Sid Sidebottom (Braddon, Australian Labor Party) Share this | Link to this | Hansard source

The point of my motion today is to draw member’s attention to the plight of millions of the world’s population, predominantly the poor, who are afflicted by the world’s three main killer diseases, being HIV-AIDS, TB and malaria and what it is that governments can do to save lives and ease suffering. Each year about five million people in the world die from these three diseases: approximately two million from HIV-AIDS, two million from TB and one million from malaria. These figures represent huge personal suffering for family and friends who lose loved ones, as many of us would know from our own experience. To many of those left behind, they also represent a familiar life sentence of poverty, disability, sickness and lost opportunity. The loss of the family breadwinner can mean that the remaining family members have insufficient food and may not be able to afford even the most basic health care and that children, particularly girls, must forego a primary education, something that most would universally acclaim as a basic human right.

In 2000 the United Nations created the Millennium Development Goals, a set of eight goals based on the world’s main development challenges and designed to build a safer, more prosperous and more equitable world. Goal 6 of the MDG specifically aims to halt and reverse the spread of HIV-AIDS and the spread and incidence of TB and other major diseases, including malaria. I am pleased to say that significant progress on this goal has been achieved. In 2000, the number of people dying from HIV-AIDS, TB and malaria was estimated to be six million annually. Today that figure has been reduced—if I can use such a term—to five million annually.

While there have been many governments and international organisations responsible for achieving that reduction, there is one organisation that stands out for its effectiveness in delivering health programs successfully. I refer specifically to the Global Fund to Fight HIV-AIDS, Tuberculosis and Malaria—pandemic nonrespecters of borders, yet all three are easily preventable and treatable. The global fund is the largest multilateral funder of public health programs in developing countries. It was established in 2002 as an international public-private partnership for the purpose of mobilising and intensifying the international response to the global epidemics of HIV-AIDS, tuberculosis and malaria. To the end of 2009 the fund has disbursed nearly US$10 billion.

The work of the global fund has undoubtedly made a significant contribution to the global reduction in the number of deaths from the three diseases. The fund estimates that its own programs have saved 5.7 million lives since its creation. Indeed, in May 2010, The Lancet said, ‘There is no sector of government expenditure that gives a better human return’ than the global fund. The global fund is an international success story that serves as a model for the delivery of international development assistance not only for its effectiveness in saving lives but for the innovative approach it adopts. Financial allocation decisions are technically based and are transparent and there is a high level of civil society involvement in its decision making. On 4 and 5 October this year, donor nations to the fund promised to replenish funding to the fund of US$11.7 billion over the 2011-13 period.

I am pleased to say that the Australian government increased its 2008-10 commitment of $145 million to $210 million. These funds will be a good investment. They will enable the global fund to continue and expand on its existing programs, they will save the lives of millions more people, they will help to keep more people out of the poverty cycle and they will make a significant contribution towards achieving the health goals of the Millennium Development Goals, particularly goal No. 6.

While I do not want to be critical of the international community’s replenishment of the $11.7 billion US fund, it needs to be acknowledged that, unfortunately, the level of funding promised will not be sufficient. Health advocates estimate that, in order for the global fund to fully realise its objectives, a total of US$20 billion is required. That is almost double the total amount promised.

Time is fast running out for achieving the Millennium Development Goals by the target date of 2015. It will require more urgent action from the governments of the world, both donors and recipients. I call on members of all parliaments and governments to review their personal and collective commitment to achieving the MDGs and funding their nation’s fair share of the required global funding for the global fund to fight HIV-AIDS, TB and malaria in particular.

It is time to make the achievement of the MDGs an urgent priority, the likes of which were illustrated in the global response to the recent global economic crisis. At the important microlevel of the program and on funding provisions, it is encouraging to note the following. In relation to HIV, by the end of 2009, global fund programs were providing: antiretroviral therapy—or the so-called ART—to 2.5 million people; 1.8 billion male and female condoms; treatment to nearly one million HIV-positive pregnant women to help prevent mother-to-child transmission of HIV; 105 million counselling and testing sessions; and 4.5 million basic care and support services to orphans and other AIDS-vulnerable children.

As regards tuberculosis, six million people who have had active TB were treated, along with $3.2 billion invested in detecting and treating new smear-positive TB cases in some 112 countries. TB prevalence is declining as are TB mortality rates. Malaria prevention has been greatly aided by the distribution of 104 million insecticide treated nets. A variety of prevention programs have been funded, to the total of $5.3 billion, covering some 83 countries. Morbidity and mortality rates worldwide due to malaria have declined markedly and, in some cases, by more than 50 per cent in an increasing number of countries. It is estimated that some five million lives have been saved and hope restored for 33 million people living with HIV, the hundreds of millions of people who contracted malaria or who are at risk each year and the 10 million who contract active TB annually.

The global fund is realising the extraordinary vision of its founders, donors and implementers. It has drastically intensified the fight against HIV, TB and malaria, as I mentioned, while contributing to improving health systems in the progress of achieving the MDGs.

Virtual elimination of mother-to-child HIV transmission globally by 2015 can be achieved. Massive scale-up of HIV prevention programs and the provision of ART continues, as I mentioned earlier, although unfortunately universal access to comprehensive and evidence based HIV prevention, treatment, care and support remains distant. As I mentioned, the prevalence of TB has significantly decreased over the last decade and the international target of halving the prevalence of TB could be met by 2015. Unprecedented coverage with ITNs and effective novel treatments have made great inroads into combating malaria. A rapid scale-up of prevention, treatment, care and support for these three pandemics has meant hope and, as the annual report for 2009-10 testified, has had a positive impact on millions of lives.

The report notes:

Such unprecedented progress would not have been possible without the support of donors and partner organizations.

That is at the heart of the Global Fund. The report goes on:

In the coming years, continued, substantial increases in long-term financial commitments by donors—

such as Australia—

will be needed to consolidate these gains and to reach the MDGs by 2015 and universal coverage of HIV, TB and malaria services. 2010 is the year that should inspire extraordinary commitments from the public and private sectors to safeguard and build upon the already substantial achievements made over the past decade.

I thank Ingrid Smethurst and Ian Sansom of the RESULTS Burnie group for bringing the Global Fund to my attention as they have and for conducting their public campaign to make us all responsible for what is a global issue and a global responsibility.

Paul Neville (Hinkler, National Party) Share this | Link to this | Hansard source

Part of the essence of humanity is our drive to alleviate the suffering of others. It is something that we seek to do as representatives in parliament, and it is a natural instinct in the everyday lives of most people. Australians are renowned for their generosity and their readiness to help others in distress.

Before going into the substance of my speech, let me clear one little thing from my mind. I am governed by two overriding principles when it comes to foreign aid and the elimination of disease. First, I cannot abide those people who peddle the glib old mantra that charity begins at home. Charity does not begin at home; charity begins when you look into the eyes of a sick or starving child. Second, anyone who believes that we have eliminated smallpox, have almost eliminated polio, can eliminate AIDS—as the previous speaker said—or can eliminate malaria and tuberculosis by somehow cocooning Australia from the rest of the world and trying to escape our obvious interdependent responsibility lives in a fool’s paradise. As a nation we have an obligation to help foreign countries which desperately need our expertise, our manpower and—yes—our money to overcome the difficult challenges they face. I also believe that any Australian government, regardless of its colour, has the duty to ensure that our foreign aid budget and other allocations in the development assistance fields deliver the greatest good for the greatest number of people affected.

Foreign aid has to be targeted at projects which empower Third World countries. There is no question that disease eradication, particularly amongst our neighbouring countries, is one of the best purposes our foreign aid can be put to. As someone who has a firsthand understanding of the importance of the fight against devastating diseases such as HIV-AIDS, tuberculosis and malaria, I am happy to speak in support of the motion of the honourable member for Braddon on the Global Fund to Fight AIDS, Tuberculosis and Malaria. At this time last year I was one of the parliamentary advisers to the Australian Embassy at the UN. I am familiar with the great work being done around the world in fighting these awful, debilitating diseases through the Global Fund and more widely through the Millennium Fund.

One of the greatest efforts to overcome these diseases has been carried out through the Global Fund to Fight AIDs, Tuberculosis and Malaria. It was created in 2002. It is a unique partnership between governments, the private sector and international communities to combat three of the most insidious diseases still plaguing the planet. The Global Fund is currently the main source of finance to help fight these diseases throughout the world, providing a quarter of all the international financing required to combat AIDS, two-thirds of tuberculosis outlays and three-quarters of malaria treatment programs.

Since its inception, it is estimated that the work done through the fund has saved around five million lives in some of the poorest countries on earth. In the same time frame, the fund distributed around $10 billion to help control the spread of HIV, tuberculosis and malaria, and invested more than $90 billion in specific control and treatment programs. These programs are saving around 3,600 lives every day and preventing thousands of new infections from breaking out.

Australia committed $145 million to the fund for 2008 to 2010, and last month the government confirmed it would contribute again, pledging $210 million to the fund between 2011 and 2013. Some Australians might question the value of foreign aid, but in many cases we reap the benefits of the work we are doing in funding other nations, even in our own nation. As I said, the global fund is responsible for the control and treatment of HIV-AIDS, malaria and tuberculosis through South-East Asia and the Pacific, covering 24 countries in our region, including Papua New Guinea, Indonesia, Tonga, Vanuatu and the Cook Islands. It is important to recognise that malaria is a global issue; and, in the case of controlling the spread of malaria, the benefits to our region are self-evident. Many of the 60 per cent of malaria cases occurring outside Africa occur in the Asia-Pacific region, so this is not some remote disease in an even more remote country; this is something right on our doorstep. Ask the diggers who served in Papua New Guinea and the Pacific Islands in World War II. Ask the contractors who work or have worked recently in Papua New Guinea or the Solomon Islands. Many of them have been struck down by malaria. It is a disease which has a serious economic as well as a human impact on poorer countries. It fuels a cycle of poverty, primarily afflicting the poor, who tend to live in malaria prone areas in poorly built dwellings that offer few if any barriers against mosquitoes.

During my time at the UN, I spoke about Australia’s leading role in combating malaria in the Asia-Pacific region. Around one-quarter of the nations that have embarked on malaria elimination programs are located in the Asia-Pacific region, and through the Pacific Malaria Initiative we are providing targeted technical and management support to governments to implement their national malaria control plans. This initiative is already making significant headway. For instance, in the Solomon Islands, the malaria incidence rate was brought down from 199 cases per 1,000 in 2003 to 82 cases per 1,000 in 2008, while in Vanuatu the rate has decreased from 74 cases per 1,000 in 2003 to 14 cases per 1,000 in 2008. Australia also hosted the inaugural meeting of the Asia Pacific Malaria Elimination Network early last year. The network is another forum to help improve the technologies, skills, systems and leadership that are needed to decrease and eventually eliminate malaria in the Asia-Pacific region.

A little closer to home, we recently heard about the dreadful outbreak of cholera in Papua New Guinea. But what most Australians do not know is that malaria is actually one of the leading causes of death and illness in Papua New Guinea. The global fund has invested around $70 million in malaria treatment and eradication programs in Papua New Guinea. Because of our proximity to PNG, this is relevant to us. Alongside this, Indonesia currently ranks third in the world for its overall tuberculosis burden. Because of our proximity to these two nations, we are particularly susceptible to outbreaks of both malaria and tuberculosis in Northern Australia.

Recognising this, the coalition pledged $40 million during the recent election campaign to help establish a tropical health institute at James Cook University upon winning government. The money would have gone towards the construction of an Australian institute of tropical health and medicine which would focus on bacteriology and biomolecular sciences, urology and pharmaceutical chemistry. Older Australians would remember the famous Sir Raphael Cilento, a doctor from Queensland who was a world leader in tropical medicine in the 1950s. We need to repeat those sorts of things in the current age. In a nutshell, such work would advance us tremendously in the elimination of many of these scourges that the world suffers.

Those of us who lived in the 1950s and 1960s would remember having the skin tests and going along to the mobile X-ray clinics. That way Australia eliminated tuberculosis. It had a tri-fold effect of detection, treatment and elimination and the end of a potential infection. We should not expect that we who got through that so lightly should not do something to help our neighbours through a similar crisis. And so I support the honourable member’s motion.

Laurie Ferguson (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

We are all involved tonight in a resolution that is of deep interest to many Australians. Only today I had a number of young advocates from Oak Tree, an organisation that campaigns in regards to Australia’s foreign aid level, visit me. This is an occurrence for many members on a very regular basis. One of the changes that we have seen in the political system over recent years is disillusionment with major parties but very strong engagement on issues such as foreign aid.

I welcome Australia’s increasing support for the Global Fund, which was established in 2002 to dramatically increase resources to fight three of the world’s most devastating diseases: AIDS, malaria and tuberculosis. That funding increase occurred at a crucial time. In the Guardian Weekly of 24 September 2010 there was a report that quoted Michel Sidibe, head of the UN HIV-AIDS agency. He talked of the momentous gains that have been made over the last few years but expressed concerns that European countries were giving $623 million less this year to HIV-AIDS programs around the world, and there was a shortfall of $10 billion in the funds needed to achieve universal access to HIV treatment. The Guardian Weekly article by Peter Beaumont said:

UNAids said access to treatment for HIV has increased 12-fold in six years, and 5.2 million people now get the drugs they need. But another 10 million who need the drugs do not get them.

He quoted Michel Sidibe as saying:

“To sustain the gains we are making, further investments in research and development are needed–not only for a small wealthy minority, but also focused to meet the needs of the majority.”

So this decision came at a time when there were some concerns that the economic crisis of the past few years, and the parallel failure of countries to meet their commitments anyway, was leading to a disturbing possibility that the significant gains being made would not be continued.

AIDS has a huge social impact and an impact on the economic productivity of developing countries. The previous speaker talked about malaria affecting most, particularly, poorer communities because of the way in which it spreads. In contrast, AIDS often largely hits the remaining educational elite of many of these African countries. Disproportionately, they are the ones amongst whom it is prevalent. Those countries have already lost many of their educated experts to other countries—they basically seize the people trained or educated overseas. It is a very crucial issue.

Around one million people die from malaria, mainly children under five, and over 300 million clinical cases are reported. Over half the world’s population in 109 countries is at risk of contracting malaria. Like AIDS, most deaths from malaria occur in Africa, with around 2,200 people dying every day.

More than two billion people suffer from tuberculosis, of which 90 per cent live in developing countries, and obviously that is clearly related to the material conditions under which they live. We know that in Australia there has to be a lot of vigilance in regard to tuberculosis in the immigration intake. For a few years we had problems because we trusted people to fulfil commitments once they arrived here, rather than ensuring that they actually got rid of the condition through treatment before they arrived here.

Each disease is debilitating and potentially deadly. When someone suffers from a combination of them it is even worse, particuarly with HIV-positive people contracting tuberculosis.

The fund has a different, I think effective, way to deliver support and to combat AIDS, malaria and tuberculosis. The fund works closely with donor and recipient countries, other organisations and local communities to prevent duplication, which is important, and to integrate effectively into the delivery of health programs. In other words, there is a lot of cooperation with the local system on the ground and ensuring that there is not a situation where there are a whole lot of overpaid Western professionals competing in the same market and basically falling over each other.

By increasing Australia’s support for the global fund from $145 million in 2008-10 to $210 million for 2011-13, we are making a contribution to the health, wellbeing and productivity of developing countries. The global fund has received commitments of $11.7 billion over the next three years, but needs an estimated $20 billion. I am hopeful that Australia’s initiative on this front is such that it would precipitate action from a number of other countries. As I said, there have been concerns over the past year that despite the major advances being made it will not be held because of countries retracting their offers.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

In combating international poverty one of the few really great successes has been the global fund to target these three major infectious diseases world wide. As we have already heard, they kill around 3½ thousand people every day and result in thousands of additional infections and enormous morbidity for families, particularly in developing economies.

The origins of the fund go back prior to the year 2000, when a number of leading economists looked at ways to provide a carrot—effectively, a reward—for both nations and corporations that invested heavily in the solutions to what at that time were unsolvable problems—the top three killers. Malaria, TB and HIV had for a long time taken hundreds of thousands of lives in the decades preceding the year 2000. Only then did a guy called Jeffrey Sachs, working together with Michael Kremer from the School of Economics at Harvard, first talk about a global fund.

The initial concept was to have donor nations in particular put money aside that would serve to be a carrot attracting investment into new forms of pharmaceuticals that could one day help us to win this titanic struggle. In the intervening period, of course, the large nations, and particularly the G8 nations, got together with the pharmaceutical manufacturers and negotiated some very impressive breakthroughs where these expensive drugs, particularly the HIV drugs, could be provided at just a fraction of the market price. So all of the negotiation around the global fund was then able effectively to be turned into a leveraging instrument which, unlike the UN bodies with which it was working, did not have major in-country offices and did not seek to tell nations what to do. Instead, it just focused on the simple principles of working with national priorities and working as leverage rather than simply as a provider of services. It sought, where it could, to leverage in-country expertise, to do independent evaluation and to be completely balanced in the way they approached these three great killers. They did not focus unfairly on one intervention, one region or one disease.

That was the essence of the global fund, and we have had three commitments to replenishing it. The most recent was on 4 and 5 October in New York, and was quite successful. There the second replenishment of $9.7 billion was increased to $11.7 billion. Over those three replenishments we have seen jumps of 80 per cent and then most recently 20 per cent. It is very promising that most of those who contribute funds have actually backed up the talk with walk. The moneys that have been committed are coming through. In fact, in the most recent replenishment, where they have achieved $11.7 billion, about $2.52 billion of that is expected to come when these donor nations are able to fund those commitments.

The estimation is that we need $20 billion over this three-year period. In reality, we have just under $12 billion. That tells us that we are getting somewhere near but still not close enough to what would be the ideal target. We know from national plans in the 83 nations that are afflicted with malaria, of the 112 with TB and around 140 combating HIV that the two really great challenges will be predominantly men having sex with men as the chief threat in HIV transmission and women having babies who are HIV positive. They will be the two key focuses around HIV because we are seeing an explosion—a radical jump—that has actually caused a J-curve in the reporting of HIV in these nations.

With multidrug resistant TB, again, the challenge is to get the suite of drugs correct and to have them available in all nations. That was the real success of the last three-year period. Obviously, with malaria, it is insecticide impregnated nets that are available to people to reduce the chance of infection with malaria, particularly around dusk and while sleeping.

I will now turn very, very briefly to those three millennium goals. The ones we are most optimistic about are: 6, which is the reduction of the dreadful communicable diseases; they are also contributing to goal 4, around child mortality being halved, and 5, maternal mortality being halved. The communique that came out from the most recent meeting in New York was really encouraging. They are pointing at country-coordinating mechanisms, CCMs, that allow this effort, which is fundamentally a financial instrument, to get down into countries and leverage the ability and the capacity on the ground. That means that it is being implemented slightly differently in each country, a real change from the struggle that these agencies have had before to coordinate multiple donors and to work with local capacity.

Finally, it is good to see ACFID right here in Australia recommending with its five health-related recommendations: that 20 per cent of Australia’s aid be health related, 15 per cent be family planning related, a focus on avoidable blindness and of course their recommendations around treatment of those three conditions. We welcome the government’s increased commitment of $210 million. This is only one per cent of what is needed and is well short of our GDP as a contribution to global GDP, but still it is a very important contribution towards the Millennium Development Goals that could well be achieved by 2015.

'ath Yvette (the Deputy Speaker):

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.