MSF Teleconference: The Need for Innovative Financing for Global Health

MSF Teleconference on Innovative Financing Mechanisms for Global Health

September 20, 2010

Sandra Murillo: Good morning everyone and welcome to the Doctors Without Borders/Médecins Sans Frontières (MSF) press teleconference on the need for innovative financing for global health. Thank you for joining us. Our press teleconference speakers today are Sophie Delaunay, Executive Director of MSF in the US; Severine Ramon, Program Manager for MSF's Nutrition Program in Niger; and Ann Akkeson, Medical Coordinator of MSF's Prevention of Mother-to-Child Transmission of HIV Program in Malawi. Ms. Delaunay will discuss the crucial need for innovative financing mechanisms for global health, including a financial transaction tax. Ms. Ramon and Dr. Akkeson will talk about their field experience and the need for sustainable, predictable funding to ensure that the latest medical advances reach as many as possible.

Sophie Delaunay, Executive Director, MSF-USA: Thank you, Sandra, and thank you all for joining this call. So, as we all know, for the next several days, global leaders will be assessing progress on the millennium development goals, or MDGs. The World Health Organization, the WHO, reports that an additional $37 billion needs to be spent every year until 2015 in order to meet the health-related MDGs in malnutrition, child mortality, maternal health and the world's biggest infectious disease killers that are HIV, TB and malaria. But in many cases, global donors and government are either freezing or decreasing their funding for global health priorities.

The Global Fund, for example, the world's largest funding mechanism for AIDS, tuberculosis and malaria, is now encountering budget constraints. It is expected that donations to the fund, which will be announced at next month's Global Fund Replenishment Meeting in New York, might fall short of even the least ambitious proposals put forward by the Global Fund. And also the Global Alliance for Vaccine and Immunization recently reported a $4.3 billion shortfall for its program, meant to offer immunization to 110 million children by 2015. So this is to say that we must continue to ensure that donors honor Global Fund and other commitments to global health, and that developing countries maintain their own budgetary commitments to health.

But as the current funding situation illustrates, there must also be another mechanism for reliable streams of funding. And we at MSF, we think there is. One such mechanism is a financial transaction tax for global health, an idea that is gaining more support and will be proposed at the summit. If structured appropriately, and with resources reserved for health needs, we think that this small levy on all financial or currency transactions could actually create reliable and sustained funding for global health. By providing a dedicated and predictable funding stream, the financial transaction tax could mean that patients' lives are no longer at the mercy of volatile markets, political priorities or even donor fatigue. The model actually already exists. The international health agency UNITAID finances HIV/AIDS, TB and malaria treatment programs through a small tax on airfares.

As you know, global financial issues are outside MSF's scope of expertise, so we today are not calling specifically for the creation of a specific financial transaction tax, but rather for innovating financing mechanisms with funds reserved for health needs. This should supplement and not replace existing funding mechanisms. So we're certainly appealing for additional sustainable resources toward existing global health challenges, and should a properly-structured financial transaction tax come into being, it would be a unique opportunity to present itself to roll back millions of unnecessary deaths every year. According to the recommendations of the intergovernmental leading group on innovative financing fund development, a currency transaction tax of 0.005% on the four largest currencies could result in US $33 billion a year.

A currency levy that would respond to health needs would actually be welcomed by MSF. For many diseases, such as malnutrition and mother-to-child transmission of HIV, doctors and medical providers know exactly what needs to be done to save lives. Our field teams are using new tools, approaches, and medical protocols to save children from malnutrition and to ensure that babies do not contract HIV at birth or shortly thereafter. But long-term, widespread implementation of these most effective programs are not possible without reliable funding.

Now I'd like to introduce Severine Ramon, MSF Program Manager for Niger, to talk about MSF's work in this area of malnutrition and how funds generated from a mechanism such as an FTT, financial transaction tax, could actually help the 195 million children affected by malnutrition every year.

Severine Ramon, MSF Program Manager in Niger: Thank you Sophie. I'm going to talk to you a bit about Niger, and just to explain [to] you how the situation is there. In the worst side, it’s a bit the same as…. So my job, first. In the [unintelligible] crisis, each year, MSF is treating thousands of malnourished children.

This year was worse than other years. That means that MSF has been developing some new strategy, in fact, to cover the worse situation in the way to attacking the curative way, and also to work in the preventive way. The problem is that for all the—each year, you have some agencies that are providing the normal food, but normal food is not adapted to children that are severely malnourished. So what MSF wants to push for is that at least this food that is given by the rich countries are more adapted to those children.

So just to give you some figures, in Niger this year, we worked to prevent malnutrition over 143,000 children and curing more than 90,000 children. Meaning that we are working on both phases. In August, we had been at the peak of malnutrition, and we received up to 60 children per day in intensive care for severe malnutrition. That means on top of the worst situation this is very [unintelligible] and we really want to move towards a new strategy to ward off this malnutrition crisis. Hello?

Sandra Murillo: Severine? Severine? Her line is just disconnected. So then we're just going to go on to Ann and then we’ll go back to nutrition. We’ll just go back to Ann in Malawi. Is that ok, Ann?

Ann Akkeson, MSF Medical Coordinator, Cholo District, Malawi: That is fine for me.

Sandra Murillo: So can you just let the people on the call know?

Ann Akkeson: Good morning everyone, from Malawi. I'm Ann Akkeson. I'm the Medical Coordinator for MSF in Cholo District, Malawi, where we, together with the Ministry of Health, run an HIV program including prevention of mother-to-child transmission of HIV. Today in this program, there are approximately 2,700 pregnant women started yearly on antiretroviral drugs to protect their health and to prevent their babies from becoming infected. But most HIV-positive women in Malawi don't have access to preventive treatment and few infants are tested and treated. Without preventive treatment, 35 percent of all HIV-positive women will transmit the virus to their children. And an untreated infant is at extremely high risk of death. Half of babies with HIV will die by age two if not treated.

For those who do receive treatment in Malawi, the regime to prevent mother-to-child transmission of HIV is complicated, and it is a need of improvement also to be more effective. Medical providers are trying their best to implement effective mother-to-child HIV prevention programs, but human and financial resources are very limited. Working to prevent infants from contracting HIV and improving the health of the mother is an extremely rewarding experience. We have seen mothers who have been worried about their children for months, and we're able to tell them that because they stuck to the medicine, their child is HIV-free. There really is no way to describe the look on the mother's face when you can give her that kind of news.

As a medical provider, my concern is that this type of progress will not continue in the rest of Malawi or other developing countries without reliable long-term funding. Mother-to-child transmission of HIV during pregnancy, childbirth and breastfeeding have been virtually eliminated in the US and Europe. Fewer than 100 babies contract HIV from the mothers in the US every year. Worldwide, each year, some 400,000 infants acquire HIV from their mothers, most of them in Africa. Yet, with appropriate tools implemented effectively, it is possible to significantly reduce transmission of HIV from mother to child. This includes a strong drug regime for the pregnant women and child, early initiation of treatment continuing during the breastfeeding period for the mother, and prevention efforts for the child.

These options are more costly in the short term, but also more effective, saving money later. Also because of limited resources, some countries in Africa and part of Asia may not be able to adapt to the regimes approved by the World Health Organization for prevention of mother-to-child transmission of HIV. They do not have the appropriate technical or human resources to support complex prevention of mother to child transmission regimes. They might also initiate treatment later than is advisable for either the woman or the child. Countries that do plan to implement robust programs that would reduce HIV transmission to the child and protect the mother’s health are increasingly facing funding constraints. Malawi, for example, wants to implement a program based on new WHO guidelines with an estimated reduced maternal-to-child-transmission of HIV to less than two to five percent. These new guidelines have important benefits. The medicines are less toxic and the treatment more effective. Treatment during breastfeeding period make it possible for mothers to breastfeed longer, reducing the risk to the children of getting malnourished and sick and other infections.  

A mother on antiretroviral treatment can stay healthy and continue to support her family. About one-third of women who are HIV positive have an HIV negative partner. A mother on antiretroviral treatment will be much less likely to pass the virus on to her negative partner. The regimen itself is simplified; just one tablet once a day, and it does not require the administration of additional specific medications to the mother during labor. A simplified regime will help improve adherence and transmission outcomes. But these benefits will never reach most women and children in Malawi. Malawi has submitted a Global Fund application to support implementation of this program. Unfortunately, even the pessimistic predictions about future funding for the Global Fund, it is quite possible that Malawi will not receive these grants and will not be able to fully implement this ambitious and life-saving program.

Here is what it will mean: In Malawi we will continue to see HIV-infected children become needlessly ill, and many will die. Mothers won’t have access to treatment that affects their own health, their child’s health, and the health of their partner. Children will continue to be orphaned by AIDS. Malawi, as well as other countries, have an ambitious plan to prevent the worst. Health providers, from government representatives to the midwife out in a small rural clinic somewhere in Malawi, are eager to reduce the number of children who contract HIV from their mothers. I ask you, how can you look into the eyes of those pregnant and HIV-infected mothers and tell them we have the knowledge to help them, but rich countries say they cannot afford to do it. Thank you.

Emi MacLean, MSF Campaign for Access to Essential Medicines: Thank you, Ann. This is Emi MacLean from the MSF Campaign for Access to Essential Medicines, and I’m based in New York, and because of the technical difficulties with Severine call, I’m going to speak a little bit more about malnutrition globally, after she introduced some of the issues around the work that we’re doing on malnutrition in Niger currently.

Severine Ramon: I am back, I am back…

Emi MacLean: Would you like to continue, Severine?

Severine Ramon: Yes…. So let’s talk about malnutrition generally. Malnutrition contributes to the death of between 3.5 and 5 million children under 5 years old every year. Worldwide, 146 million children are underweight and at any given moment, 20 million children are suffering from the most deadly form of sever acute malnutrition. But [unintelligible] experience has shown that malnutrition is not the hopeless and intractable global health issue.

New strategies in recent years have allowed MSF to roll out ready-to-use therapeutic food in ambulatory settings. By bringing therapeutic food to children’s homes and taking malnutrition treatments out of the hospital setting, MSF has been able to reach hundreds of thousands of children in so-called “hunger hotspots.” In one of the districts of Niger, MSF has also demonstrate to the capital city to protect children from acute malnutrition by distributing nutrient-rich and energy-dense complimentary foods to all children identified between the ages of 6 months and 3 years. The children who receive ready-to-use food in addition to their normal diet, were nearly 60 percent less likely to progress to the most life threatening form of malnutrition than children whose diets were not supplemented. As of July of this year, MSF and local partners in Niger have been distributing food supplements to more than 142,000 young children to prevent them from becoming malnourished.

Today we know a bit more about what we need to do to respond to the crisis of malnutrition and how much it will cost. According to an evaluation by the World Bank, it costs $12.5 billion annually to fund nutrition intervention in the most effected countries. But MSF recognizes that only $350 million of this is spent per year. A financial transaction tax for global health, which is estimated to raise anywhere from $33 billion to $700 billion annually depending on constitution, could transform some of the world hunger gap and put government much closer to adequately treating and preventing the main cause of childhood death and illness worldwide.

Sandra Murillo: Thank you, Severine. At this time Sophie will conclude with some additional comments on the need for funding, and then we will open it up for your questions.

Sophie Delaunay: Thank you Sandra. Just to conclude I would just like to highlight the fact that these two examples are of course just a few aspects of the broader fight to both sustain and improve the global response to HIV/AIDS and malnutrition where still far too many people in the developing world are on sub-optimal medicines and starting treatment too late. Clearly a pool of reliable funding such as what would be generated through a financial transaction tax for global health could help ensure that appropriate treatment scale-up continues and that the standard treatment protocols are applied. It could help eliminate some of the inequities in treatment quality that persist between patients in the US and Europe and patients in Africa both in malnutrition and in HIV.

For malnutrition, with dedicated funding we could also make a significant dent into the preventable toll that this disease takes. The same actually would apply for neglected diseases like chagas, kala azar or visceral leishmaniasis. Simply stated, reliable funding for health could prevent people in developing countries from being at the whim of political and economic cycles for their very survival.

Sandra Murillo: Thank you very much for joining us. At this time we will open the call up to your questions.

Technician: Thank you. Ladies and gentlemen, if you wish to ask a question at this time, please press the star then one key on your touchtone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the pound key. Again, if you would like to ask a question, please press the star and then the one key. One moment please. We do have a question from Mark Bastion of ASP.

Mark Bastion: I would like to check a few figures that were given at the beginning of the conference because the sound of my phone was horrible. How much money do you need in 2015?

Sophie Delaunay: First, I want to make clear that it is not the money that MSF needs. We are talking about reliable funding for global health generally in the years to come. We gave two examples actually of major organizations that were funding global health needs that are the Global Health Fund and GASI, and I didn’t announce figures for the Global Fund because actually it seems that position of the needs for the Global Fund will be $20 billion for the years to come, but we don’t have any clarity yet as to, about the commitments for the countries, so it is difficult to know what the gap will be for the Global Fund. The need that I announced was a general need reported by the World Health Organization of an additional $37 billion needs to be spent every year until 2015 in order to meet the health related MDG’s. Does that answer your question?

Mark Bastion: Yes, perfectly.

Sandra Murillo: If there are no more questions, we will close the call. For more information, you can go to doctorswithoutborders.org.