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Testimony
Before the Committee on Foreign Relations
United States Senate
HHS's Role in Halting the Global Spread of
HIV/AIDS
Statement of
Tommy G. Thompson
Secretary,
Department of Health and Human Services
For Release
on Delivery
Expected at 10:30 AM
on Wednesday, February 13, 2002
Mr. Chairman,
members of the Foreign Relations Committee, I am pleased
to be here today to provide an overview of the activities
of the Department of Health and Human Services (HHS) to
combat HIV/AIDS worldwide.
Thank you, Mr.
Chairman, for you leadership in responding to this devastating
disease. And, I want to acknowledge Senators Frist and Kerry
for their work as co-chairs of an important task force organized
by the Center for Strategic International Studies (CSIS)
on America's role in addressing the global HIV/AIDS pandemic.
We at HHS, along with the U.S. Agency for International
Development and the U.S. Department of State, are working
with CSIS to ensure that this two-year project reaps benefits
for both the U.S. and nations around the world hard-hit
by HIV/AIDS.
We all know
the dreadful statistics-- 40 million people worldwide now
living with HIV/AIDS, 3 million deaths from AIDS last year--
but they don't begin to represent the devastation this disease
wreaks upon the developing world. The relentless onslaught
of AIDS has the potential to
devastate national
economies and social systems, cause national instability
and civil unrest, and draw the United States and other developed
nations into national and regional conflicts. This Country
has a moral obligation to provide leadership in mobilizing
resources for this international health crisis.
Secretary of
State Colin Powell and I serve as co-chairs of the Task
Force on HIV/AIDS created by President Bush, and, under
his leadership, the United States has continued its commitment
to battle HIV/AIDS and other infectious diseases and assist
the world in disease control, surveillance and treatment
activities. At HHS, the Centers for Disease Control and
Prevention (CDC), the Health Resources and Services Administration
(HRSA), and the National Institutes for Health (NIH) are
world leaders in research and assistance in the worldwide
battle against this scourge.
Last May 11,
President Bush announced the creation
of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
I have the honor of serving as the U.S. representative to
the Global Fund Board, a post I sought because I believe
the Fund can make a real difference. Both Secretary Powell
and I have championed the concept of a trust fund for these
three diseases from our first days in office. And, I might
add, so have many of you on this committee supported this
effort. Thank you, Senator Frist, for your contributions
in this area. Why is this idea so important? Because Africa
and other parts of the world urgently need a public health
delivery system that includes prevention of new infections;
treatment for the sick, including the provision of drugs;
and training of medical professionals.
The speed with
which the Fund's architecture has been established is remarkable,
and President Bush's founding pledge of $200 million has
produced a 10-fold return on that investment in 9 months.
I am pleased to report to you, Mr. Chairman, that the Fund
is now up to just below $2 billion in promised resources.
The Global Fund
held its first Board meeting on January 28 and 29, 2002,
in Geneva. Because President Bush asked me to stay in Washington
to meet with Ministers from the newly formed provisional
government of Afghanistan, I was unable to attend. I did,
however, address my fellow Board members by videoconference
to announce the President�s pledge to the Fund of an additional
$200 million in FY 2003. This latest proposed contribution
would bring the total U.S. contribution to half a billion
dollars, by far the largest donation from any one country
or entity, and over one-quarter of the overall commitments
to the Fund.
The establishment
of the Fund reflects the principles and priorities President
Bush outlined last May. First, the President spoke of the
need for partnerships across borders and among both the
public and private sectors. The Fund embodies this
principle; it is an independent non-profit foundation under
Swiss law, located in Geneva in space separate from the
United Nations and any of its agencies. The Board of the
Fund consists of 7 donor governments, 7 developing country
governments, 1 representative from the philanthropic sector,
1 representative from the for-profit sector, and 2 representatives
from non-governmental organizations (NGOs).
Second, the
President wanted the Fund to pursue an integrated approach
to the three diseases that emphasizes prevention, training
of medical personnel, as well as treatment and care. We
are pleased that the rest of our colleagues on the Fund
Board have agreed that proposals may cover prevention, treatment,
and care and support in dealing with the three diseases
in ways that local partnerships deem appropriate.
The Board has
decided not to institute quotas or percentages for particular
interventions. Prevention is indispensable to any strategy
of controlling a pandemic such as we now face, but so are
treatment activities, including carefully designed programs
employing anti-retroviral therapies.
Third, the Fund
should concentrate on programs that work. We must know that
the money is well spent, people living with HIV/AIDS are
well cared for, and local populations are well served. To
that end, the Fund Board has agreed that strong financial
and programmatic accountability mechanisms must be put in
place. The World Bank will serve as the trustee for the
Fund, and have the responsibility for financial accountability,
including collection, investment and management of funds,
disbursement of funds to countries and programs, and financial
reporting to stakeholders. All partnerships that receive
grants will be subject to independent audits and provide
assurances that adequate fiscal controls are in place. While
the Board has not yet decided exactly how ongoing monitoring
and post facto evaluation of grants will be done, the Board
has embraced the principle that funding must be tied to
measurable results. Grantees must be able to demonstrate
that their approaches are having a real impact in reducing
mortality and illness.
The President�s
fourth criterion asks for scientific accountability. All
proposals must be reviewed for effectiveness by medical
and public health experts, because a plague of this magnitude
demands results. The Board will have ultimate decision-making
authority and be accountable for results, but no proposal
will move forward without a rigorous review and endorsement
by a group of technical experts. This 17-member, independent
Technical Review Panel, composed of 6 experts in HIV/AIDS,
3 in malaria, 3 in TB, and 5 from other disciplines, will
evaluate all proposals for programmatic and medical soundness,
feasibility, and financial management, taking into account
local realities and priorities. Indeed, my Department hosted
a meeting of eminent experts from around the world last
month, at the NIH's Fogarty International Center, to develop
recommendations to the Fund Board on the operating procedures
of the Technical Review Panel--advice the Board has accepted.
And, finally,
the President underlined the importance of innovation in
creating lifesaving medicines that combat diseases. Our
position has been that the fund must respect intellectual
property rights, as an incentive for vital research and
development.
I will not hesitate
to admit that much work remains to be done, but the Fund
is on track and open for business. Contracts with the World
Bank and the World Health Organization for financial and
administrative services should be finalized in the near
future. We are also looking for an Executive Director. And,
proposals for grants need to be written; in fact, applications
are currently being taken for the first round of partnership
grants. The Board plans to make decisions on applications
during its next meeting in April.
So, as I have
mentioned, the Fund is open for business and
we at HHS intend to participate actively in helping
partnerships to design their proposals and perhaps even
join in monitoring and evaluation if asked. I see the Fund
as a critical opportunity to force better coordination between
bilateral and multilateral programs and to hone their focus
on results and performance.
The President,
Secretary Powell and I are all delighted that the Fund has
surpassed even our most ambitious expectations, and we remain
convinced that innovative approaches like the Fund are truly
our best hope for curbing these diseases in the developing
world.
HHS
Programs in the Global HIV/AIDS Arena
My Department's
contributions in this arena also include the efforts of
the CDC, HRSA, and NIH. Let me briefly share with you the
very important work that these agencies are performing.
The President's Fiscal Year 2003 budget calls for $144 million
for the HHS Global AIDS Program within the Centers for Disease
Control and Prevention, the same funding level as this year.
In addition, the CDC budget includes $11 million for international
HIV prevention research.
The Department
is on the ground in 25 countries in sub-Saharan Africa,
South and Southeast Asia, Latin America, and the Caribbean,
working intensively with governments, NGOs and community
groups to build infrastructure and capacity, assist in prevention
activities, and provide direct care and treatment.
Most
developing nations lack the necessary infrastructure to
address their HIV/AIDS epidemics. Disease surveillance systems
and epidemiology are often nonexistent or greatly compromised,
making it difficult if not impossible to accurately determine
at-risk and infected populations.
HHS provides
funding and technical assistance to Ministries of Health
to bolster disease surveillance and essential laboratory
services, including training for laboratory personnel, information
systems program monitoring and evaluation, and purchasing
needed equipment.
We also offer
technical assistance and funding for a variety of prevention
activities, including voluntary counseling and testing,
preventing mother-to-child transmission, blood safety, sexually
transmitted disease prevention and care, behavior change
communications, and prevention for populations at high risk
for acquiring or transmitting HIV.
For example,
preventing mother-to-child transmission is a priority for
our programs-- it is the only proven therapy to avert transmission
from one person to another. HHS works with host countries
and other partners to provide drug therapy to pregnant and
post-partum women and their newborns and promotes replacement
feeding strategies to avoid transmission via breastmilk.
Our treatment
and care activities focus on tuberculosis and other opportunistic
infections, palliative care, and, more recently, technical
assistance on antiretroviral therapies, or ARVs. Within
HHS, the HRSA and CDC are training local health care providers
in safe and effective patient care and monitoring. Working
together, our agencies are fostering hospital- and clinic-based
care programs, as well as community- and home-based care,
for people living with HIV/AIDS.
Let me say a
few words about ARV treatment, a subject that has drawn
intense interest here and around the world. ARV treatment
is now more affordable in sub-Saharan Africa than ever,
thanks to the assistance of drug manufacturers in this country
and others. While most developing countries lack the sophisticated
medical monitoring equipment and tests that are adjunct
to ARV treatment, my team at HHS is assessing ways to effectively,
safely and affordably bring these treatments to desperate
countries and their people. CDC
and HRSA are also examining the safety and effectiveness
of what is known as "syndromic management," which means
that diagnosis and continuing care are based on observable
signs and symptoms, rather than sophisticated lab tests.
These tests are not feasible in most countries in which
the Fund will be working, so in such situations, clinicians
there have to manage patient care by look and touch and
feel - all skills that can be taught, and we hope that this
effort will be another part of our contribution to the Fund.
Tuberculosis
presents special dangers to those who are HIV-infected,
and HHS currently is assessing a rapid TB diagnostic test
that is effective among HIV-positive persons; the optimal
duration of TB treatment among those who are HIV infected;
and the acceptability of directly observed antiretroviral
therapy for HIV. With the Botswana Ministry of Health, HHS
research showed that TB is the leading cause of death for
HIV-positive persons in Botswana and another showed that
saliva tests for HIV can be used on TB sputum specimens,
offering an effective tool for HIV surveillance.
Finally, the
importance of research in attacking HIV/AIDS has long been
recognized, and the
United States
has long been the world's leader in research and practical
assistance to battle HIV/AIDS. President Bush's proposed
FY 2003 funding for the National Institutes of Health includes
$2.77 billion for AIDS-related research, an increase of
$255 million that includes expansions for vaccine, microbicide,
and treatment research. Next year, we will devote more than
$422 million to the search for an HIV vaccine, a 24 percent
increase over FY 2002.
Last year, the
NIH Office of AIDS Research developed the Global AIDS Research
Initiative and Strategic Plan which reaffirmed NIH's long-standing
commitment to international HIV/AIDS research. NIH supports
a growing portfolio of HIV/AIDS research conducted in collaboration
with investigators in developing countries, and supports
international training programs and initiatives to help
build research. Altogether, NIH expects to spend $222 million
in FY 2003, an increase of $34 million over FY 2002, specifically
related to international HIV/AIDS research.
The NIH supports
the HIV Vaccine Trials Network (HVTN), composed of 16 domestic
and 13 international sites. Directly and through collaborations
with mostly university-based investigators worldwide, the
HVTN also supports laboratory research to ensure vaccines
are efficacious against a variety of HIV strains found around
the world.
HHS also supports
university-based biomedical and behavioral research on interventions
to prevent sexual transmission, and strategies to reduce
perinatal transmission. The NIH-sponsored HIV Prevention
Trials Network (HPTN) is a worldwide collaborative network
designed to conduct research in 16 international and nine
domestic sites on promising and innovative biomedical/behavioral
strategies for the prevention or reduction of HIV transmission
among
at-risk adult
and infant populations.
HHS works to
strengthen - or create - the research and laboratory infrastructure
of developing countries and train local investigators to
conduct clinical trials of therapeutic and preventive therapies.
These efforts include NIH's Fogarty International Center
, which funds training in the U.S. for scientists from developing
countries in Africa, Asia, Latin America and the Caribbean.
Through grants to U.S.-based institutions, we have also
conducted training courses in 60 countries. A new initiative,
the Comprehensive International Program of Research on AIDS,
also provides funding directly to foreign institutions for
HIV research that is relevant to the host country. These
grants focus on training of investigators and enhancement
of laboratory and clinical capabilities, and to date, we
have made five such awards.
None
of the activities I've just outlined - infrastructure development
and capacity building, prevention activities, care and treatment
efforts, and research - could be accomplished or even
attempted without
the integral cooperation and collaboration between CDC,
HRSA and NIH, as well as other parts of the U.S. government,
most particularly USAID. At HHS, I am working to ensure
that research and activities conducted throughout the Department,
as well as within other entities, is complementary and not
duplicative, and that it sees practical application in programs.
HHS has a 20-year history of international intervention
research, established CDC field stations, and many NIH projects
worldwide. We strive to keep these efforts coordinated,
and with the help of our other government partners, I believe
we are succeeding.
Conclusion
Enormous challenges
lie ahead. Just last month, the president of Family Health
International, one of our NGOs, asserted that without treatment
and prevention, AIDS will outstrip the bubonic plague as
the world's worst pandemic. Bubonic plague killed 40 million
people in the 14th century. Seven centuries later, we stand
at the brink of an even worse catastrophe. But working together,
we can change the course of the AIDS epidemic. Our research
and its practical application have shown us that prevention,
care, and treatment work. It is our responsibility to ensure
that those at risk and those already infected have the benefits
of that knowledge.
We are seldom
presented with such clear and pressing need and such clear
means to intervene. The Administration stands ready to contribute
to a comprehensive plan for Africa and other parts of the
world where HIV/AIDS is rapidly expanding.
I thank you
again for your support of this important endeavor.
