 So thank you, thank you very much Phil and thank you Steve In terms of TV and fight against TV and you have and you have And you and you have an audience that comes, you know, so numerous to hear the Struggle that we have in fighting to break it was that's quite reassuring. So You have to be really applauded for for the effort, which is not common and I wish I mean apart You know, we have had debates we have had discussions over the last one year and a half about where we don't like this We don't like that recommendation But in reality when you can have this kind of democratic debate I wish we had it in every country in the world because that is the way you actually progress, right? So now what I want to do if I can have the lights a bit lower so that I can see What I want to do is Five things essentially talk to you about the global burden in in a summary Way and the progress that that has been achieved so far some words have been said About that I would just put them in graphic and maps and so on I will speak and present the new comprehensive strategy that the world Delta assembly Three weeks ago has Approved I will speak about the current status of coordination in in the response in my view And why therefore orchestration is absolutely necessary and then I will go to some conclusions and some remarks on that So I start always any speech with this this particular table which summarizes the burden of tuberculosis and you see very clearly there that we are talking about 8.6 million million cases every year and 1.3 million deaths those who can count will will count 3500 deaths every day 3500 deaths every day because of tuberculosis and You see also that the burden in women and children that is often forgotten Especially by agencies that prioritize Agency I'm talking eight agencies or ministries that prioritize maternal and child that they not necessarily realize that there are half a million women affected Half a million children affected nearly three million women affected and all these deaths which are listed there And by the way talking about TB and HIV and comparing them if you look at the estimates around HIV and the incidence and the mortality rather of HIV you will see that the Confidence interval at the fact to overlap so and in essence tuberculosis and HIV compete for the number one killer in the world Whether we like it or not and that's what it is Unates estimates 1.6 million deaths due to HIV But then calculate within those the three hundred thousand three hundred and twenty thousand that are dying because of TV And so you see once you put things together that the two diseases are not that different and then in We have already heard about the HIV associated tuberculosis story and so over a million cases and 320,000 deaths in people living with HIV and the last row expresses the Burden that multi-drug resistant tuberculosis now imposing to those who fight for to be controlled Nearly half a million new mdr. TB cases every year and at least we think under than 70,000 deaths So let me move quickly to the next one. There is some problem here. I'm pressing and it doesn't go Yeah, that fine. Got it. So this is the Estimated to be incidence rate. These are rates per capita Number one TV has never been eliminated in any country of the world. You all know that but there are some countries where the Level that the rate per capita is extremely high You see southern Africa and that is South Africa is Lesotho, Swaziland Namibia and so on but one Etc. They have rates that approximate a thousand per and a thousand We are talking about 1% of the South African population get into tuberculosis every year So I don't know if you've ever heard about something like that Which is really major and then you see that in the rest of of the world in Asia in the former Soviet countries in the Andean countries of Latin America, etc. TV is very at the very high level still today Okay Okay Closer is that okay, but so and what you see there is a pie that illustrates the Distribution of cases in absolute numbers now So Africa is about 27% so a quarter a bit more than a quarter of cases But Asia with rates which are lower But population that are much higher as about 60% of the cases and then the rest is in the Middle East in Europe especially Eastern Europe and the Americas and these are the Data about the progress that we can measure Thanks to a reporting system that has been going on for 17 years or so You see on top right there our global report the latest one launched in October So in essence incidents coming down slowly but coming down and this means the millennial development goal is on track That only talked about making incidents decline Mortality coming down. It has already been mentioned 45 percent decline since 1990 as a result 22 million lives Estimated to have been saved since that time and 87 percent documented QR rate and in in this is about 6 million people that are officially notified so to speak and 56 million patient that have been cured in that period of time. So these are big big numbers But there are of course the bat is there and this has been already said and there are there are a number of big Challenges I will illustrate some of them in the next three or four slides These are the five priorities for action that we have we have out highlighted in our latest report That incidentally correspond to what is in this current strategy a global strategy What will be in the in the new strategy and what I believe also the US government strategy includes pretty clearly Number one reaching the missed cases. We have heard about the three million next slide will illustrate what I mean Accelerate responses to TB HIV. We've heard about that Consider mdr. TB as a real crisis mdr. TB is the least advanced of all fields into tuberculosis with only roughly 20 percent of the existing Estimated cases that are being detected and put on treatment The issue of the financial gap and the issue of research and the delivery of new tools Let's go through some of the slides very quickly reaching the missed cases What what do I mean for those who are not? Familiar with this type of figures we estimate 8.6 million cases coming down slowly you see in green there 8.6 million cases in the last report in 2012 But we got actually reported officially and notified officially a total of 5.7 million cases So either the estimates are completely wrong, which I doubt because these are coming from long exercise They are very consistent over the years So if the number is not 8.6 it could be 8.2 or 9.1, but that is what the range is and roughly Three million therefore not in the system. What are these cases not in the system? They could be cases never diagnosed and we know of autopsy studies in people living with HIV as an example In rural Africa and so on but they could also be and this is an important issue that has to be tackled I was just talking to some people outside that of the Hiding if you like of these cases within the non-state or if you like private sector And if you look at the case the country's where the majority of these cases Estimated to exist and not reported are you see India is number one with 31 percent So one third of the missing cases are in India and we know that if you do surveys in that part of the world You will definitely find many more cases than what is being notified They're simply hidden in the private sector, which means also not necessarily being diagnosed and treated properly So it's a big issue the second one is that of accelerating the response to TV JV We heard it this morning. I don't need to go back to many issues about this But just keep in mind that this is an issue for this part of the world It's 80 or 75 to 80 percent of the cases of TV JV are in Africa and the next after Africa is India so they basically are Responsible for some 80 to 85 percent of the TV JV cases and their issues are Common common to TV programs and to HIV programs because not necessarily they do what they're supposed to do While at the same time we have seen I must say progress in the last ten years since the announcement of a policy by WHO at the time with our HIV department with the backing of unites and the TV program We have seen quite a lot of progress in terms for instance of recruiting patients with TV to be tested for HIV in Providing antiretroviral sense on and so forth But the progress will not depend only on national TV programs. It will depend actually I would say even more on HIV and ARV programs And the other big challenge is that of mdr. TV and you see completely the difference here I go back to the previous one so look at the continent here and look at this other one And that's where the problem is is particularly in Asia and in the former Soviet Union Here are the percentages of TV cases that are mdr. TV and you see that in some parts of the world You have up to 35 35 one-third of the cases That when they come to the system and they are diagnosed with TV are found with mdr. TV that is Belarus or some oblast in Russia as an example and This is just giving you the percentages, but if you look at absolute numbers That's what you find India China Russia and South Africa these four countries have 65 percent of all mdr. TV cases in the world So often time we hear that there is no progress and these and the other But if these three countries particularly in the China Russia don't move more quickly than they they are moving now Then we will always have a problem in a gap. It's very simple now when it comes to the new strategy So to face all of this we have now Gone to the World Delta assembly with a new strategy that was approved exactly three weeks ago by the World Delta assembly With the backing of the US government I must say because US government was part of the drafting of the strategy and a strong supporter of the strategy Now I'll give you a in the next three or four slides a brief illustration of what it is You should have somewhere this This two-pager I'm not so sure feel if that was ever printed because we're talking about printing this this particular two-pager So it's it's around here. So you can see all you have it beautiful. So you can see the details which are So to speak summarized in that way number one There is a vision here of a world free of TV with the zeros that are clearly Inherited from the HIV AIDS community But that is important to to underline that we want to be as ambitious as the HIV AIDS community has been so zero That's zero disease zero suffering and a goal of ending the epidemic and when we say ending We mean really getting it down to less than 10 cases per hundred thousand in 2035 that is the level of the rich countries today Okay, and finally You have the three targets the specific targets that have been approved by the world Delta assembly now 95% reduction in deaths compared to 2015 90% in incidents and Importantly people don't put enough emphasis on that no affected families facing catastrophic cost due to tuberculosis So we are in the era of universal health coverage We cannot have patients with TB becoming poor because they got to be let alone MDR to be And This would be a challenge by the way in in how to measure and it's something we were discussing in fact last week Even with our colleagues in USAID how to measure that component But we will need to measure it and we will need to integrate it with with perhaps other measurement Capacity in WTO in other places where they actually measure Universal coverage in in those terms now the strategy is based on four Overarching principles and three pillars the four overarching principles are straightforward government stewardship We need that obviously with accountability strong coalition with civil society protection and promotion of human rights ethics and equity and adaptation of the strategy to the country Circumstances the three pillars are on top there the first one on the left is the one specific to be it includes all Possible innovations that are available today So there is no more hesitation about Chemoprophilaxis for instance that has been debated for ages in the TB community We are saying we need to provide chemoprophilaxis to those at risk And we know that now there are new regiments that actually seem to be less toxic than you know Simple is on use it for six months. The central one is crucial is for the first time I would say not really the first time but is it not really the first time but this is if you like is for the First time over-emphasizing if anything the notion that without a good system around without Universal coverage without policies you cannot achieve global TB control and finally the third one is Relying on the importance of research and I go back to that in a second These are the details not to make you believe that there are just three pillars and four principle These are the details. These are all very well thought for two years There was a consultation here and building of consensus with with civil society with NGOs with partners with government And so on to reach this point of Announcing a strategy that has this wording first pillar as I said all innovation second pillar You see they are the policies that we consider essential They go from universal coverage policy to social protection people forget that during the six or More months of treatment people cannot work and they have a loss In terms of income that is actually Calculated to be about two-third responsible for the losses that patients and families Incur into when they have tuberculosis, so it's not just the direct medical cost is the loss of income So these are important issues that have to be addressed with social protection policies that that are really solid And finally as I mentioned already a research Not only to have countries collaborate in new tool development But also research on how then operationally if you like on how then to optimize their use and adapt them to country settings now This is the curve that under in a ways is is Explaining What we are trying to achieve on top there is where we are on top left and on on on the bottom at the Right is where we want to be in 2035 and this is the current global trend less than two percent roughly two percent per year of decline in incidents We need to accelerate and we are giving to the world in a way some 11 or so years by 2025 to reach an average 10 percent per year decline by doing what by using what is available today Current tools include in prophylaxis as I mentioned already and the hope that something else will become available between now and then and Ensuring the universal coverage and the social protection aspects of the game Which is exactly the recipe that worked so well in Europe and in North America Half a century ago, so we don't see the reason why in 2025 the bricks and other major Countries that are developing their economy quickly would not be able to do this They have to be put under pressure to do this and second second part of the curve is where? The new tool becomes now the new tool issue becomes now crucial Without the new vaccine or new prophylaxis. We won't be able to accelerate above 10 percent That's a maximum ever achieved in humanity and 17 percent is what we are sort of aspiring there is the decline that was seen in the Eskimo populations in both Alaska and the northwestern territories of Canada when intervention were focused Targeted and extremely aggressive. It's possible to achieve in those little population if you want But it's possible to achieve that type of level so with a new vaccine and a new prophylaxis scheme I think we should be able to reach that level and that will take us to 2035 Now let's talk about politics a bit more. So why is global coordination essential? Well, first of all TB is a global disease and must be faced globally and It means involving all countries involving all agencies. It respects no border So thinking like something that you close the border and you prevent tuberculosis. That's not going to work There are major cross-border challenges and it's a health security threat in the world And I would be very happy I heard it this morning that that becomes a very prominent part of the agenda of the global health security initiative of the US Second that the World Health Organization now has a new strategy is an ambitious one ambitious targets and Countries are urged now because they signed it off to adopted and adopted and the partners the international partners are the ones that are necessary in terms of Supporting them in a variety of different ways, whether it is technical or financial Third mdr. TB is a global threat We said it already and it's important to notice that there was another resolution at the World Health Assembly three weeks ago Talking about antimicrobial resistance. I think Tom said it in the morning Unfortunately that seems to be focusing very much on bacterial infection hospital acquired infection Which is obviously a big thing But at the same time we cannot forget disease like TB or malaria that have a similar type of problem is a health security issue and finally there are Fortunately, there is fortunately a multitude of agencies of donors or energy of NGOs or foundation that are involved in TV today And it's absolutely imperative that they synergize What is the international orchestra we are talking orchestration so what's the international orchestra about to be I think we are getting to a Critical mass now because for the first time in history We have a bunch of agency that can actually contribute at the center We always place the countries and the government because that's where the action is and that's where the sustainability aspect has to be Then we have the World Health Organization as some of our initiatives to provide the normative function and so on Then you have the stop TV partnership that is doing advocacy and it has the global drug facility that is providing drugs to countries Strongly and only I would say these days supported by USAID You have a bunch of donors there The global fund unitate USAID as a bilateral as an example of bilaterals other bilaterals are weaker today than USAID is PEPFAR the Bill and Melinda Gates Foundation that is mostly involved with research, but they also have a role in that CDC is a technical agency other Non-governmental technical agencies such as KNCV The International Union the American Jurassic Society the European respiratory Society and finally NIH for what concerns the research I just focused here mostly on American Institution and agencies, but there are a bunch of others By far the American institutions are the most prominent as we all know Fortunately with this orchestra we have a long history here of leadership global coordination Orchestration we can always do better and that's what we have to in this new era That's what we have to really have the ambition to do The global TV community has been robust and coherent I would say supporting always focusing on the country-driven responses. There have been policies Consensus-based and particularly evidence-based since the early 1990s dots was the first example of this Then the stop TV strategy, which is the current one going from 2025 and in a way expiring next year when the new global strategy will be taking over There have been three global plans prepared by the stop TV partnership with the help of WHO since 2000 We are now in the third global plan and there is work going on I think Joanne will certainly mention that later for the fourth global plan from 2015 on of 16 to be precise and in countries we have all Had in TV the three ones in place You know that this has been quite a lot Emphasized a few years ago in the HIV community in TV has always been like this In a way one a great framework a strategy one national coordination authority the national program and an M&E system And the M&E system is what has allowed the comparison of the data that we have produced We have put together over the past 17 years or so that allows us to understand what countries are doing and To estimate what they should be doing and finally another important part of this Coordination element is the fact that there has always been agreement in TV that cost effectiveness is essential and TB care mind you has always been judged and assessed Independently as one of the most cost-effective health interventions available and here is the proof So this was the World Bank famous world development report 1993 And you see what the position of TV was there is one of the most cost-effective together with rehydration salt and vitamin A and so on Interventions that was available already in 1993 chemotherapy for TV they called it at the time and in 2006 this was reiterated in this new report that was sort of the follow-up of the World Bank report and That graph comes from that report and it has been used by the eminent panel convened by Ban Ki-moon the secretary general to discuss the issue of the Post 2015 agenda you see TV is the number one there So you gain basically 30 times from one dollar investment in TV control Diagnosis and treatment more than malaria more than HIV more than other intervention including vaccines Which is quite extraordinary people don't realize that often time Just to go into more details, but I don't want to spend Really a lot of time on this one, but every single tuberculosis intervention is either highly cost-effective Defined as you see at the bottom or just cost-effective Including treatment of multi-drug resistant tuberculosis that sounds very expensive and sometime considered Unfeasible in reality compared to the GMP per capita and The other criteria used for the definition of cost-effective is cost effective and it costs by the way I didn't say it but it cost only if you look at smear positive infectious tuberculosis Five to fifty dollars right per year of life safe. That's the range Which is really nothing if you compare with other interventions And I just want to talk about financing because I think this is crucial important Let's focus on the top left. That's the BRICS countries What you see over there is the funding required according to the global plan. That's the black line You see in light blue the domestic funding that is predicted to be disbursed during the next couple of years until 2015 On the basis of the GDP GDP growth and you see in green what else this is just a sort of model What else could be in a way? Put together by the BRICS countries In in short, although this is three or four hours more than that is probably five to six hundred million dollars The gap is fairly small relative to instead what you see in the LIC the low-income countries Take the bottom right slide. It shows a curve It shows a big gap there because these are the poorest countries and it's quite unlikely that they will increase their expenditure on tuberculosis in the next two or three years and That translates into that gap and that translates in something like I do it again Additional two billion dollars per year necessary that have to be mobilized in a way or another if you want to really Reach the level of the global plan And I want to spend a couple words on research to say that number one research is fundamental For the new global targets to be reached I've already underlined that with our new tools by 2025. I'm not saying tomorrow morning because that's unrealistic But by 2025 we have a good 10 years to go without a new vaccine without a new Particularly new prophylaxis or short regimen that can be Can be accelerating the response. We will not be able to achieve those ambitious targets and Oh, there is something from some problem here. I'm sorry What happened just jumped all right the second point is that investments are needed To feed the R&D pipeline and gets and get the products in a decade time And this is where we are. So there's been a doubling of resources put in tuberculosis research between 25 20 0 5 and 2010 But then there's been a flattening an infected slight decline According to the tag group that is doing this thing over the past one year and finally final point I'm sorry again is the needs are clear in this world We have clear needs for to be is a point of care rapid and easy diagnostic is a short regimen for treatment and prophylaxis In the vaccine and these are the pipelines. We don't have time to go through it I'm sure the next panel will be talking about it the pipelines as they are today So I'm coming to the conclusions two slides number one I think that what needs to be done next is a strategic financial strategy that has to be Really a global one These are principles that we sort of summarized in a recent Lancet global health paper with our colleagues in in USAID We all agreed on this point. So number one There is a need of continuing international financing, especially for the low-income countries You have seen the huge gap they have so either we watch and we accept We accept all these millions of deaths and so on or we have to act number one number two bricks and middle-income countries must continue their Enhancement of the domestic investment that they have put because they have put a lot of money into to be But they need still to benefit from what I call smart international aid during this transition to self-sufficiency We heard the example of South Africa, but I can tell you that in case of India in the case of China Not talk about Russia. They're busy with other things now, but But Brazil and so on they all have their own problem Brazil is the only one that in a way or another is managing domestically But if you look at the other countries, there is still a need and the fact that they become non-eligible To entities such as the global fund is a concern because they are not addressing the issue of MDRTB So don't be surprised when you know, you hear the 20% only around treatment There's no one doing anything of course They don't put their money and the international community is sort of dropping them Far larger investments including from the bricks are needed to boost research and allow rapid technology Transfer and at last point OECD countries global fund unit A So the big donors need to continue coordinating efforts and adjust their aid flows By doing essentially two things strongly support the action in law and middle-income countries that are in need and leverage And I think this is crucially important and that's where I think we need a real strategy here Leverage domestic resources in the bricks to address Particularly the equity issues because it's true that the bricks are becoming richer and richer But it's also true that there are a huge amount of people there that live under the level of poverty and those are the ones with TV final slide Conclusion to collective leadership to end the global TV epidemic is necessary and that in my view Depends on five or six points number one the fact and the the fact that we need to respect that without country-owned Agenda we will not ensure sustainability So that is crucial and we have to work in that direction number two global strategy and planning now exist We have a strategy. We have a global plan that is in the making and so we must have common goals and continue third We have to continue as WHO the coordination of the global response when it comes to the normative function the M&E Function the coordination of technical assistance or the help in such a way that every country receives the technical assistance They need Partners and donors all of them they need to synergize the efforts and that is the big challenge And that's probably also what the global plan has to in a way The next global plan has to emphasize civil society. We heard it already this morning is hugely important I have been I've been Pushing for civil society and community engagement over the past decade I don't think we're there yet to have the same type of mobilization We have seen in the HIV AIDS world and finally the US government is a leader In fact is you know, some people don't like this world, but it's the top leader in the world We know that we whether it is USAID global fund that far and so on We have all the agencies here that are putting an enormity of resources But we need more resources now because that's the time really to commit to Elimination of tuberculosis in the next 20 years. So thank you very much for listening Okay, well, thanks to a doctor for providing an international perspective on the global TV Now I'm gonna I'd like to introduce dr. Joanne Carter who is who actually probably will present it both a domestic and an international perspective She's the executive director of results, which is a Grastres advocacy organization and had and she worked for them for a long time and recently became the deputy Chair of the stop TV Partnership so and Joanne will come out Well, thanks. Thanks Mario for that great job and thanks. I'm just to say first My thanks as well to CSIS for the report and for bringing us all together You know as this issue is very close to my heart My organization and our grassroots and myself have worked on this issue for a decade and a half to bring political attention to TV So this is really important at this moment that you're doing this And I would say Mario I Don't you did a really good job of going through that so I'm gonna skip a bunch of stuff about the sort of why because you laid it out But I think if there was one slide I'd want it is really that slide about the ambition of the strategy because it's incredibly important The fact that the WHA just endorsed that and it really should be a driver for our global ambition and also a driver You know really for what we need to do next And so I just want to make a few comments on some of the broad recommendations and then talk about very briefly about a few of the key Global elements around TV and so in terms of the broad recommendations I Strongly endorsed the report's call for increased US government investment in TV and TB HIV efforts And people that know me will not be surprised about this But this is really truly not about just the idea that more more money is a solution to every problem Because I think the report and Mario what you laid out make very clear Underlying analysis that shows how far we are from the global TB financing targets How disproportionately low TB funding is compared to disease burden and mortality And also how unfortunately far we are from the TB funding authorization of four billion dollars over five years and The TB targets in the 2008 Lantos hide reauthorization of PEPFAR. So we're quite far from there again Mario you laid out really well why we need that money, you know for scale up for poor countries But not just for poor countries for middle-income countries to be ambitious with new technology and to bridge some of those needs For effective long-term technical assistance. I'll say more about that in a moment To support important things like the TB drug facility for increased R&D And Specifically, I would say we really need much greater political support on TB from the Administration at the highest levels as was pointed out in the report Because as the report noted the administration the Obama administration has actually proposed a 19% cut in USAID's TB funding for FY 15 And Congress is going to consider this later this month And I would just say it becomes as people that understand this process know It becomes very difficult if not impossible to significantly expand funding without administration support to increase that budget space And and again as people who have been following this issue for years know Congress has Consistently been for the last really decade and a half the driver of increased funding for TB And they were actually house and Senate letters this year to the key decision-makers in Congress calling for $400 million for USAID for its TB efforts So and several members raised issue with Administrator Shaw about the cuts, but in this particular situation of administration cuts And the unfortunate situation we have is that Congress ends up using its budget space just to restore funding And its political capital and to reverse those cuts and we end up with a flatlining or worse So really key finding and I'd also just note that I think important lessons learned from the president's malaria initiative and PEPFAR Is the critical importance of increased budget linked both to ambitious and specific targets and also the ability for more central reporting and more central control of budgets And I'll come back to the global fund and PEPFAR in just a minute And I would just say overall the CSIS report makes a really powerful case For the need to increase political priority for TB by the administration and the global community Measured as increased resources and other political actions to implement key policies at country and global level As you pointed out new tools brought to market and we'll hear more about that later and taken to scale faster And most importantly measurably increased impact for the patients And I strongly endorse and want to help promote this need for increased prioritization for TB And I would a bit distinguish it from the issue of increased coordination Either for the USG and at the global level Which I actually think overall is is less of a gap Not that it can't always be done better and also less of the rate limiting step And I'd also say in broad recommendations that looking forward toward developing ambitious and concrete new targets for measuring progress And also continuing to strengthen ways to measure program impact across the USG portfolio is very important And I think you know an independent review done right by something like the Ion Institute of medicine could really help inform the ways to further strengthen programs But also could help build political support with the Congress and then I briefly just want to touch on a couple of international efforts so one Well global fund TB HIV stop TB partnership, so first the global fund as noted incredibly important for TB more than 80% of the external financing for TB comes through the global fund and US so firstly US financial support for the global fund, but also US political leadership to support the replenishment was incredibly important In the US pledge of up to five billion the US outreach to other donors really key to the replenishment and will be key going forward But it's also you know there was discussion about the fact that TB is 18% of the global fund portfolio going forward And I want to note that even in the new global funds new funding model It is still in very many ways a demand-driven model So part of what will determine what happens with TB in the global fund is that 18% for the global fund TB programs, but a lot of it is about the actual degree and of ambition and quality of proposals brought to the Global fund by countries And countries get access to a baseline amount of funding But they also have the potential most of them do to get additional competitive funding through something called an incentive pool And if countries do a good job and have strong proposals that which cannot be funded now can actually end up in a What they would call a Register of unfunded quality demand that can be funded both by the global fund But and also by other donors and the global a lot of the elements of the global fund new model are also about how do we improve the Quality of the investments that our countries are making with the money that they have and I raised both those things because they really make the Key point about why US support for technical assistance is so incredibly important right now as well as global fund support in the short term for Technical assistance as countries develop these hopefully bold and ambitious TB proposals So we have to continue to push that that the TB gets its fair share at the global fund But we also have to make sure that we're doing the right things so that countries can be ambitious and do more and ask for more And get more I would also just say that One of the other mechanisms the global fund has which is regional proposals are really key for some of these cross-border issues like TB and mining But also for this issue of how do we support civil society in the regions to support and push their own governments? Particularly in middle-income countries to actually do more on TB domestically So I think those regional proposals have been for HIV civil society networks really important and could do the same for TB I'd also say that on one other point is just that there is really good news about coordination I think with technical partners and the global fund right now. There's For one of a better word, it's been called the TB situation room, which includes WHO Stop TB the global fund the USG and other partners working together to look at the technical support That's needed for countries now And that really has been working in a way better than I then I think I've ever seen before And it's really mapping out the needs and the opportunities So I'd like to touch really briefly on the issue of TB HIV that was strongly noted in the report and I Particularly I think there are Opportunities with regards to scaling up for the global fund for PEPFAR as well as for some other donors as well My own organization We've been doing some sort of to supplement in many ways the work that you did We've also been doing some research on donor support for TB HIV and what we saw in the global fund our initial findings Kind of linked to yours is that global fund HIV programs historically have done far Less for TB HIV than TB programs and far less than they need to and that is less a reflection of the global fund Then on programs at country level and Julia Martin mentioned earlier the challenges of now countries being required to actually in high burden settings of TB HIV to do joint proposals and And I think it's a challenge, but it's also really important because it's actually making countries do what we know They need to do working together. It's there's gonna be some bumps there But in fact, it's what needs to happen both in terms of working together to coordinate these programs But also scale up funding in terms of PEPFAR I think what we found is what you all found and I think what the world knows which is that PEPFAR has done better really than any other donor program in terms of coordination of TB HIV Efforts, but it's still under finance So ideally we want to see PEPFAR funding go up so we can do more of this But even at current funding being able to do just 3% on TB HIV is really missing the opportunity of What we can take to scale and what PEPFAR has really shown is possible In a number of countries, but still not taken to scale across the board In the countries that PEPFAR is working in Um Third I want to say a little bit about the stop TV partnership I am I got to be vice chair of the partnership. I was asked last September so Just very quickly on the evolution of the partnership I was on the board about five or six years ago and then just came back last September and I note that because I've seen enormous strengthening and really growth in the partnership around governance around an operational strategy and I want to lay that out because I feel like with that distance I can I have that perspective But also I'm not claiming credit for it But simply seeing the kind of progress that has happened And the stop TV partnership for those of you that don't know it well plays a really critical role in Areas including really obvious stuff like engaging and supporting partners in advocacy at global and regional levels Helping mobilize TA especially for some of the community based activities They're going to be key if we're going to reach that unreached three million It also has a key role through mechanisms like the global TB drug facility and TB reach Gdf the drug facility as Mario mentioned is a key mechanism for procuring The largest mechanism for procuring actually low-cost high quality first-line drugs But now also second-line TB drugs and also some diagnostics. It's helped drive the price With us support of second-line drugs down by over 25% and the US G has been one of the biggest supporters of the GDF Since its inception The partnership also supports a really another really interesting mechanism called TB reach which is small grants with External kind of expert evaluation That are looking at ways to smartly scale up the kind of active case finding and outreach That's going to be needed to reach those three million and that can then actually be applied to bigger programs like global fund grants So kind of a let a thousand flowers bloom evaluate what's working and then take that to scale And I'd also say one of the other I think important elements of the evolution of the step TB partnership But also what it's doing right now is what we need in TB Which is a set of champions and we know we need a set of high level political champions in TB The chair of the board is one of our biggest champions in the world the minister of health of South Africa minister, Moksa lady He's been a champion in everything from bringing this issue to all of the ministers of health of Africa Just at the World Health Assembly a few weeks before leading on the issue of TB and mining in southern Africa And also taking a very key role in wanting to do even more in reaching out to all of the BRICS countries in their leadership around TB, so I think Really important lesson about the work that he's doing and much more that can be done with him and other ministers of health and leaders on the board I think the last thing I would say about the partnership It's in the midst of just beginning to develop based on the new strategy a new five-year strategic plan So a new five-year global plan With the goal that that is really an implementation plan for the strategy and a catalyst for change at country level And I think most interestingly that the plan this time will try to show region by region The great potential that lies in combining new and traditional interventions what it's going to cost And what would be possible using modeling to show how we could accelerate progress on TB and one one Suggestion I was going to make and for consideration is CSIS is called for an annual TB summit and I wondered if You know a next or a first one of those summits could even be linked around The rollout of the new global plan and linked also to the post 2015 Stop TB strategy, so I'd like to think about that and the very last thing. I just want to say Todd did note it, but I feel like we've kind of perhaps under Invested and underestimated the role of the World Bank in these issues So I heard that a little bit of discussion about how the bank works with ministries of finance How the bank might help there, but I would also note the bank has you know 52 billion dollars in IDA funding the bank has been absolutely critical in Historically in the scale up of TB in India China Russia and frankly is helping India right now Meet some gaps that it found in its you know in its budget for its program So I think thinking about both the sort of political leverage of the bank But also the resources the bank has we probably kind of under emphasize that as another Key element to tap into and I'll stop there. Thank you