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tv   U.S. Global Leadership Coalition Summit PEPFAR  CSPAN  June 26, 2018 12:24pm-1:37pm EDT

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align myself with general hayden, who made very clear how un-american this all is. so this is not the america that we are all proud of. so i wouldn't mind some statues of liberty, but i also do think that there need to be -- i have a statue, a pin that is a statue of an angel on top of the world. i think that's what we should be, that we are the ones that can help. and if we're doing it for humanitarian purposes or for self-interest, they go together. so just go up there and tell it like it is. >> ladies and gentlemen. [ applause ] how about thanking the angel of the world, madeline albright. [ applause ]
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>> good afternoon, everybody. it's an honor to be with you for the 2018 u.s. glc summit. i'm carl hoffman, president and c ceo of population services international, psi, and i'm also honored to be the vice chair of the u.s. glc board. so it's my great privilege to welcome you all this afternoon to this special luncheon program, which is a celebration of the president's emergency plan for a.i.d.s. relief, now in its 15th year of saving lives
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and most importantly a tribute to those, some of those, who made it all possible. so i remember the electric moment, and some of you may too, when president george w. bush announced the concept at his 2003 state of the union address. and this amazing moment was the result of some equally amazing behind the scenes work, which we will hear about, i hope, from today's panel. it's like washington 101, you will not get this anywhere else. it's fascinating. my organization, psi, like so many pepfar partners around the world, has been immensely proud to help deliver the legacy of impact across africa and the world. this important work is not done, of course. we're celebrating 15 years, but
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we are not done, ladies and gentlemen. and it will take the continued commitment from our leaders on capitol hill and in the administtion a from all of you to see this work through to completion. but as a former united states ambassador serving in africa, i can tell you this. the thanks and appreciation and emotion from those whose lives and families you helped save is overwhelming. so to kick off our tribute this afternoon, we want to take stock of this impact, the story, and remind us all why we are here today. let's look at a video. >> today on the continent of africa, nearly 30 million people have the a.i.d.s. virus, including 3 million children under the age of 15. yet across that continent, only
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50,000 a.i.d.s. victims, only 50,000, are receiving the medicine they need. >> so many funerals every day of children and mothers and fathers. >> people do not have hope. there was no access to drugs. so they didn't come forward to even be tested for hiv/a.i.d.s. >> it was wiping out, hollowing out societies, all of which was resulting in turmoil, in chaos. >> tonight i proposed emergency plan for a.i.d.s. relief. a work of mercy beyond all current international efforts to help the people of africa. >> president bush rallied the congress and really the nation to this cause. congress rose to the occasion. >> people like henry hyde. >> you had jesse owens partnering with liberal democrats. >> it was a great moment for the united states congress. >> every so often in this place, we have the opportunity to do something for humanity and serve the american people.
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this is such a time. >> the president's emergency plan for a.i.d.s. relief would become the largest single global health initiative by any country in the history. >> we've seen government, the private sector, nonprofit communities, and the faith community all working and collaborating together to make this the success that it is today. >> pepfar supports 14 million people on treatment globally. >> and 2.2 million babies have been born hiv free despite the fact that their mothers were infected. >> it really is extraordinary that given the pandemic, we have gotten this under control because of pepfar. >> what makes pepfar so successful today is the fact that congress continues with their staffers and members to work with us to make us better, and each administration from president bush to president obama to now president trump
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brings their unique insight. >> it worked because there was a commitment of resources but also outcomes were central to the program. setting up systems to deliver treatment in the most efficient way possible. >> pepfar works because of the generosity of the american people is huge. >> years later, i went to rwanda. people would come up to me and talk about pepfar. it changed their lives. it was a death sentence. and now it's just -- that's not the situation. i get very happy about that. >> it's just given families an opportunity to live, to hope, to dream. that's what this has been. >> millions of people around the world have been given hope. so we have to sustain and build on this progress. >> pepfar is a success story, individual stories of people's lives and the success story of public policymaking a difference. so it's a formula that really
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works. >> this is an example of american leadership at its best. >> together -- >> together -- >> together we're saving millions of lives. >> all thanks -- >> all thanks -- >> all thanks -- >> to the american people. >> to the american people. >> all thanks to the american people. >> all thanks -- [ applause ] all thanks to the generosity of the american people. and that's a story of impact that makes you and me proud to be an american. i would like to introduce now my friend, former congressman, former secretary of agriculture of the united states, and now usglc board co-chair, dan glickman.
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[ applause ] >> you didn't know you'd get to see me twice, before and after lunch. but that's t i promise you. first of all, cakarl, what a privilege being with you and your leadership. this summit is a special event. but this year even more as we celebrate pepfar at 15. and not only pepfar 15. you saw all the people behind you. i'm going to introduce one of the leaders. a spirit of collaboration and civility and humanity where republicans and democrats, the president and congress got along and got something transformationally done. it's a remarkable thing. today we celebrate that unique diverse coalition because we share a common commitment that our nation is at best when we're offering a hand up, saving lives and empowering families and
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communities around the world. first, let me note that the story of pepfar is a unique and transformational one. to save 14 million lives and combat a disease that was ravaging a continent in just 15 years, it takes something special. it takes a lot of people. to honor everyone associated with pepfar from the administration of three presidents to all the members of congress, to the faith and nonprofit community, to the private sector would take all day because so many people in this room and elsewhere were involved. so today we honor two individuals who represent literally thousands of others who are instrumental in this great american story. uniquely american success story. and on to our honorees. our first is senator tom daschle who has been a tireless advocate
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for america's global leadership, and his support for global health and development programs in the halls of congress is unmatched. as the senate minority leader in 2003 when pepfar was launched, he receives this honor today for his steadfast and bipartisan leadership and shepherding the legislation through the senate. one look at c-span, and we know how difficult that can be. senator daschle stands with us today on behalf of all of his congressional colleagues, republicans and democrats, house and senate, to remind us that this is a bipartisan story of republicans and democrats working together, standing side by side so address a global growing crisis of unmatched seriousness. champions in congress stepped up to find common ground and create the largest response to a single
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disease in history. the largest response to a single disease in history, tackling the global a.i.d.s. pandemic head on. today we also recognize those in congress who have gone before us. senator jesse helms, congressman donald payne, and those who continue to lead the fight against this disease now and into the future. senator daschle, i want to thank you for your leadership, your passion, your dedication to pepfar. it's been a remarkable journey to do good, to do well, and demonstrate the best of who we are as americans. so ladies and gentlemen, please join me in paying tribute to a great american leader, senator tom daschle, and the seismic role that congress played in tackling the a.i.d.s. crisis.
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[ applause ] >> thank you, senator. so as we commemorate this 15 years of america's signature global hiv and a.i.d.s. program, we would be remiss not to honor the man who started it all, president george w. bush. as we know, it was his leadership, first at his state of the union address in 2003, but throughout his presidency as well and in his post-presidential life, along with first lady laura bush, that
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rallied the congress, rallied the nation, and in many ways rallied the world to this noble cause. it was bause of his leadership and compassion that millions of people are alive today who otherwise would have perished. millions in africa and around the world, living full lives with hope, with potential, contributing to their communities and their nations, and giving us all a much brighter future. some have said that pepfar might be george w. bush's greatest legacy. our coalition couldn't agree more. unfortunately, president bush couldn't be with us today, but we're honored to have in his place holly kuzmich, executive director of the bush institute, to receive this honor.
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please join me in welcoming holly to the stage. [ applause ] ♪ >> thank you, karl. and thank you to the u.s. global leadership coalition for honoring president bush for pepfar. i realize i am not quite the same as seeing president bush in person, so thank you. i'm honored, obviously, to receive it on his behalf. he regrets he couldn't be here, but he sends his best to you all and his gratitude. i want to thank the others in the room today who've led on this issue, the current and former members of congress, dr. tony fauci, among others. thank you for your continued
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leadership on pepfar. 15 years ago, president bush came to understand the gravity of the hiv/a.i.d.s. pandemic, which was threatening to wipe out an entire generation on the continent of africa. he believed that to whom much is given, much is required. i saw this, his quote is on that banner over there. and he decided that the united states had a moral responsibility to intervene. he recognized, too, that the united states had a national security imperative to act. when we confront suffering and save lives, we give hope to devastated populations, strengthen and stabilize society, and make our country and the world safer. during his state of the union address in 2003 when he proposed pepfar, he said, quote, seldom has history offered a greater opportunity to do so much for so many. as we mark the 15th anniversary of pepfar, we recognize its remarkable results, the more than 14 million lives that have
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been spared through anti-retroviral drugs, and the more than 2 million baby who have been born hiv free to infected mothers. pepfar's success in partnership with national governments has resulted in a surge toward control of the hiv epidemic. and this progress is being made responsibly with a focus on outcomes, not inputs. pepfar's proof of a highly effective, results-oriented program that puts taxpayer dollars to work where the return on investment is lives saved. president bush defines this approach saying, quote, it is compassionate to actively help our fellow citizens in need. it is conservative to insist on responsibility and results. but we still have work to do to trek the gains already made in the fight against hiv/a.i.d.s. for one, women living with hiv are five times more likely to develop cervical cancer. it's unconscionable to save a woman's life from a.i.d.s., but
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then see her suffer from cervical cancer. so in 2011, the bush institute launched pink ribbon red ribbon, a public/private partnership to prevent and detect women cancers. in just a few years, we've seen great success. more than half a million women have been screened for cervical cancer, 32,000 have been treated for precancerous lesions, and 147,000 have been vaccinated against hpv, the virus responsible for most cases of the number one cancer killer among women in subsaharan africa. last month, we announced the next phase of this work. between the bush statute, pepfar, and u.n. a.i.d.s. to effectively eliminate cervical cancer deaths among hiv positive women in subsaharan africa within a generation. the partnership to end a.i.d.s. and cervical cancer will increase support for hpv vaccination, screening, and treatment, will convene government officials, global health leaders, and funders to ensure we make progress against
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cervical cancer and support the vital mission of pepfar. we also know that ending investments in pfar prematurely puts the progress that's been made at risk. because of gains in global health, the population of youth age 15 to 24 is expected to grow significantly from where it was at the beginning of the a.i.d.s. epidemic. this group is at particular risk for hiv infection, especially young women. if we do not continue to equip young people to protect themselves from infection, our success could be reversed in a heartbeat. we ought to be proud of what has taken place and know that pepfar is a successful, data-driven, resulted-oriented program. it should be fully funded to protect the gains made and achieve the a.i.d.s.-free generation. pepfar's always had incredible bipartisan support and continues to benefit from the collective efforts of republicans and democrats, and we hope that support continues. we know that u.s. engagement on
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the global stage is vital. we have a duty to care for people, both within and beyond our borders. you are some of the nation's top leaders, so thank you, on behalf of president bush. your support for pepfar and your advocacy and encouragement to policymakers around the country is making a remarkable difference. we need you. thank you. [ applause ] >> ladies and gentlemen, please welcome ambassador deborah birx. >> good afternoon. normally i get to do all the data, but you've heard it from everyone. that just shows you how much people know about pepfar. it's an honor to be with so many dear friends and colleagues. thank you so much for taking times out of your incredibly busy lives to be here and let your voice be heard on these critical issues. thank you for your passion and
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commitment. you can see that we translate that every day. to many of you, i want to thank you personally for the insights you have given to me and to pepfar to make us a better program using new business practices and working with us hand in hand through our public/private partnership. i want to once again congratulate senator daschle, representing the u.s. congress, from before and still today, who is strongly supportive of pepfar, and president bush for their well-deserved rewards. their continued leadership has been nothing short of extraordinary. and thank you for the video. we are continuously amazed and humbled as a team, a u.s. government team, by the breadth and depth of the bipartisan support and the impact that pepfar is having. so this year as we celebrate the 15th anniversary, let me go quickly back to those days and the late 1990s where i was working in africa at that time, before pepfar, before the global fund. i was overwhelmed by the level of death and devastation
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confronting communities. mothers, fathers, sons, ughters, teachers, doctors, lawyers, all entire families and communities were falling ill and diagno dying of hiv. often in the very prime of their lives, in their 30s and in their 40s, community after community were holding more funerals than weddings, and patients were overflowing the hospitals where i was working. the matrons of these hospitals would often meet the dead and dying at the gates and tell them their family members to take them home because there was nothing they could do for them in those hospitals. as a doctor at that time, i knew we had the scientific breakthrough, and my patients here in the united states while i was in department of defense at the time were on those life life-saving treatments. right here, we had it. but in africa, less than 50,000 people, as you heard from president bush, had access. we were on the verge of losing an entire generation in africa
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and having the next generation grow up without any mothers or fathers. but today, 15 years later, because of the democrats and republicans that came together to create pepfar, supported by the amazing generosity of the american people, we can tell a far different story, and you heard about the 14 million on treatment but also the babies born free and the importance of its creating hope. in 2003 when president bush announced pepfar, he infused life and hope into those communities that were consumed by death and despair. when the u.s. congress worked across the aisle to authorize pepfar in less than four months, they showed what america can do when it decides to make what many perceive was impossible, possible. next you'll hear from the team that was there at the beginning, translating president bush's and the congressional vision into the drawings of a very new program unlike any other program that had been attempted in foreign assistance.
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everything about pepfar was different. first, there was absolutely clear goals and expectations set at the highest level of the president and our congress. second, the architects understood that the u.s. government couldn't conduct business as usual, so for the first time, pepfar brought together the entire u.s. government to implement the program in a new manner coordinated by the state department. understanding that no single agency could accomplish the mission alone, nor had the required relationships and skills to do it alone, i was privileged to be part of this grand experiment at the very beginning, first in the department of defense, then in hhs, and now state department. many of you will wonder why i still don't have a regular job. but it's a privilege to still be with pepfar. every day i'm reminded that our collective success and impact comes from the brilliance of those who principles. clear goals and objectives, linked to active coordination of
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a program tha separates and is above any one agency. we provide assistance to more than 6.4 million orphans, but it's more than that because it allows these families and communities to thrive now, not just free of disease but in economic opportunities and progress that could be made every day. importantly, we also launched dreams, a prevention program focused on young women and girls, focused very much on preventing new infections in this group that's highly vulnerable. we reached 2.5 million just in the last two years, and we've decreased the new infections by 40% to 60% in many of these communities. this is what is possible when agencies come together in a new way. but more than that, pepfar is a smart investment. we're continuing to learn and continuing to innovate to expand our impact. we have a program that we have very much transparency and
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accountability, and we analyze all of our costs, much as you do in your business models, and we put everything at online so you can see the translation of you u.s. taxpayer dollars down to the site in which those dollars are utilized. we've also enhanced global health security by building the health system and laboratory structures that have been used today to diagnose avian flu, ebola, and other threats not only to the continent but to the world. but we don't do this alone. pepfar leverages the power of all of you and your partnerships, but we also work closely with foreign governments, the private sector, philanthropic organizations, multilateral institutions like the global fund, importantly communities and the communities most affected, faith-based organize, and many others to increase the impact of our efforts. because of pepfar's success across three presidential administrations, improved each day by the unique insights by president bush, president obama,
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and now president trp, and through eight u.s. congresses, we now have the historic opportunity for the first time in modern history to control an epidemic without a vaccine or a cure. you'll be hearing from from a lead scientist that is leading our efforts to find a vaccine and a cure through nih and nyad through dr. fauci, and we hope we will have a vaccine and a cure, and then we will be able to eliminate hiv. but before then, we can actually control and can shrink the epidemic by working together. pepfar represents the best of america, when we can translate dollars with expectations into performance, and every american should be deeply proud of pepfar's accomplishments, because they're their accomplishments, but it's also how business should be done within government. pepfar was born out of the belief that we could make the impossible possible, and today that belief is now becoming a reality. but as holly just said, we are not done yet. but the fact that you are here
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today with us, 15 years later, gives me great hope that collectively and together we will cross that finish line with these epidemics shrinking, and we'll be at a place where every american can be incredibly proud that they not only save people's life, but they change the course of history by controlling this pandemic. thank you. [ applause ] >> thank you so much for your leadership, ambassador birx. we have a fantastic panel, ladies and gentlemen, who's now going to talk us through some of this. senator daschle has already been introduced to us and needs no further introduction. congresswoman barbara lee represented california's 9th and 13th districts since 1998, one of the original co-sponsors of pepfar. josh bolten, chief of staff for president george w. bush at the time of pepfar's launch. ambassador mark dybul, who not
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only previously ran pepfar, but also ran the global fund for aids, tb, and malaria, and dr. anthony fauci from the national institute of allergies and infectious diseases. i call him america's public medical intellectual. all of these folks will be guided through a great conversation by liz schrayer. please welcome them back to the stage. [ applause ] >> come on up here. senator, i think you're over here. >> okay. >> welcome, everybody. we'll get settled. >> whatever's easier. >> we can move you around. >> oh, that be great. >> are we allowed to move everybody around? >> perfect. >> i don't know, mikes. please welcome. well, welcome, everybody. >> nice to see you again. >> now we're going to really learn. welcome.
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well, i am honored to get to be with, as ambassador birx said, the architects. and i want to do three things in our time together, is really underscore a little bit more of the why, talk a little bit about the transformational aspects to what was so unique about pepfar and what we can learn about, and then where we're so, i want to start with -- this is interesting -- the three right here, and to get a little bit more to the why. and josh, i'm going to start with you. because the motivation, as we saw in the video, of president bush doing something that was so unique, to stand up at a state of the union and put out a challenge to the world about doing something on the continent of africa. you were there. you were there from the beginning. you actually were on the campaign. and then as chief of staff at the white house. what sparked an inspiration of
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the president to want to take care of people literally on the other side of the world? and why was this the issue that somehow caught an imagination of a lot of people? and welcome. >> thank you. >> it's been a very important and wonderful partner, for those that don't know josh bolten. >> thank you. >> so thrilled to have you. >> and thank you, liz, for what usglc does. it's great. it's a great organization. brilliantly led. >> i paid him for that. >> yeah. uknow, interestingly, i was the policy director of president bush's 2000 campaign, and i do not remember this issue coming up. in fact, i do not remember africa coming up during the campaign. we had a policy book of, you know, a couple of hundred pages long. i see some folks in the audience who actually participated in that.
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and there was -- i correct myself -- there was mention of africa, but addressing the aids pandemic was not one of the 100-plus issues on which president bush campaigned. but ely in the administration, he was moved by the passion about some members of congress. two of them are here on this stage. senator frist, among others. and he was moved by what he was told by his secretary of state, colin powell, and by his national security adviser, condie rice, who briefed him extensively on the crisis that was happening in africa and briefed him on several dimensions -- the humanitarian dimension, of course, the tremendous suffering and loss of
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life, the economic dimension of what it was doing to destabilize large parts of africa, and the national security dimension, which where that destabilization would lead to safe havens for terrorism. and all three of those influence, i think, came together for president bush and combined with his personal faith. and i think he drew on his personal faith in making the decision to proceed. and i remember the meeting where mike gersen, it was the final organizational meeting -- mike gersen, our speech writer, said to the president that if we can do something about this crisis and we fail to act boldly, history will judge us poorly.
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and i think in that, he really captured president bush's approach on that. and so, he sent me off to put together a team, the two most important members of which are at the far end of this stage, and he told us to do it in secret, so you all probably know a lot about pepfar. this you may not know, that the pepfar was designed in preparation for the 2003 state of the union in absolute secrecy, and i remember telling tony, he said, well -- i said, you can't tell anybody, except the people working directly on your project. and he said, yeah, well, but of course i can tell my boss. and i said, no. and he said, well, of course i can tell secretary thompson, and i said, no, the president wants
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this done in secrecy. and so, in a bold act of internal insubordination -- >> oh, my goodness! >> -- tony fauci did, in fact, concoct the pepfar program working with folks in the white house, including gary and several others, and brought in a brilliant young doctor, mark dybul, and the two of them put it together. and their work was crucial, because president bush was very favorably disposed to doing something bold, but it had to be proven to him that it would be effective, that he was not going to be the republican president who came into office to double foreign assistance and pour money down a rat hole. so, what these gentlemen did was prove to the president that something would be done.
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and from there -- >> you did it. >> -- the process and the decision was easy, in part because we had such good partners in congress. >> fantastic. well, that was quite interesting insight. i'm going to come back to the two of you about what was so transformational, but i first want to go to capitol hill, because as josh just said, the power of this was here we had a republican president, but that it somehow captured the congress. and now, we all talk about how development foreign assistance has this bipartisan support, but it wasn't so clear back then in 2003. when i saw that video and saw jesse helms sitting next to joe biden and henry hyde next to tom lantos, we all look and go, oh, but it wasn't so common then. so, senator daschle, what was the secret sauce? there was a lot of tension back then, and still is. why was that -- what was it about this issue that you grabbed and said, i got it?
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and then i want to ask a estion to congressman lee. >> well, liz, i think it's often said that success hasany mothers and fathers, and at the very top of the list is president bush and his team. he inspired us, he challenged us. i would say the one word that is most important, he included us. inclusion was really critical, and i felt included from day one. i was inspired by his very, very powerful speech at the state of the union in 2003. but from the very first, we were part of a team. we felt part of a team. i wish that happened more often these days. it doesn't. but i really think he deserves enormous credit for including us, for making us feel full partners, for recognizing what we've got to do and how we've got to do it, and laid out a plan with us, and getting our input, getting our reaction. but then i would also say, in addition to that, i have to give a lot of credit to others who weighed in.
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bono was a key player, a friend of many of us, and he just really was instrumental. but the private sector, you know, and the ngo community and the faith community. they all, once they got word, all understood what powerful potential there was to do some really good things, and i think it started with the president and his team. it then extended to members of congress. but i would say this extraordinary effort on the private sector side involving so many organizations and types of people made a big difference as well. >> well, part of what you listen to everybody, the different stories you're hearing, and the reason we wanted to bring pepfar is not just to celebrate pepfar, but there are lessons learned here throughout all this story. and i turn to you, congresswoman. the congressional black caucus played a very transformational part of this story line. you in particular played a very
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important part of the story line. president bush and you and the congressional black caucus were a very important part of the beginning. share. >> thank you very much. first, thank you for inviting me to be with you today. and the history is so important, given the fact that now, probably 75% to 80% of the congress were not -- >> were not there at the beginning. >> -- there when we authorized pepfar, so we have a lot of education to do. >> yeah. >> but my involvement really came as a result of my predecessor, congressman ron dellums, the great statesman, who after he left congress, i talked to him about his vision for an aids marshal plan for africa. and subsequent to that, we put together with congressman jim leach the global aids and tuberculosis relief act of 2000, which bill clinton signed. okay, after that, when president bush was elected, the congressional black caucus, then it was chaired by a texan, congresswoman eddie bernice
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johnson. we decided, and eddie bernice wanted the cbc to meet with president bush early in his term, so this was in early 2001. we met wh president bush, and of course, she asked what we would all want to talk about, and i immediately sdan to talk about a global response to the hiv-aids pandemic. i knew what was going on in africa. i had been to africa. i had been with, actually, jesse helms' staffer, a bipartisan delegation. so, i really felt a sense of urgency to talk to our new president about this. and so, we went around the room in the office and we talked, and when it was my turn, i talked about what i thought made sense in terms of a global response to hiv and aids. and i had on my beaded ribbon. and we talked in-depth and secretary powell was there as well as secretary rice, said
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condie and colin, let's get together, let's follow up on this. i knew immediately that he wanted to do something. he wanted to do it. after the meeting, we stood in line and took a photo, and i had a chance to talk to him further about this, and he asked me about the ribbon, the button, the beaded pen i had on, and i took it off and gave it to him. and i told him that this was made by women in south africa and used for fund-raising for hiv and aids clinics and what have you. so, during that year, we actually worked on a pepfar bill, and we passed through the house -- i was on the foreign affairs committee then with chairman hyde and mr. lantos. and i have to give the staff a lot of credit, about you our staffs, they did unbelievable work day and night, working with the administration, working with everyone here to get the first pepfar bill through the house. the senate, the negotiations failed, i believe the first year in the senate.
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and so, at the end of 2001, we did not have a pepfar. but in december -- and i brought this letter, because i wanted to read just a part of it, signed by every member of the black caucus. in december of 2002, we said as members of the congressional black caucus. we are writing to draw your attention again to the growing spread of hiv and aids throughout the developing world. it would be impossible to overstate the devastation caused to date by the global aids pandemic, so we've gone and talked about that. then we say in the letter, december 2002, most importantly, a u.s. initiative should consist of new monies and policies that complement dispositioning u.s.-supported programs and are additional to the millennium challenge account. and then we say, you will have our strong support and the support of the american people for a bold, new initiative to save families and communities affected by the aids crisis to extend the parent-child relationship and to secure the future of young people.
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and we suggested he say something in the state of the union about this bold initiative. and this is the letter that i want to make sure is in the record because every member of the congressional black caucus signed this. so, we sat very intense and intently -- >> very proudly. >> -- to listen to his state of the union. and when he announced the $15 billion at the state of the union in 2003, we knew that we were working together to make sure that we would save the millions of lives. >> well, there's 14 million people alive because of what you just did. [ applause ] so, there's the why. i want to get to the transformational part, which are the two gentlemen sitting to my right. the humanitarian achievement is extraordinary -- 14 million lives, 2.2 million babies born hiv-aids. but pepfar did something, maybe the two of you in your secret
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figured out how to do. but when i look back, i mean, what it has done in terms of interagency work together, what it did to get recipient countries to actually build into their budgets now, wha it did in terms of international engagement, what it has done to get the private sector engaged. i can go on and on about how it literally changed the face of how we do foreign aid. as holly said, it is about outputs, not just inputs, so that's what i want to turn to, how this has changed. mark, i'll start with you. you were one of early -- i'm going to ask you about your international half, but let me start with as you worked as u.s. -- the global -- when you were running the pepfar program. you had to start by just getting everybody in government to work together. talk about the transformational work of what happened to just get eight different agencies to start working together from usaid to cdc to dod, to start all working together.
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this is the guy who made it all happen. >> actually, the guy who made this happen was president bush. it's difficult to get the agencies together and the president did that. we'll go into details later of how he made that happen, but it was systemic. it was an initiative, everyone knew to be responsive. and josh hates to hear this, but he was really the angel of pepfar beneath the president, who made sure things stayed on track. whether it was omb or the president's chiefs of staff office as deputy and then the chief of staff. nothing would have happened without josh making sure the president's vision was achieved, but you need that to make them work together. the second thing is the transformational piece in the country. most people doing work in government, whether in congress or the executive branch, are here to serve, and if you offer them the opportunity to do something much bigger than themselves, they will grab at it, because that's what they're
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there for. they're there to deliver, and pepfar gave them the opportunity work togethero deliver on something, which got to the fundamental principles underneath pepfar that ge them that. and i would say it's not just pepfar. we're celebrating pepfar, but it was much more systemic. there was something called the monterey consensus, which the bush administration, gary edson was key in this, basically drove. it was a revolution, a philosophical revolution of how we do development. before that, basically, if you asked anyone what you're doing in aids, agriculture, anything, the answer would be, we're spending "x" amount of money, right? that was the answer. we're spending "x" amount of money. n not what are we getting for it, what are we do. there were pilot projects run from distant capitals, whether europe or here, and they have four principles. one is country ownership, two accountability and results, three is good governance.
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everyone jumps to corruption, which is an issue, but really, it's about how do you best use money. that's good governance. and fourth was engaging all sectors, not just government to government, which is how development has already been done, but every sector, the faith community, private sector, everyone engaged. these were pretty radical views. in fact, on the private sector piece alone, the europeans almost walked away. these are now accepted, everyone talks about them. in 2000, when this was put forward, people were opposed to these basic principles. so, on accountability and results, the plan put forward huge goals. no one was thinking you could get to 2 million people in treatment. in fact, the head of cdc's hiv program said it was half baked and would never work. the largest part of the public health sector said this was not possible, people in africa couldn't do something as complicated as antiretroviral therapy. we basically said that, absolutely, you give people the chance to do that, and they will do something big and bold and work across agencies.
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the accountability piece was also critical in country. president kagami of rwanda said something i will never forgot, this is the first time someone's respected us enough to hold us accountable. someone's respected us enough to hold us accountable. it's not about paternalism, it's not about we're going to do for you these little pilot project -- we're going to support you for a national scale-up of programs that will achieve results, which they want to do, too. they want results for their people. they want results for their country. and the thing about hiv, which is somewhat unique, is it's long-term therapy, it's lifelong therapy, which is why people said you couldn't do it. it's also lifelong prevention. people are at risk for 20, 30, 40 years. so, two of the greatest legacies is believing in people in the countries, which president bush viscerally did. he would get so upset when people would say things like oh, these people can't do that.
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it would drive him insane, literally, and that led to the millennium corporation, the initiative, doubling development money, maybe a five-fold increase in support for africa. it was a strengthening agoa for trade. it was a systemic we can work together for national scale-up, but also, importantly, chronic care delivery, building the systems for that, which can only be done nationally, and the systems for chronic prevention, which is the basis for all health, not just hiv. and so, these two legacies, beyond the amazing legacy, imagine being a government worker and having that opportunity. that's what made the difference. >> fabulous, fabulous. so, tony, play off of that and talk about from what you have seen. i mean it was such a transformational ideas of what mark is laying out. from your vantage point, as the scientist in this space, of what you saw really making the transformational jump. and help us understand how the
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recipient donors are starting to actually change. countries are starting to change. because nowe're seeing countries like south africa, where all of a sudden, 70% of their budgets are investing in hiv-aids, which never would have been dreamt possible when you started this journey. >> well, from the transformational standpoint, i think one of the things many people did not appreciate or refused to believe is that this could be done in an african setting. i think there was a mostly subconscious flair of racism in that, that they can't really do this. they're poor, they don't have any resources, they can't tell time, can't take their drugs, et cetera. so, the first time we went down there from president bush, when he said -- when josh said go down and figure out whether this
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could be done or not, it was an interesting feeling that we had because i went to various places and madeoundsn the hospital, and i had ts paiul deja vu, because it was me in 1981, namely, making rounds in a hospital with patients for which you have nothing to give them, even though you desperately as a healer want to give them something. but now this is 2002, and we're there and we're seeing these people suffering and dying with absolutely nothing there, but the will and the desire to do something was very strong, and it became clear that if we gave them things and partnered with them, that we could transform. and that was the decision that was -- the data was brought by mark and i back to josh, and josh believed it. and i know josh is so modest, he
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doesn't like when we say this, but this really would not have happened, because at any given time, he could have said, eh, that's not going to work. and trust me, there were a lot of people, including in the white house, who were n particularly excited this would happen at the budgetary level. you'll remember that. this is going to be too much money, we'll never be able to do that, what are you doing with a $15 billion program? so, that was something that was really a transformation, that you made what seemed impossible in africa a possibility. now to your second question, now that we're at the point where people are starting to take over and do it themselves -- i think that getting it right by making it a partnership -- when you have a partnership, it's equal ownership, and then you tell the country, you're going to own it. they would not have felt the need or even the capability of owning it if it hadn't been a partnership, if it had just
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been, here's $15 billion, take it, here are the drugs, here are the prevention. it would have been that way forever. but what we're seeing now over the last several years and into the future is a gradual assumption of the responsibility, which goes back to the things that the president said to josh and gary and that josh said to me. there are two things we absolutely need -- a, it's got to be transformational, and b, it's got to be accountable. and that gets to -- remember, josh, those were the two things you told me in your office. and that's exactly what mark just said about what the rwandan president said about respecting us enough to make us accountable. so, that's the reason why i feel confident that going forward you're going to see a carrying over of the transformational aspect of it and the accountability aspect. and that's why it's going to continue to succeed. >> well, it's so interesting, because right from senator daschle, you used the word partnership as well.
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so, one more question on, before i turn to path forward, on the transformational. it's to josh. i hear partnership and accountability through all of these conversations. you now wear a different hat. you're sitting as the head of the business roundtable, and you mentioned senator daschle -- >> i am the man. >> you are. you are the man. and senator daschle mentioned the business communities played such an important role. and part of this partnership is this business community, the ngo community, but comment from the business community how important that's been and what has motivated them as part of this transformational component to pepfar, but to foreign aid in general. they were not such a player, you know, 15 years ago in the enterprise called foreign assistance and global development. >> well, i can't begin to answer that without a commendation,
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again, a serious one, of usglc for bringing in the business community to give it a focal point to express its own interests, becausehe business community, at least the ceos that i work with, 200 ceos of leading american companies, they all cared deeply about every one of the issues that's been discussed here, and it's not just a matter of humanitarian instinct, it's also directly in the business interest. africa would not have been a place you wanted to do business had the pandemic been allowed to run its course. and if you're going to do business anywhere, you need good workers, you need healthy workers. you need workers who are well connected with their communities.
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so, business is deeply interested in this kind of good outcome that we're having from pepfar, and more generally from development assistance that gives american businesses good partners, good environments overseas in which to operate. i don't want to finish without picking up on something that senator daschle mentioned in the partnership sense, which is the role of the faith-based organizations in addition to business and to the celebrity community. and here you've got to give a shout out to bono, who was the single best lobbyist i encountered during eight years in the white house. by the way, he's playing at the capitol one arena. >> so i want you to know, we did invite him to join us, but he had a concert last night, a concert tonight. he was a little busy today at lunch. >> he's busy, but you've got to
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recognize his role. and his role was not just in bringing his own celebrity voice, but what he did in lobbying us in the administration and lobbying on the hill was he helped bring everybody together, and he made george w. bush safe for liberals. [ laughter ] he brought jesse helms to the table on debt relief, brought him to the table on this. and so, the kind of role played by all of these external forces in creating this great synergy of partnership with business, with left and right on the political spectrum. and between the two parties, i don't think that could have been done. >> there is no question. we did invite him to join us, but he was busy today. i want to pick up on, to go path
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forward as our last part of this conversation. congresswoman, you said something pretty stunning. 75% of the elected officials that helped launch pepfar in congress are not elected officials today. so, senator daschle, how do we keep the momentum going? because they weren't there with that excitement at that 2003 partnership when president bush gave his state of the union. how do we make sure that this continues? a lot of people who are voters around the country, there are a lot of issues that they care about, so what's the answer to keep it moving and going and keep this energy around a very important issue that we all care about but not every voter may be aware of it, not every member of congress may be as excited about it? >> well, liz, that's a great question. >> i'll ask you the same question. >> i think barbara lee makes a good point in talking about the turnover. people are surprised -- at least, i'm surprised that about 200 people have been sworn into
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the senate since i was sworn in in 1986, 200. , it gives you some appreciation of the degree of turnover in both the house and in the senate, but i think the answer to your question is, it's really has many parts. first i would say we have an amazing story to tell, and i don't think that's as well told today. there are too many things that distract us, too many other crises and too many other issues, but somehow, we have to be persistent in telling that story. that's number one. number two, i think it was said earlier, but it's maybe the first disease we stopped without a vaccine and a cure, at least to date. i think that's incredible. and the ability to be able to say that and work for a cure some day is a compelling argument to keep going. but i think there's another issue we haven't talked too much about, and that is the extraordinary opportunity it presents for the united states in our image abroad. i just think there's a goodwill
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here created that is almost impossible to recreate under almost any other set of circumstances. we made friends, we made allies, we made admirers, we made people who really understood that there was a heart to what it was we were doing that went way beyond just the issue of pepfar and hiv-aids. it went to how deeply we cared about the african-american community and how much we really wanted to connect and communicate and tell our story, and that american story, unfortunately, i think withers today for all kinds of reasons all over the world. we just need to continue to make that part of the narrative about why we're doing this. >> very powerful. congresswoman? >> yeah, i think, again, it's important to tell the story. but also, i think it's important to provide the type of education to members of congress to make
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sure that they understand from the business community how important pepfar is, because right now i'm looking, and i serve right now on the appropriations committee, the subcommittee that funds pepfar, state and foreign operations, and we're looking at a possible 17% cut. and so, we have to make the case to members of congress to sustain the level of funding. i want if, of course, increased, but we have to organize in a very big way and the business community is extremely important in helping us organize. secondly, i worked with bono for many, many years on pepfar and on poverty reduction initiatives in africa, and i invited bono to my district in oakland, california, to merchandise church, actually. we have an hiv-aids program. and what we did, because you know, here in america, hiv and aids disproportionately impacts the african-american community in a big way. and so, we have in many ways
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tried to put together the international and the domestic, and so people can begin to understand that what affects one affects all and that we're not, not part of the global family. and so, the public needs to be galvanized around pepfar in seeing that it's in our own domestic interests to be able to address pepfar and hiv and aids here in america as well as throughout the world. and i think we have to do this, because if we don't, you know, the u.n. has already said, we can see an aids-free generation, and we all know that, by 2030. and if we don't educate the public and members of congress, we're going to go backwards. and so, we need to take this moment, this opportunity, all of you -- and i'm just making my pitch for your help this year as an appropriator to help get to members of congress to help us. >> we always like having appropriators here. >> do the money. because i don't want to see this 17% cut take effect.
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>> thank you for being here. mark, you in addition to playing a role here as running the pepfar program, you played a role as the head of the global fund on the international scene. and moving forward on our theme of path forward, talk for a moment about the path forward. where is the international community in their commitment to we're looking at pepfar '15, but the international community on the fight against hiv-aids. >> well, sadly, it's not particularly strong. >> where's american leadership on playing that pivotal role as well? >> american leadership is absolutely essential. the rest of the -- donors is such a bad word, so paternalistic -- but the international community, the external financiers. there's not a lot of interest in hiv. there wasn't actually that much in a lot of places before. it was really the leadership of the united states. i mean, president bush wanted the bill passed so he could go to the g-8 at the time and try to get them, if he did 15, to
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get them to do 30, so we had 45, which was at the time what was felt was necessary. he got a soft commitment, but we never got the $45 million committed, the $30 million committed from them. so it's not been that, it's been the leadership of the united states that's driven the response, and that's one of the reasons africa responds so well, because they know it's been the united states pushing. and that's only gotten worse as people have focused on other things. the global fund is absolutely essential for that, because literally, if there wasn't the global fund, there would be no other way for other countries to contribute financially. no one else has a bilateral hiv program anymore. they've all stopped them, which is a good indication of why it's so important. the global fund, because of the requirement that for every dollar the u.s. puts in $2 from other countries comes in keeps the rest of the world in the game. same with tuberculosis and malaria, the global fund provides far more than other places. malaria, the u.s. is getting close. so you know, we have to have these global mechanisms to drive
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this work, but there's a lot of other problems out there, and there is a real risk, because of the population growth that holly mentioned, that despite all the progress, because the young people who are most at risk in south and east africa are going to double in size -- we're already going to see this -- you're going to have 60%, 70%, 80% of populations 25 and under in many countries in africa. if we don't get the hiv rates down substantially, it's just math, you know. we could lose control of the epidemic relatively easily. so, the engagement right now is absolutely essential, because if you're worried about migration today, imagine an africa that doesn't have education, health, or economic opportunity as that population doubles, and they're all young people. so, we've got to invest now. and it's not just about hiv. it's much more systemic than that. but certainly, we have to invest now so that we have a prosperous, growing continent that will be our marketplace and
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stable countries where people aren't leaving the country because they have no health education or opportunity. so, the u.s. leadership has always been essential. it's never been as important as today because the interest is waned. >> so, tony, on the last question on path forward, i want to look for a moment a little broader than just the hiv-aids question, because we are fortunate to have you here. and given your extraordinary leadership on the larger health security agenda. bill gates has often warned about are we rdy for the larger global pandemic. he has talked about it. there was a spanish influenza of this century in a matter of a short amount of time, 30 million people could die in less than a year. are we ready? has pepfar taught us how to make sure we invest in health
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security systems? we could have an hour or more just on this topic alone, but just in a few minutes, talk about what pepfar lessons learned in investing in global health systems. >> yeah, well, very much so. that's an excellent question. when i get ask in my other hat of non-hiv responding to ebola, responding to zika, i use the pepfar model, really, as a model of what happens when you go into a place and part thaer winer wi country and help develop sustainable infrastructure and health systems. countries that have those health systems can respond. i think the classic example of what happened in west africa with guinea, liberia, and sierra leone, that that country was devastated -- >> around ebola. >> -- for so many reasons, around ebola. and when others came in to help -- ourselves and the cdc and other of the other nations came in -- it was using the pepfar model, that we're not
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just going to go in and do something for them. we're going to partner with them and help them build some form of a sustainable infrastructure to respond. so, right now, just a couple of years later, if we had the same situation in those countries, because of the application of the pepfar model, you wouldn't see the catastrophe that you saw in 2014 with 28,000 cases and 11,000 deaths. point number one. point number two -- during the ebola outbreak, when individuals who got infected left the west african countries and went elsewhere, such as nigeria and mali, it was the experience that they had in those other countries of a sustainable structure that almost everyone who responded to the ebola people were people who have been working through the pepfar syst
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system, so it's amazing how pepfar has created a model of when you're going to respond and you have a sustainable infrastructure and you have something there that has an -- an organization that has the responsibility to knowing that it's our job to stop this, it's created a mind-set that is really amazing what it has done for other countries. >> incredible. i'm going to do something that's very hard for all of you, because i'm actually going to do a lightning round to try to finish this up. and here's what i'm going to ask you to do, to think about these two questions. sitting here, pepfar 15, and imagine sitting here at pepfar 30. pepfar at 15, your greatest surprise. pepfar at 30, your greatest hope. so, you just get like a little snippet. no long statements, but your greatest surprise, pepfar at 15 and imagine pepfar at 30, your greatest hope. just a snippet.
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tony, you get to start off to show them how to do it quick. >> well, okay. i wouldn't say it's a surprise, because it was part of the hope of what has been accomplished in 15 ars, what was said early on, and it isn't really a surprise, it's an amazing accomplishment of 14 million lives saved and 16 million infections prevented. so you're talking about president bush's vision that was discussed 15 years ago has already saved 30 million lives. you can call that a surprise. you can call it whatever you want. but it's amazing. >> it's pretty good. >> it's amazing. my hope in pepfar 30 -- >> we're here 15 years from now. >> yeah, 15 years from now, it's my hope that we actually will catch up ahead of the curve of the youth spurt. >> of the youth bolt. >> i mean, we need to get ahead of it. if you are a little bit behind it, you're going to lose. if you're a lot behind it, you're going to get destroyed. >> okay. >> you have to get ahead of it. >> all right. mark.
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>> greatest surprise is that it actually worked on time and on budget. i mean -- >> all right. >> the data we were using -- >> that's an applause line. [ applause ] >> no one knew. i mean, we thought it was possible, but the data we were using were very difficult. during the state of the elation bit of fear, now we have to do this. >> i wasn't told this, by the way. >> they never tell you anything. the greatest hope. >> the greatest hope is similar to tony's, but i would add to that, that we get ahead of it, but secondly, that the countries are principally in the driver's seat, as they are today, in running the programs, but we really need to back off more and more and let them direct. >> right. >> they know how to do this, whether it's responding to youth. it's remarkable -- 250,000 people in africa have been trained through pepfar. that's something we haven't mentioned. that's health care workers that wouldn't have existed. >> that's great. >> that they're taking more responsibility and that we're ahead of the youth.
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>> which goes back to your accountability point. congresswoman. >> biggest surprise at 15, very few members know the importance epfarr know what pepfar is. >> we have our work to do. >> 2030, no more need for pepfar or the global fund, because -- >> won't that be great? we will have been successful. >> we will rid the world of hiv and aids. >> thank you from one of the architects. >> i'll adopt everything that's been said and just underscore, too, on the greatest surprise front, the extent to which our partners, and especially in country had stepped up and seize the challenge and taken responsibility and accountability. and the greatest hope being that that process will be fully complete by the time we get to 30 years on. >> wonderful. senator? >> i agree with all of my
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colleagues, as well i would say my greatest surprise is that a foreign assistance program of any kind, especially one like this, survived three administrations and two reauthorizations in that 15-year period. that's a surprise. and my hope is that in 15 years, hiv-aids will be history. >> how about that? [ applause ] my greatest hope would be in 15 years from now, we can join together with these five architects of one of the greatest success stories in foreign assistance and even celebrate more. please join me in first thanking them for their extraordinary contributions. [ applause ]
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later today, a senate judiciary subcommittee will hear testimony on the influence of shell companies a virtual currencies on elections. live coverage starts at 2:30 eastern here on c-span3, also on, and you caniste l with the free c-span radio app. housing and urban development secretary ben carson will testify tomorrow before the house financial services committee, live coverage on c-span3 and online at and you can listen with the free c-span radio app. also tomorrow, president trump's pick to lead the veterans affairs department, robert wilke. his confirmation starts live at 2:30 eastern on c-span3 and also is available online and with the c-span radio app. more from this globalea


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