Global Plan to Stop Tuberculosis

with
George Soros, founder of the Soros Foundation and the Open Society Institute
Gro Harlem Brundtland, the Director General of the World Health Organization
Jozef Ritzen, the Vice President of Human Development at the World Bank

Washington, D.C., Tuesday, October 23, 2001

PROCEEDINGS

MR. HAY: A very good morning, ladies and gentlemen, and thanks very much for coming along to our media launch this morning. The global plan to stop tuberculosis, the urgency behind the plan is clear if you think that four people die somewhere in the world every minute as a result of TB and that the epidemic is growing because of its deadly pairing with HIV/AIDS.

Let's start off with a few quick introductions up here on the podium. On my immediate left is Dr. George Soros, who scarcely needs any introduction, I'll warrant, but, anyway, for the record, the founder of the Soros Foundation and the Open Society Institute.

On his immediate left is the highly familiar figure of Gro Harlem Brundtland, the Director General of the World Health Organization, and the former veteran Prime Minister of Norway.

And on her immediate left is Dr. Jozef Ritzen. He's the Vice President of Human Development here at the World Bank and a veteran Education Minister and Health Minister, and just on a personal note, Jo was telling me his own mother suffered from TB just shortly before he was born.

So, without any further ado, let me ask Dr. Soros to start us off with a few quick introductory remarks.

MR. SOROS: All right. This document, the Global Plan to Stop TB, is really a major accomplishment because it has brought together all the players involved in fighting TB and presents a business plan how to - what can be accomplished, what it would take. It's a very detailed document. It has a budget of $9.3 billion over the next five years.

I will not tell you about the problem of TB because other people here are more qualified. I will also not repeat what I said inside the conference about how I came to be involved in this issue because it was a little circuitous. But once I did get involved, I was happy to be able to sponsor the process which led to this consensus document.

I'd like to focus on the slight financing gap, being a financier, $9.3 billion, of which $4.8 billion is going to be put up by the 24 countries which are most affected, leaving a financing gap of $4.5 billion. And that is where donors will be solicited, and I hope that this is a serious enough plan that monies will be forthcoming.

It so happens that this plan fits in very well with my own work. I've been working on a draft report on globalization - a draft of it is available here - where I advocate new ways of providing international assistance. That argument, it involves, I suggest, the special issue of special drawing rights that would be pledged by the rich countries for international assistance. And while they would retain, the countries would retain control what projects or programs they support, the programs themselves would have to meet certain criteria in order to avoid many of the adverse features that currently characterize foreign aid.

So I'm particularly pleased that this report came along just at the right time to provide a practical example of the kind of programs that bring together all the players, which present a master plan, but at the same time, because you've got people on the ground and at every level feeding into the program, it's also open to be modified in the light of experience. So this is the kind of program that would qualify for the allocation of the special drawing rights.

So I think the fact that you've got this feedback and this cooperation allows modification. I don't really want to go into the technicalities of it all, but we basically started out applying DOTS - that stands for - what does it stand for?

MR. HAY: Directly observable -

MR. SOROS: Directly observable treatment shortfall, which is much cheaper than putting people in sanitoria, et cetera. So that was the protocol that we applied in the Russian prisons, and we discovered that there was a strain of multi-drug-resistant tuberculosis that it didn't attack, this treatment. In fact, in some ways it was causing it if it was improperly applied.

That led to a reconsideration of the whole way of treating tuberculosis to include treatment of multi-drug-resistant tuberculosis, which at the time would have cost $15,000 per person. And by forming a coalition, the cost of that treatment has now been reduced to $300. So it has become practical. That's a tremendous achievement. This is called, if you are interested - it has a name, this - but it doesn't matter. Anyhow, there is this coalition that negotiated it.

So I think that's enough for an introduction.

MR. HAY: Let me bring in Gro Brundtland.

MS. BRUNDTLAND: Thank you very much. Now, first of all, the global burden of TB is immense, and it affects eight million people every year that get the disease, and about two million people die every year from TB.

The socioeconomic impact is equally devastating, and yet a simple, cost-effective intervention and cure has been available for decades.

So the plan that we are launching here today is tremendously important and exciting. It will enable hundreds of thousands of people with TB to have access to cost-effective treatment for their curable illness. And the overriding purpose and principle of the plan is to communicate this one simple message: We can control TB.

The global plan has four clearly defined objectives:

One, to expand our current strategy, DOTS, so that all people have access to effective diagnosis and treatment. DOTS is the standardized treatment which ensures that a patient takes the medication throughout the six- to eight-month period of treatment and that it is observed in the first two months specifically.

To adapt this strategy, number two, to meet the emerging challenges of HIV and drug-resistance. They have added to the complexities, as you can understand.

And, thirdly, to improve existing tools by developing new diagnostics, new drugs, and new vaccines.

And, lastly, to strengthen the Stop TB Partnership so that proven TB control strategies are being effectively applied in all countries.

Now, the plan estimates a five-year cost of TB control to be US$9.3 billion, and there is a funding gap of $4.5 billion. It is crucial that we are able to come up with these resources, and let me say they are not without reach. I mean, these are not sizes, when you look at the global society, that in any way should be impossible to get.

The most affected countries will provide their share, even the poor countries, but it is clear that a major injection of a development aid is needed to achieve our goals. With TB on the increase also in industrialized countries, this is not only the right thing to do, but it is also an act of enlightened self-interest.

So, finally - let me see if I have covered - yes. I will just mention to you the past 18 months, over those past 18 months, almost all of the 22 countries that account for 80 percent of the global TB burden have developed national plans for stopping TB based on the internationally accepted strategy that we have talked about.

Country plans for rapid expansion of DOTS are an integral part of the global plan, and WHO is honored to play a lead role together with so many key partners, like the World Bank, Partners in Health, the Open Society Institute, and many others in this global fight against TB.

I would like to reiterate that partnerships like this one against TB is the future of global health efforts. We have an unprecedented opportunity now to make a difference, and we as a global partnership are able to make that difference. We know it can work with the support of many enlightened individuals and groups who see what opportunity we have to really stop a major scourge.

Thank you very much.

MR. HAY: Okay, Dr. Brundtland. Thanks very much.

George Soros has asked me to -

MR. SOROS: I just want to add one little tidbit because you mentioned that it's a cost that is really affordable. There was an outbreak of MDR-TB on Rikers Island in New York, which was eradicated at a cost of about $1 billion. So put that in the perspective of the potential cost if you don't treat MDR-TB at its source, which is, for instance, in the prisons in Russia and in some other countries, in Peru, and so on.

I just wanted to add that.

MR. HAY: Thanks, Dr. Soros.

Let me bring in Dr. Ritzen.

MR. RITZEN: Thank you. A great pleasure to say a few words from the side of the Bank.

Why does the World Bank think that the strongest possible support for this partnership is essential? That is first and foremost because TB is the scourge both in terms of life, in terms of hope, but also simply in terms of the economy, in terms of productivity of people. Estimates are that annually $12 billion in income is lost due to - and I should add - curable TB. And then there the support for an effort which essentially looks forward to - what is it? - tripling efforts in countries in the next five years. That's what actually the figures mean of 70 percent detection, 85 percent cure. That's tripling, somewhat more even than tripling what we are doing, but feasible.

So the first reason for the Bank, it is pro-poor. It is precisely the kind of policies which the Bank should be engaged in.

Second, it is a good investment. It does indeed have a high rate of return. It is cost-effective.

Third, in this case, also, it's a very well-thought-through plan, with ownership. Mrs. Brundtland pointed to country ownerships. This is not something where the donor community came in and showed the way. It's something which countries individually themselves have developed the plans and where the donor community has been involved, but very much as an advisor at the side.

What does the Bank - what can the Bank do in this? Support the partnership, yes, with its comparative advantages being indeed also money. The lending program of the Bank will definitely also have possibilities for every good project in this area to be financed.

Second, convening power, bringing partners together. We, I think, are in that somewhat privileged position.

Third, analysis, particularly playing a role in trying to bring good practice to the table from the experiences in Peru to India or the other way around.

And then, lastly, as far as I'm concerned, I'd like to add to this usual and unusual circumstances. The usual has been something in which we have a long track record, that is, dealing with the formal government. But I'd like very much also to stress that we are also looking forward to be more involved in unusual situations. Haiti is an example. We have a substantial AIDS project despite the fact that we do not have a lending program.

We are also looking forward to being more active with respect to refugees, both in health and in education, and then particularly also health with respect to communicable diseases.

Thank you.

MR. HAY: Okay. Let's open it up to questions. Just one quick caveat, if we can stick with TB as a topic through to the end of the press conference, and then if you'd like to talk to Dr. Brundtland - let me be euphemistic here - about more general questions, you can feel free to talk to her about those more general questions.

Wait for the microphones in the aisleway, if you will. Please identify yourself and who you represent for the benefit of the transcriber there on the right-hand side.

So, the gentleman here in the middle.

QUESTION: Khalid Hassan (ph), Associated Press of Pakistan. Mrs. Brundtland, are you not really attacking the symptom rather than the cause? Because tuberculosis is rarely poverty related. It's lack of proper living conditions, lack of clean drinking water, lack of everything. And so are you not attacking the symptoms rather than the cause? Thank you.

MS. BRUNDTLAND: I think that was a very good question for me to get first because there is no way to be effective in dealing with the links between poverty and ill health without attacking also the causes, the direct causes of disease. If you don't go after the TB bacteria as it spreads, whether in poor or non-poor populations, not doing that will increase the burden of poverty. It will make it more difficult for people who are poor to emerge from poverty. Illness adds to the burden.

So if you look at what has happened in countries, even in your region, for instance, you saw in India that in the years preceding the great increases in economic growth on that continent, there was great investment in public health action, in immunization, in cleaner water - although we have a lot more to do. Without thinking those links both ways, investing in health helps avoid poverty and investing against poverty improves health. If you don't do it both ways, we are not going to be successful as quickly as we can.

Now, let me give you another example. This is TB. Let's say HIV/AIDS. Some people have said HIV/AIDS is linked to poverty, even questioning whether the virus is a key reason that we have HIV/AIDS. You have to be focusing on the fact that there is a public health threat communicated between people, but more easily spread in poor populations, with bad housing, with lack of nutrition, with all the difficulties of a life that doesn't protect you from infectious diseases.

So it's the same in the case of TB as it also on HIV/AIDS. Societal problems linked with poverty, but you have to do health interventions to prevent it and to deal with it and to treat the cases.

Thank you.

MR. HAY: This lady here, and then we'll come back to you.

QUESTION: Akwei Amazu (ph), AllAfrica.com. Can I ask you how much this campaign will depend on you making progress or countries, individual countries making progress on HIV? If you have a government that's not making what you consider to be adequate or strong enough efforts to deal with HIV, does that block this campaign effectively because HIV makes it so much more difficult to fight TB?

MS. BRUNDTLAND: They are very closely linked, and millions of the cases of HIV-affected individuals have TB in addition. But if we are able to get the DOTS strategy implemented in the countries that are the same countries that are struggling with HIV, then the fact of that program reaching people will help even to deal with HIV. Because as you have an infrastructure where there is a systematic approach to a major threat like TB, and you should develop in parallel with that better programs to deal with preventing and early treatment of HIV and dealing with opportunistic infections, both of those aspects will increase the basic ability of the health system to deal with many things, including other infectious diseases. But these are the major killers - HIV and TB - and we have to have effective programs, and they will supplement and increase the ability to have a functioning health system.

MR. HAY: A question down here on TB.

QUESTION: Para-(?), Press Trust of India. You have been able to wipe out some diseases like smallpox. Do you have any target date for wiping out TB just as you wiped out smallpox?

MS. BRUNDTLAND: What we have here is we have the millennium targets, which is halving the burden of malaria and TB within ten years. That is what the global community has set, and they are targets that are possible to achieve if there is a reasonable willingness in all countries to deal seriously with the millennium targets. And the fact that both HIV, TB, and malaria are singled out as important aspects of the Millennium Declaration indicates that countries should be ready - they have signed up to these as global goals.

But that is the kind of ambition that we can make. The elimination of a disease like TB is a completely different thing than to deal with it in a systematic way and to get the numbers very much down. So I don't think it is feasible to set a target of elimination yet. But we know we can get very extensive results and really make it a much lesser burden within a time frame of about ten years.

MR. HAY: Okay. The gentleman here, Andrei Sitov, in the front.

QUESTION: Thank you, Phil. My name's Andrei Sitov. I'm with Tass, the Russian news agency. I have a specific question on the Russian project and a more general one.

I think at least for the last couple of years the Russian Government has been talking with the Bank about signing a new TB and HIV/AIDS project, and the latest I heard a week ago from our Finance Minister was we are still considering it.

My understanding is that there is a powerful local lobby, maybe the pharmaceutical industry locally, that is against the project. But I would like to ask Dr. Ritzen probably to comment whether anything is wrong with that project from the point of view of the Bank.

And maybe in a more general way, does this initiative in general allow for taking into consideration the interests of such national lobbies that would probably fight for their interests rather than for the public good?

MR. SOROS: Well, I can comment on this because unfortunately I think you are right, that so far the Ministry has declined to take a loan, and it buys its medications from an importing company whose head is also the head of the Duma's Commission on Health. So you can see that there is a relationship there that is detrimental to, let's say, the introduction of cheaper medications, because through this program actually you could get medications at no cost or much greatly reduced cost. And there is nothing much to be done about it except exposing it, so I think your question is well taken.

I think the Ministry of Justice which has jurisdiction over the prisons is much more receptive. It's the Ministry of Health that has been obstructing this loan from going forward.

MR. RITZEN: Can I just add something to that? Also, with my own background, having served for almost a decade as a Minister, and realizing always the limited room for maneuver of politicians, and then adding the good news, which is that the negotiations on this project are still going on. And then the question was in particular, Is this project well designed? And the answer I think is yes, it can really stand the test of, say, international good practice.

But I think the questions are with respect to room for maneuver, how can you get it done, and at the same time develop a strong health system in which you need partners, and also on the other side, and that was the way in which it was communicated to us, concerns about the financial consequences for the Russian budget.

MR. HAY: Okay. Second row, chap with the glasses. John Donnelly, second row.

QUESTION: John Donnelly from the Boston Globe. For Director General Brundtland, I think this is sort of a period of great confusion in terms of global - or health issues in general around the world with so much attention now being put toward the anthrax issue.

I wondered if you could help sort of sort out this muddle in a way and say where does TB stand on your list of priorities in terms of tackling global health issues.

And as a related question, there's also kind of a muddle on how this would be financed, considering the new global fund for AIDS, TB, and malaria, whether some of the financing would go through that or through Mr. Soros' idea of this special drawdown plan.

MS. BRUNDTLAND: Well, first of all, as you look at the global health issues and the global burden of disease, then HIV/AIDS, tuberculosis, and malaria are three major scourges. They are those that have to have the attention of the global community and where we really have to work together to tackle those. They spread across borders. They keep people in poverty. There are easily available interventions that are not beyond reach, and they are not too expensive. They can be implemented.

So that's why in this area of global communicable diseases, tuberculosis figures high on the agenda. And as we have to have laboratory capacity, infrastructure of public health around the world to deal with any of these, it also helps us have a basic public health system that can pick up other threats.

As you all, I'm sure, know, childhood and maternal illnesses are other parts of the basic agenda for every country. But in addition to that, we have a number of other infectious diseases that can be picked up and dealt with if we have a basic functioning infrastructure.

So as we are looking at other kinds of threats which people have not thought much about until the last six weeks or so, we need the same collaboration and the same network of addressing public health issues to deal with such potential threats as we already have, the ones that we know of and the ones that we can clearly identify and that we have to deal with, like the tuberculosis challenge.

So those would be under some of my comments at this stage. But also, looking at the financing part of this, 4-1/2 billion U.S. dollars is not a big amount when you look at the kinds of levels of development - official development assistance that should be, ought to be forthcoming. The level is now around 50 billion worldwide, this ODA, but it is only at the level of .22 compared to .7, which is the generally agreed target for official development assistance. I don't think we can continue over the next decade to be so far below a reasonable target for those global common goods that we need to address as the poor countries struggle and really have no chance alone to meet the bills. They can, as their economies start growing and as their people can be brought out of ill health to a reasonable degree. Then, of course, this is not a permanent situation, but it will be for the coming couple of decades necessary to finance at a higher level of common endeavors to deal with development challenges.

And health figures very strongly in that picture, because people who are not healthy are neither going to be able to learn, and they are certainly never going to be wealthy.

MR. HAY: John, one of the big health challenges at the moment - and let me bring in Jo Ritzen here - is obviously the large number of Afghan refugees that are either camped along the southern border of Pakistan or have crossed into it. Let me bring in Jo Ritzen maybe to talk a little about our concern about the higher incidence and risk of transmission there in those circumstances.

MR. RITZEN: That's what I meant also was the unusual circumstances, that we are looking for ways and means in combination with the government of Pakistan to at least, in this area specifically, or this area of TB control, that may be also broader in areas of basic health, areas of education, to provide assistance. The Pakistan Government has, I think, very quickly stepped up to the plate and developed for TB control a plan to be dealt with in the next 18 months, and that's a plan which we are seriously now looking at, and in which teams of the World Bank are working together with the Pakistan Government.

MR. HAY: Emily Bloomberg -

QUESTION: Emily Schwartz from Bloomberg News.

MR. HAY: Absolutely.

QUESTION: I just want to follow up on what Mr. Ritzen said. How much money is being discussed for the TB action plan in Pakistan, and wouldn't that also possibly provide some kind of assistance for people in Afghanistan who right now cannot obtain World Bank lending, to the best of my knowledge?

And then what so far have the drug companies offered to do in this plan? Are they offering to provide money, sell drugs at no cost? If you could name some of those companies, that would be, of course, really great.

And then you're saying that the $4.5 billion gap, I just want to make sure that's over the next 5 years. I'd like to know how much of that money you expect to come from G-7 and Scandinavian, other large donors in the OECD, and whether or not the World Bank and other lenders should try to step back and not lend money for this so these countries don't get farther into debt. So what percentage of this money do you expect to come from donors?

MR. RITZEN: Just specifically on the way in which the Pakistan Government has at the moment envisaged a approach to help the 4 million refugees, which are at the moment Afghan refugees, which are in Pakistan. The total program at the moment is viewed as a program which should be directly full financed. There is no involvement of drug companies, and I think also that might be smart in a sense that it would be too complicated to look for solutions in which many partners would be involved. The total amount which is involved at the moment is pretty low, as would be really looked at as financeable. It's in the order of magnitude of $1.5 million, and that could still be a major way in which the problems in the refugee camps with TB - I'm talking specifically on TB - could be addressed.

QUESTION: I mean drug companies for the whole initiative.

MR. HAY: Well, why don't we bring in Mrs. Brundtland here to speak.

MS. BRUNDTLAND: Well, first, the prices have gone down by about one third, but I think I have to call on some of my experts here to be able to name companies and so on, but - they've now left. They were sitting here, huh?

MR. HAY: We can - Emily, we'll fix you up with them afterwards. Let's carry on.

QUESTION: Can you say about how many, what percentage of the 4.5 billion -

MS. BRUNDTLAND: But I should also say that, you know, when we're talking 4.5 billion, you have to remember that it is a five-year plan, so it's only - only - 900 million. When I say it is not something out of reach, it's 900 million a year.

Now, how that burden is going to be shared, you are absolutely right that it has to be taken by donor countries, and - but there is no way for us to divide and tell each country how much they are going to pay. What happens, of course, is that you mentioned Scandinavian countries, they pay, and they pay and pay, and they continue paying at .8, .9, or even 1 percent of the GDP. It is the people who are not paying who have to get a little up from their low chair and pay a little more. Because if you have a .1 percent of ODA going to development aid, and you are a big country, if you even increase it to .15 or .20, a big difference is made with the global resources. So I think one has to speak a little more loudly about that gradually.

MR. HAY: I won't ask her to name names. Gentleman in the back there.

QUESTION: Thank you. Matt McKay with Interpress Service, and my question is to Mr. Soros.

Mr. Soros, I'd like to hear your comment on what some of the NGOs and anti-localization campaigners would perhaps say now? They would in a way say that the World Bank and international financial institutions are being hypocritical in the sense that they advocate some policies in poorer countries, in developing countries, that actually are detrimental to health and increase poverty by, for example, pushing for the sale of public water utilities, you are depriving the poor of access to water. And that in turn causes more health problems. What do you say to that, sir?

MR. HAY: May I just answer on his behalf, and just say we're free to talk to him afterwards, but just until the end of the press conference let's stick to TB.

Lady just at the back.

QUESTION: My name is Lisa Friedman. I write for the "Oakland Tribune" and a group of California papers. California has the largest number of TB rates domestically, and I think ranks third highest rate in cases in the country. What's the importance, what's the relevance of an international program, of a global program like yours domestically in the United States to states like California, that have such high TB rates?

MS. BRUNDTLAND: Well, I think it is possible to look nationally and domestically at the United States and what happens in all the states of the United States in a key program like this, and at the same time think about being part of a global challenge and looking at other parts of the world as well. There is nothing to stop California from dealing better with is tuberculosis situation, and California can afford it, should be doing it.

[Laughter.]

MR. SOROS: I think that basically the public health services in the United States are pretty good, and in any case, the United States should be able to take care of its own needs.

There is this danger of the MDR-TB spreading to the United States, which when it does, becomes extremely expensive, and that's why I mentioned this case of Rikers Island in that context.

MR. RITZEN: If I may just add - it's always dangerous to add to a person like Gro Brundtland, who knows so much about it. But there is also really here an investment aspect in the sense that Californians should be willing to invest in TB control in other countries because TB is not something which is sitting on one place. It's transmittable. And if the west, if the rich countries want to remain free, particularly of the TB of the worst type, which is difficult to treat, then they better should indeed engage in this. What is $1 billion when you look at the way in which we have been speaking in the past weeks about new resources being made available? And in that respect I do think it's very important to make sure that all efforts are directed to, indeed, in the long run to eradicate, but that may not be something which is in the short run - and I speak still about 10 years as a short run - feasible.

MR. SOROS: I wouldn't be astonished if the higher incidence of TB in California is connected with higher rates of immigration in California.

MR. HAY: Let me just remind you there are copies of the global plan outside this room. I think we'll call it to a close. If you want to buttonhole our panelists up here afterwards, feel free. And let me just remind you that -

MR. SOROS: Maybe you don't want to - give a few more - let's have a few more.

MR. HAY: Oh, okay. I was trying to safeguard their precious time, but that charity is not called for.

Gentleman there in the middle then.

QUESTION: Thank you. Todd Zwilick with Reuters. Following up on the question about this effort versus the U.N. led global fund on HIV, tuberculosis and malaria, how do these two plans interact? Is there any money interacting between them? How does the public distinguish between the global fund and this plan, when to them it might be just another international/U.N./World Bank effort to eradicate diseases that they don't distinguish between?

And how do the two plans avoid bumping up against one another? In a country where there is a TB problem, how will they avoid competition that might be detrimental to the actual people who have TB or have risk of contracting it?

MS. BRUNDTLAND: I think if we look at the global AIDS and Health Fund, which will now be called the Global Fund for AIDS, Tuberculosis and Malaria - that is the new name which has just been defined a week or so ago. That fund will help us move resources into the key health areas and add to what is already happening around the world on these issues.

As we sum up what has happened based on this plan, money that will flow into TB programs from the global fund will be part of this 900 million. It is not going to be in any way I think confusing because the key agencies, the World Health Organization, the World Bank, the key donors, will all be involved in the Global Fund for AIDS and Health, which it had been called until now, and will be following what happens with this concrete plan about TB as such. It is part of the input to have the technical and total background about what is needed in the area of tuberculosis, as well as we have the document from the Summit on HIV/AIDS, to lead us on some of the key priorities within that area, and of course the technical background documents that we work on between the U.N. AIDS cosponsors and of course World Health Organization being central to it with regard to AIDS.

And the same is with malaria. We have the Rollback Malaria partnership, which then brings in other sources than the classical donors, which helps us also raise money from private sources, foundations and even from private citizens, because it depends on where you would like to put your money. We will be able to keep track of that money, I can assure you, and see to it that there is no duplication, that there is national ownership, that it is based in government efforts and planning in these areas so that we are using resources efficiently.

MR. SOROS: There's a much more interesting, or just as interesting question as to how the Global Fund for HIV will be organized, and I think that the governance that has evolved here can serve as a - tell me if I'm right in this - it could really be an example of how the HIV effort will be organized, because this brings together all the players. And I don't know how it stands on HIV. I don't think it has been decided yet how that global fund will be organized, and I think this should be taken as possibly a prototype of how that should be organized.

MS. BRUNDTLAND: So the fund planning is going on in Brussels with the support of all of us here, and it is on track to be starting in January, as the Secretary General has announced, and it will cover all of the three diseases, not only eight, but it is built on partnerships, and it's not only donors, not only international agencies, but it is also NGOs and, of course, the countries that are affected themselves being represented on that board, so that we can work together to find the best solutions, also, in the AIDS field.

QUESTION: But I'm confused. I'm still confused as to how - you explained it, but I think the public may be confused -

MS. BRUNDTLAND: What is your problem? I can maybe help you.

QUESTION: Yes.

[Laughter.]

QUESTION: How the money in the global fund for AIDS, tuberculosis and malaria interacts with the funds from this. You said that resources from the global fund will be used to -

MS. BRUNDTLAND: There is no fund in this plan. I mean, this is a technical plan explaining what needs to be done for tuberculosis. There is no money pledged for this as such, but there are people engaged in the TB field, there are donor countries, there are actions going on at country level trying to raise the awareness on TB and to increase domestic resources going into TB, and we are telling what needs to be done, and we are telling that we need to support these efforts and try to mobilize resources. So the global health fund is an answer to this plan, to help the plan being able to be implemented.

MR. HAY: Okay, time for, I think, two more. I see one hand up. One last question. So the gentleman here in the second row.

I hope that was clarified, sir. It certainly was in my mind.

QUESTION: My name is Scott Hartman [ph] with U.N. Wire.

The question is for all members of the panel. In light of the economic problems that are beginning to develop in the global economy, do you foresee that there are going to be any problems with private, at least private fund-raising for such global initiatives, with a lot of people's attention focused on other issues, especially, for example, the humanitarian situation in Afghanistan or even in this country?

MR. HAY: Why don't we bring up one such private individual right now?

MR. SOROS: Undoubtedly, there's going to be a tremendous pressure of demand from various sources. And private donors can't, will not be able to meet at all, and that is why I think it is so timely to have a greater public contribution to the provision of public goods. And that is, in fact, I was working on this plan before September 11th, but September 11th has made it much more pressing.

MR. HAY: Do you want to add to that dr. Brundtland or Jozef Ritzen?

MR. RITZEN: If I may.

MR. HAY: I mean, for the private sector to step up.

MR. RITZEN: I can't really judge on the private side, but the signals which we receive from the public side are actually encouraging. The September 11th event has given rise to also a greater concern about the way in which inequalities in the world give rise to insufficient fertile ground for peace. And in that respect, I think in many governments there is this awareness that ODA, which is not the only solution, but which definitely also would be a major contribution, Official Development Assistance, should be raised, and we have seen signs of that.

There is this Finance for Development Conference in Monterrey, and I know from several political leaders in Europe that they are going around particularly making this point, as Gro Brundtland made it just a second ago, that it is really now the time to raise official development assistance. And I think they also find that there is receptivity.

The U.S. also has indicated also in the negotiations for IDA-13, for the new round of International Development Assistance, that they are willing to raise the amounts. And, of course, we have also seen, but that's maybe a minor point, but part of the same spectrum that also in the U.S. there was the immediate resolution to pay all of the United Nation's fees.

And I think those are all signs of awareness of we are in one world, and in that one world much more can be achieved if we are closely, more closely working together, closely working together in terms of spirit, in terms of thoughts, but also simply in terms of money flows.

MR. SOROS: But governments are unlikely to act unless there is public demand for it.

MR. HAY: Thanks very much, indeed, everyone.

[Whereupon, at 11:51 p.m., the press briefing was concluded.]