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Commissioner Nielson's Speech on Aids in Africa at the EP

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Ladies and gentlemen,

Firstly, I would like to thank the Green Party for inviting me today to this symposium. I see from the agenda that a number of interesting topics will be covered during today's sessions. For my part, I will present the European Commission's external policies for fighting communicable diseases in developing countries.

Before presenting the Commission's work, I wish to make myself absolutely clear on certain basic points:

• HIV/AIDS is a disaster in many African countries. It is the worst global pandemic in more than six hundred years. It involves the loss of lives, of entire generations, of economic and cultural systems, and the undoing of decades of development.
  
  
• We have to confront the truth. And the truth is that, on average, every 10 seconds a man or woman in a developing country dies as a result of AIDS. The truth is also that the disease is spread mainly through heterosexual sex. I strongly reject the arguments that AIDS is mainly a homosexual disease spread through anal sex, or results from unsafe injections. This is simply not true in the African context. In fact the group that is hit hardest, and where the infection rate is increasing fastest, is amongst young African females. And most of them are infected by men.
  
  
• Most of these new infections could have been prevented by the regular and correct use of condoms! Condoms are scientifically proven to prevent the spread of infections. This fact cannot be disputed. It is, therefore, our duty to ensure they are made available in sufficient quantities in developing countries. However, we recognise that the use of condoms has to be seen within the cultural context and is not as straight forward as one would like to think.
  
  
• This strikes at the heart of the problem: Dealing with HIV/AIDS means talking frankly about the modes of transmission, which means talking about sex. This is not easy in any society. However, in the face of the scale of the HIV/AIDS disaster, we have no choice!

The silence and stigma that surrounds the HIV/AIDS debate, the prevention efforts and those who are infected and affected by HIV/AIDS needs to be addressed. Stigma is preventing people from discussing HIV/AIDS openly, from being tested for HIV and, in the end, preventing patients from seeking treatment and care. We need to break the silence and address the stigma. HIV/AIDS is a personal tragedy for more than 45 million men, women and children. More than 24 million people including almost 5 million children have already died since the beginning of the epidemic; 90% are from developing countries, leaving behind a legacy of more than 15 million orphans. More than 3 million people died and another 5 million were newly infected during 2002 alone.

Africa, especially sub-Saharan Africa, is the region most affected and 60% of adults infected in Africa are women. They are often infected at a very young age.

Inequality, poverty, limited knowledge, the lack of access to prevention, care and treatment, as well as stigma, all fuel the transmission.

The global disaster of AIDS must be stopped and we need to work together to halt the spread of HIV/AIDS and the suffering that it entails.

The EC, as part of the global community, is facing up to its responsibilities and playing a significant role in the international action to halt the HIV/AIDS pandemic. The basis for the Commission's work stems from the EC Programme for Action on Communicable Diseases, which is the EC's approach to HIV/AIDS, malaria and tuberculosis, the three major communicable diseases in developing countries.

This Programme for Action highlights the EC's recognition of the importance of dealing with HIV/AIDS in the context of poverty as well as recognising the important links between HIV/AIDS and other diseases such as TB.

The Programme runs from 2001 to 2006. It reflects a broad and coherent Community response to the global emergency caused by HIV/AIDS, malaria and TB. The strategy builds on the principles of country-led development processes and national ownership, as well as recognising the importance of regional and global action to support countries' efforts.

The Community's response entails 4 main actions:

1) Increasing the impact of existing interventions;

2) Increasing the affordability of key pharmaceuticals;

3) Improving research and increasing development of specific global public goods (such as an AIDS vaccine); and

4) Increasing the effectiveness of global partnerships and regional co-operation.

The first action involves increasing the impact of existing interventions. In order to ensure adequate support to implement the Programme for Action, the EC, with full support of the Member States and the European Parliament, has allocated more than €1 billion to fight these three poverty diseases from 2003 2006.

Optimising the impact of existing interventions, services and commodities requires increased support to strengthen health systems and a continuum of prevention, care and treatment efforts.

The second main target involves promoting access to affordable medicines. The Commission took the lead in the process resulting in the adoption of the Doha Declaration on the TRIPs Agreement and Public Health and in the agreement reached in August resolving the question for countries with no manufacturing capacity for pharmaceuticals.

The Commission strongly advocated the tiered pricing of medicines. This has received a boost through the adoption of unprecedented legislation in the European Union last May. The new legislation seeks to prevent the re-importation of reduced-price medicines into Europe and therefore encourages the pharmaceutical industry to make products available at near to cost of production price. This regulation has been operational for a few months and to date one European pharmaceutical company has filed applications for seven anti-retroviral drugs.

Today we see a good response from both research based and generic pharmaceutical producers to provide low cost medicines to developing countries. In fact prices have dropped as much as 95% on certain products during the last five years. With industry finally ready to substantially lower their prices and with the generic industry on board, more and more people should have access to anti-retrovirals.

The European Commission calls on others to show the same willingness to make quality medicines available at the lowest possible price for people living in developing countries.

Tiered priced medicines shall, even when imported, remain low cost, but in order to pass this on to the consumer, importing countries have to make sure that tariffs, taxes and fees are not levied on those medicines and pharmaceutical products, as well as bed nets for example. The Commission has carried out a study which shows that not all developing countries are complying with this.

The EC also aims to develop local manufacturing capacity of pharmaceuticals. The European Commission is committed to support initiatives promoting the local production of condoms, long-lasting insecticide treated bed nets and anti-retrovirals.

The third main part of the Programme for Action involves increasing investment in research and development of global public goods targeting the three major communicable diseases. Research and development in the pharmaceutical industry is very largely driven by the demands of the industrialised countries' markets. Those diseases prevalent in developing countries, where markets are perceived to be small, are to a large extent neglected. Hence we have seen several new drugs developed in the past few years for heart diseases but not for TB. Just 10% of global health research efforts target the diseases that account for 90% of the global disease burden.

The EC has allocated €400 million for the period 2003 to 2006 to research and development. Of this, €200 million has been allocated to the new European and Developing Countries' Clinical Trials Partnership (EDCTP). This pilot R&D initiative, which aims to unite and support Europe's clinical trial activities specifically targeted at interventions for use in developing countries, constitutes a concrete response to the fight against HIV/AIDS, TB and malaria which primarily affect developing countries.

A further €200 million has been allocated to current research projects on HIV/AIDS vaccines and drugs in Europe, Africa, Asia and South America.

The EC is also working hard towards developing incentives for the pharmaceutical industry that will make it more attractive to invest in research for neglected diseases.

The fourth action involves increasing the effectiveness of global partnerships and regional co-operation.

One such example of a global partnership is the Global Fund to fight HIV/AIDS, TB and malaria. The Commission has been closely involved and active in the development of the Global Fund from the outset.

Total pledges to the Global Fund have reached 4.8 billion US dollars. The EU, meaning the 15 current Member States of the European Union and the EC, is the main overall contributor to the Global Fund, with pledges worth 2.6 billion US dollars, which accounts for 55% of all pledges. The United States is the second biggest contributor, with 1.6 billion US dollars, or 33% of all pledges. Private sector contributions are less than 1%. The EC calls on the private sector to play a much larger role in the fight against HIV/AIDS.

I have described some of the EC's more specific actions targeting HIV/AIDS as well as TB and malaria. However, I would like to remind you all that the bulk of the European Commission's development assistance for health and communicable diseases is committed within regional and country indicative programmes covering periods of four or five years. These are developed by the Commission and the authorities of the recipient country or region, in consultation with the Member States and other development partners.

We fully recognise that AIDS is not simply a health issue and that an effective response requires actions in all areas.

To sum up:

The new millennium has brought a renewed international commitment to fight HIV/AIDS, and the international community has agreed ambitious targets to be achieved by 2015.

Therefore it is time to act and focus on issues that will make a difference. From what I have seen and learnt as a Commissioner for Development, I stress the following points:

• Wherever a country's response to the threat of an AIDS-epidemic has been successful, we have seen national leaders speak out and act accordingly. We have to support these leaders.
  
  
• We fully concur with WHO, UNAIDS who state that "unsafe sexual practices continue to be responsible for the overwhelming majority of infections" of HIV in Africa. We should never forget the need for prevention, the provision of condoms, the education and information all actions needed to avoid more HIV infections.

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