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interview: kofi annan

[photo of Kofi Annan]

Kofi Annan has been secretary-general of the United Nations since 1997. In January 2000, the U.N. Security Council held its first session of the new millennium on the AIDS pandemic, marking the first time a Security Council session had ever been held on a health issue. The following year he announced the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Here he talks about how the Global Fund came about and his disappointment that the U.S. directed more money to President George W. Bush's bilateral President's Emergency Plan for AIDS Relief [PEPFAR] than to the Global Fund. Annan also recounts his discussions with some reluctant African leaders, trying to encourage them to promote condom use as a preventative measure. "Encouraging young people to postpone [sex] until they are mature, if you can get them to do it, [is] well and good," he says. "But we also know the nature of human beings, we know the nature of our society, and we know that not all the young people are going to be able to do this. So it is best for them to protect themselves if they are going to go and do it and risk being infected." This is the edited transcript of an interview conducted on June 10, 2005.

When you became secretary-general, describe the state of the AIDS epidemic as you saw it here. At the time, the new drugs had just become really available. … There was a lot of excitement about treatment and even stopping the disease. At the same time in Africa and the rest of the developing world, it was probably a different story.

No, no. You are right that at that time, many people in the developing world were not getting the treatment, and that was very tragic, because you can imagine a sick person in Africa who knows that there is treatment for his or her condition, but they cannot afford it because they don't have the resources. They know that others live with their disease and that AIDS need not be a death sentence. Yet in their case, at that time, they knew it would be.

This is one of the reasons why we organized a U.N. special session on HIV/AIDS, and [it] was well attended, and we came out with a call for action. That also led to my proposal that the Global Fund for HIV/AIDS, Malaria and Tuberculosis be established.

We also did something else. We engaged the pharmaceutical industry. I met with the chairman and CEOs of five pharmaceutical industry [companies] twice, urging them to reduce the price of medication. Yes, they were determined to protect the intellectual property, but as I told them then, if you insist only on intellectual property and you do not take any measures to ensure that the poor have access to affordable medication, the whole regime is going to come under serious pressure.

What regime do you mean?

The protection of the intellectual property, because for most people, it will not be defensible. I think they have come a long way. Not only have they responded; the prices have dropped, and some of the companies have offered medication free of charge in certain countries. The relationship between them and some of the governments in the Third World has also changed. The inroads made by generic producers, they are not and no longer [are] resisting the governments' invoking emergency to be able to produce a medication, and at that time, and initially, they were. In fact they took Mandela, President [Nelson] Mandela, to court for trying to invoke an emergency. In the end they dropped the case and then began to cooperate much, much more.

What about your personal interest in this?

I have been interested in this. Of course the disease came out about 20 years ago, and no one had an idea of how it was going to evolve or develop. But suddenly we realized it had a potential to decimate whole nations and people. Here we are talking about development in Africa, help in the developing world, trying to strengthen the institutions, trying to plead for additional humanitarian assistance, development assistance, debt relief. And yet the people who are capable of running the states, the people who could run the hospitals, the teachers, the nurses, were being taken away by the HIV/AIDS. In some of these countries, life span has dropped from over 60 to about 40, and so we felt we needed really to tackle the issue.

It has been proven that care and treatment can be given in very rudimentary conditions, provided the people around the patient are taught how to handle it.

The most [cruel] of all transmissions for me is mother to child. These millions of orphans who have been left behind -- you go to some village, there's grandparents and grandchildren, no parents. You have situations where a child of 10 or 12 is already a parent looking after younger siblings.

It was one of those issues which was more than a health issue. It was more than a health issue. It was decimating societies, taking away not just the present but their future as well, so we really had to put as much energy into it and to save lives. I've seen the faces of some of those living with HIV/AIDS, and the courage they have shown.

In the late '90s, in the runup to the Durban conference [in South Africa], there was a lot of institutional resistance -- WHO [World Health Organization], USAID [United States Agency for International Development] -- to the idea of treatment in the developing world. Did you come across that yourself? And how did that change?

I did come across it, because there was the sense that it didn't have the medical facilities. Without the medical facilities, you cannot do it. In fact, there was a famous saying by a senior [USAID] official [Andrew Natsios] who said the Africans don't have watches, so the question of even taking the medication, they wouldn't know the time and to be able to do it regularly and at the right time. Yet we have proven over time, it has been proven that care and treatment can be given in very rudimentary conditions, provided the people around the patient are taught how to handle it. And it was happening.

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Part Two: Chapter Five Financing the Battle

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Of course we also need to improve health facilities and health systems to back up some of the needs that the ministry of health has got.

Why did you feel that in April 2001 that the time was right to announce your vision for a global fund?

We had discussions amongst ourselves and with some of my people who were engaged in the fight against the epidemic. One of the issues we were confronting was resources -- resources to be able to help the countries, resources to scale up some of the very small programs that were in existence. After the U.N. special session meeting here and leaders indicated interest, I felt we should take advantage of the momentum and press for action so that we can do something about the intentions they had expressed and the promises they had made.

I was happy to see that it has taken off. We haven't got all the money that we need. The fund has raised several billion dollars, but we need much, much more. As you may have heard, we'll be grateful to get $2.5 billion each year for the next two years.

When we talked to [economist] Jeffrey Sachs, he described going to the White House and, after the Bush administration came into office in January of that year, laying out a plan for $3 billion a year after you announced your plan for a global fund. Then I think it was in May of 2001 you went to the White House, and the U.S. was the first contributor, contributed initially $200 million. Was that a disappointment for you?

I know that some NGOs [non-governmental organizations] ... one zero was missing, was what some of them were saying. But the president was very committed. He did say, "I take it seriously, and we would want to contribute." I had no doubt that that would be the initial contribution, and since then [he announced his] $15 billion program.

But that was a good beginning, because once the first contribution came in, when we went to the G8 summit in Genoa, I had been in touch with other leaders, and they were ready to also contribute. So we got quite a bit of additional contribution at that G8 summit, and the fund took off.

We're also looking at the development of the PEPFAR [President's Emergency Plan for AIDS Relief] program. There was a lot of skepticism within the Bush administration about that amount of money that at least Sachs was requesting being given to something that came out of the U.N. Did you encounter that?

Yeah. Some had the feeling that you can solve the problem by throwing money at it. We can't argue with that, but nobody was suggesting one throws money at this, because we are also prepared to work with them to set up structures at the country level to ensure that the money is effectively used and goes to the people in need.

But there was skepticism as to why does one need all this money. What's going to happen to it? Can it be absorbed? Do these countries have the absorptive capacity? But I think over time it has been proven that these countries can. If you travel around Africa, you've seen the circumstances under which some of them have been very meticulous in following through the instructions of the doctors, taking their treatment. In fact, I have read somewhere that some of the African patients take their medication much more regularly than some patients in developed countries.

Were you aware that the Bush administration was developing its own unilateral program throughout 2002?

I wasn't aware of it. The president has said they would do more. So when they came up with a program, a big program of $15 billion, I tried to suggest that at least a billion dollars should go through the Global Fund, and tried to encourage the European Union to match it. If we were able to get a billion from the U.S., another billion dollars from the European Union, we were going to make every effort to raise the additional billion from other sources, and then you would have had the $3 billion a year that one wanted for the next several years. We did not get that. ...

When did you find out that in fact the president was going ahead with a unilateral program?

I think I got to hear about it before he announced it at the State of the Union [in January 2003], but not much before then.

Were you surprised?

I was pleased. I was surprised, and I was pleased, and I was encouraged. I would have preferred that some of it went through the Global Fund, but what was important was that here is the president of the United States making a major commitment and committing serious resources to this epidemic.

The Global Fund ... is a global program. The president's fund is targeted really at 15 countries.

That's correct, yeah.

Do you think that it's not just unilateral but too narrowly focused?

Yeah, I wish the program can be expanded to cover other countries, but because their needs are enormous, the problems are global, and we are nowhere near stemming it. This past year, AIDS infection increased on almost every continent, so we have major issues to deal with, and I hope, I wish the program would be expanded to help some of the other countries in desperate need of assistance.

We're seeing what's often called a next wave of the epidemic going to China, Russia.

Exactly.

What is at stake here?

These are countries with huge populations. With some of these countries, even 2 percent is huge. If 2 percent are infected, it's huge numbers of people. I've tried in my own travels to encourage some of these governments to take it seriously and stem the tide before they get to an explosive stage which will have a very negative impact on their society and on their economic development.

China is taking some very serious measures to [manage] the disease. I think the Eastern European area can do more. India is also pushing ahead with these programs.

But it requires what, political will?

It requires political will. It requires commitment of resources. It requires a determination by the leaders to speak out, to lead, to speak out against stigma and discrimination, to let it be known that those who are living with AIDS are of concern to the leader and to the society, and that they are also citizens of the state. I have had this debate with many leaders. Some have responded incredibly well and have led, and their countries are doing extremely well. Others have been shy, have been shy to lead.

I recall trying to get one African leader -- I won't mention his name -- to encourage his population to protect themselves, to use condoms. He said he couldn't utter that word, "condom." In fact, I told him that I've even tried to get the Catholic Church, and I had written to the pope about this. And his reaction was, "When it comes to condoms, the pope and I are one." He wouldn't even use the word "condom."

In fact, another leader who had a line in his speech recommending the young people to pay attention, to be aware, to protect themselves, talking about prevention, protection, care and treatment, he said: "I'm the father of the nation. If I get up and recommend condoms, I am encouraging the young people of this country to be promiscuous, and I'm the father of the nation. I can't do that." It took them two weeks to convince him. In the end he did it.

That's why I said it requires leadership from the top to the bottom, almost complete mobilization of society at the grassroots level -- women's groups, people living with HIV/AIDS, and the government and the leaders of the country.

The issue of condoms and whether they encourage promiscuity is still something that's hotly debated.

I know.

... What's your view of this issue?

Obviously prevention is helpful, and encouraging young people to postpone until they are mature, if you can get them to do it, [is] well and good. But we also know that the nature of human beings, we also know the nature of our society, and we know that not all the young people are going to be able to do this. So it is best for them to protect themselves if they are going to go and do it and risk being infected.

I think whilst one can talk of prevention, this is one of the preventive measures. One would need to educate the young people to make sure that you don't increase the ranks of those infected when you are beginning to struggle to deal with even the numbers that you have.

[Samaritan's Purse President] Franklin Graham in our interview said the U.N. program largely -- he was speaking generally, but the program largely is condoms, condoms, condoms, and that that is ignoring God's laws, and the U.N. does not want to follow and many countries do not want to follow God's laws. What's your response to that?

Let me say that many governments in many countries, vast majority of governments around the world, agree with the approach of the United Nations. In fact, for a long time they've been saying ABC -- you know, abstinence, be careful, and condom. The U.N. has been pushing the government to adopt [this] program. Of course, society has to adopt a solution that best suits the society, but there are certain basic things which are common in all attempts to stem the infection, to stem the rate.

Until you have a vaccine, which is years down the line, until you get microbicides for women, which is also down the line, you have to use the protective measures that you have. I think given the fact that we are not even getting the resources required to treat those who are affected today, I think it would be unconscionable that we don't take measures to stop others from being infected for whatever reason, ideological or religious or whatever.

We are all God's children. You're talking about saving lives. You're talking about preventing transmission from mother to child. You're talking about ensuring that the mother lives to protect this child. You're talking of ensuring that you don't have those situations where the parents are gone and the grandmothers, with hardly any income, are bringing up their grandchildren. Avoid a situation where there are millions of orphans and young parents, children at 10 and 12, looking after siblings. I think this is the reality of what we are dealing with. Ideological situations will not help that.

I know your discussions with leaders are private, but in general, do you want to comment on the views, particularly in the runup to the Durban conference, of President [Thabo] Mbeki of South Africa.

Let me say that the South African region is one of the worst hit regions in the world, the Southern African region as a whole, and there are some very serious programs. Botswana is doing extremely well, and President [Festus] Mogae is leading the effort very energetically and is totally committed. In fact, when we had the AIDS conference here about two weeks ago, I think he was the only head of state, or one of the few, who bothered to come to discuss this issue here in the General Assembly.

I think they need to also work on a regional basis, and other governments in the region will have to adopt the same aggressive attitude to deal with the epidemic. I admire what Mogae is doing, but when you have people crossing your borders, you cannot not just look after your people and think that you are dealing with the problem, although they have been educated and obviously they will take greater measures. But it would be ideal if all of the governments concerned got engaged in a program of prevention, of care, of treatment, and shared best practices and experience. I think it would be extremely good not only for the region, but for the future of that part of Africa.

And President Mbeki in the late '90s.

I think he has moved on since the late '90s. I think he was really struggling with what the response should be. I know that he got into lots of flak for that in his own community, but I think he's moved on since then.

The issue of giving treatment to the developing world, both the Global Fund and PEPFAR promised getting millions on treatment. Both programs are limited both in terms of time, scale and funding. ... People say you can't limit this. We have a moral responsibility, once you put people on treatment, to continue it.

... I think the needs are there, and they are right. I don't think they should rely entirely on the Global Fund. The Global Fund can't do it alone. Governments have to commit some of their own resources to the health sector and to the treatment of their HIV patients. We also have to be careful that apart from the HIV/AIDS, there are other diseases that the countries have to [contend with] -- whether it's malaria, tuberculosis, cholera or whatever.

The needs of these countries are really quite broad. To be able to assist them on the AIDS epidemic is only partially dealing with their needs, so the governments have to put in [money]. Where possible, they should also be helped to upgrade their health systems to be able to cope with the strain that is being put on that.

Recently, private companies have been very active and have made a major contribution. One of the first examples was Volkswagen de Brazil, which used to sit back and watch its managers die, and then they would bring in new people to train. Then decided they would treat them. So they began treating them, the managers lived, and the experience continued with the experienced managers -- fathers lived; husbands lived. In fact, economically, it was better for them than going the other way.

There is a lot of expectation out there, everywhere, that people know about the drugs, and they know that there are these big U.N. and U.S. programs. They're waiting for the drugs, or if they're on them, they're hoping that they're going to continue. Have we made a promise [to] the international community that we might not be able to keep?

I think even if we cannot get everybody, but we get the $3.5 billion or $4 billion a year, and reach as many people as we can and begin to stem the spread of the epidemic and to reverse it, we would have made a major contribution. It is much better than sitting back and crossing our arms.

I know the numbers frighten people. When they see an individual, as you bring it down to the individual level, people are moved to help. When you throw millions of people at them, it becomes a dilemma. They don't know what to do, and they get frustrated. But let's help the people one person at a time, one patient at a time, one child. Even that makes a difference.

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posted may 30, 2006

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