The Global Fund to Fight AIDS, TB, and Malaria: Understanding the First Grant Announcements and Access to Medicines

Transcript of a press teleconference hosted by MSF on April 22, 2002, on the occasion of the Global Fund Board of Directors meeting (April 22-24, 2002)

Transcript of a press teleconference hosted by MSF on the occasion of the Global Fund Board of Directors meeting (April 22-24, 2002)

Featured speakers:

• Rachel Cohen

  , U.S. Liaison, Access to Essential Medicines Campaign, MSF

• Ellen 't Hoen

  , Coordinator, Access to Essential Medicines Campaign, MSF

• Paul Davis

  , AIDS activist, Health GAP

• Brigitte Syamalevwe

  , Zambia Program Director, Life AIDS International

• Kris Torgeson

  (moderator), Communications Director, MSF

Issues to Be Discussed:

• The Global Fund to Fight AIDS, TB, and Malaria Board of Directors meeting will take place in New York City, April 22-24. What will be announced? How did the application process take place?
• What must happen to ensure that the Fund fulfills its promise to provide access to treatment to the millions dying of AIDS, TB, and malaria?
• Will the Global Fund grants explicitly prioritize treatment, not only prevention and care programs, and encourage the procurement of the most affordable and effective drugs for HIV/AIDS, TB, and malaria?
• Will the Doha Declaration on TRIPS and public health be upheld and endorsed in the funding process?

Kris Torgeson:

OK, I think we'll get started, then. We've had some changes to the people on the call, which actually I think will be great. We're going to start out with Rachel Cohen. She's going to give a little overview of where we are in the granting process and some of the concerns that MSF had.

I wouldn't have survived [AIDS] up to this time if it weren't for the survivors. So what I know and believe in is the ability of human beings to change humanity for the better. [...] This is a war to end all wars. Meaning it is a war between good and bad. Between greed and responsibility. [...] I would just hope and believe as I have been doing for 12 years that we are finally, you know, turning the ship toward a global concern for public health. — Brigitte Syamalevwe (Zambia Program Director, Life AIDS International)

Ellen 't Hoen is actually going to be replacing Bernard Pécoul, from MSF's Access Campaign. She'll say a few words about that, as well as the announcements about the essential drug list, today.

And Paul Davis, from the Domestic Government Relations Desk of the Health Gap Coalition, will say a few words. He will be followed by Maryline Mulemba from Malawi, and Ms. Brigitte Syamalevwe. She's a Zambia Program Director for Life AIDS International. So, if we could just start with Rachel.

Rachel Cohen:

I just wanted to give a brief background on the fund, and I apologize if this is repetitive information for people.

The idea of the creation of a Global Fund came after years of concerted efforts by a global movement of people pushing for access to treatment. It first was discussed at the G8 summit in Okinawa, Japan in June 2000, and at a subsequent meeting in December 2000 in Okinawa at a conference on infectious diseases. An initiative was prepared there to tackle major infectious diseases worldwide, primarily HIV/AIDS, malaria, and tuberculosis.

Later, in April 2001 at the African summit on HIV/AIDS, TB, and other related infectious diseases, in Abuja, Nigeria, Secretary General Kofi Annan brought this to the forefront, issuing a "call to action" to African and other world leaders to make an international effort to fight the three diseases. He called for a war chest, urging all countries to mobilize $7-10 billion per year to fight AIDS, tuberculosis, and malaria.

This call to action was issued in a number of other major settings over the following weeks and months—the U.N. General Assembly Special Session on HIV/AIDS, the G8 summit in Genoa, Italy, and a number of other places.

Right now, although it was originally conceived as a UN-operated mechanism, it is seen as a public-private partnership, and is broadly considered to be a potential vehicle for massively mobilizing resources to reach a number of global targets for fighting those three diseases.

A transitional working group and technical support secretariat were set up before the creation of a formal board—and I just want to make sure you know this is information that's generally available on the web site of the fund. We are not experts on the fund. I just wanted to give you this brief background before launching into a discussion of where we are now and what some of our concerns are.

A call for proposals was issued on February 4th to countries interested in applying to the fund for money. Over 320 proposals were received by the deadline, which was just five weeks later on March 10th, totaling nearly $5 billion over five years. We believe that only approximately $200 million is available for disbursement in this first round, just to give you a sense of how far the needs are outstripping available resources at this stage.

A number of the proposals were then referred to a 17-member technical review panel of experts in the three diseases. Those proposals were reviewed between March 25th and April 5th, and this week, the technical review panel is making recommendations to the board about funding decisions that will ultimately be made.

There are several questions that remain very unclear to us at this point. How many proposals will be funded? How much the total grants will amount to. What proportion will be for HIV versus TB versus malaria? And then, within that, it is very unclear what proportion will be for prevention and other interventions as opposed to or in addition to treatment.

And, in particular, how much of the funds might be available to purchase desperately needed treatments for HIV, TB, and malaria? Regardless of what the fund actually ends up funding during this first round, there are several things that are clear that we feel are important to raise in terms of what kinds of funding decisions the board will make this week.

We feel strongly, as a medical humanitarian organization, that treatment is a medical and ethical imperative. And that in making funding decisions this week, the board has to take bold steps to support new scientifically sound and lifesaving treatment programs and to issue a clearly articulated public statement that will indicate that access to treatment is an indispensable part of any truly comprehensive proposal to control HIV, TB, or malaria.

We know from our experience in the field that distributing condoms and providing general health education is incredibly important, but alone they fail to control these three diseases. Treatment is an absolute must and the fund must make its decisions accordingly.

It is also important that the fund not inadvertently expand the use of ineffective treatments, if it does indeed fund treatment programs. For example, it would be wrong for the Global Fund to support programs—malaria treatment programs, for example—that use drugs in areas where resistance to them is high. I will give you an example.

We were working in Burundi during a major malaria epidemic at the end of 2000 and the beginning of 2001 where there were about 3.2 million cases of malaria. About 90% of these cases were patients who were resistant to chloroquine. Sixty-three percent were resistant to the second-line traditional anti-malaria drug, sulfadoxine-pyrimethamine, which is also known as SP or Fansidar®.

There are other more effective treatments for malaria that combine various drugs using an artemisinin derivative. This is called artemisinin-based combination therapy. They are more expensive, but more effective. And where appropriate, the Global Fund can play a critical role in ensuring that all people who need it—including the poor and most vulnerable—have access to effective malaria treatment. This regimen is available in the private sector, but only to those who can afford it.

It is very important that the fund offer treatment to the highest number of people possible. And one of the most important ways of ensuring that this happens is that funds be available for purchases of medicines and medical technologies at the lowest possible cost. This includes medicines produced by generic manufacturerers as well as brand name companies.

One thing that is very disconcerting about the proposal process—and maybe Maryline will be able to speak to this a little bit—was we did see in one proposal, the proposal from Malawi, that the country was advised that they could only purchase patent-protected drugs in their programs, the programs they had proposed to the Global Fund. This is very disconcerting and it goes very much against the spirit and letter of the Doha Declaration on the TRIPS Agreement on Public Health that was signed by all trade ministers in 2001.

I'm sure that Ellen can go into more detail about that. So I will just close by saying that I think more funding is desperately needed for this fund and for other financing mechanisms to fight these three diseases, as they claim 14 million lives each year. Thank you.

Ellen 't Hoen:

Thank you, Rachel. First, I just want to mention some of the events taking place in the last week and say that this meeting of the Global Fund comes at a very timely moment. Some of you may be aware that today the WHO has released the conclusions of the expert committee that has drawn up the new essential drug list. And we are absolutely delighted that 10 new anti-retrovirals are included. And these are anti-retrovirals for use in combination therapy.

Before, the essential drug list only had ARV drugs for the indication used in the prevention of mother-to-child transmission. And the expert committee has expanded this list with 10 anti-retrovirals. WHO makes it very clear that this is part of an overall strategy to increase access to these medications. In addition, they are establishing treatment guidelines to help governments and medical professionals assure that those drugs will be used properly.

This comes just after WHO published information about the pre-qualification of anti-retrovirals. And that included a number of generic drugs. And WHO has announced that they will increase that work, speed up that work, and then publish additional lists, which will also include other medicines—for example, medicines for TB and malaria.

Fairly soon, a database of the sources of these medicines with their prices will be released. We expect that in May. And some of you—this is interesting—will also have seen the news last week. The list was released the day before the one-year anniversary of the Pretoria court case—for those of you who didn't follow that, 39 drug companies sued the South African government over their Medicines Act, and were forced, because of international pressure, to drop the case a year ago.

Well, last week, the South African government finally changed its policy with regard to AIDS and has publicly announced that this is a cabinet decision, including President Mbeki, who is becoming increasingly isolated in his government because of his position on HIV/AIDS. South Africa has said ARVs are drugs that can help people who are HIV-positive [and] people who have AIDS improve and prolong their lives, and we are going to set—we're going to look at strategies and policies to make these drugs available in our country, including the negotiating prices with pharmaceutical companies and looking at generic production and generic availability in the country.

This has all taken place over a short period of time, and it is obvious that the treatment agenda is gaining momentum, and we hope that that will find its echoes in the Global Fund and in the decisions of the Global Fund this week. What this means in terms of anti-retroviral treatment—which I would like to stress on this call—is the availability of fixed-dose combination medicines. And that will help with compliance. It will help simplify treatment and assure that people will take their medicines correctly.

Those fixed-dose combinations are becoming increasingly available because of the generic companies, which are able to put together medicines that come from different originators. And we are also calling upon the WHO to include these medicines in their pre-qualification process, and in the next round of the essential drug list experts committee. Thank you.

Torgeson: Thanks, Ellen. OK, we're going to move right on to Paul Davis, who's speaking on behalf of the Health GAP Coalition.

Paul Davis:

I want to make three points. The first is about how back-door dealing from wealthy companies is undermining the applications from recipient countries. The second point is about a predisposition towards mediocrity amongst the board members that's hurting the Global Fund. And the third point is about how Senator Arlen Specter and Senator Jesse Helms are holding the power to dramatically enhance the success or failure of the Global Fund; the talk needs to be followed-up with some action.

The board of the Global Fund must clarify itself this week on policies that already exist about treatment and use of legal generics. These policies are being circumvented when rich country aid agencies help craft a country application.

The board should make clear that treatment—including anti-retroviral treatment for AIDS, including second line TB therapies, including effective malaria treatment—the board should make clear that these are necessary components of the required comprehensive proposal.

Today, Viziwick Mawale, who is in charge of the application process from Malawi, told The Financial Times that they were under a great deal of pressure from donor governments to reduce the size of their fund application. They said that their application would be rejected if they submitted what they had originally intended, which is $1.6 billion over five years. At the eleventh hour, they reduced that application to $306 million over five years. I know that I've talked to a number of you guys about this in the past, but now we have people from the Malawian government on record. [We've] Also seen this yesterday during the NGO meetings; it seems to be happening in a lot of countries.

The second point is about mediocrity. The Global Fund board is far too concerned about embarrassing stingy donors. And we implore the board to embrace a vision of the Global Fund as a meeting point to actually make fundamental shifts for response to global AIDS disaster.

But instead, we have a fund board which is today leaning towards reserving almost one-half of the meager resources they have on hand for a rainy day fund in the future. During the hurricane of death and dying, now is not the right time to sock away savings for a rainy day fund. They want to spend $200 million now, $300 million in the second disbursement later in the year and saving almost $400 million for next year.

The last point I wanted to make, and we talked more about this, if you want, is that about Senator Arlen Specter and the big bail out. The Emergency Supplemental Spending Bill is now before Congress. It's deeply intertwined with the success or failure of the Global Fund.

Pennsylvania Republican Senator Arlen Spector and Illinois Democratic Senator Richard Durbin have circulated a Congressional sign-on letter to President Bush asking essentially for $700 million in new contributions to the Global Fund to be included in the Emergency Supplemental Spending Bill.

An emergency supplemental appropriation is "now money." It's money that goes out the door immediately. It's not in some future, authorizing the appropriations bill that might get out the door in a year or two. It's disbursed immediately. This bill will be marked up and passed in the House the first or second week of May. And the Senate bill could come as early as the second week of May.

Senators Specter and Durbin are on the appropriations committee. So they get a shot at including language in the bill that will go to the floor. They get to take the first crack at working the original supplemental bill.

Senator Durbin met with us during last week's rally and explained that he was willing to include the money in committee by amendment. For this to succeed, however, counting the votes, we would need Arleen Specter to co-sponsor this amendment.

Senator Durbin told us that Specter would not commit. So it is not just my phone calls they aren't returning, but it is Senator Durbin's phones calls as well.

We hope that the Senator from Pennsylvania is not circulating his letter to the President simply as a gesture towards activists and the 40 million people who have AIDS who don't have access to medicine. And we implore Senator Spector to push the money through committee.

On this note, there has been a lot of talk about Helms and mother to child transmission. We welcome Senator Helms' incomplete steps toward atonement. He and Senator Frist are working to amend the emergency supplemental bill or to add $800 million that would simply be turned over to the State Department to figure out what to do with.

Looking at the absorbative capacity of existing mother to child transmission programs, the Global Fund is the logical recipient for at least some of this money, especially if we expand mother to child transmission to include MTCT plus. MTCT plus is treatment for whole families when the HIV positive mother is detected in a prenatal clinic.

Stabilizing families and communities rather than simply increasing the number of healthy orphans—that might be more coherent but the security bill is under consideration and we hope that Senator Helms will find that infants deserve families too.

I think our biggest message to Senator Helms, Durbin, and Specter is that these two amendments should not be played against each other. We insist that Senator Specter come out and lead the charge to include $700 million for the Global Fund in committee and when the floor vote happens, Senators Frist and Helms should add $500 million for MTCT plus programs, some of which should be directed toward the Global Fund.

Torgeson:

We'll jump right ahead to Brigitte Syamalevwe who has traveled here to New York all the way from Lusaka, Zambia where she heads a program that she can tell you about called Life AIDS International. It's one of the support consultants that is helping the NGO reps to the Global Fund board with their decision making process this week. Brigitte?

Brigitte Syamalevwe:

Hello. I'm Brigitte Syamalevwe from Zambia. I'm a volunteer through and through. I'm a woman living with HIV for 12 years. And I have a beautiful son who's four years old, who's HIV negative because of prevention of mother to child transmission in a time when the situation did not allow access to anti-retrovirals.

I have no access even up to this time to anti-retrovirals, although I have provisions that I could get because I'm a United Nations volunteer now.

But what I'm saying or what I intend—why I traveled here is because the people in the North get entangled with economies, with statistics, with strategies and other challenges and they keep on muscling each other. You know, they are in the muscle show to show who has got power over all life.

I would want to appeal to people that they should stop playing God. We all have humanity. My death is a death of a part of humanity. My life, dignified or undignified, has repercussions to the society that we live in.

I want to speak on my own behalf, and on behalf of my husband who I left on his deathbed. He's very, very ill in Zambia, in Lusaka. I would want to talk on behalf of persons living with HIV because I think I'm every woman living with HIV. And I'm every person living with HIV. Speaking a language that is not heard by people who are full of their other ambitions, their own greed, and their own self-satisfaction and not looking at what the South is saying.

What I'm saying on behalf of the AIDS belt in sub-Saharan Africa, specifically in Zambia which I'm particularly familiar with—for the community of women living with HIV—is that 20 years without access to drugs is a crime to humanity. And allowing time for decisions to pass while parents, daughters, and husbands, wives and children are dying, is an act of terrorism. I have as much right to live and quality of life as any part of humanity. My dignity is your dignity. My rights to life are your rights to life.

Let us decide now, today, to end this act of global terrorism by equating prevention with access to treatment for HIV and TB and malaria. I am every woman or every person living with HIV because I live in an area infested with HIV issues, and also with malaria that has been endemic in the area that I am living, in my part of Zambia.

Today, medication can be accessed, and I am happy to hear that the WHO was put on the protocol and everything, and I want us not to lose this chance to say 14 million people are dying every year. And that is more than the population of my country, Zambia, which stands at 11 million persons.

I want you to imagine the devastation that is being caused, where now I have had to call my mother, my old mother who is 87 years old, to come and live. I can't have quality of life, and I know my son needs a mother. He is only four years old, and he is hoping for life. I am saying today, we don't want to equate prevention with the access to drugs, because this is a social justice issue—I want the policymakers and the Global Health Council to really realize that I have been fighting this epidemic for 12 years in the 20 years it has existed, and we have had prevention activities all along.

It is good to have prevention activities, but we need the treatment part—malaria, TB, or HIV/AIDS. Malaria and TB—you can get cured—but HIV/AIDS drags you along. I want us today to decide—decide for giving all the money that is there today—to keep people from dying. It is our human right. It is our right for all of us in this global village that you want to propagate.

Torgeson:

Thank you so much, Brigitte. I'll open it up to questions.

Q:

You were, if I can ask Brigitte a question, you work in the Copper Belt of Zambia? I mean, you live in the Copper Belt?

Syamalevwe:

I would say I work all over Zambia, because I am working with basic communities, villages, education system, the UN system. I have sort of brought in a creative and innovative world, working with systems without being broken down by the limitations of what systems can offer, looking at the realities of life that a woman living with HIV/AIDS is facing in Africa, today.

Q:

How large is your family, may I ask?

Syamalevwe:

I have 11 children and five grandchildren.

Torgeson:

Other questions from others on the call?

Q:

Yes. I had a question regarding—you mentioned generic fixed-dose combinations. I'm just—I'm not clear whether brand name companies have essentially agreed on all of them or how many three-in-one and six-in-one combinations are available. In other words, if you have to switch from one to the other, how much flexibility is there in that?

't Hoen:

The brand name companies do not offer a fixed-dose combination except for Glaxo, which has a combination of AZT and 3TC, which is known as Combivir.

The problem, of course, is the brand name companies, if they want to produce a fixed-dose combination, they have to actually do that with a compatible drug. Those drugs are under patent. So that becomes very difficult.

The companies that are able to produce the fixed-dose combinations are the generic companies which are active in countries that do not provide pharmaceutical product patents or where the drugs in question are not under patent. So at the moment, the fixed-dose combinations for anti-retrovirals comes from India. The lowest cost triple therapy is from an Indian producer, which is at the moment priced at $209 a year. Now that is still expensive for many people but it is an enormous difference compared to the $10,000 a year for a triple therapy, which was more or less the norm two-and-a-half year ago.

Cohen:

Just to be—just to clarify, though, the combination that is made by the Indian manufacturers is AZT, 3TC and D4T. And also, the Thai Government Pharmaceutical Organization is looking at producing that but don't yet have it available. But they are definitely planning on producing that in the future—the near future.

Q:

The essential drug list announced today does include a couple of protease inhibitors. But as far as I know, there are no generic manufacturers that make protease inhibitors. Is that true?

Cohen:

Yeah, I believe that is correct. But I would have to check that to be absolutely sure and get back to you after the call.

Q:

But then what that means is that adding it to the essential drug is that it is going on the essential drug at its current price structure...

Davis:

This is Paul Davis. I am fairly certain that Brazil makes a copy of Crixivan, Merck's drug, that should be verified for certain, but they—Brazil, of course—has not been willing to export their medicines to any other country. I think they locally manufacture Indinavir and Crixivan. I guess that's the only generic protease inhibitor that I am aware of.

Q:

If I may, just one last question from me. Brigitte said that all the money should go for treatment. That is being discussed today at the Global Fund. Is that the position of your organization, Paul? And of MSF?

Torgeson:

I will let Paul answer first.

Davis:

We think that the Global Fund board should issue a clarifying statement, perhaps strengthening existing policies, and should make clear to the country coordinating mechanisms to craft the plans at the country level, that a substantial treatment component is a priority in a successful application. This is the only way, we think, that the history of the failure of bilateral donors to contribute to treatment can be addressed. If the Fund board issues a statement insisting that treatment be a substantial component in the applications.

Q:

When you say substantial, what do you mean? Ten percent? Ninety percent? One hundred?

Davis:

We mean substantial.

Q:

All right, so did you want to comment on that, the position from MSF?

Cohen:

Yeah, we have not necessarily even attempted to try to say what proportion of the funds should be devoted to this versus that. The important principle is that, of course, one reinforces the other. And prevention alone as we know from the past couple of decades has absolutely failed to control not only HIV but also malaria and other infectious diseases. So I would say, in many ways, echo what Paul said which is to say it should be huge priority and central to any successful proposal.

Torgeson:

Paul just wants to add something to that.

Davis:

I want to say, broadly speaking, activists from the North should follow the lead of the activists from the South who are facing this as a life and death issue.

't Hoen:

Can I just make a quick comment on the prevention and treatment. Because I think it's really regrettable that prevention and treatment are always pitched as if they're two separate things competing with each other. I think we have to look at, you know, sensible approaches have prevention and treatment intertwined. You can't have one without the other. You can't have successful prevention without treatment and you can't have successful treatment programs without having prevention activities. The trends over the last decades has been in funding for health and developing countries. Let's focus on prevention because that is most cost effective, and we'll just forget about treatment. And we see happening, and I think that is because the pressure of activists and of people with HIV, particularly in developing countries, speaking out, people like Brigitte who are very courageous and very active in this and have said this trend has to change. And it's like a huge oil tanker that now begins to change its course. And we hope that that course will also be visible in the outcome of the Global Fund.

Q:

My name is Bill Haddad; I'm a generic manufacturer, and I volunteered to work with Cipla—can I make a comment for a moment?

Torgeson:

Yes, go ahead.

Q:

There are three countries that can make these triple antivirals—Brazil, Thailand, and India. Cipla, which is a company that I work with, has made them. But having worked on this on a day-by-day basis, there are visible and invisible barriers to access these medicines.

I am very troubled by reports that the United States government is putting pressure on the fund only to use the products that are patented or claim to be patented. This is very distressing because of the numbers that you heard earlier.

Two things have really shocked me in the last few weeks. I saw a PBS news report of children in South Africa under five years of age who are dying in a hospice. Most of those children would be alive if nevirapine was available. And I hope it is available now.

The second was I sat in a warehouse filled with medicine, probably made to alleviate pain and suffering, and extend life for maybe 100,000 people, waiting to be shipped to various parts of the world. But, they have these invisible barriers, many of them erected through bilateral or secret positionings by the U.S. government, and I find that intolerable.

Torgeson:

Thank you, Bill. Other comments on that? And then we'll take any other questions.

Davis:

There's some tying-up to the stories to look for during this week, while the Global Fund is having its Board meeting. It's the Global Fund has to spend all the money and spend it now; that the Board has to stop these end runs from bilaterals at the country level in forming applications. There's a vacuum of policy coming from the Fund board. The U.S. has to raise the bar with contributions, in its new emergency supplemental, and it has to be a priority if we're serious about the Global Fund being additional to efforts that already exist.

Q:

At this point, is there any real money in the Fund, or any real commitment from the EU at all?

Torgeson:

Ellen, do you want to comment on that?

't Hoen:

Well, I don't have the figures here in front of me. I think Rachel is more up-to-date on how much money there actually is in the fund, but what we do know is that it's nowhere near to what it—what it should be, and that's also one of our calls towards the contributors or potential contributors to the fund, that if, no matter how good the policy of the Global Fund is, imagine, if they really include treatments; they endorse and encourage strategies by countries to access the lowest cost medicines; they get all of that right, you still won't get very far if the amount of money available does not increase, and these countries do not pledge the money over a longer period of time.

I think there's also risk that it's sort of, you know, fashionable, and it's the flavor of the month that amounts of money are given for two or three years, and after that, you know, end of story, so...

Q:

Let me—let me follow up, because, I mean, more than two years ago, you and I had this conversation about the EU. We know that there's all these set-aside funds at the EU for dealing with global AIDS and malaria and tuberculosis. But none of that money ever seems to get into the Washington bank account, World Bank. What is going on here? The thought was if the U.S. keeps upping the ante of its commitment, the EU would respond. But has the EU actually put a single dollar in the bank account yet?

't Hoen:

Some of these figures can be verified on the Global Fund web site, which is, I think, globalfundatm.org.

Davis:

The—if I remember right—the European Commission has put up $106.9 million for the Global Fund. And interestingly, we learned this just the other day in the middle, sort of, an inopportune moment in the middle of a Congressional briefing that we were hosting—that the United States has not actually put its money into the account either.

't Hoen:

Laurie, it's—the 1.9 billion is pledged, apparently. But it's very unclear how much of that is actually available right now.

Cohen:

There is a chart on the Global Fund web site, globalfundatm.org

Davis:

It's scuttlebutt—unverifiable scuttlebutt until the end of the week—that they have $200 million in the bank. And it's not clear who's actually put up their money or not. But the U.S. and the European Commission evidently has not yet.

Q:

I'm just—you said what you expect—I mean, what you're hoping for, or what you want. What—do you have any sense of what you expect to come out later this week or what they're going to say? Do you have any sense of that? Do you have any concerns about what you think you're going to hear?

Torgeson:

Does anyone want to speculate? I think probably we're going to—Rachel or Paul? I think they'd both would rather wait to see exactly what comes out than speculate at this point.

Davis:

I think that on this call, you've heard people predict the worst on some hotly contested issues of unknown outcome. What will happen if there's no intervention from us and you on the call is that the fund will have $200 million to spend and they will find about $200 million worth of applications and declare that the others weren't good enough.

If they were to receive a clear message from Senator Specter and Senator Durbin that there was more money on the way soon, that could dramatically change the outcome of this meeting. If the—if the NGO board members and some others like Brazil and France, for instance...

On this call we talked about some of the—what the likely outcomes are if there isn't intervention from activists and some of the more productive board members. The fund will find $200 million—has $200 million on hand. It will spend $200 million and declare that the rest of the applications weren't good enough. It will sock away about—nearly 50 percent—$400 million for next year—for a rainy day fund.

These are the worst possible outcomes that are still unknown because there will be a great deal of intervention from activists and NGOs on the board.

Syamalevwe:

Can I just make a contribution?

Torgeson:

Please go ahead.

Syamalevwe:

Yes, I don't want to speculate on the negatives. Because I wouldn't have survived up to this time if it weren't for the survivors. So what I know and believe in is the ability of human beings to change humanity for the better.

And I believe that in the outcomes of our interventions and our love for human rights and I'm really privileged to be in a country where human rights are bold and part of a process that is going to uphold humanity.

This is a war to end all wars. Meaning it is a war between good and bad. Between greed and responsibility. So I am not going to even speculate on the negatives. I would just hope and believe as I have been doing for 12 years that we are finally, you know, turning the ship toward a global concern for public health. And this is a science that needs no other kind of prize than to uphold life and humane responsibilities.

— End of teleconference —