25 April 2001


NEW YORK, 24 April (UN Headquarters) -- The Spokesman: I would like to thank the Deputy Secretary-General for coming down to brief you on the involvement of the United Nations in the fight against HIV/AIDS. This briefing, of course, anticipates the Secretary-General’s speech on Thursday in Abuja, Nigeria, and you have copies of that speech embargoed until Thursday morning, 8 a.m. GMT; the press release accompanying it is also embargoed until that time.

We have interpreters in the back, so anyone who wants to ask a question in French may do so.

The Deputy Secretary-General: The purpose of this morning’s briefing is to offer a bit of background to the Secretary-General’s speech in Abuja on Thursday -- in other words, to situate that speech in what I think is a continuum of United Nations involvement on the issue of HIV/AIDS. In fact, it goes back, I think, as far as 1986; WHO was engaged in the issue of HIV/AIDS. Of course, in 1996, six different entities of the United Nations family -- United Nations Children's Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Educational, Scientific and Cultural Organization (UNESCO), World Health Organization (WHO), of course, and the World Bank -- were grouped together as co-sponsors of what has become known as UNAIDS. Later on, I think in 1999, the United Nations International Drug Control Programme was added to the list of co-sponsors. Of course, the fight against HIV/AIDS is a major priority at the country level. Everywhere there is a risk of the disease spreading; it is very high on the list of priorities of the United Nations country team.

The Secretary-General himself has been active on this file for some time now. I will recall that in June of 1999 -- in other words, almost two years ago -- he delivered a major address, the Princess Diana lecture, in London, which focused very much on the issue of HIV/AIDS and its impact in Africa in particular.

In December 1999, we held here at United Nations Headquarters the first meeting of the Strategic Partnership against AIDS in Africa, which for the first time brought together African governments, donor governments, non-governmental organizations, foundations and the private sector, including pharmaceutical companies. That partnership was confirmed and formally launched in December 2000 at Addis Ababa, in the context of an event called the African Development Forum, which had been convened by the United Nations and the Economic Commission for Africa. The Secretary-General also participated in the event.

The Partnership against AIDS was, in a sense, the launching point for the discussions that ensued with a number of pharmaceutical companies. The first agreement with pharmaceutical companies involving the United Nations system was announced in May 2000. As you know, a few weeks ago the Secretary-General met again with pharmaceutical companies, that time in Amsterdam. At that meeting the six major pharmaceutical companies agreed to accelerate the reduction in AIDS drug prices in the least developed countries, especially in Africa, and to cut prices in other developing countries as well.

Of course, the intergovernmental organs of the United Nations have also been seized of the issue, in addition, of course, to the governing boards of the various operational agencies. I think it is worth mentioning the two debates that the Security Council has held in the past year on the issue and, of course, the upcoming special session of the General Assembly in June. I know you have been briefed by Ambassador Ka of Senegal and Ambassador Wensley of Australia, who are acting as the co-facilitators for the preparation of that session.

The Secretary-General will be speaking to the summit in Abuja. It is a meeting that was called by President Obasanjo under the umbrella, if you will, of the Organization of African Unity (OAU). It is expected to be a major gathering of political leaders in Africa. This speech will be delivered on Thursday, 26 April, and will be followed by a second speech here in the United States, on 30 April, at Philadelphia. That will be a speech to the Council of Foundations.

I think that the reason why the Secretary-General is taking an increasingly clear leadership role on this issue is that there is a need for it. You will have seen in the last several months a proliferation of initiatives, suggestions and recommendations coming from various quarters: groups of governments getting together to propose various initiatives and academics and foundations working on the issues. It has been made clear that there is a need for some -- I will not say order; that is not the point -- clarity to be brought to the key things that we should be focusing on. There is also a need to tackle the issue of resources, how to implement the strategy, including the financial dimension.

That is what the Secretary-General will be doing in Abuja and in the second speech he will be making in Philadelphia on 30 April. Again, it is really with a view to raising the political profile of this issue -- injecting some clarity into the strategy and into what we need to do so as to sort of shift all this into an international campaign, which is really starting to take shape, and into high gear. That is what he will start doing in Abuja. Then there is the speech in Philadelphia, as I mentioned. All of this with an eye, eventually, on the special session that will take place in June.

There is no contradiction or competition between the two. What the Secretary-General is doing is raising the profile and presenting the problem in a way that is understandable and appealing to the largest number. I think it is very much in support of the intergovernmental process, which will itself probably lead to the adoption of a much more detailed plan of action in June.

I think I will stop here, Fred, and respond to questions. I have to tell you that I am not a medical doctor and that I am not an expert on the disease. So any technical questions that you may have, Mr. Sy here, who heads the UNAIDS office in New York, is much better placed than I am to answer those questions. So I would ask you to reserve those questions for him.

Question: Do you know which, or how many, countries have taken advantage of the agreement that the Secretary-General made with the drug companies?

Secondly, it seems that in all the press releases that have come out there is a big emphasis on promising to honour intellectual property rights. The trend seems to be going in the opposite direction in Brazil and in the South African decision. Is that not going to trip you up when generic drugs come out?

The Deputy Secretary-General: First, in terms of the number of countries that have taken advantage, the agreement that came out in May 2000 foresaw a process of a country-by-country negotiation and the establishment of a system and conditions for the introduction of these drugs. I think it is about half a dozen countries by now.

Mr. Sy: About 18 have expressed interest.

The Deputy Secretary-General: No, no. How many have actually completed this process?

Mr. Sy: Last year there were Senegal and Uganda. And now there are more: the Democratic Republic of the Congo, Rwanda, the Central African Republic, Côte d’Ivoire and Togo. With regard to signatures, Senegal and Uganda have signed and have started the programmes.

The Deputy Secretary-General: But one of the reasons for the second meeting was to suggest that one has to find a more agile way to introduce these drugs to Africa and elsewhere. That being said, one has to recognize that it is not an easy challenge to meet. It is not like administering aspirins or simple antibiotics. It is quite a bit more complicated. Therefore, I think that in each country the proper way has to be found to make the drugs available at the least possible cost, and to have a system that will sustain the administration of this treatment.

Now, countries are at various levels of development. The state of their health infrastructure varies very much from one country to another. But I think the goal here is to find a way to accelerate the introduction of these drugs in all cases, taking into account the particular circumstances of each country, so that treatment gradually becomes a real possibility everywhere the disease is present.

I think that, regarding the debate over generic or not-generic, if one goes back to the TRIPS Agreement, there are clauses in that agreement that permit the use of compulsory licenses and other mechanisms. It is not as if there was no possibility within the international framework to either produce locally or import generics. So it is perfectly possible to reconcile the two. One also has to realize that, certainly in most African countries, there is no patent protection in any case. The real goal is to make sure that the drugs are available at the best price. But, at the same time, that the necessary research for the development of drugs continues to happen.

I believe that the principles that have been followed by UNAIDS and the United Nations in general allow for the use of a broad range of solutions, while at the same time respecting the need for research to continue to happen on the further development of drugs.

Question (spoken in French): Several African countries have asked the United Nations for screening among troops. Will the Secretary-General take up this issue during the conference, and what is his position on this question?

The Deputy Secretary-General (spoken in French): The Secretary-General is not going to be taking up the specific question of United Nations troops, because this is really a very marginal problem as compared to the tremendous AIDS crisis in Africa and elsewhere.

That being said, however, you will have heard in Security Council discussions recently that we have taken preventive measures. At the present time, we are carrying out an information campaign for the troops. We give them access to condoms. As for mandatory screening, that is a thornier issue. It is not something that is done in the majority of countries, so the course we have taken is one of prevention and education.

Question: Knowing that it is still shameful to speak out about HIV/AIDS, especially in the Middle East, do you have specific figures on the spread of this disease in the Middle East and in the area?

The Deputy Secretary-General: UNAIDS has published detailed statistics for just about every country. The statistics are as reliable as we can make them, but, of course, we have to bear in mind the fact that because of the stigma, because of weaknesses in testing systems, many of these numbers are approximations. In fact, we estimate that the vast majority who suffer from AIDS probably do not know about it. That is one of the elements in any strategy. If you are going to have a strategy that involves not only prevention but also treatment, then you have to be able to identify who has the virus, so that you can design the proper treatment strategy. And in that respect we have a long, long way to go.

Question: Some time ago, the Vice-President of the United States was here to preside over the Security Council on the issue of HIV in Africa, and there were some promises made that $150 million was going to be provided. Do you know if this money was given? What happened, and [inaudible] of this session of the Security Council?

The Deputy Secretary-General: I cannot answer specifically regarding what the Vice-President was talking about at the time, whether that has happened specifically. What I do know is that we sense that there is a greater awareness among the donor countries about the magnitude of the problem and the recognition that significantly greater amounts of resources will have to be forthcoming if we are going to make a dent in this crisis.

I think it is worth noting that HIV/AIDS was one of the subjects that was discussed by the Secretary-General with President Bush when he went to Washington. This gives me some hope that there will be additional resources forthcoming for the fight against HIV/AIDS. One of the issues that will have to be sorted out in the coming weeks is, what kind of financial vehicle would be the best way to attract funds not only from governments but also from the private sector?

It is interesting to note that HIV is one of those issues where there has been a significant private-sector response. Think of the contribution from the Gates Foundation, from the UN Foundation. I think there is potential for a greater contribution from the private sector and the not-for-profit sector if we have a good strategy with a good financial vehicle. So that is one of the priorities we will be pursuing in the coming weeks with all concerned.

Question: The Secretary-General says that we need $7 billion to $10 billion annually, for an extended period of time, to fight AIDS. My question is this: how much have we spent so far, and is the AIDS epidemic expanding or decreasing?

The Deputy Secretary-General: The best estimate is that AIDS-specific spending is probably below $1 billion at the moment, when you count everything, although I am not sure that that figure includes the recent contributions, for instance, coming through the Gates Foundation. There was a $100 million contribution directly for research for an AIDS vaccine from Gates a couple of months ago. But I think that for the year 2000 we estimate about $1 billion, maybe a little less than that.

Now it is always a little difficult to produce very, very specific figures, because some of the things that are required for an effective fight against AIDS are things that are required for the fight against other diseases as well. The strengthening of the health system in poorer countries will benefit not only AIDS but all of the other health-related problems that one encounters, so it is not always easy to separate what goes towards AIDS and what goes towards strengthening the health sector in the poorer countries.

But there is no doubt that we are looking at a very, very significant increase in the level of funding from all sources, which means from donor governments, from governments of the countries affected, from the private sector, from the not-for-profit sector -- a combination of all of that.

Question: So is AIDS expanding?

The Deputy Secretary-General: So far, AIDS is expanding just about everywhere. A few countries have been successful, through very aggressive prevention campaigns, in stopping the progression of the illness, but these are really the exception. Everywhere else, the disease is on the increase. That is what makes a general mobilization so necessary.

Question: How do you respond to reports that inside the United Nations system, the fight against AIDS means a lot of money, a lot of territory, a lot of turf battles, agencies looking to do more. How are you going to deal with this, and has there been any reaction to the UNICEF move to say, we can do this regarding retroviral drugs? What is your response to that?

The Deputy Secretary-General: Well, as a person who has been coordinating the efforts of the system for the past several weeks, I must say that I have seen, in fact, quite good cooperation among the United Nations agencies, the co-sponsors of UNAIDS. Yes, of course, each agency has its own priorities, and each agency would like to see enough attention given to the problems that they dedicate all their efforts to solving.

In fact, I was a little surprised by what I read in some of the press reports recently over infighting within the United Nations system, because that is not what I have seen in the last several months.

The speech that the Secretary-General is going to be delivering in Abuja, which contains, as you will see, under embargo, five priorities -- that is not something that we wrote all by ourselves in the Secretary-General’s office up there. That is something that really was put together by the co-sponsors of UNAIDS. We asked them to sit together and come up with something that was simple and clear enough to deliver a powerful message to the broader audience. They did not have any particular difficulty in agreeing among themselves on these five priorities.

If you look at the five priorities, it means that some agencies would seem to be better placed than others. But that did not stop the process from, in fact, producing what I consider to be a very, very clear document, a very clear set of priorities and considerations for the Secretary-General.

Question: You said at the beginning that the Secretary-General hopes to bring some clarity to the issue. Could you say where you think clarity is lacking? And perhaps related to that, if I heard you correctly, you said that the majority of people suffering from AIDS do not know it. Does that mean that the figure of 36 million AIDS sufferers worldwide is a serious underestimate?

The Deputy Secretary-General: On the last one, not necessarily, because I think there are projections and extrapolations. But that does not mean that because we advance the number 36 million, that those 36 million actually know that they have it. So what I was saying was not in relation to the validity of the statistics, although they are approximations, but more in relation to the challenge of actually designing a strategy that reaches people who have the virus when the majority do not know that they have it.

As for the lack of clarity, I was really referring to the kind of shift of attention from prevention to treatment and back to prevention. The fight against AIDS is not simple, but in terms of defining for the greater number, for public opinion in general and for political leaders what it is that we should be focusing on, I think that we have had partial views of the problem over time, depending on the most recent developments, and that is normal.

But you will see from the Secretary-General’s speech, that he tries to offer a comprehensive strategy. It is not an issue between prevention and cure. Any strategy must have these elements, and it is important to situate a comprehensive strategy as the sort of guiding message, out of which then the experts will have to work out in great detail -- how do you work it out?

And we always have to remember that things have to be worked out at the country level. That is where things happen -- not in Geneva or New York -- but at the country level, and there each country has its own set of circumstances and the best strategy within the framework of those priorities has to be elaborated with the authorities of that country, with the people who are most directly concerned -- the people affected by AIDS -- the donor community and, of course, the UN system, which is very often pretty central to bringing all these countries together.

Question: When the Secretary-General went to Europe, he made an agreement with the European pharmaceutical companies to deliver medicine at cheaper prices to the poor countries. I hear that in South Africa there was a lawsuit concerning this problem. I do not think they have come to an agreement yet, but they are talking about that. What do you think about the private sector’s cooperation in this kind of help? Do you think it is good enough? I hear that some United States pharmaceutical companies are not really willing to help. They are trying to protect their patents rather than helping the poor countries.

The Deputy Secretary-General: First, on the South African case, you should know that the 39 companies that had brought a suit against a new law in South Africa have withdrawn their suits. So there has been a settlement there. Secondly, I do not think there is a necessarily a contradiction between having a concern to protect your patents, which is a proven tool to ensure that there is continued research and investment into drug development, and a recognition by companies that they should do their part in facilitating access to treatment by providing the drugs that they produce at the lowest possible cost. There is no contradiction between the two, and that is what we are finally starting to see being enacted.

Can I add that the private sector at large, beyond the pharmaceutical companies, can also play its role? Many big corporations are employers in countries where there is a high incidence of HIV/AIDS. They themselves can adopt policies and practices within their own companies to make sure that their own employees are looked after. Major companies can also look beyond their own employees and contribute to community projects or other forms of support in countries that are affected.

One of the messages that we are delivering, I think, pretty clearly is that this is a big endeavour that will require the efforts of all the stakeholders for a long time. So we have to have real mobilization and the recognition by each of the sectors of society of what their responsibility is and how they can best contribute.

Question: You have already touched on the fact that cheaper drugs are not in and of themselves what is needed at clinics, medical staff and the infrastructure to administer these drugs. Can you give us an idea of, particularly in Africa, how prepared countries are to do this job? So even if they get their cheap drugs, is the battle still far from won?

The Deputy Secretary-General: I think it depends very much on the circumstances in each individual country. Some countries are better equipped than others to take advantage fairly quickly. Correct me if I am wrong, but I think a country like Botswana, for instance, is well equipped and it should be able in pretty short order to start a major programme of treatment. Other countries that are in the middle of a civil war or that have had all their social and community networks destroyed because of civil war are probably in the worst position to be able to do that. So that is why I said that once you have a global strategy and a willingness on the part of each of the stakeholders to play their parts, you still have a lot of work to do at the country level to define what is best for each country, and it inevitably means that some countries will be able to take advantage of the new possibilities more quickly than others.

Question: [inaudible] that it is in these unstable countries where nothing is going to be done.

The Deputy Secretary-General: Well, you cannot say that nothing is going to be done, but the capacity to make a real impact is limited by access. Even the delivery of simple humanitarian assistance in countries in conflict is sometimes impossible, so to be able to establish a sustained programme of prevention …

Let us not forget that prevention continues to be a very, very high priority. That is part of the message of the Secretary-General. We should not, because suddenly we now have drugs that are available at reduced cost, shift all our attention to treatment. Prevention was identified a long time ago as absolutely key to the fight against AIDS. It has been demonstrated to work in certain circumstances. Therefore, you will have to remember that we are not talking of shifting all our attention to treatment. Prevention continues to be very, very high on the list. In some countries, the mix between the two will vary, depending very much on the circumstances. You are the expert, Mr. Sy.

Mr. Sy: Right. Also, it should be added that treatment does not necessarily mean only anti-retroviral drugs. It is also about treatment of opportunistic infections, for which we have efficient drugs that are much easier to administer, even under very difficult circumstances. Just as an example, tuberculosis is one of those. Most of the people living with HIV/AIDS die of diarrhoea that can be treated and prevented. There is also the treatment of sexually transmitted infections, which constitute a very important entry point for HIV transmission in most settings.

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