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Cablegate: Who: 58th World Health Assembly: Ministerial

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A

REF: A. STATE 74933
B. GENEVA 1673

1. SUMMARY. Secretary of Health and Human Services (HHS)
Michael O. Leavitt and Ambassador Randall L. Tobias, U.S.
Global AIDS Coordinator, invited the Ministers of Health from
the fifteen focus countries of the President's Emergency Plan
for AIDS Relief to meet with them during the 2005 World
Health Assembly (WHA) in Geneva, Switzerland, on May 17,
2005. This Ministerial meeting has been a feature of the WHA
since 2003. Dr. Julie Gerberding, Director of the HHS
Centers for Disease Control and Prevention, and Dr. William
R. Steiger, Special Assistant to the HHS Secretary for
International Affairs, also participated.

2. The purpose of the meeting was to brief the Ministers
and/or their representatives on progress in the Emergency
Plan, and invite questions. The meeting provided an
opportunity for the Secretary and Ambassador Tobias to have a
candid discussion with these senior health officials on what
is working well and what challenges remain at the country
level as the implementation of the President's Emergency Plan
for AIDS Relief moves forward. It also enabled senior
Administration officials to continue to strengthen the
communication channels necessary for more effective operation
and implementation of the Emergency Plan at the national
level, and reiterate the President's commitment to alleviate
the suffering from and devastating impact of the AIDS
pandemic on these countries and around the globe. END

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3. Ministers of Health and/or representatives of the
Ministries of Health from all the Emergency Plan countries
except South Africa attended the meeting. These included
Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya,
Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, Viet
Nam and Zambia.

4. Highlights from Secretary Leavitt's remarks included the

(a) The United States Government (USG) is committed to doing
all we can to end the suffering and death caused by AIDS.
The United States is pleased to say that we are devoting
unprecedented resources to this crisis, and combating AIDS is
one of President Bush's major foreign policy goals.

(b) The President's five-year, $15 billion Emergency Plan for
AIDS Relief is the largest and most ambitious commitment ever
made by a single nation toward an international health

(c) The Emergency Plan includes both a pledge of support for
a dramatic increase in our bilateral assistance in more than
100 countries and a commitment to the Global Fund to Fight
AIDS, Tuberculosis and Malaria of $1 billion over five years.

(d) HHS is working with Ambassador Tobias and the U.S. Agency
for International Development (USAID) to implement these
commitments by adapting the Plan to local circumstances. The
U.S. five-year strategy outlines a strong blueprint for

5. Ambassador Tobias's key points included the following:

(a) One of the vital tasks of the President's Plan is to
provide support for in-country programs.

(b) The USG realizes there is a long road ahead, and is
already planning a course of action for when the initial
period of the President's Plan ends.

(c) The USG realizes the need to ensure the availability of
drugs matches the speed with which people are put on
treatment. As such, O/GAC is working with the HHS Food and
Drug Administration (FDA) in the review of generic drugs.

(d) Under the expedited review process Aspen Pharmacare of
South Africa has been granted tentative approval by HHS/FDA
for its anti-retroviral treatment blister pack. HHS/FDA
tentative approval makes this product eligible for
procurement under the President's Emergency Plan. (NOTE:
Since May, HHS/FDA has given tentative approval to several
other anti-retroviral drug products from manufactures in
India. END NOTE)
6. All Delegations in attendance spoke with the exception of
Mozambique. The participating Ministers of Health were
well-prepared; some spoke from prepared remarks. It was
clear the Ministers were much more positive than they had
been in past years, which indicates progress and increased
understanding about the President's Plan. All expressed
great appreciation of the U.S. support through the
President's Plan; many invited Secretary Leavitt and
Ambassador Tobias to visit their countries; and some
expressed hope Secretary Leavitt will continue the momentum
created at HHS over the last several years to work closely
with countries in the fight against HIV/AIDS.

7. Several consistent themes emerged from the Ministers'
presentations, comments and questions:

(a) Coordination - Ministers asked for the U.S. Government
to redouble its efforts to coordinate Emergency Plan
activities with those of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the World Bank, the World Health
Organization (WHO), the United Nations Joint Program on
HIV/AIDS (UNAIDS) and independent non-governmental
organizations (NGOs).

(b) National Capacity-Building - Ministers urged that the
Emergency Plan create standard modules for training
healthcare workers.

(c) Extension of Activities into Rural Areas - Ministers
asked for the Emergency Plan in 2005 and 2006 to make even
greater efforts to move beyond urban areas and capital cities
to provide care and support to rural populations.

(d) Management and Leadership Training for Ministry Staff -
Ministers asked for the Emergency Plan to support specific
management and leadership training for key personnel within
Ministries of Health and Provincial or District Health

(e) Drug Procurement - Ministers asked a number of detailed
questions about the policies that govern the Emergency Plan's
procurement of anti-retroviral medications. The level of
misinformation to which the Ministers had been exposed and
their lack of knowledge regarding U.S. policy spoke to the
need of better and clearer communication with government
officials in Emergency Plan focus countries around
pharmaceutical issues.

8. Excerpts from the Ministers' remarks include the following:

Botswana: Appreciated the contributions of the President's
Emergency Plan for AIDS Relief and reiterated the need for
human resources development for sustainability. The Minister
is working actively to implement the President's Plan, which
includes active work with NGOs.

Cote d'Ivoire: Shares many of the problems of the other focus
countries, including the need for equipment and
infrastructure, expanded human resources for health and
increased availability of anti-retrovirals and antibiotics;

Ethiopia: Making reasonable progress, but the Minister is
not satisfied and sees room for improvement from the Ministry
and the President's Plan, with renewed commitment and
flexibility needed. He stressed the need for closer
harmonization and collaboration, with sustainability at the
forefront as implementation moves forward. The USG needs to
help build capacity and strengthen health systems at the
country level.

Guyana: Working closely with the USG, but the U.S.
partnership is one among many. Guyana has a national
coordinating mechanism for all HIV-related programs and views
success against HIV/AIDS only possible if placed within the
context of overall development. Like Ethiopia, the Minister
requested help with capacity-building to strengthen the
health sector overall.

Haiti: The Minister is grateful for U.S. assistance, and
stated that with assistance from the President's Plan, six
out of ten districts have anti-retroviral treatment for
persons living with AIDS. Their reference laboratory will
soon have safe blood-transfusion capacity. In Haiti, there
is a high and increasing prevalence of HIV infection among

Kenya: While the Minister hopes to have 95,000 on
anti-retroviral treatment by the end of 2005, 200,000 people
need therapy. National HIV prevalence rates have decreased
from 14 to seven percent. Kenya needs help to track funding
so as not to duplicate efforts and maximize all resources
coming into the country. He cited a number of other
challenges that have a negative impact on sustainability: 1)
the World Bank/International Monetary Fund caps on hiring of
civil servants limited the ability to hire health care
workers, 2) the lack of infrastructure and of equipment, and
3) a lack of generic drugs.

Namibia: Latest sentinel survey indicated HIV prevalence
rate of 19.4 percent, down from 22 percent in 2002. In 2001,
Namibia began its prevention of mother-to-child transmission
program; and in 2003 initiated both opportunistic infection
and anti-retroviral treatment. By the end of 2005, they plan
to have 10,620 people on anti-retroviral treatment. Namibia
is using its own funds to purchase anti-retroviral
medications, and funds from the President's Plan are
underwriting capacity-building. The Minister stressed the
need for flexibility in drug purchasing policies, including
generic drugs.

Nigeria: Nigeria currently treats 28,000 people with
anti-retroviral medications and projects to scale up to
treatment of 40,000 people with anti-retroviral medicines by
June 2005, 100,000 people by December 2005, and as many as
350,000 people by 2007. Nigeria has strengthened laboratory
services in six states, and is training additional health
personnel. Ongoing challenges include 1) coordination among
implementing partners; 2) tracking activities and
information; and 3) building capacity at both the state and
federal levels. A major challenge is sustainability of
treatment, including the need for generic anti-retroviral
medicines as soon as possible. They are very appreciative of
the HHS/FDA fast-track approval process.

Rwanda: Noted less stigma for people with AIDS, that local
conditions for people with AIDS are improving and more of
them are able to continue to work and contribute to their
community. The Minister cited the need for more treatment,
including psychological treatment, as well as epidemiological
surveillance for HIV. Rwanda's current HIV prevalence rate
is 11 percent, down from 13 percent. Rwanda would like to
strengthen health systems and build capacity to ensure
sustainability of ARV treatment and tuberculosis treatment,
and expressed concern about antimicrobial resistance.

Tanzania: Noted a 7.7 percent HIV prevalence rate and hopes
to enroll 200,000 people in anti-retroviral treatment
programs in the coming year. They requested additional
assistance with 1) the provision of drugs, including
anti-retrovirals; 2) the building and strengthening of
laboratory capacity; 3) help in the development of programs
that jointly target HIV and tuberculosis; 4) increased
voluntary counseling and testing; 5) expanded home-based
care; 6) information systems development; 7) the
implementation of monitoring and evaluation systems; and 8)
the training of health workers.

Uganda: Expressed appreciation the President's Plan is
helping to meet the challenges of HIV/AIDS, and reported its
program is on track. The Executive Office of the President
leads the national efforts with strong support from the
Ministry of Health. Uganda needs sanitation and clean water
to help with treatment. The Ugandan HIV/AIDS prevention
program is based on "ABC" with all three strategies
emphasized -- abstinence emphasized for youth, monogamy
emphasized for married couples, and condom use emphasized for
others; the current HIV prevalence rate is seven percent at
the national level. By end of 2005, Uganda projects that
60,000 people will be on anti-retroviral treatment, and, by
2007, all in need will be on treatment, with a plan to give
free anti-retroviral medicines to the poor, and a fee system
for those who can afford to pay. Among the challenges are
reaching people deep in the countryside and increasing
treatment rates for malaria and tuberculosis.

Viet Nam: The increasing rates of HIV/AIDS are causing a
great burden on Viet Nam, and the Government has invested
resources for prevention and control initiatives. Viet Nam
would like a bilateral framework agreement with the United
States for HIV/AIDS and wants to work with the U.S.
Government to develop a joint HIV/AIDS strategy for 2006.
Viet Nam is considering tax waivers for the importation of
drugs and medical supplies.

Zambia: The Minister stressed the need for better
coordination among all donors, to maximize the existing
resources for HIV/AIDS and development.


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