20 THE EU AND HIV/AIDS, MALARIA
AND TUBERCULOSIS IN SUB-SAHARAN AFRICA
(30949)
10776/09
SEC(09) 748
| Commission Staff Working Document: Progress report on the implementation of the European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007-2011)
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| Legal base | —
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| Document originated | 29 May 2009
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| Deposited in Parliament |
30 September 2009 |
| Department | International Development
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| Basis of consideration |
EM of 8 October 2009 |
| Previous Committee Report |
None; but see (30109) 15521/08 HC19-iii (2008-09), chapter 14 (14 January 2009) and (26527) 8689/05 HC 34-i (2005-06), chapter 36 (4 July 2005)
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| To be discussed in Council
| 26-27 October 2009 General Affairs and External Relations Council
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| Committee's assessment | Politically important
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| Committee's decision | Cleared
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Background
20.1 In October 2004, the Commission issued a Communication entitled
"A Coherent European Policy Framework for External Action
to confront HIV/AIDS, Malaria and Tuberculosis (TB)".[72]
It was based on a progress report on the "EC Programme for
Action: Accelerated action on HIV/AIDS, malaria and tuberculosis
in the context of poverty reduction", which highlighted key
results and areas for further action.[73]
The Council reached general conclusions on 23 November 2004, welcoming
the policy framework, urging the Commission and the EU Member
States to enhance their cooperation to confront the three diseases
and asking the Commission to present a Programme for Action (PFA).[74]
20.2 On 4 July 2005,the then Committee considered
the Commission Communication that set out a PFA covering the period
2007 to 2011, together with two separate Communications on the
EU's contribution to replenishment of the Global Fund for HIV/AIDS,
TB and Malaria (GFATM)[75]
and to the achieving the UN Millennium Development Goals (the
latter two it recommended for debate; the first it "tagged"
to the first of those debates).[76]
20.3 The PFA proposed collective EU action to support
country-led programmes and action at global level where EU involvement
added value. A major objective was to scale up those interventions
that had shown results, with the EU aiming at a contribution that
helped to fill the financing gap for the three diseases and reflected
Europe's weight and importance as an international partner in
development. It highlighted the need for further funding by both
public and private sectors to meet projected resource gaps. The
paper used the GFATM estimates of the resource gap: US $14.9 billion
by 2007 — US $11.5 billion for HIV/AIDS, US $2.6 billion
for malaria, and US $0.8 billion for TB.
20.4 The Communication (which is summarised in detail
in the Committee's earlier Report)[77]
said that EU actions at country level should focus on support
for country-led, participatory strategies, with specific actions
including:
- Political and policy dialogue
to support country-led strategies
- Building the capacity of national health and
social systems
- Financial resources to confront poverty diseases.
20.5 Selected areas for action at global level
included:
- Affordable and safe pharmaceutical
products
- Regulatory capacity and prequalification
- Addressing the human resource crisis for health
providers
- New tools and interventions
- Strengthened partnerships
20.6 In his accompanying Explanatory Memorandum of
19 May 2005, the then Parliamentary Under-Secretary of State at
the Department for International Development (Mr Gareth Thomas)
generally welcomed the PFA, but also said that the Communication
was "weak on defining the EC's comparative advantage in this
field". In some areas he saw a danger of the EC duplicating
work better suited for others — notably the UN. He drew
attention to the lack of any reference to the UNAIDS-led Global
Task Team to define the "division of labour" among key
players in the sector and little reference to the "Three
Ones Principle" (UNAIDS' approach to improving AIDS responses
at country level, to help prioritise and improve coordination.).[78]
He took the view that the EC's comparative advantage at country
level was related to its direct budget support and support
to sector wide approaches, including support of the "Three
Ones" rather than project focus; and at global level,
lay primarily in its support of the GFATM, its aims to promote
policy coherence, and on research and trade issues. Looking ahead
to the 2007-13 Financial Perspective, the Minister supported moves
to more transparent funding arrangements for the three poverty
diseases and believed that the EU should continue "to significantly
increase funding for poverty diseases" via the GFATM.
20.7 Within the PFA, building the capacity of national
health and social systems included strengthening national research
capacity through the European and Developing Countries Clinical
Trials Partnership (EDCTP). The EDCTP was launched in September
2003 as the first application of Article 169 of the EC Treaty.
For the first time, 14 European Member States, together with Norway
and Switzerland, agreed to coordinate their national research
programmes to build a new structure to coordinate their clinical
research activities on HIV/AIDS, malaria and tuberculosis in sub-Saharan
Africa. The research financed should have a direct impact on the
hardest-hit populations, in terms of new drugs, vaccines and public
health interventions.
20.8 EDCTP performance was lower than expected in
the first three years and a 2004 report from the European Court
of Auditors revealed some shortcomings. In addition, from 2003
to 2006, the EDCTP had four different Executive Directors. In
December 2006, the Commission requested an Independent Expert
Review of the EDCTP, which resulted in the Van Velzen report,
delivered in July 2007.
20.9 Commission Communication 15521/08 (which the
Committee considered on 14 January 2009) followed a recommendation
in the Van Velzen report, that the Commission should inform the
Council and the European Parliament about the current status of
the EDCTP Programme, in advance of the 2008 evaluation (required
by the original EDCTP Decision) due at the end of the first five
years of the EDCTP.
20.10 The report noted that setting up EDCTP proved
to be very challenging: it was the first use of the Article 169,
it had to address poor research capacity to address poverty-related
diseases in the countries in sub-Saharan Africa and it involves
Member State co-funding from both development aid and research
agencies, to tackle the capacity-building and public health aspects
of this research.
20.11 The report illustrated ways in which performance
of the EDCTP Programme had improved, with specific achievements
against the original goals of the Programme and the recommendations
of the Van Velzen report. The Commission saw the remaining two
years of the EDCTP contract until 2010 as being crucial in determining
the extent of Member States' financial and political commitment
and the Secretariat's capacity to negotiate and follow up research
contracts; this and the 2008 evaluation would determine whether
or not the Commission would recommend a fresh Council Decision
in order to continue it. Though cautious at this stage, the thrust
was that the long-term nature implicit in effectively tackling
these "poverty" diseases would warrant continuation.
20.12 The Minister (Mr Michael Foster) welcomed the
report and recognised many of the issues that it raised. Overall,
he noted that as EDCTP had improved and increased its activity
it had become more positively regarded. He saw it as an important
source of funds for UK and African researchers and the work funded
as in line with DFID health, research and AIDS strategies. His
main concern was the inability of some donor countries to comply
with one of the main recommendations of the Van Velzen report,
viz., the achievement of a common funding pot.
20.13 The Minister explained that the Medical Research
Council (MRC) had been the main UK link with EDCTP and provided
UK Member State contributions. Like the Commission, he saw the
development in the last few months, in addition to contributions
from national research agencies, of increasing financial contributions
from Member States' development agencies (including DFID), focused
on activities in developing countries (where most of the EDCTP
funding goes), as an "innovative solution [that] greatly
improves the ability of Member States to co-finance EDCTP projects."
By funding the EDCTP, DFID had increased the amount of funding
for teams of researchers from a number of countries (Africa and
Europe) and the amount of UK funding for clinical trials, in particular
those led by African researchers; had also diversified DFID's
capacity building activities for African researchers; and leveraged
significant amounts of additional funding for projects from other
European countries and from third parties such as The Bill and
Melinda Gates Foundation, the pharmaceutical industry and product
development public private partnerships. Whilst EDCTP activity
was low, the Minister said that MRC contributions were sufficient
for EDCTP to fund successful research programmes: "As EDCTP
has become more active a significant shortfall in member state
contributions has developed. In response, in 2006-7, DFID contributed
£7.5m to EDCTP. Future contributions will continue through
the DFID-MRC Concordat."
20.14 We felt that, although some of the main challenges
were evident — particularly funding levels now that the
EDCTP has started to find its feet and the inability or unwillingness
of some Member States to comply with the Article 169 model —
it was difficult to draw any firm conclusions ahead of the Commission's
evaluation: but that, nonetheless, the importance of the issues
that the Programme was endeavouring to tackle, and the way in
which it was endeavouring to do so, warranted drawing this "first
impressions" report to the attention of the House. For similar
reasons we also drew it to the attention of the International
Development Committee.
20.15 We also looked forward to the Minister depositing
the Commission's evaluation report in due course, along with his
views on its implications and recommendations, and in the meantime
cleared the document.[79]
The Commission Staff Working Paper
20.16 The document recalls that the EPA was adopted
as the basis for a concerted and strong EU response and action
to confront the three diseases, and says that this progress report
"has been prepared in a consultative process with Member
States and other stakeholders, aiming to review progress and constraints,
update policy areas, stimulate joint EU1 actions and develop recommendations
on priorities for such actions."[80]
20.17 The report says that mortality as a result
of HIV/AIDS, Malaria and TB is declining slightly, and in many
regions and countries, fewer people are becoming infected; however,
the epidemics are far from over and will continue to pose exceptional
global challenges to growth and development for decades to come.
Strong and continued leadership of the EU in confronting HIV/AIDS,
malaria and TB is seen as being of critical importance.
20.18 It says that this leadership should be based
on the commitments and directions set out in the European Consensus
on Development and the EU Agenda for Action on the Millennium
Development Goals (MDGs) and underpinned by the common values
of country ownership, gender equality and human rights. The EU's
commitments to increase development aid and its strong emphasis
on country ownership and aid effectiveness are seen as providing
significant opportunities to reinforce and sustain country-led
responses, with the move towards financing based on country demand
and priorities also bringing "policy dialogue, capacity building
and accountability to the centre of effective EU collaboration
with partner countries on the three diseases."
20.19 The Commission says that such collaboration
would also "promote comprehensive and balanced country responses,
which are based on evidence, address gender inequality and human
rights infringements and ensure that the most at risk populations
receive proper attention." While access to treatment must
be further expanded, particular attention is needed to accelerate
progress in crucial areas such as HIV prevention and care and
support for people affected by the three diseases. Research and
development of new tools and interventions "remains crucial
for effective and sustainable responses to the three diseases,
and will continue to require a longer term strategic approach
and investment."
20.20 Greater involvement both of people affected
by the three diseases and of civil society organisations in national
planning, decision making, implementation and evaluation is also
regarded as being of critical importance. At country level, "an
effective EU division of labour, sharing of tools and closer collaboration
with civil society and other stakeholders would strengthen capacity
for policy dialogue", while "innovative approaches to
mobilise and engage stakeholders in the context of a stronger,
broader and more comprehensive EU response could be explored,
based on the recommendations for priority actions developed with
Member States and stakeholders during the progress review."
20.21 The paper notes that:
— as
the world's largest donor, the EU has collectively provided the
majority of the significant increase in recent years of international
financing earmarked for HIV/AIDS, malaria and tuberculosis;
— collective EU contributions
to the Global Fund have almost quadrupled, from a total of US$403
million in 2003 to US$1 546 million in 2008, representing around
55% of total contributions in the years 2004-2008;
— In 2007, EU donors
provided around 54% of the disbursements of earmarked financing
for HIV/AIDS totalling US$4.9 billion in 2007, up from US$1.2
million in 2002;
— earmarked international
funding disbursements for malaria have increased from US$249 million
in 2002 to US$1 127 million in 2008;
— with the contributions
of EU donors and others, the Global Fund has provided the majority
of new resources for malaria control, up from US$36 million in
2002 to more than US$427 million in 2008;
— earmarked financing
for TB control from international donors and governments in twenty-two
high burden countries has also increased, reaching US$2.3 billion
in 2008;
— the Commission and
other EU donors are making funds available to strengthen health
systems and confront communicable diseases through a variety of
financing instruments. In the case of the Commission, for the
period 2007-2011 covered by the Programme for Action, programmed
ODA financing earmarked for health is estimated to total €3.043
billion, a slight decrease from the total of €3.151 billion
programmed for the preceding five years 2002-2006. This financing
includes support for research and technological development, where
more than €200 million have already been allocated in the
7th Research Framework Programme (2007-2013) specifically
for research on the three diseases;
— general budget support
has increased sharply from a total of €1.425 billion in the
period 2002-2006 to €2.571 billion for the period 2007-2011:
"General budget support can be particularly beneficial for
health systems and other social sectors, as it provides longer-term
and predictable financing, which strengthens country ownership
and allows countries to cover recurrent costs such as salaries
of health workers and teachers, buildings and infrastructures";
— the new MDG contract
introduced by the Commission[81]
expands the financing cycle from three to six years, and parts
of the disbursements are based on progress in MDG-related indicators.
20.22 The report then reviews progress, identifies
gaps and constraints, and makes recommendations for an update
of policy areas, identifying options and priorities for collective
EU action to confront the three diseases. It concludes with a
ten-point prescription for what the what the EU's leadership role
should encompass.[82]
The Government's view
20.23 In his Explanatory Memorandum of 8 October
2009, the Minister of State at the Department for International
Development (Mr Gareth Thomas) says that the report's statements
and recommendations about HIV, malaria and TB are "in line
with DFID policies and strategies" — in the case of
HIV, the 2008 document "Achieving Universal Access: the
UK's strategy for halting and reversing the spread of HIV in the
developing world".[83]
20.24 The Minister sees the report's important policy
areas as including:
— an
emphasis on the need to accelerate HIV/AIDS prevention efforts,
by supporting evidence-based, locally appropriate and comprehensive
approaches;
— greater attention to gender and the feminisation
of the HIV epidemic;
— the need to address groups most at risk
of HIV infection and deal with sensitive issues (men who have
sex with men, harm reduction);
— recognition that greater involvement
of people living with the three diseases and civil society to
address the epidemic is needed;
— a shift towards longer-term financing,
based on country demands and evidence based priority interventions;
— emphasis on strengthening health systems
and integrating services, and commitment to the principles of
the International Health Partnership Initiative (IHP+); and
— a commitment to support the capacity
building of governments and civil society.
20.25 The Minister describes the findings and recommendations
of the report as "very broad". Noting that, as a way
of targeting areas where progress is slow, the report recommends
the establishment of EU Action Teams, he says that "DFID
is interested in leading the HIV prevention work and is in discussion
with members of the Commission and civil society about an operational
strategy."
20.26 The Minister goes on to note that:
"DFID remains one of largest supporters of the
Global Fund to fight AIDS, TB and Malaria (GFATM) through its
£1 billion commitment. DFID also provides long term support
through its 20-year commitment to the drugs purchasing facility
for AIDS, TB and Malaria, UNITAID. In September 2008 the UK made
a commitment of £40 million to the Affordable Medicines Facility
for Malaria which aims to make highly effective drugs affordable
to the poor and to slow down the rate at which mosquitoes become
resistant to these new drugs."
20.27 Finally, the Minister says that the Swedish
Presidency would like to take the report to the General Affairs
and External Relations Council (meeting of Foreign Affairs/Development
Cooperation ministers) on 26-27 October 2009.
Conclusion
20.28 The questions that the paper raises are
for others, which is why we are again drawing it to the attention
of the House and to the International Development Committee.
20.29 We now clear the document.
72 (26100) 14245/04: see HC 42-xxxvii (2003-04), chapter
5 (17 November 2004) and HC 38-iii (2004-05), chapter 13 (12 January
2005). Back
73
COM(04) 726 and SEC(04) 1326. Back
74
Council Conclusions of 23 November 2004 (15158/04). Back
75
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created
to increase dramatically resources to fight three of the world's
most devastating diseases, and to direct those resources to areas
of greatest need, through partnership between governments, civil
society, the private sector and affected communities. Since 2001,
the Global Fund has attracted US$4.7 billion in financing and
has so far committed US $1.5 billion to support 154 programmes
in 93 countries. Back
76
(26459) 7455/05 and (26496) 8137/05: see HC 34-i (2005-06), chapters
3 and 4 (4 July 2005). Back
77
See headnote: (26527) HC 34-i (2005-06), chapter 36 (4 July 2005). Back
78
In April 2004, the international community endorsed the "Three
Ones" principles, to achieve the most effective and efficient
use of resources, and to ensure rapid action and results-based
management: One agreed HIV/AIDS Action Framework that provides
the basis for coordinating the work of all partners; One National
AIDS Coordinating Authority, with a broad-based multisectoral
mandate; One agreed country-level Monitoring and Evaluation System.
Back
79
See headnote: (30109) 15521/08 HC19-iii (2008-09), chapter 14
(14 January 2009) Back
80
"In the context of this report, the reference to the EU is
made on the basis of a holistic and political approach without
legally prejudicing institutional competencies." Back
81
Described by the Commission as "an enhanced form of General
Budget Support with outcome indicators linked to education, health
and other MDG relevant sectors. The aim is to improve the effectiveness
of budget support in accelerating progress towards the Millennium
Development Goals by increasing its predictability and focusing
on results." See http://ec.europa.eu/europeaid/infopoint/conferences/2008/06-24_mdgcontract_en.htm
for further information. Back
82
Set out at Annex 1 of this chapter of our Report. Back
83
Available at http://www.dfid.gov.uk/Documents/publications/achieving-universal-access.pdf
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