# Presentation: 245963

## The President’s Plan for AIDS Relief

- Joseph F. O’Neill, MD, MPH
- Medical Director and Deputy Coordinator
- Office of the US Global AIDS Coordinator
- U.S. Department of State

**Notes:**
Thank HVTN
Dr. Corey
Dr. Wasserheit
Dr. Tabet
Others---------------------------

Importance of research
Importance of the work of vaccine research
Often referred to the “end game” in the HIV epidemic

The introduction of PEPFAR is potentially game-changing

How PEPFAR works with research community is critical to success of both agendas
Goal of my comments:
	orient you to PEPFAR, especially to the vision behind this historic initiative

AIDS has multiple impacts: death, suffering, community disruption, economic collapse, security instablility

Next slide

## Slide 2

**Notes:**
Moral impact

Why did we act?

Wiesel says that for the individual, silence and inaction in the face of suffering is destructive
For America,for the same reasons, being inactive and silent in the face of this epidemic is corrosive

## Slide 3

**Notes:**
When POTUS gave state of union address
Amount of funding
Focus on africa and caribbean
Focus on treatment
Leadership

You will have the money you need, but don’t ask me to write a bigger check
I took this to mean:  business not as usual
Accountability
 impact
Strong management
Based on recognition that

## PEPFAR

- USG Budget Highlights for Global AIDS
- 	FY 2001:		$ 840 million
- 	FY 2003:  	$ 1,581 million
- 	FY 2004:		$ 2,443 million*
- 	FY 2005:		$ 2,821 million*
- 		* $15 billion over 5 years, not $3 billion/year

**Notes:**
This is the largest global health effort directed against a single disease in history

## PEPFAR

- 	HIV/AIDS is a complex issue requiring complex responses.

**Notes:**
Medical issue
Developmental issue
Secutiry issue

## PEPFAR

- A comprehensive strategy:
- Global fund
- Bilateral activities in over 80 countries
- 15 focus countries
- PMTCT

## PEPFAR

- 15 focus country initiative
- Focus on treatment, care, prevention
- Focus on regions of world where treatment is most needed
- 50% of HIV in world in targeted countries
- 70% of HIV in African and Caribbean

## US role in Global Fund

- Global Fund
- USG made founding contribution of $200 million
- USG currently provides almost 40% of all pledges to fund thru 2008
- USG currently provides 31% of cash on hand
- Statutory limitations on contributions

## PEPFAR

- HIV/AIDS is an emergency

**Notes:**
Need to move quickly
Be willing to take some risks
	Challenge is how to manage these risks:
             Evidence based policy decisions
	    Accountability for results
          Programs must meet local needs and host govt. policies and strategies
          Effective coordination with other donors and govts

## PEPFAR

- An aggressive strategy
- January 20, 2001: President Bush inaugurated
- May 11, 2001: POTUS makes founding contribution to global fund and provides technical assistance to implement activities
- June 19, 2002: POTUS announces $500 million PMTCT program
- January 29, 2003 POTUS announces $1.5 billion PEPFAR

## PEPFAR

- An aggressive strategy
- January 28, 2003 State of the Union Address
- May 27, 2003 POTUS signs authorizing bill
- January 23, 2004 Congress passes appropriations
- February 23, 2004 first round of grants ($350 million) in hands of partners in Africa and Caribbean
- June 23, 1004 second round ($500 million) released

## PEPFAR

- Role of the Global AIDS Coordinator Office
- Policy and program direction for all USG Global HIV Activities
- Close coordination with other USG entities
- Close coordination with multi-national and other bilateral activities

**Notes:**
Eg. Coordination with NIH and other research

How?   APPROPRIATIONS FOR TARGET COUNTIRES COME DIRECTLY TO AN ACCOUNT UNDER CONTROL OF GLOBAL COORDINATOR----
        atchinson:”  the way to predict failure is to find a program with the title of “coordinator” in it

Not in this case

## PEPFAR

- Pharmaceuticals
- USG > $4 billion in pharmaceuticals and distribution systems
- Stimulate Market in target countries
- Increased interest in new manufacturers

## PEPFAR

- Issue of resistance is real
- Large numbers
- Weaker clinical systems
- Potential for significant impact

## PEPFAR

- Procurement:  Low cost
- Working on mechanism that will allow for cost reductions by large scale purchasing
- Administration is on record that we will purchase high quality drugs at lowest cost

## PEPFAR

- Procurement: Quality
- Due diligence
- Regulatory review of Data
- Consumer safety
- Equity
- FDA tentative approval will be quick and complete
- GMP underway in India and RSA

## Consumer Safety

-    At the beginning of the century, Theodore Roosevelt recognized that new challenges demand new government -- in this case, a government that demands responsibility from industry and producers, but also provides clearer, stricter standards of safety and the means to enforce them
- 			William J. Clinton
- 			March 4, 1998

## Progress

- PMTCT on track to achieve goals:
-  reaching 1,000,000 women
-  providing ARV prophylaxis to 80% of HIV + women delivering children in target countries
- In first 18 months
- 14,700 health workers have been trained
- 900 facilities have established PMTCT capacity
- PMTCT services provided to 378,000 women
- 34,000 women provided ARV prophylaxis
- Estimate: 4,800 cases HIV prevented

## Progress 

- Based on current projections, PEPFAR in first year:
- > 200,000 on treatment
- Support > 1.1 million
- Expose millions to information that will prevent infection

## Slide 20

**Notes:**
No one will go without treatment