E: The Role of Health: Poul Nielson, European Commissioner for Development Co-operation and Humanitarian Aid: Speech to the Thematic Session on Enhancing Productive Capacity, 3rd UN Conference on Least Developed Countries, Brussels, 16 May 2001
I thank the organisers and H.E. Mrs. Minna, Minister for International
Co-operation, Canada and Dr. Banda, Minister of Health and Population,
Malawi for inviting me to participate in this panel on "Enhancing
productive capacities: the role of Health".
The Commission has recently adopted a comprehensive Programme for Action on communicable diseases with special emphasis on HIV/AIDS, malaria and tuberculosis. These three diseases, which particularly affect the poorest, will require a new approach if we are to reduce their impact. This Programme for Action was strongly endorsed by the General Affairs Council of 14 May.
The Programme sets out, in my view, our best possible response to combine different approaches which target the impact of existing interventions, the affordability of medicines and the need for research and development of global public goods such as AIDS and malaria vaccines. Prevention remains at the forefront of our efforts, we clearly recognise that we must find ways to increase access to effective treatments. However we should not lose sight of the fact that, in the case of AIDS, even if anti-retroviral drugs were to be provided free, there remain significant obstacles to overcome in getting effective care to those in need. The discussions of economics and priorities in health policy must be based on the reality of economics and priorities in the developing countries. There is a big risk of this whole discussion being hijacked by media and PR-politics in the rich countries.
I have been specifically asked by the two Chairs to express my views on the recent international calls for the establishment of a global HIV/AIDS and health fund. Our Programme for Action calls on global partners to develop new approaches to deliver greater, and additional, recourses through more efficient means. A global fund could, on some conditions, be one response and the Commission has played an active part in early discussions to establish such a facility. Last week we held a meeting of health experts from the EU Member States to discuss emerging global initiatives and the basic principles of a fund. The principles are clearly in the right direction. We wish to see the full engagement of developing countries, including civil groups, in this process to define how a fund could best work at the country level. The Commission is of the view that such a fund should complement ongoing support to strengthen national health systems that we see as the bedrock of efforts to improve the health of the poor.
I was pleased that most Member States shared this perspective. We need to build strong and effective health systems and where the policy and practice environment is right complement those longer-term efforts with support targeted at the major communicable diseases. We have not as yet pledged financial support to a global fund. We need to make sure that it is more than a G8 stunt. We would wish to see first a number of principles or conditions fulfilled. I will name just a few:
1. donors should make available additional and new resources over an extended period of time;
2. the OECD countries need to take measures to assume a fair share of the global financial burden of reducing poverty and disease;
3. we do not support 'single-issue funds' and plead for a broad approach targeting the three major communicable diseases: malaria, tuberculosis and HIV/AIDS;
4. we will continue to raise the need for: country ownership, integration with national development strategies and health systems development, effective co-ordination on the ground, and keeping prevention efforts to the fore. This is crucial. If all this is not helped by a fund, the fund is no help at all. So; does it improve delivery? We have had enough empty donor-driven manifestations. If the answer to the question about delivery is not a clear yes, the establishment of the fund will only be like crossing the creek to get wet feet.
5. a fund should be open to contributions from all interested parties, both public and private and should support action beyond the public sector;
6. the governing structure of a fund should be light and transparent. The basic and multilaterally agreed health policy principles of WHO should be secured on how is it managed;
7. the fund should be 'outcome-driven' (as opposed to input-focussed);
8. decreased transaction costs for countries should be a priority.
Finally I wish to say that a global fund cannot succeed and will not get our support without a commitment by industry to a global tiered pricing system. We have been advocating a 'global tiered pricing' system for some time now and indeed, some pharmaceutical companies have made significant price reductions for certain drugs for developing countries.
The EU is also opening up for global bidding for essential drugs relating to AIDS, malaria and TB as part of our new Programme for Action in order to further stimulate the drive for lower prices. But we need an agreed system.
I call upon the industry to go much further and work to establish a tiered pricing system whereby the cost of drugs for, in particular the poorest countries, would be related to their ability to pay. We have long experience in applying this principle in the global vaccination effort. Together we need to commit to a set of guiding principles to which all partners agree. I can assure you that the Commission is more than ever before committed to work with all partners towards addressing the global health challenges. This should be one of the deliverables of this conference.