Remarks at the Partnership Symposium of The Global Fund's Fourth Replenishment Conference
Secretary of State
It’s a pleasure to be here with so many leaders and activists from around the world, literally, and to share the stage with such a distinguished panel. It’s an honor for me to be here. When the folks at the Fund were looking for somebody to come and keynote this, they said they wanted somebody who would dazzle you with their speech and overcome all obstacles with their charm. And unfortunately, Elton John was not available – (laughter) – so here I am.
I want to thank Dr. Mark Dybul for bringing us all together. I have known Mark for a number of years now, and I think from the introduction you just heard from Minister Mboi, you understand that I am not – while I’m new as Secretary, I am not new to this issue or new to this effort because of my privilege of being on the Foreign Relations Committee and leading the charge on this back in the early 1990s. I’ve worked with Mark on the reauthorization of the U.S. President’s Emergency Plan for AIDS Relief in 2008, and Mark was a voice of clarity and conviction at a time when we really needed it and during that debate, and he’s brought those same qualities to the stewardship of the Fund, and I think all of you know that.
I also want to recognize Deb von Zinkernagel, as well as our – she’s our Acting Global AIDS Coordinator at the State Department, and John Monahan, who is our Special Representative to the Global Fund Replenishment and has done just a superb job of corralling and working. And I am very privileged to have such a competent team and so many people dedicated to this. I thank them for their work, as I thank all of you for your work.
Without any question, this decade really marks an amazing period of progress. I don’t think any of us would’ve quite foreseen it when we started tackling this back in the early 1990s and even in the late ’80s. I personally will never forget a few years ago, traveling with my wife Teresa to Umgeni Primary School in Durban, South Africa. And I really was moved. I was stunned, really, by the forced adulthood that so many young kids have assumed and lost their childhood in an effort to care for younger siblings. It’s quite remarkable. Our hearts really broke as we saw these orphans and watched these kids who had taken over, even taking care of their grandparents. We saw firsthand the courage of many single mothers who were scratching out an existence – subsistence, literally – in mud huts, their husbands lost to horrific disease and themselves infected and coughing and weak and struggling to be able to worry about their kids.
The fight against HIV/AIDS is the challenge of our generation in many ways, one of the principal challenges of our generation, certainly. And it is an enduring challenge, but thanks to landmark scientific advances and the grit and determination of many of you here in this room, we actually have put an AIDS-free generation within sight. That is a remarkable accomplishment, and everybody should feel good about their efforts. (Applause.)
It’s really a stunning story that speaks to the extraordinary progress that we’ve been able to make together in our global health efforts. It’s also a story about how the world came together to support a 40-fold increase in people receiving lifesaving anti-retroviral treatment during the past decade alone. It’s a story about how the global target of a 50 percent reduction in TB-related deaths by 2015 is now actually within reach. It’s a story about cutting malaria so dramatically in some regions that infant mortality has dropped by a third.
Since its inception, the Global Fund has been a vital partner in the fight against these three diseases. And I’m not chauvinistic when I say to you that we feel a certain pride, as I think all of you do. The United States is proud to be the Global Fund’s largest donor. And that’s why Republicans and Democrats alike, in one of those rare moments around here, have come together across two administrations and continued their broad bipartisan support for this Fund. That in itself is pretty improbable when I think back to the attitudes that we faced in the late ’80s and early 1990s. And that is precisely why we are challenging others to step up their commitments and make this replenishment cycle a huge success.
We’re very, very grateful for the major increases from our partners in the United Kingdom, the European Commission, Canada, Sweden, Norway, Japan, and the Netherlands, and we recognize the very strong support from France and Germany, among others. As the President said earlier today, the Administration will commit to seeking appropriations from Congress matching $1 for every $2 contributed by other countries over the next three years. And the Global Fund has obviously made unbelievable strides over the course of these past years because of this kind of support that is being given. No other international organization has undergone such profound changes in its business model, its management team, and the financial systems that have swept through the Global Fund over the course of this last decade.
Now, it’s important to underscore the reforms are not cosmetic. They are real. They’re tangible. And they are going to help save more lives, there’s no question. But we have to ask ourselves as we gather at this replenishment conference, where do we go from here? Where should we go from here? How can we build on the success and marshal the global effort that we need to defeat – not just stop or stem the tide of, but defeat – these devastating epidemics once and for all?
So let me start with HIV/AIDS. As I mentioned to you earlier, this is a fight that I have been privileged to be part of from the earliest days when Bill Frist and I were asked by CSIS to become the co-chairs of a task force which was then trying to learn more about it, literally examining what are the possibilities, what should we do about this in Congress, what can we do in the context of a legislative initiative. And so we ultimately came back and Senator Frist and I worked together on this comprehensive HIV/AIDS bill, which ultimately, believe it or not – and we were even surprised a little bit – we managed to get Jesse Helms to support, then the Chair of the Foreign Relations Committee. We passed it unanimously in the United States Senate. And I’m proud to say that that became the foundation of the PEPFAR program within a short period of time.
In September of this year, I hosted a session with top African leaders and stakeholders in order to launch the innovative concept of PEPFAR Country Health Partnerships, which try to bring this down to a grassroots-managed sustainable concept. Now more than a decade after PEPFAR was launched, Congress happily has reaffirmed the United States commitment to this historic health program and to fight against global AIDS by passing the PEPFAR Stewardship and Oversight Act. And just this afternoon, the President reminded us of his readiness to sign that bill into law.
Today, thanks to our collective investments, it is not an exaggeration to say that we are on the cusp of a really remarkable victory, the possibility of an AIDS-free generation. Now as President Obama announced earlier today, the United States is now supporting 6.7 million people on anti-retroviral treatment through PEPFAR. That is a four-fold increase since the beginning of this Administration. We’ve also reached 1.6 million HIV-positive pregnant women in order to prevent transmission to their babies. That’s also an accomplishment that we could’ve only dreamed of 10 years ago. If somebody had suggested that we were going to do that 10 years ago, they’d have thought you really didn’t understand the nature of this challenge and the crisis that we were up against.
With all of the work that has been done, with all of the hope that I think brings you all here today and tomorrow, now would be exactly the wrong time to pull back from what we have achieved. We need to move forward together, and we need to make sure that there are several principles that should guide us as we do so.
First, we need to continue to make strategic investments that are based on the latest science and the best practices. In tight budget environments in almost every one of our capitals, every dollar, every yen, pound, euro, all of them, are going to be competed for in a zero-sum game, and it’s going to be imperative that we come in and show people how we are producing and what we are getting for the value of that currency. That’s why we need to continue setting benchmarks for outcomes and put our weight behind HIV prevention. It doesn’t do you any good to simply be treating and treating and treating if all you’re doing is feeding an endless cycle and an endless supply of people to be treated. We have to begin to put in practices that stem that tide. And treatment and care interventions that work can make an enormous difference in creating the culture that can begin to do that.
Second, we need to focus on the impact of HIV/AIDS, the singular impact, on women and girls. We know that HIV remains the leading cause of disease and death for women of reproductive age in low and middle-income countries. We also know that women and girls represent nearly 60 percent of people living with HIV in sub-Saharan Africa. That has to change.
And finally, the United States and Global Fund have to work with partners across the board – public and private – in order to improve the effectiveness of antiretroviral drugs and pool the procurement of those drugs in order to drive down the costs.
Now, we also have to answer another crucial question: Are investments in global health something that we can actually afford? Well, I’d reverse that question. I’ve heard that, frankly, from some members of Congress and others as we get involved in this zero-sum competition that is driving so many governments in the world today. But the truth is, in an interconnected world, where drug-resistant tuberculosis could be on the next plane landing at Dulles, or Johannesburg, or London, the answer – emphatically – is we can’t afford not to invest in these programs that stem the spread of this kind of infectious disease. (Applause.)
TB is curable, and make no mistake: With the right effort and the right focus, the right energy, we can eliminate it. But for that to happen, we need an innovative plan, a plan of attack for addressing the alarming increase in multidrug-resistant TB. We also need to develop new and more effective drugs and diagnostics. And we need to work together in order to prevent tuberculosis-related deaths by focusing on HIV/TB co-infections. Happily, the Global Fund is the largest funder of TB programs in developing countries, and it is an absolutely vital pillar in the global plan to be able to stop TB in its tracks.
So clearly, our fight against TB and HIV/AIDS as I’ve just described to you is far from over. The fact is the same is true for malaria, and in malaria we actually face many new challenges. This is an improbable place to come and give a climate speech, but climate is having a profound impact on the movement of malaria. As our climate warms and as mosquitoes extend their range, which is what is happening, we see malaria surging in areas that have hardly ever seen it before, like the Kenyan Highlands.
Now, we’ve started to make some important progress in some areas. The President’s Malaria Initiative has expanded prevention and treatment for those most vulnerable to the disease, especially children under the age of five and pregnant women. And our financial and technical contributions are major drivers to reducing the burden of malaria on child mortality in many, many countries. The Global Fund is already playing a vital role in this effort.
So together, my friends, we are contributing and distributing tons – I mean literally. Actually, that’s a bad way to describe it. It’s tens of millions, tens of millions of mosquito nets and millions of doses of anti-malarial drugs in order to get them to those who need them the most. If we double down on our global efforts now, believe me, we have the ability to beat this disease, too.
So those are the stakes. This is our world. And the true measure of our success is not going to be what happens here in Washington. It’s going to be what happens in capitals from Maputo to Monrovia, from Kigali to Kabul. That’s where the difference will be made, and that’s why our partnership matters.
The partnership really comes directly from the board of the Fund to the hard work of governments represented here, civil society, faith leaders, and communities who are touching and healing the people who need our help. And that’s why the Global Fund and this year’s replenishment cycle are so absolutely vital.
I really do have faith that we can get this right. But faith alone is not going to get us there. It’s not enough to simply hope or believe that we can defeat these three epidemics. We have to go out and do it. We – all of us – have to take actions in order to make it happen, knowing that we have the power to make it happen. And let me tell you, no one country, no one program, is going to stop AIDS or TB or malaria on its own, and I think every one of you knows it. That’s why the Fund is so critical. That’s why the partnership is so critical. That’s why coming together for a conference like this to dedicate ourselves and to focus our energies is so critical.
Our mission is clear and the need is great, and the time for action is now. And we’ve proven what we’re able to achieve over these last years. It would be almost criminally negligent to turn our backs on the knowledge we have gained, the capacity we have built, and not go out and try to complete the task. That’s the challenge for every partner in this room. And our success demands that we work together in order to try to achieve it.
Thank you all for being here. God bless everybody for their efforts in this. Let’s get the job done. Thank you. (Applause.)