 Good afternoon. Good afternoon, ladies and gentlemen. My name is Stephen Howes and I'm the director of the Development Policy Centre. Welcome, everyone, today. Let's begin by acknowledging the first Australians, the traditional owners on whose lands we are meeting. And let us pay our respect to the elders of the Ngunnawal people, past and present. Thank you, everyone, for coming. We still do have a few seats left, but I'm guessing that they'll be filled up by people who are just running a bit late. But welcome if you're joining us on live streaming. We are live streaming this event around the world. We have a number of distinguished guests here today. I'd like to begin by welcoming Mr Harold Mitchell, AC. Harold is, among many other things, the person after whom this lecture series, The Mitchell Orations, is named. He's our founding funder and you'll be hearing from him shortly. I'd like to welcome our speaker, Dr Mark Dible, Executive Director of the Global Fund. We're very much looking forward to your lecture, Mark. And I'd also like to acknowledge Bill Bartel, Director of the Pacific Friends of the Global Fund, who really made this event possible today. Thank you, Bill. We're honoured to have the American Ambassador. His Excellency, Mr John Berry. We're delighted you could join us, Ambassador. I'd also like to acknowledge the former First Lady of Papua New Guinea, Lady Rosmar Outer, and former Vice Chancellor of the University of Western Sydney, Professor Janice Reed. Also welcome former MP and Minister Bob McMellan, and Acknowledged Secretary of the Department of Finance, Jane Holton. This year will shortly be joined by Australia's Chief Medical Officer, Professor Chris Bagley. A number of my distinguished colleagues are here as well, starting with the Vice Chancellor himself, Professor Brian Schmidt, Dean of the College of Asia and the Pacific, Professor Bronika Taylor, Director of the Crawford School, my director, Professor Bob Brunig, as well as Director of the Research School of Population Health, Professor Archie Clements. Welcome to everyone. Today's a very special day for the Development Policy Centre. And if you don't know much about us, if you'd like to find out more, we've actually just completed our annual report for 2015. So that's available outside. This is our fourth Mitchell oration. The series was designed to provide a forum at which the most pressing development issues could be addressed by the best minds. I'm probably biased, but I think so far the series has done that, and I'm sure today it will. Now copies of the other lectures delivered in this series are available outside and, of course, on our website. As well as taking part in the fourth Mitchell oration, we're also very proud today to be launching another collaboration as part of our partnership with the Mitchell Foundation, the Harold Mitchell Foundation. That's the Mitchell Global Humanitarian Award. And so if you'll excuse me, I'd just like to take a minute to tell you about this new initiative. The Mitchell Global Humanitarian Award is a new honour that will recognise Australians and other supported by Australian aid who have made an outstanding contribution to the cause of international development. Its aim is to educate and inspire. It will be given annually to a contribution to the cause of international development which inspires others, which is of lasting and significant value, which has a link to Australia and which has not yet been adequately recognised. The successful awardee will be selected from a short list of aid profiles, which the Development Policy Centre will select and author. The aid profiles will be published throughout the year on our Dev Policy blog and in other outlets, and in fact the first one is coming out in the Canberra Times and online tomorrow. A distinguished selection panel for the award has been established, and fortunately we've got two of them here today. So the panel will be chaired by Stephanie Copers Campbell, who is an experienced Development Practitioner, currently directed with the Harold Mitchell Foundation and Executive Director with the Oil Search Foundation. So welcome to Stephanie today. Another panel member is Bob McMullen, who I've already mentioned, former Parliamentary Secretary for International Development Assistance, and the third panel member is Joe Chandler, award-winning journalist, author and editor. The award will include a $10,000 donation to the charity of the awardee's choice, and the cause of the awardee's choice. The winner of the first award will be announced in early 2017. So we're going to take this year to write up the first lot of aid profiles, and from that select the award winner. So nominations for both the award and the aid profiles are welcome. Please send them to us. So that's an exciting initiative. There's a flyer outside. Please take it away and tell others about it. But now back to the, back to today's event, the Mitchelloration, and I'd now like to call on the Vice Chancellor of the Australian National University, Professor Brian Schmidt. Please welcome Professor Schmidt. Thank you, Stephen, and please allow me to welcome you to the Australian National University. This is my second time here at an event at Crawford in my very short time as Vice Chancellor, and it is great to see such high quality and interesting events being here. And so I'm glad to see so many people here today, and it is my pleasure to welcome you today for the 2016 Mitchelloration. Harold, welcome to A&U. I have known Harold now for the last several years, doing some interesting things down in Melbourne with respect to music, but your passion in this area of development has been known to me, and we've had a chance to discuss it everywhere from the Los Angeles Airport Lounge to, as I said, to Hamer Hall. So thank you for your personal friendship, but also thank you for being a great friend and supporter of the A&U, and for so many things else around the country. I'm also pleased to welcome Stephanie Campbell, director of the Harold Mitchell Foundation. Stephanie and I have an interesting connection, which is I think will be the only two people in this room who were born, or not born, but grew up in Alaska. So she and I hold that together, and that's how we were introduced for the first time. I also thank the American Ambassador to Australia, my other alter ego, sexistly John Berry. Thank you very much. And I will go on and on if I mention everyone here today, but since I think most of you have been covered, welcome to you all. Whether or not you've been mentioned or not, it is a great audience that you get from you, where there are interesting people popping up everywhere in this lecture theater. Of course, the person I really am here to welcome is our speaker, Mark Dible, executive director of the Global Fund and distinguished scholar in his own right. We are very much looking for your address this afternoon, Mark. The Harold Mitchell Development Policy Lecture Series, of which Mark's lecture will be the fourth, is only one aspect of a broader collaboration between A&U and Harold Mitchell and his foundation. Our partnership extends back to 2012 with the award of $2.5 million in the form of a grant from Harold's foundation, over five years to Development Policy Center here, and that was matched by A&U. We are very proud of what the center has achieved in its relatively short existence, and as you can see in our annual report, there's a lot in here that makes for great reading I recommend it to you. Just two weeks ago, I opened in my first event here at Crawford, the 2016 Australasian Aid Conference, which the center also hosted, which some 500 people participated and it was a great event. In his opening address at the conference, Peter Varghese, the secretary of the Department of Foreign Affairs, paid tribute to the work of the center, noting its quality, and that it kept them de-fat on their toes. I think you could not ask for higher praise, as I think Jane could tell you as a secretary. It's not often that secretaries like to be kept on their toes, but we'll do our best. I also commend the center and the Harold Mitchell Foundation for their new initiative with Stephen mentioned, the Mitchell Global Humanitarian Award, which will recognize Australians and others supported by Australian Aid, who have made an outstanding contribution to the cause of international development. This is a very worthwhile initiative, and I was delighted to learn that the first person to be shortlisted for this award is in fact an ANU alum, Robin Alders, who graduated with a PhD from the ANU in veterinary immunology in 1989, and who has since undertaken path-breaking work in combating Newcastle disease in Africa. Harold, we very much welcome our partnership with you. My first chance to welcome you here to the ANU. Our interactions with you are a model for this university, and I hope we can continue them with you and with others into the future. Bringing together leading thinkers and policy makers, having the brightest minds address the most pressing issues, is very much what ANU is about. We are the National University, but our orientation is and has to be global. From this perspective, the Harold Mitchell Development Policy Lecture Series fits squarely in with the mission of the university. This series has already established a strong reputation for both excellence and relevance, and I'm sure Mark's lecture tonight addressing critical issues of global health, development, and innovation will make a substantial contribution both to further enhance the reputation of the lecture series, but I think much more importantly to our shared knowledge and understanding. Thank you very much. Thank you very much, Brian, for those words. That's now my great honor and privilege to call on Harold Mitchell to come to the lectern to say a few words. Please welcome Harold Mitchell. Thank you very much, Stephen, and Vice-Chancellor Fisley. Can I congratulate you this is the first time that I've been back here as an old friend to see you as Vice-Chancellor. Outstanding Australian Americans we're just talking about, it's so important. It's an incredible time in the world. The world has always been changing dramatically. At the planned breakfast I had with Joseph Stiglitz in New York just three weeks ago, it was underscored the great difference that there is amongst the people of the world is the top 1% that people now move to a point where they have 40% of the world's wealth. The unevenness of what the world is has been covered upon all of us to do something about it. I'm delighted, having spent 40-plus years of advertising to be able to look beyond what I can do in the world and so it was always a pleasure when Stephen Howes approached me some four years ago, I think it was, to say he wants to make a difference in the world and that's what we all want to do. You want to do what you can in the immediate environment that you've got and where you can do it outside that, you can. We're troubled, as you know, in so many parts of the world, but our near-neighbours are the biggest troubling points that I've always seen and I congratulate you, Vice-Chancellor, for what has been developed by yourself and others inside the Corford School. Every time I look about and see the effect that you're having, the little bit that I was able to help with, the world is made up of universities. I welcome other Vice-Chances, I just saw here a little while ago, good friends from Papua New Guinea and I'm looking so much forward to what you have to say. I've read what you are and I know that we all are encouraged that you're here. We're very lucky to have you in every way like that. What we can do is about universities, it's about institutions, it's about countries, it's about governments, but mostly this world is about people and that's the one that makes the real difference and so when Stephen told me that he had another initiative, how good was it, that the University of the Corford School and everything that we're involved with here wants to pick out an individual that made a real difference and so Stephen, thank you for what you've allowed us all to do because it's the individuals of the world and there's every other individual to make a difference. There's a total group of people we can do what we can to make that difference but in the end it's us all as individuals. I'm not going to take any more time because today this is the fourth in a series which I should say Mark have been outstanding people before you and you will add to that in every other way and I know and it will make us tough to next year who are going to be able to follow you. We look forward to everything you've got to say and thank you so much for coming. Well thank you Harold, thank you for your time over the years and the faith you've shown in us. I'd now like to call on the Dean of the College of Asia and the Pacific, Professor Veronica Taylor. Veronica is a great supporter and a great champion for our college. Today she's kindly agreed not only to introduce Mark but to chair the lecture so I'm now in fact going to hand over to you Veronica to take charge of proceedings. So please welcome Professor Veronica Taylor. Thanks so much Stephen and I join with you in welcoming all of our distinguished guests, introduced to you formerly Dr Mark Diable who will be delivering the 2016 Mitchell oration. Mark has kindly agreed to deliver the lecture and then also to engage in questions and conversation afterwards. Mark has worked on HIV and public health for more than 25 years as a clinician, scientist, teacher and administrator. After graduating from Georgetown Medical School in Washington DC, Mark joined the National Institute of Allergy and Infectious Diseases where he conducted basic and clinical studies on HIV, virology, immunology and treatment optimization including the first randomized controlled trial with combination antiretroviral therapy in Africa. Mark is also well known as the driving force in the formation of the US President's policy plan for AIDS relief better known as PEPFAR. He was appointed as its leader in 2006 becoming US Global AIDS Coordinator and he served in that capacity until early 2009. Mark then served as co-director of the Global Health Law Program at the O'Neill Institute for National and Global Health Law at Georgetown University where he was a distinguished scholar. He took up the position as executive director with the Global Fund to fight AIDS, TB and malaria in November 2012. Mark, you're eminently well qualified to address us on the topic of global health development and innovation and judging from the title of your address this evening we look forward to being excited and challenged and perhaps also a little bit frightened. So ladies and gentlemen please join me in warmly welcoming Dr. Mark Dible. Thank you very much Dean. It's a great honor to be here and I'd also like to begin by paying respects to elders past and present of this great country. It's a great honor to be the Harold Mitchell speaker this year. Although we just met I have actually read about him because there aren't a lot of philanthropists in this part of the world and it's nice to meet one. And actually like the one I know best Bill Emelinda Gates what impresses me the most about what you've done is you fund ideas whether it's the arts or this policy center ideas been understanding that ideas drive the world and drive positive change in the world and how ideas then translate into action and I think this center is an example of that and so I also it's great to be here with our colleagues from the Australian government and the people of Australia who drive the ideas but also the change in action. It's also a great pleasure to be here with Ambassador John Berry who actually is hosting at his home so I feel particularly thankful to him and Jan Reed who knows academics extremely well having been a vice chancellor now chair of friends and Bill who you all know. Lady Ross from Papua New Guinea who is a driving force of many things in Papua New Guinea and around the world but I really do want to thank the people and government of Australia for the support for the Global Fund and because they support not only money but ideas we really do view Australia's ideas and policy in this region as the driving force in this region because you know it best and are here and that's important to us because the Global Fund was actually created as a fantastic idea it was an idea that grew out of a radical change revolution is not too strong of a word and how we looked at development. This is that dangerous thing to do in a university so I'm going to encapsulate a very Cliff Notes version of development but the origins of development are not particularly savoury it grew out of basically colonialism there was no interest in the parts of the world until colonies existed and the healthcare and the education system and everything were basically built for colonies Missionary zeal was a piece of that and that's basically how we function for over 100 years in development until World War I and it was World War I that began to change things not in this part of the world necessarily but in Europe it was actually the post-World War I World War I response particularly around feeding people that helped change in some sense the way people thought about development not the way we think of it today but how one country would actually act in a more humanitarian way in another country that wasn't related to something like colonialism very self-interested as well as actually a lot of good development is we then went into a period where development was largely driven by the Cold War it was actually about winning friends paying friends actually and that's not why people were in development certainly people who worked in development didn't come from that perspective but that's where the money came from and post-colonial guilt which drove a lot of the concern and engagement in development and so it's not terribly surprising that literally if you go back 15 years ago before the revolution and how we looked at development if you asked anyone in the world what was happening in nutrition or education or health the answer would be we are spending X amount of money it wasn't we are achieving we are supporting what we were partnering with it was we are spending X amount of money an extraordinarily paternalistic view and largely built into impulses one to feel better about yourself for what you've done to countries and people as your colonel passed and one to make people feel good about you as part of the Cold War so it wasn't particularly surprising that the powers that be weren't overly interested in how the money was being spent what results you were getting for the money that was being spent what you were getting although not the doing was fundamentally different and then 2000 came and while it was building up over time 2000 was an extraordinary watershed in the history of development for those of you that are interested in this area which I assume is most people in the room I highly recommend you read something called the Monterey Consensus Monterey Consensus is about four pages for those of you who work in international diplomacy you know how rare that is it's a few paragraphs founding new principles a fundamentally new philosophical approach to development those principles were country ownership moving past the paternalism but actually to support and build countries to view them as partners not as a paternalistic colony or not as a paternalistic entity but as a true partner in fact the leading partner that we were all to support the second was a result space and I can't tell you how different it was no one was talking about results what was the money achieving no one in fact when we created PEPFAR we set specific goals the president Bush set very specific goals we were roundly criticized by the development community for doing something like setting goals people said it's complicated we just need to spend the money and we'll get some results but you can't set a goal now everyone talks about result space development that was literally 15 years ago so that result space was absolutely essential and actually very much related to country ownership a third principle was all sectors needed to be involved that development does not actually happen government to government it happens people to people and so you need the private sector you need the faith sector and civil society in all its forms you need people engaged you need everyone because development is about human beings it's not about governments necessarily the fourth fundamental principle was good governance and we talk about good governance but there's a lot in between good governance and corruption and it's actually about accountability and transparency and good decision making with accountability and transparency and so that key principle of good governance which again didn't exist in fact no one cared about governance it was for those impulses we talked about these four principles actually guided what is nothing short of a revolution and development another key factor of the Monterey consensus was that economic growth and development was a key underpinning factor in overall development and that we needed to recognize the importance of economic growth and development to achieve basic development goals that was pretty heady stuff and it's been followed by multiple documents since then the Paris Declaration the Accra Accord if I get them all right Boussin most recently financing for development the Accra Accord so we went from four to five pages and what we tend to do in in the world we do and now it's about 500 pages but it's basically the same principles the same driving principles it now just has taken the philosophy the ideas and tried to push on how we put them into action the Global Fund like Gavi actually many of you know does vaccines and Australia also is a huge supporter of Gavi were actually created out of this revolution and development of structure and in function we were created to respond to that change that philosophical shift that country ownership results based good governance in all sectors being involved and that's why we are public-private partnerships we're actually not part of the UN although we love the UN and they're great technical partners and we work with them we are public-private partnerships that were intended to respond to that new approach that new philosophical approach that we've done pretty well so since the Global Fund was created in 2002 the programs we support and I'm very clear that it is not the Global Fund, it is not us in Geneva it is the people and the programs we support have saved 17 million lives 17 million lives that's extraordinary and we do it in a global way there's a lot of disease around the world and particularly HIV, TB and malaria is one of these diseases in Africa but it's not just Africa actually this region is hugely important and it's a region that can end malaria can end tuberculosis and can actually end HIV probably before most other regions in the world and so we stay global and this is a really important number especially for those of you who want to in the Global Fund for every dollar Australia has put into the Global Fund we put 20 back into the Indo-Pacific region that's a pretty good return on investment I think Mr. Mitchell as a businessman would agree 20 to 1 is not so bad so it's actually done rather well globally and it's done rather well in this region but the interesting thing is the change in the world that Mr. Mitchell actually began to talk about because we went on in a very similar pattern in development for decades and you could argue actually over a century and then it all changed in 2000 and that was awfully exciting stuff that was heady stuff we are actually now in a period just 15 years later of an entirely different change because of the changing dynamic in the world and it's based in changes in geopolitics and in power centers and this region is certainly at the epicenter of that as power is shifting back from where it was centuries ago millennia ago actually back to the east but it's also based in something Mr. Mitchell mentioned which is growth in equity and growing in equity despite economic growth and despite efforts in development and not unrelated probably instability as a consequence of this great change and flux in where we are it's also driven in part by an interconnectedness that we have not had before and that interconnectedness exists in cyberspace but it also exists person to person people are very mobile there's enormous migration in the world today and we can put up whatever we want but that migration is going to continue because of the change and the movement of ideas and the movement that is possible because of connectivity in the world today and that's not just refugees we do see refugees and we'll see refugees but it's actually the patterns of our life it's the patterns of our world it's the patterns of mobility of ideas but also of people and all of that great insecurity we as human beings are not particularly predisposed to massive change all at once of massive flux in the world scientists can be pretty excited about that but as people we get very anxious about it and that's true for nations and nation states in the post-westphalia era but it's also true of individual people that make up those nations and that's why I picked the title because it's a very exciting time really the most exciting time in the history of development I think and that's saying a lot because it was pretty exciting 15 years ago it's an extremely challenging time but it's a little frightening because of this massive flux and that is usually the stuff of innovation innovation is a lot easier when everything is in motion it's harder when things are stable and there are two basic paths and for those of us who spend some time reading history we've gone down the wrong path too many times in the periods of flux in the periods of general instability personal instability and national instability and global instability the path we have often gone down is isolationism and returning inward it has been wrong and caused massive harm every time it's been done it'd be wonderful if we learned from history just once or you can go down the other path which is innovation connectivity ideas use the ideas that we have that will lead to action to change the world and for all the problems in the world we have an extraordinary opportunity an extraordinary moment where we can innovate Gerard Manley Hopkins is a poet not many people know but he's one of my favorite and he was writing a little bit about this when he said but for all that nature is never spent there is a dearest freshness deep down things and that dearest freshness deep down things is actually expressed in the sustainable development goals that the world adopted not too long ago in New York because the sustainable development goals are different in some to some extent than the millennium development goals and they're different in two fundamental ways one is they call on us to shift from a focus on individual issues and that's not just HIV or TB or immunizations that's issues education nutrition whatever the issue in development is that we move from just focusing on issues in isolation to focusing on people because people need multiple things they don't just need health they don't just need education they need everything in order to be the person of equal opportunity they can and should be and that's the second key part of the sustainable development goals the massive focus on equity on equal opportunity on the most vulnerable and marginalized in our populations to overcome the inequity that we are actually experiencing in the world and for the first time the sustainable development goals that we adopted are not just for low and middle income countries they actually are for all countries including high income countries so that focus on a person is actually fundamentally a focus on equity and equal opportunity and one of those sustainable development goals that are essential for us to achieve overcoming inequality and equity is ending the HIV, TB and malaria epidemics which is a part of the sustainable development goals because of the massive investment of the last 15 years we are on the right side of the tipping point in all three of these diseases the epidemics are in retreat we're seeing declines in new infections and we're seeing massive increase in care and treatment which actually because they're infectious diseases is a significant way to declining new infections and that's hugely exciting but the thing about infectious diseases is you actually have to end them because if you don't they'll come right back and that's the nature of infection and they'll all come back as they are in this region in the form of drug resistant versions of those epidemics and those are very dangerous because we don't always have the science we don't always have the technology and we definitely don't have the money for some resurgent epidemics if we stay on the right side of the tipping point if we get to the end of these epidemics it will allow us to focus on other things many of the people in this room the young people in this room have never lived in a world without HIV it's pretty extraordinary for some of us of our age to think that the generation today have never lived in a world without HIV but we are the generation that can actually end the epidemic we have the science to do it malaria and TB have been around literally since recorded medical history they have been around for millennia we are the generation that can end two diseases that have been around for millennia and you know we can because Australia has done it the only cases of malaria and TB you have for the most part are imported cases just like the United States just like most of Europe but if we don't actually get them to the end when they come back and unfortunately you are seeing some of that and that relates to health security but before I get to health security I want to really shout out what your country is doing on malaria elimination because this is a region that can eliminate it and the prime minister and the minister are focused on something called Aploma which is something no one should ever have to remember but it is a regional effort to come together as a region and end malaria in this region and it is very possible and just to emphasize the health security piece where we see drug resistance to malaria is also in this region in the Mekong Valley and the only way to overcome that resistance is elimination so it is great that Australia is leading this effort and the Global Fund is here with that 20 to 1 return on investment to make a difference but when you think about health security a little bit more broadly the same mosquito that causes malaria causes dengue and causes zika so you put an insecticide-treated bed net out and you kill the mosquito you do service to malaria, dengue and zika and lots of other mosquito-borne diseases so that is part of the integration that we are called to do in the SDGs to look more broadly than individual diseases and individual issues to look at how we deal with health and build a health system that can respond not only to individual diseases but to other epidemics as well and in order to achieve all that in order to stay on the right side of the tipping point in order to achieve the end of these epidemics in order to take advantage of the massive flux in the world and grab hold of it the key is innovation and that is another thing in this country and that this government and the governments actually throughout have focused on is innovation how do we innovate how do we take ideas and put them into action so that we can be a better world so that we can truly understand the dearest freshness deep down things for those of you who read your local, well not local, national paper, Jenny Huart really amazing woman wrote a great piece today on the global fund that outlines some of the areas of innovation we're engaged in and I just want to mention a couple of them because we're hyper excited about them and they all relate to those new principles the revolutionary ideas of 2000 where the principles are still valid but how we implement them needs to change the first actually relates to that idea of engaging all sectors of not just being government to government but to really look to see in a given location for an individual person in their community who is best suited to deliver services and as great examples all you have to go up to Papua New Guinea, Stephanie is here she's the head of the oil search foundation they work implementing HIV programs because they can get up to Taru they can actually put accountability and sustainability plans into place and they're doing a really fantastic job but so is world vision and save the children and the Rotary Club that's actually done quite an excellent job in driving malaria rates down in Papua New Guinea despite all the challenges that are there and so when we work with DFAT and the Australians on how we work in a place like Papua New Guinea we look at the most innovative best partner to deliver the services to the person at the site and Lady Roz has been a great and I would say all the scars on her back to show it at bringing all of those partners together to drive to ensure results a second key area relates to some of the key areas of a health system that we know impede not only results in HIV, TB and malaria but actually impede all health and when we've done analyses of these and we've gotten pretty good we hire a lot of people from the private sector to help us so we follow cash flow and we follow results and we follow discrepancies and disbursements compared to projected disbursements and what we've found and learned is that procurement and supply chain are two of the single biggest impediments to effective health systems healthcare workers are key financial management is key but the procurement and supply chain are often the stumbling block huge stumbling blocks to equity because you'll often get services and you'll get drugs and commodities into the capital cities but it's very hard to get them out to the remote areas and so building those procurement and supply systems are huge we also need to be able to do better with the money we have and buy as much as we possibly can with the money we have so we brought private sector pooled procurement now what pooled procurement means is the area under the curve you can sell something you can sell 100 things for $1 or you can sell 100 things for $1 and your area under the curve in terms of revenue is the same so by having more procurement more buying power you can actually negotiate reduced rates and so over the last two years we have systematically done that we've taken the middle people out of the way negotiated with the other large procurers in the case for example of malaria bed nets we are about 50% of external procurement for bed nets but if you add UNICEF and the US government and the UK government and you get 85-90% we come together and negotiate with companies and you have volume that can reduce price so in the last two years in the last two years we have reduced the price of long lasting insecticide treated bed nets that kill the mosquitoes that cause malaria dengue and zika by 40% 40% in two years that is breathtaking that is taking ideas and implementing best practice and implementing that is taking advantage of all sectors and the know-how in all sectors to the best advantage where appropriate we are now engaged in trying to do the same thing on supply chain because supply chain is key to getting those commodities out to the most remote areas in a sustainable way and you will have seen in Jenny's article that one thing we pioneered in Africa with the Gates Foundation was to work with Coca-Cola because the insight was you can go to any village in Africa and I can assure you any village in Africa you will find Coca-Cola you will find an empty formulary at the health clinic but you will find Coca-Cola now the initial thing people think is oh throw that stuff on the trucks and it will get out there that's a really bad idea and it's not sustainable what we did is take the expertise of Coca-Cola to embed them in the ministry of health to sit with their supply chain people in the health care system we did it first in Tanzania the president in Tanzania says without qualification that without that program they would not have been able to turn their supply chain around now because of the success in that program we are taking it to nine other countries in Africa and we are working now with Coca-Cola here to see if it's possible to do the same in Indonesia and in Papua New Guinea these types of innovations pulling from the sectors that can do the best job there are some things the public sector is fantastic at including pushing for equity there are some things pieces of the private sector are fantastic at there are some things the segments of the faith sector are fantastic at the idea is to take the best ideas from wherever they are and turn them into action and that leads to long term sustainability that leads to the ability to transition from external support which is necessary for a time to a country to be able to stand up and sit on it stand on its own in health and in development we've done a lot of work on this we call it the development continuum the pathway of a country from a challenging operating environment to self sustaining state and it's not a one way path countries move up and then they have either a natural disaster or a political disaster and they can slide back but you need to keep pushing and understand where a country is and what the pieces are that are necessary for it to develop to be self sustaining and a piece of that is finance and as countries grow their economies they don't necessarily invested in equity and so just looking at gross national income and to say well we won't invest there because they have a high gross national income right now today the majority of poor people in the world live in middle income countries 70% the majority of people with HIV TB and malaria and non communicable diseases and everything else live in middle income countries so if we're right about the sustainable development goals if we're right on the focus on the person equity how do we not engage in middle income countries but how do we engage in middle income countries what is the right role of an external financier when a country actually has revenue and one of the ways we can do that is to stimulate countries to move from grants to loans to actually take responsibility on their own to do something that's somewhat complicated and I'm learning far more than I wanted to about finance what you would call a buy down so for example in Indonesia $10 million a year thanks to the generosity of the people of Australia and other places given current interest rates they can do somewhere in the neighborhood of 20 times that and use our grant to pay the interest so that over time they can build their own capacity to pay for that so that 100 million a year can turn into the money that they need to control their epidemics and build a health system that's like I saw Jane nodding so I'm very happy about that because she knows a lot about this stuff so if you have innovative approaches to finance for sustainability you have to be careful in how you do this and you can't do it the next day it takes time and planning and that's where real development that's where that partnership comes in that's where that shift from paternalism to partnership to going country by country and then person by person who has the ideas and who can turn those ideas into reality the last thing I want to mention and this is hugely important and it's a very important piece and something Michael Kirby and I wrote about last year actually the uniqueness of HIV and tuberculosis Zika or most infectious diseases are by their nature great equalizers they are terribly nondiscriminatory it doesn't matter if you're rich or poor in the old days royal or not if you came into contact with an infectious disease you were as likely as your neighbor depending on nutritional status and other things or to just get sick and possibly recover HIV and TB are remarkably discriminatory diseases they prey on the most vulnerable and marginalized and it is driven by discrimination it is driven by inequity and inequality and that's true in the LGBTI community it's true in prisoners and migratory populations it's true in sex workers and rates are very high but today Dr. Bishop launched something hugely important in this country and this is one of the few countries to do it to have a national strategy on gender equity because the reality is that the epidemic the HIV epidemic whether it's in Papua New Guinea or in southern Africa is being driven by gender inequality we are at risk huge risk of losing control of the HIV epidemic because of gender inequality because of basic discrimination because of how women are treated 30% of women in some of these countries up to 50% have their first sexual encounter through violence or abuse which is a pattern that is repeated women are not only second-class citizens in some countries they are non-citizens their birth isn't even recorded they are that insignificant and that inequality is driving the HIV epidemic let me give you a scary number the rate of HIV among 15 to 24 year olds in some parts of Africa is 6 to 8% per year that's incidence that's not prevalent 5 to 10 times more than young boys because of that gender inequality even if we reduce the rate of new infections in that group by 50% the epidemic would still increase because the size of the population is doubling and therefore the size of the pool of risk is doubling so if we don't get control of gender equality we will lose the battle against HIV of all the investments we've made of all the progress we've made we will lose control of the epidemic but what's really exciting is it's not just HIV we actually can't achieve any of the sustainable development goals if we don't have a more gender equal world any one of them it doesn't actually belong as a separate goal that will allow us to achieve all of the sustainable development goals and relative to linking areas we're very active now including with Julia Gallard who's at the global partnership for education in linking education and health for adolescent girls and young women because the data show from Botswana for example that if a girl stays in secondary school for each year she stays in secondary school her risk of HIV drops by 12% in a study in Malawi girls that stayed in secondary school had a 60% reduction in risk of HIV so we an HIV organization I was just in Swaziland are now investing in innovative ideas taking those ideas to provide incentives to keep girls in school what else happens if a girl stays in school she's much less likely to be a child bride she's much less likely to be pregnant early she's much more likely to have a smaller family she's much more likely to have an income when a woman has money and for all of us men this is to our great shame when a woman has money in the countries we work she'll spend about 90% of it to feed, educate and provide health care to her child we men will spend about 30% so you invest in health and education and you turn the world you turn the world into a gender equal world you turn the world into a world that will achieve the development potential we were intended to achieve the Millennium Development Goals and what's exciting about that challenge and frightening growth in population of young people is it's also our salvation the Romans had a great saying there's hope and death meaning that we with the bad ideas will eventually die and the next generation will take over that normally takes several generations because of the massive growth rate and the youth if we can get to it now syndrome of gender inequality it can change in 10 to 15 years it can change in a generation we can have the world we need to have to attack inequality and so it is an exciting time it's a challenging time it's a frightening time but it really is the stuff of innovation and if we stick to the ideas if we have people like Harold Mitchell and this policy center and organizations like DFAP taking ideas and putting them into action if we stick to those principles that philosophical shift that occurred in 2000 and implement them in better and smarter ways we will be the world we want to be Martin Luther King had a lovely saying many of them actually the arc of history bends towards justice the arc of history bends towards justice it's up to us how quickly that bends it's up to us how quickly we overcome inequality it's up to us if we will take the ideas that will allow us to not just bend that curve but to have it come to the equal more perfect world we want to be it's up to us it's our decision thank all of you for your ideas and your action if we do it all together we'll get there thanks so much Mark that was tremendous and you have also very generously allowed ample time for the questions so we will as we generally do questions from you all we'll ask you to identify yourself and if you wish also your affiliation to help Mark we'll take two or three questions together and then invite Mark to respond so for those colleagues who are working the microphones I'd ask you to move to the people that I'm indicating in order and we'll take two or three questions and then go another round okay so I'll invite Mark from the floor over here thank you hi Dr. Dible that was an excellent talk and you've done some great work at the Global Fund I'm Jane Van Vleet from DFAT I actually used to manage our relationship with the Global Fund a little while ago and I noticed when I was working on the Global Fund there was a fair amount of criticism on the global stage about sectoral funds and they're very focused and they don't help the countries more broadly and I notice you've been pushing working on education in Africa and cross-sectoral work and I was just wondering if you could reflect on that more broadly how you're expanding your remit and how that fits into your funding model many thanks we have another question down here hello my name is Kerry Vani I'm an academic here and I chair the Advocacy Subcommittee of the TB Forum thank you Dr. Dible for the excellent presentation I think Dr. Dible you mentioned the Asia Pacific Leader Malaria Alliance and we've had a lot of advocacy and support for the HIV issue in the region we've got less commitment for tuberculosis and particularly drug resistant TB in the region and I think a lot less political commitment even from our own government so I'm just wondering what you would recommend we would do to increase that political commitment particularly in the context of the NTB strategy thanks we might start with those and then we'll move across the room thank you excellent questions so if you go back to the founding documents of the Global Fund it was HIV, TB and malaria but the health systems piece was always there at the beginning and the partnership piece that's how we solve these problems partnership right they were always there but we didn't implement that way at the beginning which is natural and I understand that we need to get going we need to support countries we need to see results to maintain the financing I did the same thing in the bilateral program but the reality is over time partnerships are tough things but you actually it's much easier you know there's the African saying we always quote if you want to go far if you want to go if you want to get somewhere fast go alone if you want to go far go together and it's very true it's very hard it's a lot of work to do partnership it's easier to just go in and run a program and that's what we did historically in development but when you bring everyone together you start seeing really exciting things and sustainable long-term things and so the ideas were always there so our remit actually hasn't fundamentally changed we've just shifted how we act on the ideas and brought the movement and the knowledge and the information that's come forward from implementing in countries and supporting countries to implement to change which is how we got to the sustainable development goals because there was that recognition the MDGs actually kind of pressed us to do that the SDGs we hope will get us to do better so there's a lot of debate in global health architecture and then development architecture should we just start over recreate something that makes sense philosophically from an ideal perspective I've actually pushed for that when I was an academic and it's a great idea the problem is by the time we get around to it development won't exist anymore the political fights that are necessary for that are not worth it what is worth it is partnering and supporting the countries and that actually relates to the second question about HIV and TB and how you support countries in different stages at the beginning you're a challenging operating environment you have to invest heavily in health systems and we know this we've seen that or you're never going to get results in anything HIV, TB, malaria or anything when you do a national response you can do pilot projects but you can't do a national response as you move along the development continuum hopefully in the direction as you get close to self-sufficiency there are a few countries that are even though they're not necessarily high income we started to see what some of those component pieces are so how do we support them to build those so we can get there and focusing on key affected populations it's hugely important in upper middle income countries because it's very difficult for them to do it and we've seen great success in some countries working in that really tough conversation to begin to change so it really is how we partner with each other and will we accept the sustainable development goal approach of focusing on a person not an issue or a country to progress in development or will we not we're trying to be proactive in how we act on the idea and education and health and adolescent girls and young women is a great way to do it but we also do nutrition, we also do a lot of other areas so I think it's incumbent on us and I think an institution like this can really help create the ideas that will lead to the action not of in best case scenario how would we create a perfect architecture but how do we create incentives and drive the change that's necessary so TB is an interesting disease to me and actually I get in trouble for saying it and it infuriates me that we haven't ended tuberculosis imagine if we had curative therapy in six months for HIV do you think we'd be accepting a 1.5% decline in new infections in TB in HIV if we had curative therapy in six months now it's tough to diagnose and we need innovation on diagnostics and we have to really reach into the community and do active case detection to change the ideas we've had in the past for hospitalized care for how we do directly observe therapy for how we actually understand adherence and this is true in HIV as well bring in the social sciences we have too many white doctors running around to be honest, I'm one of them we need to bring in people with ideas from other areas to help drive some of this but a fundamental problem and so the ideas need to shift no question about it but one of the issues is 70% of tuberculosis is in the bricks mostly in India China South Africa we have pretty substantial programs 70% Russia has one of the fastest growing rates one of the fastest growing rates of drug resistance as is true of Eastern Europe that's the place to be doing massive program investments which is why while we're at 70 to 80% of external financing for TB 80% of financing comes from the countries themselves because of their economic status so it really is about changing ideas and acting on them better and supporting countries in a way that is a partnership to help drive towards elimination of tuberculosis and basically if India and China don't move and Indonesia increasingly given their increased rate we will not get there on tuberculosis but we're not going to invest billions of dollars in those countries it would be inappropriate, they're in the wrong place on the development continuum and it wouldn't be sustainable and it wouldn't be the right approach so then how do we do it so I think the two questions are actually related and they're an excellent question We'll take a couple more Sir, over here and then over here Thanks very much, I'm Michael Moore I'm the CEO of the Public Health Association Australia President-elect of the World Federation of Public Health Associations and you're talking about partnerships the one example you gave of partnerships with industry was Coca-Cola so I'm wondering where you draw the line in terms of working with industry so you're prepared to work with Coca-Cola are you prepared to work with alcohol companies are you prepared to work with tobacco companies and because these all have pluses and minuses in the system Thanks for your wonderful talk I'm Clemens the director of the Research School of Population Health here at the ANU My question is about what happens when these diseases start to go away particularly malaria which is one of my interests the cost of maintaining freedom of disease and preventing resurgence is high but the donor interest may not be there what advice or what are your sort of plans for when things like malaria do start to go away that's my question so Michael it's a good question and it kind of gets back to the question on what's the perfect global health architecture we can do whatever we want people are going to buy what they want and how you work with people is different anyone who wants to help we want to work with but we do have pretty strict conflict of interest policies and that's one of the reasons for example putting things on Coca-Cola trucks was a bad idea to all of us it's different if you embed them in the ministry of health and that works and then you work with them you then have a conversation with them cigarettes I actually think we should ban cigarettes if we're going to do anything we have electronic cigarettes but we work we don't work very much with cigarette companies and I'm aware of alcohol companies we do work with and again because we have to in Sub-Saharan Africa the alcohol companies own a lot of shabines the neighborhood places where people go to drink if you don't do HIV prevention in those places we don't care about having any impact on HIV but at the same time we work with governments like Botswana to actually have much more restrictive laws on alcohol and policing of alcohol and work with the companies to make sure that they have those policies you can have that conversation if you're working with them you can have the conversation if you're not working with them and you can have it around health and their self-interest that over time they're going to be dinosaurs they're going to be out of business if they don't start shifting and they need to engage in a different way in a similar way it's a very different conversation with ministries of health heads of state who we talk to the faith community in countries with very restrictive laws around key affected populations because we enter from a health lens and we can talk with them about their congregation and the health of their congregation we can stop working with a faith community because they have bad policies on key affected populations if we do we won't be dealing with anyone so we have a saying well we hardly invented it but it's meet people where they are and we'd all like to be pure people that did everything right and saintly but chances are we're not going to do that so how do we not let the perfect be the good and what ideas do we have that can solve these problems by triangulating them by squaring circles and to me that's the exciting thing about say the pooled procurement mechanism and the online version we've created called wambo.com of it because we challenged our team and said how do you square the circle of building this pooled procurement mechanism that's global for a sustainable long-term approach using an external source so we created an online mechanism that's priceline.com that is now being adopted in countries and integrated into the software being integrated into the national system so they can participate in pooled procurement like you would on priceline that's how you square circles so we need to square circles around some of these challenging issues on malaria it's true it's an infection basis so we need to stop looking at things if we want to end epidemics and we have to look at the cost of ending an epidemic it actually is expensive but it's a lot more expensive if the malaria comes back and we've learned this so I think many of you have probably heard this when the U.S. President's malaria initiative was announced I happened to be with the Minister of Health of Zanzibar not long after and it's like oh eliminating malaria that's easy we've done it three times so if you don't do the global approach if you don't actually get to elimination to me that comes back to ideas how do you put forward the idea that if you don't get to elimination it's going to come back do the cost, show the cost show the cost of drug resistance that you can't overcome drug resistance unless you overcome, unless you eliminate have the ideas, show how you implement them and really create those partnerships so you know this region and again Apple was doing a great job on it the Asian Development Bank and ASEAN should just be putting more money into eliminating malaria the massive economic drain in the country and in the region and Apple was helping drive that we can play a role in that it's about ideas and driving the ideas and convincing the heads of state ministers of finance and others that this is what you need to do and here engaging the private sector is enormously helpful because they can go to the government and say why am I going to invest in your country if malaria comes back I'm not going to invest in a place if a third of the workforce is out during malaria season again and those are our ideas and you take those ideas and put them into action and then last question thanks very much Douglas Robertson from the ANU what would you say to the funders, the state funders of research in terms of the investments that they're making or should make in the three diseases and some of the challenges you mentioned about bringing in the social sciences thank you my name is Jane Haycock I work for the innovation exchange at DFAT I just wanted to bring you back to several of the points that you made and you talk about the focus on people and inequality in the STGs and this really isn't a question about HIV and ATB in malaria but it's more a question about people and how from all your experiences of partnering with the private and the public sector and with countries where do we look for true expertise understanding people so where do we look to understand expertise so we can get people to make better choices in their health-seeking behaviour or in their lives such that we're looking at a different disease burden a different non-communicable disease burden into the future so a question about people, thank you so two additional great questions we're not a research institution but we're doing something that we hope will help drive this change which is quality assurance and it actually relates to the second question that's happening in northern Europe and in the United States by Kaiser Permanente where you're looking at quality assurance we're not a technical agency and I can tell you part of the partnership is if we start inching into technical support we get slapped pretty quickly as we probably should because we have two long-term advisors in TB two in HIV and two in malaria we should not be engaging that's part of the partnership but quality assurance is different and so we actually what's been happening in healthcare in northern Europe and again Kaiser in the United States is to look to see where you're getting good outcome and bad outcome and we tend to take a national look but when you start digging below national you can actually start seeing spots that are performing at over 90% in whatever you're looking at adherence or something else and you can find places that are performing at an average of 30% or 50% so by really getting the data on a site specific level or program specific level and in Europe they've actually gone to provider specific once they got passed and they see the same fluctuation in the same institutions with providers then you start building in quality assurance and those are ideas and that's it's not research but it's a way to really drive and which gets to your question who has the ideas where are they coming from the community whatever the community is is the community of practice of public health officials is the community of practice of community healthcare workers if you show them a problem and have the data we almost always find them solving it on their own but they have to have the data so one of the responses to Ebola and we're somewhat engaged in this is build surveillance systems I mean huge family surveillance systems but surveillance isn't going to end in epidemic and if you're waiting for a community healthcare worker to report to id supervisor to id supervisor to have a head of state look at it to go to an international organization before you make a decision and go back down the chain you will have lost control of almost every epidemic so what you really want to do is build data management systems not surveillance systems that create the data in each environment including from the community healthcare worker to the national decision maker that allows them to look at the data and make decisions and bring them together as communities of practice and those communities of practice have been shown to find solutions and share them with each other so they find a solution and then start sharing it around Ethiopia has done this where Wanda has done this in Nigeria interestingly enough is looking at it but you have to change people's mind it comes back to ideas and data drive a lot of those ideas so show the data on where you have most healthcare workers don't particularly want to provide bad healthcare but they need to have the data and if all they're doing is reporting they're not interested in doing it and they're not thinking about how to respond so that when the next bad thing happens they're not going to respond but if they're looking for fever and thinking about and have data on the number of people with fever in their environment and you create the data whatever it is it doesn't have to be computers it can be a lot of different things what we've seen is you can reduce you can improve impact and value for money significantly so communities of practice whatever those communities of practice are come up with the ideas then we have to have the guts to support them and solve them and that's where that idea to implementation is so important so I come back to Harold Mitchell who's one of the people who funds ideas to action and without people like him and without people like you to do the work we would never get there but again working together we will bend that arc of this history towards justice so thank you for all the work and thank you for having me thank you so very much Mark I'm going to give the floor now to Stephanie Cobus Campbell to make a formal vote of thanks Stephanie is a director and the former CEO of Harold Mitchell Foundation she's also closely linked to the Global Fund as the director of the Oil Search Foundation and she's a very good friend of ANU and so a very appropriate person to close before she does I would also like to invite you to stay for more conversation and questions it's not quite a theme but we do have drinks to follow thanks Stephanie thank you and I'm losing my voice so I'll be short I am giving this vote of thanks with three different hats on tonight and the first is as the director on the board of the Harold Mitchell Foundation and I can't pass the opportunity to recognize Harold and everything that he does and Mark you said it's rare to find a philanthropist in Australia it's a heck of a lot rare to find a philanthropist who gives into our region and as you were speaking you touched on a number of points that I thought Harold's involved in that and he's involved in that so he's been funding John Thwait St. Monash University to lead our region in developing the sustainable development goals and in fact we just met with Jeffrey Sachs in New York not too long ago he's been an active funder for programs in Papua New Guinea from snake bite to gender-based violence through some incredible work that Steven and others are involved in to literacy programs in Papua New Guinea he's been a personal mentor to Shanana Guzma who was prime minister and again funded a number of really important programs in Timor and he's chair of the Australian Indonesia Center and that's just what he does in the region the list can go on for what he does for Australia and of course I'm a proud supporter of the Development Policy Center so I want to in this photo thanks to Recognize and to thank Harold who is on proud to call a mentor and also a dear friend so thank you Harold I do remember when Steven came to see Harold four years ago and I was in that meeting and Harold said Steven I will fund you on one condition and that is that you become the very best in what you do in the entire world and Steven you looked a little bit daunted by that I have to say it may be quietly confident you knew you had it you knew you had the formula and there was a need for it but I have to say again we were in New York recently and I heard from colleagues at UNICEF that they get their information on the Pacific through the Development Policy Center heard similarly from colleagues in Geneva they get their information on the Pacific through the Development Policy Center I heard from someone in a little community in Popin again the other day that they were reading your blog at the Development Policy Center so you are making a worldwide impact on that performance indicator that Harold set for you you are certainly well on your way and again thank you for everything that you do for development and also in our region it's noted and appreciated so the second the second hat I wear today is my current job as a director on the board of the Oil Search Foundation Oil Search is the largest company in Popin againy and we have a fairly comprehensive foundation funding programs in women's empowerment health and education and we are a principal recipient for global fund implementing programs in HIV and if I could recognise Lady Rose here tonight as well who has been an absolute champion for all things HIV and now Malaria and TB as well as other things in PNG and again it's a pleasure to have you here tonight and thank you for all of your amazing work and we can definitely recognise Rose tonight and as Mark was talking I was reflecting on how far we've come in the region and in particular in PNG on these three diseases I think collectively the region has made a real headway in Malaria we can't take our eye off the ball but I was reading the other day that Malaria rates for under 5 have decreased in Popin againy from 24% to 3% and that's an absolute achievement absolute achievement HIV we've also come a heck of a long way I remember when I started working in PNG in the year 2000 it was a dooms day scenario it was going to be an African like scenario PNG had all the risk factors and through the work of Lady Rose and many many partners in Popin againy through a multi-sectoral approach as Mark mentioned that has not come to play but again we cannot take our eye off that ball and gender based violence is one of many things that could prevent us from achieving our goals and gender based violence in Popin againy is a particular challenge and something that multi-sectorally we all need to help to change TB I think is an absolute challenge last week I was in Gulf province which is right next to western province so many people have heard of western province not so much about poor little forgotten Gulf I was in Kukori Kukori hospital a little district in Gulf province their beds are overflowing with TB patients 60 out of 80 of their beds had TB cases and many many many people aren't even accessing medical care when they do start treatment they're already quickly because all the challenges to stay on treatment in Popin againy and in a really remote part of PNG Gulf and I can tell you that multi-drug resistant tuberculosis is right throughout Gulf province it's right throughout Popin againy and it is on the increase and again this is something it is a call to action for Australia multi-drug resistant extreme drug resistant and TB in our region is here and it is scary and I have seen that firsthand just this week so for our DEFAT colleagues and others you know we do need to continue to get that message across but Mark you inspire me tonight and I think the words that really made me excited it is partnership it's multi-cycle approach it's innovation it's ideas it's equality and gender equality being so important these are the call to action for change and to change the world and together we can do great things when those elements are there so thank you for reminding us of that and I guess with the third hat on I have tonight is someone who is incredibly passionate about development in our region and development in particular in Popin againy which is the country for me I said to people about 20 years ago I fell in love with Popin againy and I've been faithful ever since but thank you for everything the Global Fund does in PNG and the region you are making a real difference and we look forward to our partnership with you for years to come thank you