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October 29, 2009

9:00 a.m. CT


Operator:        Good morning.  My name is Melissa and I will be your conference operator today.  At this time, I would like to welcome everyone to the Global Health Initiative Conference Call.  All lines have been placed on mute to prevent any background noise.  After the speaker's remarks, there will be a question and answer session.  If you would like to ask a question during this time, simply press star then the number one on your telephone keypad.  If you would like to withdraw your question, press the pound key.  Thank you.

                                Ms. Russell, you may begin your conference.

Asia Russell:        Thanks so much, Operator.  Hello, my name is Asia Russell.  Welcome to this teleconference on President Obama's global health initiative.  I work with Health Gap, an organization working for universal access to HIV treatment and prevention in developing countries.  Thanks so much for joining us about such an important topic, the need for this Administration and congress to invest sufficient funding and enact the right policies to in order to dramatically expand the U.S. response to global health crises that are responsible for millions of preventable deaths each year in sub Saharan Africa and throughout the developing world.

                                As you know, in May 2009, President Obama announced that his Administration would develop a six year global health initiative focusing on the priority areas of reproductive health, maternal newborn child health, neglected tropical diseases, HIV, tuberculosis and malaria and health system strengthening.  So the purpose of this call is to share findings contained in a new report just released today called, "The Future of Global Health: Ingredients of a Bold and Effective U.S. Initiative".  This report is being launched by a broad coalition of health and development organizations that was formed in order to describe the appropriate scope and scale of the U.S. response in these priority health areas.  As a civil society coalition, we also set out bold, but feasible targets for the global health initiative, as well as the right funding levels in order to achieve those targets.

                                We feel the launch of the global health initiative earlier this year was an important step by the Administration.  It's important to note that the White House signaled new approaches, for example a commitment to advancing a scaled up response to reproductive health and family planning needs of women and girls and to maternal newborn and child health.  These are areas where we are not only not making enough progress fast enough, but in some countries, we're actually moving backwards. 

However, civil society groups are seriously concerned that the funding levels being sought by the White House would be indicated in the announcement by the White House are so low, essentially about $10 billion per year or $63 billion over six years.  And, according to our calculations, there's clear evidence to show that with these funding levels, the global health initiative itself will not be able to achieve success. 

                                By contrast, the coalition is calling for a six year commitment of $95 billion, approximately one-third more than the announcement from the White House.  And we've calculated that this additional investment is the minimum needed for crucial increase particularly in the areas of health work force and making a real and sustained impact in reproductive, maternal, newborn and child health.  It's also important to note that our funding estimates largely validate and cohere to the costing work done by an independent commission of the Institute of Medicine of the National Academy of Sciences in a report they released in 2009, as well.

                                In addition to concern over the budgeting levels projected by the White House over the next six years, civil society is also concerned by the troubling possibility, which our speakers will also explore, that the Administration might be preparing to pit different diseases against each other by shifting resources, for example, from HIV AIDS to neglected tropical diseases, and thereby, undermining programs that are delivering impressive results.  We have the strong position that the global health initiative cannot be successful if it pits one disease or one condition against another or cherry picks, relatively cheaper interventions while taking funding away from highly effective, but more effective interventions. 

                                Instead, adequate investment in global health priorities overall is what is needed and what we're calling for.  For example in the case of HIV, it's important to note that the AIDS crisis underpins many other interconnected health problems, for example achieving integrated and comprehensive reproductive health and family planning alongside essential HIV prevention and treatment services actually requires additional resources in order to achieve those compelling and results driven synergies.  More resources are needed not fewer.

                                So by focusing on these priority areas, our calculations indicate that the U.S. can achieve bold, but feasible targets in the priority areas, such as assuring  that 35 million birth take place in facilities that provide quality care, that 40 million women receive quality antenatal care, that appropriate treatment for an additional 40 million episodes of child pneumonia are able to be delivered, on top of existing baseline HIV, tuberculosis and malaria commitments, for example, that HIV care for 12 million people, including five million orphans and vulnerable children can be delivered. 

                                I think we'll hear a lot more about these targets from our speakers and I'll just hand it over to them since I know they're all extremely busy folks.  But just to conclude by saying that these targets are very much within the grasp of the U.S. government and this Administration, but they require sufficient funding which in turn can leverage increased commitments from other donors, as well as from developing country governments themselves. 

                                Our first speaker is Representative Jim McDermott.  He's a leader in the U.S. Congress on global health priorities.  He's the chair of the congressional HIV caucus and he's a medical doctor.  We're very pleased that he could join us for just a few brief moments today.  Thanks, Representative McDermott.  I'll pass it over to you.

Jim McDermott:        Thank you very much, Asia.  It's really pleasing to see a good solid report like this being released that has data in it that can be used to justify and educate people about the problems of global health worldwide.  It is clear that there is a major commitment in this country, started by President Clinton, and greatly expanded by President Bush and now greatly expanded by President Obama. 

This is not a partisan issue.  This is an issue where people recognize that global health is something that is really in the United States' best interest, as well as the humane thing to do and I think that it is going to be supported.  It is, however, important to note that although $9 billion sounds like a lot of money, it is a quarter of one percent of the GDP of this country.  So we're not making that big a commitment and I hope that we can go much larger because there clearly are things that need to be done. 

                                One of the things I would point out and as people look at this report, it's easy to read the first couple of sections and never get to page 31, which is health work force.  My wife has been working for the last three years in Africa for an NGO called Africa Health Placements, which is recruiting doctors in the United States, the United Kingdom and Canada to come out and fill the holes left in the healthcare system in South Africa by the brain drain.  The brain drain, I think, is an issue that is not well understood and we are the beneficiaries in the Western world. 

                                America is filled with doctors who have come from South Africa and from India and from all over the place and left problems in their own country.  So part of the real problem here is how to develop an effective work force because if you're going to deal with maternal and child welfare, you have to have physicians.  There are pediatric hospitals in South Africa where there is no pediatrician.  There is no doctor.  So you can't deliver the healthcare no matter how much you put into pharmaceuticals and how much you put into all sorts of other things if you don't have a work force that is in place.  You can't deliver tuberculosis under a DOT, direct observation treatment, unless you have people to do that and so, I think that one of the issues and I would emphasize, is the whole question of, how are we going to increase the work force in the health marketplace in the world?

                                I'd be glad to answer questions.  Unfortunately, the speaker is rolling out the healthcare bill at the moment and so I have to get over there to participate in that, but I would be glad to answer questions.

Asia Russell:        Thanks so much, Representative McDermott.  We'll be sure if there are any questions coming in from folks joining the call that they're also able to be routed to your office so that we can make sure to be on top of any follow up.

Jim McDermott:        OK.

Asia Russell:        Thanks so much.

Jim McDermott:        Thank you.

Asia Russell:        Our next speaker – thank you.  Our next speaker is Professor Jeffrey Sachs, the director of the Earth Institute at Columbia University and the UN's secretary general's special advisor on the millennium development goals.  Professor Sachs?

Jeffrey Sachs:        Thank you very much.  Well, I'm really thrilled with this new report on the future of global health.  I think it's enormously important, very well done and I think it will be very helpful for the Administration.  This is an Administration which we all support and we admire and we believe that the global health initiative that this Administration is taking up can be truly a historic contribution of the United States to a major challenge. 

                                And as Representative McDermott has just said, it is an initiative which is very much inline with the values of the American people with the great capacity of the U.S. to contribute to saving lives and improving health and thereby to unlocking economic growth and also helping to stabilize very unstable parts of the world where high mortality rates and high disease burden contribute directly to instability and impoverishment and therefore, to security challenges, as well.

                                Now I would like to put this in the context of the millennium development goals, which are another major objective that the Obama Administration has taken on front and center.  I hope everybody remembers that the millennium development goals were adopted by all of the countries of the world, of course including the United States, in September 2000 with a 15 year interval to achieve very important goals in fighting poverty, hunger and disease. 

                                And it's not a coincidence that about half of the millennium development goals are about health because lack of access to lifesaving health interventions constitutes perhaps the cruelest form of poverty overall and the drafters of the millennium development goals, led by Kofi Annan and adopted by the world, understood that the fight against poverty was also a fight for the human right to health and as a very practical matter, poverty could not be eliminated if children are constantly infected with worms or are dying of malaria or their mothers and fathers are dying of AIDS for lack of treatment or their mothers are dying in childbirth, leaving orphaned families behind.

                                So the millennium development goals are now in their ninth year.  Health is actually one of the most important accomplishments of these first nine years.  What we've seen in the health area, and I think this is really the point that needs to be emphasized in thinking about a report like the future of global health, is that every time the world has invested in health in poor settings, the results have come through in a spectacular fashion, even better than was expected and often, again, lots of initial opposition that said, "It can't be done", it turned out, yes, we can.  It can be done. 

                                So malaria is now falling sharply throughout Africa because in the last two and a half years about 200 million bed nets have been distributed.  Measles deaths are down by more 90 percent.  Millions of people are now kept alive successfully through anti-retroviral treatment and there's been a significant spread of testing and awareness of the AIDS infection, which is, of course, a predicate to prevention itself because of the expansion of programs like the global fund to fight AIDS, TB and malaria and the U.S. PEPFAR program.  Similarly, there has been a massive expansion of new vaccines that have come along because of the work of the Gates Foundation and the global alliance for vaccines and immunizations, GAVI, which the Gates Foundation helped to launch a decade ago.

                                So all in all, the scale up of the fight against disease has been a remarkable success as far as we've gotten and the point of the global health initiative of the President and of the future of global health, the report being issued today, is that we've gotten perhaps one-third of the way that we need to go.  In other words, a big increase from what started out at about a tenth of the effort that was needed.  We've roughly tripled the effort during these nine years since the millennium development goals were established, but we're roughly one-third of where we need to be in the global help for the poorest places in the world.  And very quickly, let me just run through the numbers.

                                Several reports, starting with the one that I helped to chair for the World Health Organization in 2000, followed by the UN millennium project report in 2005, followed by the Institute of Medicine report, a recent report called, "The Task Force on Innovative International Financing for Health" and now, today's report have all come to the same conclusion, which is that if we invest around one-tenth of one percent of our income, one-tenth of one percent of our annual income, that's 10 cents out of every $100.  If the United States does that, if Western Europe does it, if Japan does it and other high income countries, that would create a total pool of funding of roughly $40 billion and that $40 billion would, if properly invested, save six to eight million lives per year and also enable the world's population to stabilize through access to family planning services and to contraceptive services.  And so we have a remarkable opportunity for 10 cents on the $100 to get this done.

                                Where we are right now is that we started at about one cent on the $100, roughly around $3 billion a year.  We've climbed up to probably around $14 billion per year now, maybe $12 billion to $14 billion.  We need to get to between $35 billion and $40 billion and so we've gone from one cent per $100 to three cents per $100 and we're on our way to just 10 cents per $100 would get the job done.  And what the Administration's plan calls for is to step up efforts in areas that have not yet been the focus.  So right now, there has been a lot of focus on AIDS, TB and malaria through the global fund, through PEPFAR, through the so called PMI, the President's malaria initiative.  There's been a lot of focus on immunizations through GAVI.  There is beginning a focus on the so called neglected tropical diseases, which are various horrible worm infections and other parasitic diseases in the tropics.  But there hasn't, for example been almost any funding at all to keep mothers safe in childbirth or to help neonates, that is newborns in the first 28 days of life, to stay alive and yet, that's where almost 40 percent, it's estimated or roughly 40 percent of children under five face the peril of death during the first 28 days.

                                So what the Administration has recognized is that we need to invest in reproductive health, in family planning, in newborn survival, in neglected tropical diseases, in health systems, including what Representative McDermott said in training community health workers, midwives, nurses and so forth who can be trained quickly and make a huge difference.

                                Now the point of this report today is that all of these things can be done and indeed, the world's experts have said, "Yes, yes, yes.  Let's do them."  But the funding is not really in place to accomplish what the global health initiative is setting out to do.  For the United States, one-tenth of one percent would be about $14 billion to $15 billion a year because our GNP is from $14 trillion to $15 trillion a year right now.  For the world, if you combine the other rich countries, that would be, as I said, between $35 billion and $40 billion per year. 

                                Whatever the U.S. does has to be matched by other countries.  This report has figures for the U.S. that are averaging $16 billion a year and climbing over time.  I think what's important to note is that we need more financing, we need the holistic, comprehensive approach because all of these different interventions are synergistic, they all build a basic primary health system.  We need in the aggregate the United States and other countries to combine to the total of .1 of one percent of the rich world GNP and very importantly, we need a plan to get this done. 

                                And here's where I want to end by reminding everybody of a very important speech that President Obama gave on September 23rd to the United Nations' general assembly.  This was, of course, his first speech ever to the assembled leaders of the world.  I was in the chamber.  It was stunning.  The speech was great and the worldwide reception was absolutely dynamic.  People were thrilled because the President said, "We're going to cooperate to solve great global challenges."  And one of the statements that he made is the following, he said, "We will support the millennium development goals and approach next year's summit", which will take place in September 2010, on the MDGs.  He said, "We'll approach next year's summit with a global plan to make them a reality and we will set our sights on the eradication of extreme poverty in our time." 

                                So what I would strongly urge the Administration is read this wonderful report, take these numbers seriously that come from this report, the IOM, the task force on innovative international financing.  They all come to the same point about the scale of need: Gather the rest of the high income world to make a reality this wonderful pledge, that the President made, that the United States will come to next year's summit with a global plan to make the MDGs a reality.  And, since the MDGs include maternal health, child survival, the fight against undernourishment, the fight against the specific killer diseases like malaria, AIDS, tuberculosis, the neglected tropical diseases, since all of that requires a health system to do, today's report provides crucial guidelines.  The numbers are clear.  The United States is not far off from what it needs to be; we're doing a good job on the health area.  We have to actually build up in other areas, but we still have to stretch in the health area.  That's the message of this report.  Good start, some way to go, but all within an absolutely achievable timeline.

                                We certainly should take as a standard that the bonuses to the bankers on Wall Street should not outpace the U.S. aid for the world and the U.S. aid for international health.  And yet, that's what's been happening.  What we need is an effort that is commensurate with our great wealth, our great stakes in the world, our great leadership right now saying that we will achieve all of the millennium development goals and really for the first time, that we'll have a plan of action, a global plan to make the MDGs a reality.

                                So in conclusion, an important report, a very important message, holistic strategy, proper financing, let's get the U.S. to do it's part and surely get the U.S. to mobilize the other countries to do their part so we view this as a package deal and we'll get this job done and the U.S. will make history just the way the American people would like.  Just the way we've started out, we're not quite there yet, but we're getting there and I think this report takes us another step on this incredibly important journey.

Asia Russell:        Thanks so much, Jeffrey Sachs.  I know you have to step off the call, so Operator, I think we have time for just two questions, if you can open the lines and then, we'll carry on with our final two speakers and the overall question and answer session.

Operator:        At this time, if you would like to ask a question, press star then the number one on your telephone keypad.  We'll pause for just a moment to compile the Q&A roster.

Asia Russell:        Thank you.

Operator:        Again, if you would like to ask a question, press star one.  There are no questions.

Asia Russell:        Great.  Thank you so much, Operator.  Thanks, again, Jeffrey Sachs.  We'll carry on then with the next speaker.  Doctor Peter Mugyenyi, who is the founder and director of the joint clinical research center on AIDS in Uganda and is a leading infectious disease clinician and researcher in sub Saharan Africa.  Doctor Mugyenyi.

Peter Mugyenyi:        Thank you.  We, too, welcome President Obama's health initiative and thank the American people for the commitment to continue the fight against catastrophic diseases in Africa.  I would like to present this in the perspective of my work.  I have witnessed the devastation of diseases fueled by severe resource constraints in my country, Uganda.  I have witnessed situations whereby AIDS is overwhelming the entire health care facility and all available hospital beds and floor spaces were occupied by dying patients.  PEPFAR came and succeeded beyond its primary objective of alleviating the AIDS crisis.  PEPFAR helped my institution, the joint clinical research center, to rehabilitate many health care infrastructures, establish new laboratories, train healthcare providers and also make it possible for us to reach remote villages and provide services there.  We are able to start over (inaudible) thousand patients on lifesaving anti-retroviral therapy and we are able to build capacity of many health centers and hospitals successfully, thanks to PEPFAR.

                                While PEPFAR has saved millions of lives in Africa, it has not merely been about AIDS only.  It also achieved remarkable results in other needy areas of health.  We have been able to treat not only HIV, but tuberculosis, malaria and other diseases and in the process, PEPFAR became one of the most effective health care strengthening initiatives that we have so far seen in the African continent. 

                                I'd like to tell you about a real life story that happened just a few months ago.  I visited a remote area in the impenetrable forest of (inaudible) and there is a clinic over there and the community around that clinic used to be devastated by malaria and the victims, as usual, were children.  Now when I returned recently, the doctor in charge insisted I go to the children's ward that used to be crammed with very sick children with malaria, many of them sharing beds and many of them dying.  I was very surprised to find very few children on the ward.  The doctor told me excitedly, "See what happened?  PEPFAR provided the mosquito nets in the communities and you can now see the results for yourself."  He didn't need to say any more.  He also told me the complications of pregnancy and maternal death rates in the area had also declined. 

                                Now, the immediate impact of flatlining the budget, as recently happened, for AIDS has been to freeze treatment for all new patients.  Now unfortunately, we have been seeing queues of frantic AIDS patients, daily gathered at our clinic, saying that they have been moving from facility to facility and been turned away.  Then, we started getting reports of people who started the dangerous practice of sharing out drugs with their desperate family members.  Soon we fear the carnage of AIDS will once again surge and the obvious success we have seen of PEPFAR may begin to be reversed.

                                In Africa, AIDS remains the top most concern, and it is still escalating.  In AIDS most devastated countries in Africa no health initiative can succeed without treating the millions of AIDS patients in frantic need of lifesaving therapy.  Unless adequate and equitable treatment is provided along other initiatives like those in the global health initiative, AIDS will, unfortunately, continue to incapacitate the other health initiatives.  For example, it is important to achieve maternal, newborn and child health objectives without addressing AIDS, and this is simply because it is AIDS that killing many of the mothers.

                                We, therefore, call upon the Obama Administration fully fund AIDS, TB and malaria, at the five year levels authorized by the U.S. Congress last year.  This will make it possible to lift the restrictions on treatment of new patients and it will make it possible to avert the impending crisis that we are seeing surely coming unless some bold initiative is taken.  Thank you.

Asia Russell:        Thank you, Doctor Mugyenyi.  Our next speaker, our final speaker is Ms. Rolake Odetoyinbo, who is coming from the positive action for treatment access initiative, calling in from Nigeria.  Rolake is a well known advocate in the region of Western Central Africa and throughout sub Saharan Africa and she is living with HIV and we're very pleased that she was able to join us today. 

Rolake Odetoyinbo:        Thank you very much, Asia.  Well, I work for positive action for treatment access and thank you very much for this call.  I think this is an amazing initiative and it's great to have things like this happen to talk about what the U.S. support to Africa means, what does it mean for those of us who are in the community, what does it mean for those of us who are recipients of care and those of us who are also care providers.  The assistance the U.S. government has provided has completely changed the way we see things.  We have dared to dream.  We have been given back hope.  Which means that before now, we had people living with HIV who imagined that this was the end of the world. 

                                In 2002, the Nigerian government started free ARVs for 10,000 people.  By 2004, we still had less than 50,000 adults on ARVs but no child at all with access.  What has happened since we have PEPFAR and the global fund and other global initiatives is that we now have children on ARVs.  We have right now in Nigeria over 250,000 adults on ARV.  This is coming from a position of 10,000 to now 250,000 and I think this is really, really amazing.  What this simply means is that with more people on treatment, you can think of reducing the numbers of babies born with HIV.  So treatment has, on the other hand, also been something that helped with prevention.  So you have babies who have access to treatment, either to treat the HIV infection or even completely prevent children from getting infected.

                                Right now, however, we are at a critical moment.  We're looking at the millennium development goals, which by 2015 will be there.  For us to reach our MDG goals, it's obvious that all of us have to aggressively scale up on what we are doing.  We need investments to continue if we are looking a global health as a priority.  In this case, right now, we are looking at Africa, specifically, which is what I am most familiar with.  We have in Nigeria 833,000 adults needing access to anti-retroviral drugs at the end of 2009.  We have reached 265,000.  So we've got over 60 percent of adults still not accessing care and with children it’s extremely pathetic.  We have 83 percent of our children without access to treatment which means we cannot afford to slow down.  What this means is we really must keep investing both globally and even right here on the continent.  As Africans, we must keep pushing for our government and the world's governments to keep on investing in the lives of people and helping to ensure that we have continued access.

                                The interventions that we need right now, what's needed in the field right now to take this to the next level:  We know, for example, we need to invest in healthcare workers and equipment.  We need to deploy thousands of healthcare workers to rural areas.  We're going to have to reach difficult to reach areas, such as the riverine areas and those in northern Nigeria. For us to make this happen, we need to redouble our efforts. 

                                We need to ensure that our women have access to treatment.  I live in a country where we have about five million pregnancies every year.  Only about 40 percent of these pregnancies even show up in the healthcare center for any antenatal care and of this 40 percent, less than 50 percent of them come back to the hospital to have their babies.  So we are talking about over 70 percent to 80 percent of our population of our women not even being able to access care, not having babies in the health facility.  If we are going to think of reversing maternal mortality, if we are thinking women's health, if we are thinking of maternal health and children's health, we must reach the women where they are.  We have to reach the population where they are and this is why, at this point, we really can not afford not to make this investment.

                                A lot has been said about the role the U.S. government should and can play, and we can't overemphasize this because we know the U.S. has been the leader in this response and it's what is keeping everybody together, it's what's helping other donors commit.  It's what's helping our governments continue to commit to this. 

At the global fund level, I am aware that right now there is a need at the global fund level and the U.S. is the biggest leader, the biggest supporter of the global fund, so, right across the board, take the global fund or whatever health initiative you are looking at, once the U.S. government slows down, then the entire world is going to slow down and what this means and it is obvious. 

                                We need global investment to help pressurize the Nigerian government into doing more.  It's important that our governments and our leaders on this continent meet their targets.  African leaders have committed to investing 15% of their budget in health, which we still haven't achieved, but the only way this will be achieved is if we keep pushing and we have other outside parties who commit to pushing our governments because they themselves are putting some resources on the table. 

                                In 2003, I think, when President Bush came to Nigeria, I was one of the women who met with him when we were talking about PEPFAR.  I shook hands with President Bush and I remember writing an article on that because ultimately what matters is where are the drugs and what is important for us is that we need for these programs to work for women in the rural areas.  We need for whatever initiatives, whatever investment has been made to work for everybody who needs to access this.  And it wasn't just about a handshake because he wanted to show President Bush shaking hands with African women living with HIV, that would have been extremely insulting if it was not about real commitment, if it wasn't about caring for the lives of others and that's why, at this point, it's really important that we cannot afford to rob Peter to pay Paul.  We know it's – the temptation is to say let's go to easier things and let's leave out these things that are too cost intensive. 

                                But in this part of the world where I live in, we are still talking about the same woman.  The same woman we are trying to reach with strategies to prevent infant transmission of HIV is the same one we are trying to reach for preventing her dying in childbirth.  The same child we are trying to reach to prevent HIV infection and to treat HIV is the same child we are trying to reach with services for diarrhea.  We are talking about the same, same set of people. 

                                It's not one versus the other and at this point, I think it's really important that we see this as something that we all cannot afford to fall back on.  We must keep pushing.  Whether we are addressing drug resistant tuberculosis or we are talking about AIDS, there is no choice.  We can't choose between maternal health or AIDS.  As a woman living with HIV, it's really about my health as a woman.  It is ultimately the health of a human being we're looking at.  And we can't pit one against the other.

                                Trying to cut down on the cost intensive things to take on the cheaper things is nothing but a recipe for failure and at the community level, we are all looking at how we must ensure that these are things, whatever programs that our governments and donors have committed to must be scaled up.  We are looking forward to a program being scaled up not being cut down and too, we are calling on the Obama Administration to please keep its promise.  Let's scale up this response globally because that's the only way we can achieve the promises that have been made. 

                                Thank you.

Asia Russell:        Thank you so much, Rolake.  At this time, Operator, if you could open it up to any questions.

Operator:        If you would like to ask a question, press star one on your telephone keypad.  Again, if you would like to ask a question, press star one.  There are no questions.

Asia Russell:        Well, before we wrap it up, I actually have a quick question for Doctor Mugyenyi and for Rolake.  Doctor Mugyenyi, we've heard from various sources that leaders in PEPFAR are under the impression that they won't have additional resources above and beyond their current budget levels into the future, which is a precise contradiction to the commitment that President Obama made when he was campaigning to be President that is to scale up the investments in HIV, tuberculosis and malaria on par with need, while investing in the health systems and health work force investments that are also needed to build out from success.  So I guess my question is, what could it mean for treatment scale up in Uganda if the Administration doesn't keep its promise to continue expanding investments in HIV treatment?  What does it mean both for HIV treatment in Uganda and also for other priorities like maternal newborn child health, family planning and reproductive health?

Peter Mugyenyi:        Thank you for the question.  This is a very important question and of great concern to us.  Additional resources have not been made available for treatment of new patients who need anti-retroviral therapy and yet this is a very crucial area.  So the failure to commit more funds would bring the program to a standstill.  The flat-lining budget, we are told means that we can't start new patients on treatment and this is extremely dangerous to the program.  First of all, the patients who are already on treatment whom PEPFAR is committed to continue supporting cannot be supported because in Africa people come for treatment as a families and it would be virtually impossible for any mother to take treatment while the daughter who needs treatment goes without.

                                The net effect we have already seen it, families are beginning to share out drugs and when they share out drugs treatment will fail and it's not only that treatment will fail other complications come on board like resistance and then the situation becomes much more serious.  So we are very much concerned about this state of affairs and hope that there will be a way of accommodating new patients and not only new patients, but also the fulfillment of the promise that have been made.

                                With regard to maternal health and child health, the affects will be devastating.  It is the same mothers who are suffering from HIV, some of them, and then those mothers, if they don't get treatment, they are (passing the infection on to their) unborn children and if children who are born with HIV don't get treatment, you are just escalating the problem.  The key to success, not only on HIV but on many other diseases targeted in the global health initiative, is actually to treat the very disease that is placing the heaviest burden in sub Saharan Africa so that it becomes cheaper and possible to be able to tackle other diseases.

                                So that is the situation that is pertaining to Africa at the moment, particularly in my country and I hope that the global health initiative will take this in account and address AIDS without taking away money from AIDS.

Asia Russell:        Thanks so much.  If there are no questions from journalists, (inaudible), I have a question for you, as well.

Female:        Yes.

Asia Russell:        The main difference between the funding levels projected by the White House and which is $63 billion over six years and the funding – the minimum investment that we've calculated would be needed in order to achieve success in the Administration's global health initiative, that's $95 billion over six years.  The main difference is in a scaled up – we've calculated the need for the majority of that one-third increase to be dedicated to the areas of human resources for health, health work force and maternal, newborn and child health, two areas where more aggressive and also sometimes quite expensive, but very cost effective investments are needed.  I guess my question to you is, do you feel like these interconnected and priority areas of the health work force and reproductive, maternal, newborn and child health, adequately reflect some of the priorities that you're seeing in Nigeria and also in West and Central Africa?

Female:        Well, one thing is stressed.  If we are going to reach our target, it's important – if we're going to halt the spread of HIV and reverse it, we need to stop new infections.  Talking about prevention, the easiest way to scale up prevention, which is what we've been able to do in United States, is stopping direct to child transmission, we have to go back to maternal health.  We've got to go back to women's health.  We've got to go back to reproductive health.  If we do not invest in this it’s like pouring money into a bucket. 

                                What I find – what the most painful to watch is to see the U.S. commit so much money in the last five years.  So much money to AIDS in Africa.  So much has been done.  So many people have been reached.  If at this point in time that stops, it means all of the investments will be money down the drain.  Nobody makes an investment – you don't invest your time, money and efforts and then just watch it waste away. 

                                And I say waste because if we stop right now, it means that there will be a reverse on every single thing we've done.  Everything we've made will be reversed.  If we are not able to halt new infection, if we can't address maternal health and look at a way to make sure that a woman has access to the best healthcare so that she has help and so that her baby is healthy, so that you have both mother and child and not have women dying in childbirth, now the result will be increasing the number of orphans and vulnerable children.

                                It's really not – I mean it doesn't sound like a very wise choice if we're going to pit one against the other.  Maternal health and newborn child health is something that however expensive it is, we are talking human life and the way to cut down the cost is making sure that people have access to services very early on. 

                                In 2006, I had a baby.  I made a choice to have a child even though I had lived with HIV for seven years.  It was a choice I made which was an informed decision.  I had the opportunity to work with my medical team, to work with my doctors, and one of the greatest blessings of my life is my three year old son who is HIV negative.  If I had had a child who was positive, I am not sure I would have been able to cope.  It's something I would not have been able to deal with.  But if I had access to that medicine living in Lagos, then it's essential that we ensure that all over women have access to that same service.

                                You asked a question – you asked Peter a question earlier about scaling down on treatment.  What we are seeing in Nigeria is that you cannot even access test kits anymore.  Here in PATA we have a project where we are working in two primary health centers in Lagos state and we cannot get test kits.  So women who are pregnant and in antenatal care cannot access HIV testing.  If we can't even test the people, how then do we will know who is infected to get them on treatment?  And that's one thing that's really very scary and is of concern to a lot of us.  We have no way right now – we must increase access to testing.  We must increase on treatment, but it looks like in Nigeria, we haven't yet said do not treat anymore, but what's being done is stop the massive testing because the people are not testing, then you don't even know they have HIV.

                                I hope that answers your question.

Asia Russell:        Thank you so much.  Operator, are there any questions in the queue?

Operator:        There are no questions.

Asia Russell:        OK.  We can wrap up the call at this time.  This – an audio file of the call will be made available along with the reports and other materials related to this project.  The URL to visit to find these tools is

That's also where you can find information about how to get in touch with our speakers.  I think we've heard today a very strong warning from a range of experts that although a welcome step, the Obama global health initiative can't succeed without funding levels – without adequate funding levels in order to reach it's important goals. 

                                With insufficient budgeting, what will happen instead is the pitting of diseases against one another, the pitting of priority health conditions and health crises against one another and what will end up taking place, as we've heard described so eloquently from Peter, from Rolake, from Jeff and from Representative McDermott, is what will happen instead is an effort where the Administration and the U.S. response is spread so thin that the effect and impact that's possible with the right investment and the right level of resources will simply be impossible to achieve.  And that's something that we call on the Administration to prevent by investing in the priorities of the global health initiative at the right level starting with the fiscal year 2011 budget, which is being negotiated within the Administration now and will be delivered to congress early in 2010.

                                We know in order to achieve the goals of the Obama global health initiative at least a one-third increase in projected spending levels is needed to reach $95 billion over the next six years.  That's the minimum investment that's needed and it pays in dividends in multiple interconnected ways, as we've heard described by our experts here today.

                                So thanks, everybody, again, for your time and for participating in this effort and we look forward to continuing dialogue on this priority and in moving forward with this shared effort to achieve a comprehensive, ambitious and aggressive scaled up response on the road to comprehensive essential healthcare services for all.  Thanks so much.

Operator:        This concludes today's conference call.  You may now disconnect.

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