Talking Points for Callisto Madavo
Durban, June 6, 2001 Mister Chairman,
Thank you for that wonderful introduction. I am very pleased to be here.
Consensus beyond the controversy
Achieving affordable access to treatment for communicable diseases is really a "hot-button" issue. The debate has been intense, particularly as it relates to HIV/AIDS treatments, including anti-retroviral drugs. In recent months, governments, the pharmaceutical industry, development agencies, academics, and activists have all weighed in, passionately.
What I find interesting is that if you filter out the rhetoric, you find that those on the various sides of the debate have quite a bit in common, much more than they may realize. They have the same basic goal – expanding access to life-prolonging drug regimens – but they have different ideas on how this goal should be achieved. Today, let us look for common ground, and see how we can best work together.
Let's begin with what we can agree on.
I think we all agree that communicable diseases, and in particular the HIV/AIDS epidemic, are no longer public health issues – but that they have become a development issue. Their impact on society and the economy is wiping out Africa's hard-earned development gains of the last decades. I think we all agree that HIV/AIDS, tuberculosis, and malaria interventions are not reaching nearly enough people in Africa. Only 10,000 of the 25 million people living with HIV/AIDS in Africa are currently taking highly active antiretroviral therapy. Only 2 percent of African children are protected from malaria-carrying mosquitoes by treated bed nets, even though this simple, relatively inexpensive tool is known to be effective.
I think we all agree that none of us can tackle these challenges alone. We – government, the private sector, civil society, and the development community – need to work together. We need to mobilize a strong partnership against these diseases. And I think we can all agree on the key characteristics of successful interventions. Let me mention four of them: a comprehensive approach, result-oriented programs, local ownership, and capitalization on a diverse range of comparative advantages. There is a shining example that shows success is possible: the international partnership against onchocerciasis. "Oncho" is a parasitic disease that causes debilitation, eye damage, and eventually "river blindness" in West and Central Africa. The "oncho" program, which involved African governments, the private sector (and in particular Merck), NGOs, and donors, has halted transmission of the disease in 95 percent of the program areas. More than 12 million children are growing up without the risk of contracting the disease.
The importance of prevention
Before I move on, I would like to emphasize that the debate on treatment should not overshadow the fact that the best way to fight communicable diseases remains prevention. All the partners – governments, business, civil society, including religious groups, etc. – need to speak up forcefully on this issue.
And there are good and encouraging examples of this. The commitment of the governments of Senegal and Uganda, for example, has made a critical difference. Still, prevention will never be enough – and we must also find ways to ensure affordable access to treatment.
Let me turn to three of the key issues that underpin this challenge of access: infrastructure, drugs, and financing.
Health infrastructure
Given the limited health infrastructure in many areas, is large-scale distribution of ARV drugs possible in Africa ? We can't wait until we have perfect infrastructure. We have to distribute in as feasible and efficient a way while we build the infrastructure. We, at the Bank, stand ready to support such an approach.
We have to work together on this infrastructure issue. Governments can design and implement the necessary reforms to improve the health systems. But, even revamped, the public sector cannot face this challenge alone. Private sector and civil society need to participate on a large scale in the delivery of medical services. And we have to encourage communities to get involved in the provision of these services, to maximize impact and reach out to isolated areas.
Making drugs available
The second issue we have to address is the availability of drugs.
For HIV/AIDS, the private sector is leading efforts to develop life-prolonging treatments and vaccines. Pharmaceutical companies are advancing the state of the art in HIV/AIDS research, moving us to a point where HIV can be treated as a chronic illness. At the Bank, we stand ready to expand our support to ensure that priority products of the future¯such as vaccines against AIDS and malaria¯are more rapidly developed and tested.
But, as we all know, HIV/AIDS drugs remain out of reach for the vast majority of the 25 million Africans who need them. Our common objective is to find ways to make these drugs, as well as treatments against other diseases, affordable. In this process, we need to strike a balance between the urgency of the crisis and the need to ensure that there remain sufficient incentives for the private sector to continue engaging in a constructive partnership and developing new products.
Financing access to treatment
Such efforts must be financed. We have all heard the numbers. Most recently, at the Abuja Summit last April, UNAIDS suggested that $3 to 4 billion are needed annually to finance a large-scale assault on HIV/AIDS in Africa – for at least the decade to come. This includes $1 to $1.3 billion every year for treatment. But it does not include the cost of fighting other communicable diseases such as malaria and tuberculosis.
It will be our common challenge to help make such funds available. Most African countries cannot make the necessary resources available. Several bilaterals have announced contributions. At the Bank, we have launched a multi-country, $500 million program, that we intend to replenish regularly. Civil society and the private sector could also contribute large amounts.
Part of this increased funding could come through a new multi-billion dollar Global Fund against communicable diseases. Proposals are expected to be discussed at the July meeting of the G8. If we were asked to do so, we would be willing to host this fund, and to help implement it – working very closely with our partners in that area.
But, at this stage, it is not clear whether these needs will be met. The contributions that have already been announced remain far below what would be required. Resources will remain scarce. And as a consequence we may have to make tough choices.
This is an area where we have to make sure that all stakeholders are adequately involved. Making the necessary choices is not a matter for the government only, or for the donors. It calls for inclusive processes, where civil society and the private sector are duly represented. This is an area where we need to work closely together.
Conclusion
Let me conclude where I began. Let us not allow controversy to divert us from our common objectives of fighting HIV/AIDS and other communicable diseases and ensuring effective and affordable treatment. We– governments, private sector, civil society, and donors – have to work together to find comprehensive solutions to help tens of millions of African men, women, and children have proper access to the treatments they desperately need.
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