MALE SPEAKER: This press conference is to discuss funding for HIV -– global funding for HIV. Our speakers this afternoon are, from my left, Stephen Lewis, who is the Secretary-General special envoy on HIV-AIDS in Africa, former Deputy Director of UNICEF and former, among other things, former Canadian Ambassador to the United Nations. On my immediate left is Jeffrey Sachs, well-known international economist, and he’s now at Columbia University with the Director of the Earth Institute of Columbia. He’s also the special advisor to the United Nations Secretary-General on the millennium development goals, which he participated in developing. On my right, many of you have been in press conferences already with Dr. Peter Piot, the executive director of UNAIDS, and to his right we’d like to introduce Dr. Richard Feachem, who is the executive director of The Global Fund on AIDS, TB and Malaria, which is based in Geneva. Formerly was teaching with the University of California, San Francisco, and prior to that he was with the World Bank. We’re going to begin with an overview of the current funding situation from Dr. Piot.

DR. PIOT: Thank you, David, and good afternoon. As I said at the opening ceremony, we’re not here to renegotiate the needs to fund the response to the epidemic. We are here to make sure that we have a plan to get and make sure that the needs are being filled. Last year when the Secretary-General called for $7 billion to $10 billion to fund the AIDS response in low and middle-income countries, he didn’t pick up that figure out of the blue. This was based on a quite sophisticated study by a group of economists and staffing UNAIDS and was published in science magazine in June of last year and a later deadline, or target date, were one of the main differences.

I would say that at least $10 billion are definitely a minimum need and a start. We realize that there are obviously bigger needs, also needs outside health sector spending. For example, the World Bank estimates that education for all, which I mentioned in my opening speech, is a fundamental strategy to deal with HIV, will require immediately $4 billion. So we have to really specify better what is included in here. The second point is I want to make, as you know is, what is available today according to our estimates for this year in terms of expenditure, not so much in terms of budgets, is $2.8 billion. And that $2.8 billion comes from governments in the developing countries, they come from bilateral donors, they come from the multi-lateral system at the UN, or world bank loans, they come from the private sector and NGOs, international NGOs particularly, and they come from the global fund to fight AIDS, TB, and malaria. So, we have an enormous gap. And, the way to fill that gap is really basically by the fact that each of the major channels for funding the response have to demonstrate their worth and have to increase their funding.

At least 50% per year, as a minimum should be the increase the next few years, so nobody gets a free ride here. That should be made very clear. This is a minimum and non-negotiable, as I said. The key issue now is how to get there and to make sure that these are additional resources. It would be plainly a disaster if the response to AIDS would be funded with money that comes from, that the purpose of which was to fund fundamental investments in development, be it in education, be it in water development, etc., etc. So, I’ll stop here.

MALE SPEAKER: Jeff’s next.

JEFFREY SACHS: Thank you very much. I think, in a quite important way there is enormous progress represented at this meeting. There is a global strategy based on prevention and treatment for confronting this disease. There is also, I think for the first time, realistic numbers on the table with regards to the financial requirements for this battle. What is lacking now is a plan of action. And, I would predict that within 90 days, we will have a global plan of action. We have the leadership now with Peter Piot, at UNAIDS, with Dr. Bruntland (MS?) at WHO, and with Richard Feachem (MS?) at the Global Fund that can put together this plan of action.

I know that it is desperately needed. Secretary Thompson was probably surprised at his reception today, but he should not be surprised. It is a reflection of the utter confusion within the United States Government about what they are actually doing. They believe that they are doing the right thing, I have little doubt about that, but I know that they are utterly confused about the situation because they have not tried to put together, or to adopt, a plan of action. They pick numbers out of the air week to week, they have not budgeted systematically over the next few years, and when I inquired about this at the White House and elsewhere in the leadership of the administration, the responses I’ve gotten in recent weeks showed that they had not done their homework. And, this is why the reception is the way it is. They have failed to understand that the global fund must support, not only direct interventions, but the scaling-up process itself. They have forgotten that the Global Fund is for tuberculosis and malaria, as well as for AIDS. They are using internally unrealistic measures, which are not the ones that experts are using internationally. And this is what’s leading to the confusion.

What is quite heartening is that there is leadership in the United States. Secretary Thompson noted that, just recently the administration turned to Tony Fauci at NIH and to the Centers for Disease Control, and they quickly came up with a plan. So, in addition to a Global Plan of Action, which I believe the Global Fund, UNAIDS and WHO should present to the world within 90 days, I hope that the administration would turn to it’s own experts, to Dr. Fauci, who is one of the world’s authorities on HIV-AIDS, to the Centers for Disease Control, to take away the misconceptions that are utterly clouding US Policy right now, so that we can get on an appropriate track. Without the United States, it is much harder to accomplish this goal. The numbers are clear, the need for scaling up to around $10 billion a year from the donors for the HIV-AIDS fight, has been made clear by UNAIDS and it’s very similar to the numbers in our report, the WHO report of the Commission on Macroeconomics and Health.

In addition, we need donor support of around $3 billion per year to fight malaria and tuberculosis, which are also mass killers and which are under the purview of the Global Fund. Properly so, because the diseases are not only afflicting the same populations, but are also interacting in devastating ways, as people know.

So, I would conclude by saying that the pieces are coming together. I admit that the United States Government doesn’t quite know that yet, but I think within 90 days it will know it. There can be a global plan of action, with specific funding recommended by UNAIDS, by the World Health Organization, and by the Global Fund, which will eliminate the massive confusion, which unfortunately continues to afflict the world’s most important donor and the one who has failed most in meeting the challenge to this point.

MALE SPEAKER: Dr. Feachem from the Global Fund.

DR. FEACHEM: Well, thank you very much and good afternoon. I will briefly –-

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Good afternoon. Thank you. I will repeat, briefly, the comments that I made on the subject on my speech earlier today. Firstly, the Global Fund is aware of the various estimates that have been made for he Global Resource needs in HIV-AIDS and in TB and in malaria. We think those are sound estimates. Jeff Sacs just repeated them. $10 billion a year for HIV-AIDS as a minimum. Possibly an additional $3 billion per year for TB and malaria. We agree that this is in the right ballpark. These are the kinds of resources that will be needed. A substantial proportion of those resources, we don’t know exactly how much, will flow, and should flow through the Global Funds. The Global Fund is committing today to undertake detailed financial projections on the revenue side and the expenditure side and to agree those projections with our board at its third meeting in October.

So, before the end of October, the Global Fund will be announcing its resource requirements and putting those in the context of the other flows and the other mechanisms which exist, both bilateral and multilateral to address the same three diseases. And, we look forward to taking that discussion further with all of you and with the donor countries following our October announcements. Thank you very much.

JEFFREY SACHS: And that is the suggestion that the United States administration has not done their homework. I’m a Canadian; I’m paranoid about the 4,000 miles of undefended border.

I have four points I’d like to make. Number one. There is a coincidence and irony here that Barcelona is occurring at exactly the same time as Durbin. The lessons of Barcelona, I’d like to point out, hugely compromise the objectives of Durbin. We’ve the African Union founded largely with the new partnership for African Development as its centerpiece. The new partnership embraces the millennium development goals. There is no way, within Africa as now constituted, that those goals can be realized, unless the pandemic is defeated. This point was made vigorously within the Macro Economic Commission on Health.

When you’re looking for a 7% increase every year in productivity, a reduction by half in poverty by 2015, a reduction in infant mortality rates, a reduction in maternal mortality rates, universal primary education, leading to gender equality, it can only be said that the lessons of Barcelona are on a collision course with the objectives of Durbin. And, they are on a collision course in significant measure because we don’t have the resources.

Leads me to the second point -- the figures of $10 billion, which everybody agrees, and I will steal a phrase from a friend, must constitute a moral minimum. A moral and economic minimum. Plus, the additional money from tuberculosis and malaria. Those figures will undoubtedly increase significantly over time. Because, when they were first proposed by the Secretary-General, and thank god he laid down that basis for discussion at Abuja in April of 2001, the results of the Macro Economic Commission on Health had not yet been published. The apocalyptic figures released last week on the numbers of potential deaths had not yet been released by UNAIDS. The discussions which underlayed the GH speaking to increases of $4 billion a year for primary education, in order to create an infrastructure in Africa where the pandemic could be dealt with, the continued grinding down in parts of Africa of the human condition, as a result of famine and poverty and drought, particularly in East and Southern Africa. All of these things have compounded the situation desperately, and made it necessary, therefore, to compensate with the frail and inadequate contributions that the Global Fund has so far received.

Three -- the Global Fund is obviously seen by everyone as a significant new vehicle to rescue the world from the pandemic and certainly to intervene in Africa. And whatever the amount be that is determined for the Global Fund as a proportion of the overall dollars, I’d like to suggest, however presumptuous, that in the design of a 90-day plan, some formula be found in order to indicate what is expected of the various country contributors -- of the various donor contributors. One of the basis on which that formula might be constructed is to look at the formula which presently exists, by which countries make their contributions to the United Nations budget, because that’s a formula on which every country in the world has agreed, even if some of them tend to pay it rather later than others.

And that formula indicates that the G7 countries would be responsible for about 70% of the overall contributions to the fund. Another 40 relatively high-income countries in the human development index, would be responsible for another, roughly, 20%, and the last 10% shouldn’t be occupied by the poor countries, but should, I think, be occupied by the private sector. And you get, therefore, a nice constellation of contributors.

But, that’s a suggestion based on UN experience. There may be others. There has to be some kind of formula for countries like the United States to know what is expected. Finally, and I feel this more strongly than I can possibly convey, the two reports which undergird this conference, which emerged last week: The Global Academic Report from UNAIDS and the report, which was launched by Carol Belamy (MS?), and Peter Piot was there with the World Health Organization on AIDS and Youth.

Those two reports demonstrated, more dramatically than ever before, that it is women, it is women and girls who are overwhelmingly the casualties of this scourge and it is getting worse. There are 8.6 million young people, between the ages of 15 and 24, living with AIDS now in sub-Saharan Africa, of whom 67% are women and girls. It is a nightmare.

And the discussion of resources leads me to say that all allocations must be subject to some kind of gender analysis. So, whether it’s Richard Feachem sending money for treatment or sending money for prevention, we’ve got to make sure that the money is going proportionately to those who are paying proportionately the greatest price. And, at the moment, the greatest price on this planet is being paid by the women and girls of Africa. Thank you.

FEMALE QUESTION #1: Quite insisted that it was understood, from the outset of the idea of the Global Fund, that bilateral donations could be considered “fund donations.” I’d like Dr. Feachem to respond.

DR. FEACHEM: I’m amazed to hear that. That is absolutely not our understanding. Contributions to the Global Fund are contributions to the Global Fund. Bilateral assistance, however welcome, however useful, however needed, is not a contribution to the Global Fund. And Ambassador Dr. Jack Chow of the State Department, who is also here and was asked this question a few moments ago, has the same impression of that as I do.

MALE SPEAKER: Okay, next question. If you could please give your affiliation. Could you stand up?

PARIS, FRANCE, POLITICAL ORGANIZATION: Sure. I’m with Political and Active Paris (MS?), an organization in Paris, France. My question to the panelists would be, what would be your recommendations for immediate action on the part of the (MS?) countries -- in the US, for example -- and especially in terms of financial commitments that need to happen there if the goal that we’re hearing at this conference -- which is, for example, four million people and treating them by 2005 -- is going to be ever reached? What needs to happen now?

JEFFREY SACHS: The beauty of the Global Fund and the reason why it should get the preponderance of the resources is that it invites countries to make proposals that are specific to the country needs and priorities. Because the fund has lacked resources, there was quite a desperate attempt by many donors to twist the arm of countries, as they applied to the Global Fund in the first round, to keep the size of their requests down. And then very sound proposals were rejected in the first round on the basis that they were too large. And it was requested that a country like Malawi, despite receiving an official report that said that they had a technically sound proposal, was requested to slash significantly the amount of funding for treatment, management, oversight and evaluation -- all the things that we’re told are so significant.

There was a game going on by important donors who wanted to hide the fact that there is massive capacity for scaling up, and therefore massive ability to receive resources responsibly right now. The donors did not want that to be known. So they twisted the arms of countries to hold back on the size of their proposals. We will be out in force all over the world -- we in academia -- to make sure that this does not happen again, or that it’s utterly exposed systematically, because this is what is holding back action -- the attempt to pretend that there is not the ability to fight this pandemic when we on the ground know that the ability is utterly there and the Global Fund makes it clear what that ability is.

So the point is, let’s treat this honestly and transparently, and then the process will go forward as long as there’s money in Dr. Feachem’s account. And that’s what we need to increase right now and then encourage all countries that need help to apply for the September allocation of proposals. And we will be out by the hundreds, and we will work with experts all over the world to make sure that countries are putting in the kinds of requests that they need at the scale that they need. And I believe that the plan of action that the WHO, UNAIDS, and the Global Fund will come up with in three months will make perfectly clear how much funding is needed to meet those plans as they come in.

DR. PIOT: Two things. One is to estimate this so-called “program capacity” or “absorptive capacity.” And just to underline what Jeff said, that is there. As I said in the opening ceremony, I don’t know of any health infrastructure in developing countries that has been used to the maximum to offer treatment. I mean, that’s not -- the need for building infrastructure is obviously there, but let’s also start with what’s already there. Secondly, or thirdly, and so we are monitoring that further – program capacity. And lastly, we are refining also the resource needs.

There was some presentation this morning by (MS?) on the needs in Latin America and the Caribbean. We are also working on the countries of the former Soviet Union, because there, as you know, there is an emerging epidemic and we’ve got to take care of that as well.

ANNA ROSS, ASSOCIATED PRESS: Secretary Thompson mentioned that the US contributes 45% of all the funding worldwide to all the AIDS-HIV activity and 25% of the Global Fund, and that was kind of presented as a fair contribution in that activists should look to other countries to ante up the way that the US does. Is that a fair contribution, or if it’s not, what is the ballpark range that is more fair?

JEFFREY SACHS: (MS?) The US is about 40% of the high-income world GNP. The United States GNP is about $10 trillion out of a $25 trillion high-income gross national product. So 40% would be somewhere along the share of income of the United States.

One could also say that those numbers might have to be qualified, but Secretary may be correct. I would say around a third perhaps might be a realistic number. But what’s important to understand in this game -- because it is a game unfortunately in politics too often -- the United States puts out a marker and then other countries match it. So we determine the overall scale. And it’s quite predictable, if the United States contributes $200 million to the Global Fund in fiscal ’03, that that might get multiplied by another $500 million or $600 million by other countries in fiscal ’03.

But if the United States put in what it needs to put in, $2.5 billion or so, then that would get matched by another $5 billion to $7 billion. And for the United States to say “we’re doing our share” is not the point. The point is for the United States to be doing the absolute amount that it must be doing so that other countries are doing the absolute amounts that they are doing. For everybody to be doing their share of a total sum, which is a 10th of what’s needed, is not a solution to the AIDS pandemic.

And by the way, the virus knows the difference. You know, all of this game playing hasn’t stopped the pandemic. And these deaths are on the watch of the Bush administration, they are on the watch of the leadership and politics in Europe and the rest of the world. So, however one skins it, the pandemic itself is out of control. That’s what the findings are. Despite the availability of strategies, despite the availability of a course of action, because we have no plan of action, this pandemic is not yet being curbed.

JEFFREY SACHS:(MS?) May I take the opportunity just to put it in a Canadian context, by simple comparison? Whether we use the UN formula or the rough figure of 25% from the United States, which is the UN formula, Canada’s percentage of the formula is 2.579%, and that means that if we -- if the Global Fund, let us say -- was receiving $10 billion a year at some point, Canada’s responsibility would be $250 million a year American, or roughly $400 million a year Canadian. Canada has now contributed $150 million Canadian over three years. The American shortfall induces a shortfall in the response of every other country.

UNION JOURNAL OF PUBLIC POLICY:(MS?) My name is Padraic O’Malley (MS?). I’m from the “Union Journal of Public Policy” (MS?). This is a question of puzzlement. I’ve gone through a number of African countries and spoke with people who are working on AIDS at the highest level in government. And, to a person, they will say that the amount of an assistance coming into the country is not fully used or, in some cases, even minimally used. Do you have to create an infrastructure that allows people to effectively use the aid that is given? It’s like aid before aid, to make that aid work effectively in prevention and treatment.

JEFFREY SACHS: There are innumerable countries in Africa begging for more help that say that they need a massive scaling up, and yet are not receiving the assistance. And they are calling me and calling our institution at Columbia University -- morning, noon, and night -- for help in trying to find the additional resources. So I don’t think that the characterization is universal in Africa. I know of many governments that are pressing morning, noon, and night to try to keep their people alive.

Of course, with those resources would come the complex process of scaling up. Doctors do need to be trained. Clinics do need to be outfitted. Nurses do need to be trained. And given the numbers of doctors and nurses dying of AIDS or being pulled away by brain drain by the United States and Canada and Europe, going in actually to recruit African doctors to take care of hospitals in our countries, there is a massive shortage.

So let’s not say that it’s – let’s make clear that there is a lot of work to do. But my sense is that there are dozens of governments around the world that are pleading for help and that could use the help effectively, but it has not been on offer. The beautiful thing about the Global Fund is that it invites such governments to act boldly to run, if they can, but not if the donor is holding their leg and saying, “You can’t run. You see?” and pulling them back by the back-room operations of saying, “Don’t even ask for that. We will pounce on you if you say what you need.” And I know of cases like that, and I’ve been in the room to see that horrible kind of behavior, and that’s what has to end now.

DR. PIOT: This is an issue that we are very concerned about because it has been brought up over and over again. The history of the global response to the AIDS epidemic is a history of demand reduction -- demand reduction by the communities, by those who are in need, so that governments -- the domestic governments -- or international donors didn’t have to pay the bill.

And as I mentioned before, in UNAIDS, we are monitoring the program capacity -- the so-called “absorption capacity” -- and there are problems. And there are particularly problems if you think that the response against AIDS is limited to clinics, to hospitals. That’s true. There is still an enormous absorption capacity for treatment, but the response to AIDS has to happen in all sectors in society, and they are totally under funded. They don’t get any funding and they are not utilized.

Fourthly, I would say there is a need also to improve absorption capacity of donors. If we’ve learned anything with AIDS, and that is that we need institutional behavior change as much as individual sexual behavior change. And that if donors continue to focus on just tiny little projects with tea-bag accounting -- well, you need to fill in 15 forms to tell the donor how many pencils you will use three years from now -- of course, then there is a problem to spend that money. And that’s why multilateral assistance is far more efficient.

And the last point I’d like to make is that we present this as if all the money that is needed to take on AIDS in the developing world will come from the rich countries. In our estimates, we feel that about one-third of the $10 billion can come from the governments in the affected countries themselves. And that is going to be more true in Asia and in Latin America, the Caribbean, than in Africa, where the needs are bigger, but also the financing capacity of the countries is lower.

But all these countries have an army. It is about the future and the survival of the nation. And they are also – there is an increase now in domestic funding, which has to go on. But that will only be possible if that is our (MS?)

JEFFREY SACHS: --donors. Therefore, not $10 billion, including what the countries themselves were paying. The difference is, we factor in the infrastructure buildup needs that go along with scaling up, and I believe those have to be factored in. I just want to be clear, when I speak of $10 billion, I’m talking about from the donors only. In addition will come money from the countries.

The difference of our numbers is not technical disagreement. The difference of our numbers is what’s counted in those numbers. So it’s not a fight among experts. It’s the same experts. But our numbers include the scaling up and the infrastructure, the equipment, the building of clinics also over time, because this is a battle over time, where you scale up that battle, and our numbers include that scaling up. And that’s why they are a bit higher. Same experts, same method of calculation, higher numbers here, because they are more inclusive.

MALE SPEAKER: Okay, question from John Donnoly (MS?) and then John Kahn (MS?). Just a second, John.

JOHN DONNOLY: Two questions. First, for Peter. What is the absorptive capacity for these countries? Have you quantified that? Right now. I assume it’s above the $2.8 billion that you estimate (MS?). And secondly, I’m wondering, if you’d put together this model, where you slot nations in terms of what percentage they should pay of the $10 billion, if you essentially change the dynamic of who will pay first. In other words, if you no longer need the United States to lead, you could then go and ask any other country to lead the effort.

PETER PIOT: On the first question, the so-called “absorptive capacity” today, and that’s –- I agree with Jeff’s last comment, by the way, just to make that clear that that explains the difference in figures. It is well beyond the $2.8 billion that are available today. It’s probably at least half of that. And I’m saying “immediately.”

MALE SPEAKER: At least twice that.

PETER PIOT: At least twice – yes, at least.

MALE SPEAKER: You said it was half of that.

PETER PIOT: Oh, sorry, no, sorry, sorry. I’m not a native English speaker. I’m the only one here who can always use that excuse. Where was I? Well, it’s double, yeah, yeah. “Twice,” “double” -- that’s the same word.

And as Jeff also said, as programs are rolled out, the capacity has to be built up and will expand. And that’s why both the Commission on Macroeconomics and Health and our estimates are –- have to be taken over a certain number of years.

JEFFREY SACHS: On absorptive capacity, please remember also, malaria and tuberculosis are killing millions now, and they can be bought and scaled up dramatically -- in both cases, dramatically with billions of dollars of immediate absorptive capacity.

When you go to a clinic, as my wife and I did in January in Malawi, and there’s no quinine there, you know you have a problem. Children are dying for lack of the most basic emergency interventions, because the hospitals do not have the money to keep the inventory stocks that they need. This is pervasive across Africa right now.

So if you add in the $6 billion or so of immediate absorptive capacity per year on AIDS, another $2 billion to $3 billion on malaria and TB, you begin to get a picture of what immediately could be done. But then, with some scaling up in short order, this will readily reach the $10 billion for HIV-AIDS and the additional $3 billion of donor funding for malaria and tuberculosis that I spoke of earlier.

Your idea, John, of not having the US lead, is perfectly sound. It is not how the world has tended to work. It’s interesting that the United States actually attempts to pull back other donors as well, or at least other donors like to hide behind the skirt, and so you tend to get this kind of choreography. I believe that, when we have fully fledged numbers from WHO, UNAIDS, and the Global Fund within the next 90 days, the dynamic will change. And that is why it’s so important to get these plans of action on the table.

MALE SPEAKER: Okay, John Kahn is next, and then Lori has a follow-up. How many people – could I see a show of hands –- the number of people that want to ask questions? Okay, we have about 15 more minutes left, so we’ll try to get everyone in.

JOHN KAHN: I’ll be brief. I’m confused about a number that might confuse many of us. How much do you think the US should be spending right now? You said $2.5 billion, but you said one-third. You said $13 billion. I’m lost. What number is it? And, then my other question is, can you name names of people who, in meetings that you have been in, directly observed, have twisted arms and made things happen so that we can actually write about real people doing real things, not just allegations?

JEFFREY SACHS: The United States, for fiscal year ’03, should be spending about $3.5 billion for AIDS, tuberculosis, and malaria, of which about $2.5 billion should go to the Global Fund, and $1 billion should be through bilateral programs. This would allow us to address these three diseases at a scale on which they can be addressed right now.

That would be roughly a third, in my view of the total effort, which would come to about $9 billion to $10 billion, and that would be with the Global Fund doing roughly 60%, which is the broad indicator, that I would suggest of about $6 billion -- bilateral programs being $3 billion to $4 billion. I say “about” because the right way to do this would be to invite countries to honestly set forth their needs and capacities and then to begin to fund them properly. That’s what’s needed right now. Fortunately, we have a mechanism to do that.

A dramatic case of this arm-twisting took place in Malawi. This was a country that had a plan to scale up treatment from 10,000 people in the first year, to 100,000 people in year five, for HIV-AIDS treatment. They worked around the world with leading centers -- Liverpool, Hopkins, Harvard, UNAIDS, WHO, and others -- to systematically evaluate how to do this scaling up in the most careful, detailed, professional way. I visited one of the clinics targeted for this in January. I saw first-hand how there was an outpatient successful treatment program on one side of the hall, and on the other side of the hall were hundreds of people dying in a misnamed medical ward -- misnamed because there were no medicines, just dying people, three to a bed that day, because there was no money available.

Now, Malawi was told, “No way we’re going to fund this effort.” And they were told to cut from 100,000 under treatment in the fifth year to 40,000 under treatment in the fifth year. And they were told that the donors, as a group, under their CCM -- their Country Coordinating Mechanism -- got together the donors and told them, “We will not support you if you ask for such a large amount.” And it was the donor community there.

Oh, you understand how this works, don’t you, ladies and gentleman? All donors of Europe and the United States get together to coordinate how they deal with the government. Yes? All the donors were party to this. I can name the donors that are party to the Country Coordinating Mechanism. I did. The parties to that which are the European and the United States -- Europe and the United States. Governments -- these are governments I’m talking about. I’m talking about the bilaterals.

Then they submitted the proposal, and the proposal came back from the technical review process that said, “This is a technically sound proposal, but it is too large. We ask you to cut further. In particular, we ask you to cut further the treatment program and the spending on management oversight and evaluation.”

Now, this is not the way that we are going to scale up to win the battle against AIDS. We don’t know the final resolution yet. All they were told, they were asking for 40,000 at the end of five years and they were told that was too big. And the formal letter that came back, the formal –- I don’t remember at the end – a couple hundred million dollars over a five-year period. But I don’t remember exactly the number at this point and how much was part of this piece. But when they got the letter back, they were told, “Cut further in a general way,” because there was no technical complaint. It just said, “This is too large.” This letter was signed by the Global Fund. (MS?) Oh, but that’s how the process works.

MALE SPEAKER: Does anyone who has not asked a question have a question? Lori, you want to follow up?

LORI: Yeah, two quick things. First, Jeff, have you looked at how much money could be spent on grants made by America if the buy-America requirements that stipulate that all goods purchased for a program in a developing company have to be American-made – American-made notepads, American desks, American cars? If the buy-America element were waived, how much money will be suddenly freed up and be more available, number one? And number two, I’m getting really confused because the day before this meeting occurred, the Global Alliance had their meeting -- a few consortia with WHO, World Bank, etc. -- and they were talking $20 billion a year for infrastructure alone, period -- and that’s just infrastructure to distribute highly active anti-retrovirals.

Now I’m hearing from you, Jeff, that you factored in infrastructure and you can do everything -- treatment, everything -- $10 billion. The numbers are starting to be all over the place. It was you, Jeff, who once said, “A billion here, a billion there, these are round-off figures from macroeconomists. But they’re not round-off figures for journalists. I really think we all need to hear a careful delineation. What is it you want and how does that reconcile with what the Global Alliance is starting to call for?

JEFFREY SACHS: The fact that not all numbers can be put into a single sound bite may be part of the confusion. So we spent two years doing the most detailed costing estimates that have ever been done in the world, led by a team at the London School of Hygiene and Tropical Medicine, and the details can be laid out with great care.

One of the reasons for the confusion certainly is the following, Lori. You can talk about what are the costs of doing something, versus what are the responsibilities of donors to cover part of those costs. That is, no doubt, part of the issue. We find, for example -- just to give you an example –- and now you’re going to say, “Oh my God, more numbers!” All right, well, now I’m going to give you more numbers, not to make things more confused, but to explain why you can’t put it so simply in a sound bite.

We found that the total cost of scaling up in the low-income countries is actually $57 billion a year. But that includes what would happen within countries plus what would have to come from donors. That mixes together countries that can afford their own scale-up with countries that need donor assistance. Africa, in the low-income Africa, needs about 90% of its increase met from the outside. Some other high-end countries that we’ve studied need only about 10% or 15% of their needs met from the outside, because most can be met from the inside.

We found, therefore, that $22 billion a year of that total was needed from the donors. Now, why $22 billion when I just said “$10 billion or $13 billion, including all three diseases”? Because we weren’t studying just AIDS, malaria, and TB, but also diarrheal disease, respiratory infection, immunization, and other things. We found that the HIV-AIDS share of the total costs was a little more than half -- about 53% of the total. We found that malaria was roughly about one-eighth of the total costs.

So, you have to then go through each of the kinds of interventions. You have to take into account not just the direct cost of the interventions, but the costs of scaling up, which means the clinics, the facilities, the doctors’ and nurses’ salaries, and so forth to run the systems. The management evaluation, oversight, that we hear so much about, also costs money. So I want to stress, this is not just playing games and throwing numbers around. It’s the problem that there are lots of categories in a table, and we’re trying to summarize in a straightforward as possible way where we stand right now, and that’s where the confusion is coming in.

These numbers, by the way, are not definitive. They are the best around because they are the most careful attempt, but the only way we’re really going to get precision is in the course of doing it -- in the course of the operation itself. That’s where you’re going to learn, finally, about absorptive capacity, scaling up, management oversight monitoring -- as you do it. So these are indicative, and they are what you need in a plan.

I will quote Secretary of Defense Rumsfeld. As Americans prepared to attack the Torra Borra (MS?) mountains, he was asked, “Do you have enough troops?” He said, “I think so, but I’m not sure. But I’ll tell you one thing -- if we don’t, we’re going to be sending more. And if we don’t still, we’re going to be sending more, and we’re going to be sending more and we’re going to be sending more, until we get the job done.” So he had a plan and he also had a goal.

We need a plan, and the plan can be made because we have the strategy, the components, the country ownership and involvement through the Global Fund, the indicative numbers, and now we need the plan of action and the money in the bank to implement. On your question about the “buy America,” it is a basic tenet of all foreign assistance that it should be untied, and the United States has been party to this repeatedly. Money for the Global Fund should not be tied to any country’s products, and it would be a sad waste if it were, of course.

MALE SPEAKER: Okay, last few questions and the last of the follow-up and then (MS?). We’ll get to you for sure, and then that will be the last question.

FEMALE QUESTION #2: Sir, this is just to clarify the rules of the Global Fund. Are donors to the Global Fund allowed to have any say over the distribution of the money, or how do they know who’s applied for what?

JEFFREY SACHS: The basic operation of the Global Fund is that countries -- meaning both government and civil society together operating through a coordinated mechanism -- submit proposals to the Global Fund. They are reviewed by a technical review panel, which is to judge the technical aspects, whether they are scientifically sound, and sound from a public-health point of view. Those recommendations are made to the board, and the board then votes on the proposals. The donors have their role as they are voting members on the board.

MALE SPEAKER: Okay, final question, the gentleman right here.

MALE QUESTION #2: One part for the speakers, other than Jeff, and one part for Jeff -- I’m sorry Dr. Sachs. Dr. Sachs proposed that, over the next 90 days, a plan be developed of what the needs are. What is not clear to me is whether that is Dr. Sachs’ proposal and others have just said, “that’s interesting,” or whether we can go any further than that -- whether there is any comment on that proposal from anyone else at the table. My second question is for Dr. Sachs. Could you just repeat those numbers for 2003? AIDS, TB, and malaria by all countries, and within that, by the US, and do you have any suggestions for 2005 as well, or not? Thank you.

DR. PIOT: Well, I think I should respond on the first question. As I said before, we’ve been working on refining the figures, the absorptive capacity, the sources of money that are potential sources of money, and now is indeed the time to put it all together in a coherent plan. This is obviously that something that cannot be done by one organization alone, because if those who are going to come up with the money are not involved in it, it will also not go.

I’d like to stress another point, and that is that the -- just in response to Lori’s question about $20 billion for infrastructure –frankly, I think that is a very, very rough figure that is not supported by any thorough study, as the one that is the basis for the report of the Commission of Macroeconomics and Health, or the paper that we published last year in “Science” (MS?). So I think that, at the moment, without infrastructure, $10 billion per year is still the goal and then the money that Jeff mentioned for infrastructure building, etc.

And lastly, I would like to say that, to stress that as far as we are concerned, that it is really important that each channel takes up its share and that nobody should be given an excuse not to contribute to their specific channel and that, for example, for the Global Fund to function, there is a need for beefing up capacity in organizations such as WHO -- I see Andrew sitting there – and the UN needs to deliver.

JEFFREY SACHS: Let me try one final time on the numbers. I believe that indicative numbers are around $6 billion for HIV-AIDS and around $3 billion for tuberculosis and malaria. By these numbers, I mean what the donors contribute, because the countries themselves would contribute more. So I’m talking about donor financing. I believe that the United States’ share of that should be around one-third. I recommend $2.5 billion appropriated for the Global Fund and $1 billion for bilateral programs.

If not all of that were absorbed in the Global Fund, there would be some spillover of the money in the fund to the following year. I believe that, in general, the Global Fund should dispose of approximately 60% of the donor effort for AIDS, TB, and malaria. So, if we are talking about $9 billion to $10 billion of total donor effort, we would be talking about Global Fund disbursements of around $5.5 billion to $6 billion for the year -- for 2003.

I believe that these numbers will be supported by expert analysis, and I believe, as I said, that there should be at least three processes now. One is the one that Dr. Feachem has promised us -- very important. The Global Fund itself, the Secretariat, will lay out a plan of action for the fund for the October board meeting of the fund.

Second, UNAIDS and the World Health Organization together should lay out a plan of action at a world scale that goes beyond the Global Fund, because the Global Fund is a major part but not the only part. UNAIDS is our great repository of expertise on fighting AIDS. World Health Organization is not only expert on AIDS, but also on malaria and tuberculosis. Together, they could produce a critical document by the same October timetable.

And then my final recommendation would be to Secretary Thompson, following precisely what he said today, I would encourage him to ask Dr. Fauci to lead an NIH/USAID/CDC task force also to report to the President of the United States within 90 days, on what the US contributions should be. Or let’s make it 120 days so that they can study the proposals, but that they will have done their homework for the first time. I can tell you, there is no document in a drawer in the US that lays out a multiyear scenario for actually fighting this disease, and that’s what we need. We need it, not just in the drawer; we need it on the President’s desk.

MALE SPEAKER: I sense that this press conference is virtually complete. Let me add just this word. I’ve always thought that the figures contained for the years 2007 and 2015, in the Macroeconomic Commission report -- including HIV-AIDS, malaria, and tuberculosis -- set out the requirements pretty effectively and explicitly.

I want to shift, therefore, from that for just a moment and remind you that, at this Barcelona conference, Dr. Bonu Kahn (MS?), the Director of the National AIDS Council in Botswana, said that her country was facing extinction. That’s the word used. There are a number of countries in Southern Africa that are on the edge of self-immolation if the pandemic is not turned around. I think what Jeffrey Sachs and Peter Piot and Gro Brundtland and Richard Feachem are attempting to unleash within the context of 90 days is an effort to galvanize the dollars and the conscience of the rich world to make the response, because if they don’t respond -- and we know that $2.8 billion in 2002 is dooming countries to extinction -- if they don’t make the response, we have reached hitherto unknown levels of moral irresponsibility.

MALE SPEAKER: Thank you very much.

(MS?)