January 28, 2004
REMARKS BY AMBASSADOR GUEST AT THE SYMPOSIUM "PUBLIC-PRIVATE PARTNERSHIP FOR INCREASED ACCESS TO TREATMENT FOR HIV/AIDS PATIENTS",
AS PREPARED FOR DELIVERY.
Mr. Minister, Madame Secretary, distinguished guests:
Imagine waking up one morning and reading in the newspaper that 20 fully loaded Boeing 747 airplanes had crashed the previous day, killing everyone aboard. Imagine the shock and horror that all of us would feel.
Then imagine waking up the next day and finding that another 20 aircraft, with all of their passengers, had been lost -- and then each day another 20, day after day after day, as far as the mind can see.
Some of you may have heard this comparison before, and if so, I apologize for repeating it. But my friends, that's how many lives are being lost each day to AIDS. 20 planeloads, day after day after day. An AIDS-related death somewhere in the world each 12 seconds. And eleven new HIV infections every minute of the day.
Each life that is lost is, of course, a tragedy in and of itself -- a life on which others depended, many of which have left behind a child without a mother or a father. A life that enriched a community.
Please, please put aside any moral judgments that you may have regarding how their disease was contracted - whether through unprotected sex among homosexuals or heterosexuals; through drug users sharing needles; or through mother-to-child infection.
The people that are dying are humans. They are like you and me. In my Christian upbringing, I've been taught that every life is a precious gift from God. Any of the lives that are being lost today might one day have achieved a scientific breakthrough, or empowered economic growth in a small town. Any might have been a cherished friend or neighbor.
Over the past decade, remarkable progress has been made at stemming the development of HIV into AIDS -- in other words, at allowing HIV-infected persons to have a reasonable expectation of a more normal lifespan, and a more fruitful life. The treatments are costly, however. They cannot always be afforded by the health budgets of many countries and individuals.
As all of us know, public-private partnerships have significantly helped Romania care for its HIV-infected children. And in 1997 only about 30 people in Romania were on antiretroviral regimens in accordance with international guidelines, now around 5000 - in other words, all of those known to need it - are being treated in accordance with these standards.
That is a relatively small number of patients compared to the number of HIV/AIDS patients worldwide, of course, but it is a real public health success for this country. It demonstrates that when you want to achieve reform, you have proven that you can do it.
As previous speakers have stated, Merck has played a large role in this positive development. Other pharmaceutical companies also have contributed in different ways:
Efforts like these are changing the face of how HIV/AIDS is being treated in Romania. They're also paving the way toward a broader understanding of how public and private officials can cooperate to improve the lives of the citizens of this country.
Today's symposium is aimed, of course, at exploring how public-private partnerships can go further, including by ensuring that HIV/AIDS patients writ large have affordable access to the treatments they need. Its participants include not only government health care officials, but a range of other stakeholders -- doctors, pharmaceutical representatives, NGOs and patients -- the right grouping to discuss how to find the best solutions for Romania.
I hope that, in this forum, participants will discuss in sufficient detail what is needed to ensure that the treatments offered are most appropriate for a disease that affects individuals in different ways.
The HIV/AIDS children that I've seen in some private clinics, for instance, have appeared far healthier and better developed than those in some state-run hospitals. That fact alone suggests several things: that public-private partnerships must be flexible and adaptable; that treatment regimes need to be compared and reviewed; and that public health officials must ensure that hospitals receive from central authorities the precise medications that have been prescribed by the doctors in whose hands these precious lives are entrusted.
I hope you'll also discuss the need to ensure that responsible health care officials who are counting costs and placing orders have the right managerial training to perform their functions effectively.
I'm particularly glad to see that a roundtable this afternoon includes attention to the problem of corruption in the health care sector -- an issue that I've discussed in detail with two previous Health Ministers. Though I cannot attend that session, I hope participants will put aside all protocol and discuss this issue frankly, no matter to what doors it leads.
As you know, my Government has given generously to this country in an effort to help meet the health care needs of the Romanian people. But let me be clear: without a serious and sustained effort on the part of Romanian officials to tackle the layers of corruption and special interests that have distorted sound health care policy in this country, that assistance is in jeopardy.
The fact is, I simply cannot justify to Congress, and to the American people, ongoing assistance at current levels without such a clear and uncompromising effort on the part of the Romanian government. And more needs to be done:
Corruption in drug procurement and distribution is, of course, a problem that many countries are being forced to confront. The bottom line here is this: corruption takes away money that otherwise could address the health care problems of this country, for the benefit of the people. Those countries that are able to demonstrate success in the fight against health sector corruption will benefit from renewed international commitments in the fight against HIV/AIDS. In contrast, those countries that do not show success may soon find that foreign assistance to this critical sector will be reduced, and that the value of any public-private partnership will be diminished.
Minister Branzan, I am glad that your colleague and temporary predecessor, Minister Blanculescu, has announced that his control ministry will review Romania's HIV/AIDS program in the first quarter of this year. As lives are very much at stake, I urge that any irregularities in this area be treated with appropriate severity.
As I have told previous health ministers, I am prepared to fund anti-corruption measures to the tune of some $400,000, provided that these funds are used to target the problems that I have discussed with them. That offer will not remain on the table much longer; otherwise, the money risks being returned to Washington. I look forward to a dialogue on how we can work together to chart reforms that will produce the results that both the donor community and the people of this country expect.
I wish all of you success as this forum explores imaginative ways in which we can work together for the improvements that Romania's health care system needs. Thank you.