of armed conflict to a wider definition of human security encompassing the fundamental conditions that are needed for people to live safe, secure, healthy and productive lives.

15. A whole generation of children are growing up without their parents. The current estimate of 13 million AIDS orphans is projected to increase to 40 million within the next decade. Children are growing up deprived of the most basic human rights of family, education and confidence in their future. Many are condemned to live their lives in poverty and are vulnerable to abuse. Apart from the tragedy of every life not lived to its full potential, the orphan crisis is breeding ground for conflict and disintegration of the very fabric of society. This is a security risk.

16. The second issue I would like to address is the key constraints to addressing challenges posed by HIV/AIDS, Tuberculosis and Malaria. HIV/AIDS and other infectious diseases affect Africa exceptionally, but Africa's ability to respond to the unique challenges posed by HIV/AIDS is limited by the following constraints: -

17. The first constraint is that GDP growth rates have consistently been below the six percent growth rate that is required for Africa to achieve sustained economic growth and poverty reduction. It is also important to recognize that the HIV/AIDS pandemic itself undermines growth prospects. AIDS erodes saving and investment by both individuals and Governments. ,,, Conservative estimates for Africa suggest that the reduced productivity and costs associated with the AIDS pandemic alone are equivalent to more than 20 percent of GDP. These figures do not include the external effect of the disease on families, communities and enterprises.

18. The second constraint is the debt burden of US$206 billion and debt service obligations of around US$13.5 billion per annum. Debt remains a pervasive obstacle to Africa's capacity to invest in economic infrastructure; it also diverts resources from the fight against poverty and HIV/AIDS. In the majority of African countries, we spend more on debt service annually than on education and health combined. In the words of a recent UNICEF report "To spend more on external debt than on social services when hundreds of millions of children lack access to basic education, primary health, adequate food and safe drinking water is not only morally wrong, it is also economically senseless. Hunger, disease and ignorance have never been a foundation for rapid and sustained economic growth"

19. The third constraint is that levels of official development assistance (ODA) to Africa have declined substantially over the past two decades. By 2000, real per capita inflows were less than one-third of the level reached two decades earlier. Only the Nordic countries of Sweden, Norway and Denmark and the Netherlands have met the target of allocating 0.7 percent of GDP to official development assistance. The average ODA/GNP ratio of the developed countries declined from 0.33 percent in 1992 to 0.24 percent in 1999.

20. The fourth constraint is that Africa has faced a long-term decline in the terms of trade and Africa's share in world trade has declined substantially. Furthermore, Africa has faced extreme volatility in export prices and difficulty in accessing Northern markets. After the Uruguay Trade Round, it was estimated that the new agreements would lead to an increase in global income of some US$212 to 510 Billion. However, Africa did not share in the benefits of global trade. Africa experienced a net loss of US$1.2 Billion per year. This reflects the fact that global economic policy making occurs in a world of grossly unequal economic and political power. ...

23. The third issue I would like to address is the need for a comprehensive approach to HIV/AIDS covering prevention, care and treatment. It is a paradox that for the majority of diseases in the world, it is accepted wisdom that disease prevention, care and treatment should be addressed in a comprehensive manner as prevention and treatment are complementary and have major public health benefits. None, for example would question the wisdom of treating Malaria, Tuberculosis or indeed any other common communicable disease. Indeed with the exception of childhood immunization, no major disease control programme focuses on prevention alone. However, it was only this year that consensus emerged that there is need to provide comprehensive treatment for HIV/AIDS.

24. Until a few years ago, HIV infection led almost inevitably to an early death from AIDS. However, in the mid 1990s the HIV/AIDS community saw a scientific breakthrough with the introduction of anti AIDS drugs. These regimens have resulted in a reduction in HIV levels in the blood often to undetectable levels and lead to a markedly improved immune function in HIV infected individuals. Anti AIDS drugs have transformed HIV infection into a chronic condition that frequently remains without symptoms for years. Moreover with the ability of these drugs to dramatically decrease viral replication, the chance of transmitting the virus has diminished correspondingly thus reducing rates of mother to child transmission and reducing death rates.

25. The picture of continued improvement in the prevention and treatment of AIDS in high-income countries is in marked contrast to the situation in low-income countries. Sub-Saharan Africa in particular has been unable to effectively control the epidemic. This has been so because HIV/AIDS programmes in Sub Saharan Africa have not been comprehensive in approach to cover prevention, care and treatment. ...

When these therapies will become available the lives of HIV positive people will be prolonged thus also reducing the number of orphans. People will also be more willing to go for testing as access to treatment reduces the stigma associated with HIV/AIDS. ...

29. The fourth issue I would like to address is the need to invest in public health as the foundation of human development and economic growth. Low-income countries, especially countries in Africa have far lower life expectancy and far higher mortality rates than the rest of the world. ...Improvements in health translate to higher rates of economic growth and reduced population growth. The world needs to implement such a comprehensive and broad programme.

30. This will require high-level political commitment in the developing and developed world. The investment would be repaid many times over in saved lives, enhanced economic growth and global security.

31. The fifth issue I would like to address is the need for countries themselves to determine their priorities for investment by the Global Fund. We in Malawi are close to finalizing our proposal to the Global Fund. The proposal has been developed over a period of six months and is based on extensive consultation within Malawi and with international experts. ...

32. May I suggest five key principles for the operation and governance of the Global Fund.

i) The countries themselves should develop proposals that they have authored themselves independently. Countries are best placed to determine the appropriate balance between the three diseases and the balance between prevention, care and treatment. ii) The resulting proposal should be subject to scientific and public health scrutiny by a panel of independent experts serving as an independent advisory group to the Global Fund. iii) Funds should be disbursed as grants not loans. iv) Build in a clinical and operational research component into every programme so that the lessons learned from scientific research should be applied in the programme and that international best practices should be developed. v) Developing country governments should be adequately represented on the Board of the Global Fund.

... The Malawi Government proposes four actions for consideration by the international community.

38. First there is need for faster and deeper debt relief. We endorse UNCTAD's proposal for a "comprehensive assessment of the sustainability of African debt". An independent body that would not be unduly influenced by the interests of creditor nations should carry this out. Consideration should be given to the suspension of debt payments by all African HIPC countries until a final agreement is reached on debt reduction. This initiative could make a significant contribution to growth and poverty reduction provided that it is combined with additional financing on grant basis to fill the external financing gap.

39. Second we call on the international community to fully finance the Global Fund for HIV/AIDS, Tuberculosis and Malaria to the required level of US$10 Billion per annum as a matter of urgent priority.

40. Third, we call on the intentional community to increase international aid in order to invest in health as the foundation of economic development. We call on the international community to increase levels of ODA by 0.1 percent of GDP in 2002 in order to invest in global health. In the longer term, we endorse Article 83 of the United Nations General Assembly Special Session on HIV/AIDS Declaration and ask the international community to increase aid levels to the agreed target of 0.7 percent of GDP and to increase the proportion of aid directed to the poorest countries.

41. Fourth, we call on the international community to mobilize global science for the benefit of the poor. There is need for a significant investment in further research into safe and affordable HIV vaccines and their delivery including methods to prevent mother to child transmission and to improve our understanding of factors that influence the epidemic and actions that address it. ...

In conclusion, Mr. Chairman

42. People are suffering and people are dying. A whole generation of children are growing up without their parents, condemned to live their lives in poverty. Tens of millions of people have died of AIDS, Tuberculosis and Malaria. This is a new holocaust. Without serious action now, tens of millions more will die. Every single death is an indictment on our consciences. The HIV/AIDS pandemic threatens world security. How long is the world prepared to wait? How many tens of millions more have to die before we address this situation seriously? ...

The international community must invest in health as the most urgent priority and allocate a minimum of 0.7 percent of GDP to overseas development assistance. Such an investment is required if we are to meet the human development targets agreed at the Millennium Summit. We need to make essential drugs and vaccines available to the worlds poor. Every nation has signed the Universal Declaration of Human Rights. It states that all human beings are equal in rights and dignity. The Universal Declaration of Human Rights places a moral obligation on the international community to invest in human development. I am not asking for charity, I am asking for justice.

44. We do not need further intellectual debate about whether to focus on prevention or treatment. We have to do both. We do not need further debate about cost-effectiveness of focusing on principal communicable diseases or HIV/AIDS. We have to do both. We do not need further debate about whether health sector reform should precede a significant increase in investment for health. We have to do both. ...

45. Now is the time to take action. Now is the time to invest in health. Now is the time to translate our commitments into reality and fully finance the Global Fund. Humanity demands that we do not delay or prevaricate or find excuses any longer. Let us build an international alliance for justice as the foundation of a lasting peace. ...


Message-Id: <> From: "Africa Action" <> Date: Fri, 16 Nov 2001 09:48:17 -0500 Subject: Africa: Global Health Fund

Editor: Ali B. Ali-Dinar

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