 Good afternoon ladies and gentlemen. I think we're going to try to get started So I'd invite you if you'd like anything else from the buffet table. There's a few nice desserts over there or coffee or tea Please help yourselves My name is Lisa Cardi and I'm delighted to welcome you all here today to CSIS and to the Global Health Policy Center It's a great honor to have with us this afternoon the Minister of Foreign Affairs of Norway his Excellency Jona Stor as well as Ambassador Vegar Stolman and the rest of the Norwegian delegation Mr.. Minister, I bring particular greetings from John Humray the president of CSIS who's very sorry that he can't be here with us today John's traveling overseas, but he's a great admirer of your work and deeply appreciative of your visit here with us At CSIS we like to describe the Global Health Policy Center as the bridge between Foreign Policy and Global Health In fact the contributions of Norway and Minister Stor your own personal leadership in this area long before it was a Recognized field have clearly demonstrated the importance of linking global health and foreign policy And the critical advances that can be made in both fields when they work together I think everyone here knows that Norway has long been visionary in helping set the global health agenda From its early support for the Global Alliance for Vaccine to the immunization and the Global Fund To its ongoing leadership around the MDGs and the 0.7 commitment to overseas development assistance To the Minister's own direct engagement and launching the Foreign Policy and Global Health Initiative With six other foreign ministers an initiative I think that for the first time this fall will result in a report to the UN General Assembly by the secretary general of the importance of health and foreign policy Minister Stor has been deeply engaged in all of these processes for more than two decades First as director general of the international department in the prime minister's office Then as ambassador to the UN organization organizations in Geneva followed by an assignment as chief of staff to who? Director general Brogurt Lynn a period as secretary general of the Norwegian Red Cross and then chief of staff to Prime Minister Stoltenberg Mr. Minister, thank you for bringing your wealth of experience to CSIS today and for sparing us some time in your busy schedule We have an audience that's very anxious to hear about Norway's experiences and to hear how you think the US should be Looking ahead to the critical challenges of the future Thank you for those nice words and happy birthday if this is World Health Day You all knew of course And I recall from my days at WL show that that was a day we should be Have respect for so that being said is a special pleasure to be here Send my regards back to John Henry and we have Norwegian government a lot of contact with this fine house and fine center And I appreciate that I had this opportunity to come and talk to you And I you know when I am invited to talk about this issue I always start by saying that it is a fair question. Although I see friends around here who would have an idea of the answer Why invite the foreign minister to speak on health? What does he know about medicine health systems health purchased hospitals? mental health and other diseases The answer to be honest is little and Certainly far less than any health minister and hopefully far less than many of you But here is the point when I had the privilege of Serving the World Health Organization with dr. Brunthlin from 1998 I had the opportunity to discover how much more there is to health The global health and the strict medical side of the issue I did so by seeing listening and working with some extraordinary people from the global health community from around the world and there are some of them here today who I Remember as good friends and very inspirational people for me I learned from them a few very important lessons and I'd like to share a few with you I learned that health is more than a budget expenditure It is an investment in human dignity Human development and thus in economic development and welfare of people Communities and nations needs to be said. I believe I learned that investing wisely in health was a powerful tool to the fight against extreme poverty Poor health breeds poverty that we have known but we now know much better how improved health breeds growth and Development the equation works both ways offering us a powerful opportunity to both fight poverty and stimulate development Finance ministers need to know My own as well. I learned more about the amazing work that is carried out by health workers all around the world from modern and Sophisticated clinics in both Oslo and Geneva where my wife has given birth to our children To the local facility in an Indian village where brave midwife Helps a mother to save both her newborn baby's life and her own life Because she gives birth there and not on the floor at home at her mother's in laws house I learned about how much more we could accomplish by working differently by Reaching out to other partners beyond health By assembling the evidence necessary for dr. Bruntlin to call presidents prime ministers Finance ministers and tell them you too are health ministers Your decisions matter to health get to work and get engaged. I Learned about the opportunities and complexities of these new partnerships About the new financial resources we could mobilize through creation such as Gavi And the global fund to fight htb and malaria but also about the very complex landscape that we are about to create With private public interactions and sometimes the lack of overview and unity of purpose The price we are paying by seeing the you and relatively go down Being a foreign policy man myself. I learned how much global health matters to foreign policy and security policy How health holds perhaps the strongest stories of globalization talking to young people? Of all ages you can use health as the lens to explain what globalization is really about How an outbreak of a pandemic immediately will challenge our diplomatic and security systems? How modern states might be brought to closing borders? Norway closed its border with Sweden in 2000 because of the outbreak of food and mouth disease in Britain and I remember I advised the minister of the agriculture at the time that closing a border is relatively easy Opening it again is much harder How the ownership of a virus quickly becomes a diplomatic struggle between the north and the south? Patents how a polio immunization campaign can offer the opportunity of a truce and perhaps by the be the first step towards peace and the peace process and Finally, I learned about what it takes to make a difference in health. I remember at Paho in 1998 Bill Fagy told this masterfully when he described all the efforts that would have to fall into place to immunize a child From the initial research in some laboratory through testing production Transport establishment of the cold chain in some tropical country and the training of the nurse at the local health station With the injection and the clean and safe needle All of this and much more in a long row until that lucky child would be protected for life against fully preventable diseases Dr. Fagy drew on that saying ambassador from Tanzania Which also became the title of Secretary Clinton's books on ten years ago. It takes a village to raise a child Dr. Fagy elaborated on that title beautifully by saying it takes a whole the world to immunize the child So this is me a foreign minister who had the privilege to discover the world of global health and With the ambition of continuing to deal with it As an interested person, but also as a foreign minister with all the challenges and in settings not always accustomed to these issues And in this context, let me add another thing that I learned and still learn The importance that professions break out of their boxes and dramatically improve their interaction health professionals in particular Who are boxed in if I may say so a famous Norwegian public health official Mr. Carl Evan who took part in the drafting of the Constitution of the WHO back in 1948 He said that to him economists were worse than TB Now in these days of financial crisis, he may have had a point actually But another point far more relevant I believe is that the health profession and the economic profession can now do a lot by maximizing their efforts and working together As we see they do I believe we made a contribution to this with the report of the Commission on macroeconomics and health in 2000 to 2001 that highlighted the potential of investing wisely and Strategically in health as a strategy to fight extreme poverty So in short Global health is more than an issue. It has to do with managing complex international relations important principles and major challenges of inequality and Injustice it involves changing financial priorities and establishing organizations and working relationships In short, we must reach beyond our grasp to fulfill our task So what is the Norwegian approach to this? Health has always been a major issue in our development policy Since 2000 we have scaled up We have been focusing on taking the lead in three concrete initiatives First Gavi and I I recall this story when Jens Stoltenberg became Prime Minister in March 2000. I came home from WHO as his chief of staff and He had read about Gavi and the immunization efforts to the good all and I had written articles about that in Norwegian papers So he put into his government platform the short document to Parliament in addition to all the Infrastructure and hospitals and butchers and pensions one line Norway will take the lead in helping immunizing every child Very strange sentence in the government statement. It wasn't really debated in Parliament, but it was the ambition So he were the first government to pledge to the partnership of Gavi and we have remained commit committed since And you know of course about What Gavi has done and how it is organized and and and it's it's ambition I believe the results have been impressive Doble at show estimates that between 2000 and 2008 some three point four million Future deaths have been prevented Through immunization campaigns supported by Gavi That is the equivalent of the number of inhabitants in Chicago and Washington DC combined And I use these figures when I speak to young people in Norway Because there was in addition to me coming from Geneva There was a one person who really convinced the Prime Minister's to put this into his Parliament speech and that was the head of the social democratic youth And I'm using this argument to say that you know it matters to engage in politics. You can achieve great results and and this young Youth leader she's now member of the cabinet, but at that time she was an activist and it led it to the government Investing billions over the years for Gavi and when I say that you know 3.4 million future deaths have been prevented. I say that she can probably not claim honor for all of those But in a way she can Because in a world where young people are cynical saying, you know, nothing works. Can we make a difference here is an example? It really can matter Successful, but we must not be complacent We must constantly look for improvements be accountable and transparent and ready to adjust as we go forward, especially in these new initiatives Second Norway has been actively engaged with a global fund to fight AIDS tuberculosis of malaria. I remember Jim Sherry And I went to Brussels on complex meetings In the setting up of that institutions the global fund It's also a creative mix of governments private sector actors support from WSO unites and the World Bank We have seen huge boost in treatment counseling and prevention of HIV AIDS Distribution of 70 million bed nets the most cost-effective measure we have for preventing malaria as well as delivery of 74 million malaria treatments and Detection and treatment of 4.6 million additional cases of infectious tuberculosis Today we stand on the threshold of a real breakthrough in the battle against malaria There are people working hard for that here in this room for so long at the core of global health efforts and frustrations and Third if I were to mention on methodology, we have pushed for more results-based management in the way we do global health Global health issues cut across traditional organizational structures in international affairs and should be addressed Accordingly unites was set up to work primarily through its sponsoring organizations in the UN system While also forming partnerships with the broad range of NGOs governments and other actors Rollback malaria stop TB are other partnerships that were formed anchored in WSO reaching out So I repeat here accountability and transparency is key and both may become harder with this new complex landscape In order to keep the trust of both taxpayers and private investors we must constantly work on our methods on how we spend and invest and monitor and report and If we were to add to this this long list and I know as we discussed over lunch that many of these achievements are right now As we speak being challenged because of the financial crisis Money going down burden on poor people going up and we will see dramatic figures But if we look at the last decade, we see some extraordinary results It's worth reminding about them more than 200 million children have been vaccinated in low-income countries by vaccines previously not available and The old rule of thumb I believe it was that 10% of them would die if they were not immunized so by immunizing 200 million We get we get close to that 3.4 million lives saved deaths from measles dropped by over 90 percent in sub-Saharan Africa major achievement More than 100 million bed nets have been distributed in South, Saharan Africa It can be expected that malaria mortality can be rolled back by more than 90 percent in the coming years We can fail, but we can also succeed Treatment costs for AIDS reduced from more than $30 to less than one more than three million people are on treatment as we speak That's impressive but far too little as I think dream would would say if it if he's the same man that I knew a few years ago in short These are telling figures Gavi and the global fund alone may have saved six million lives Based on an investment of some nine billion dollars Six million lives by nine billion dollars. I think it is it is a reasonable return on investment Then some have asked isn't there a risk that we could lose coherence in our effort to promote global health if we concentrate on just a few diseases at a time and Don't we rise risk to lose overview by having all of these complex partnerships operating together With nobody keeping an overall coordinating function and this touches on my real responsibility as a foreign minister Responsible for support to the UN and to the established international system. I believe this is a very valid point and There should be no and there should be no Not it should not be our ambition to cut those answers or to cut that debate short It is a debate on the matrix of horizontal versus vertical intervention And it is a debate on the governance of global health now that voluntary contributions outstrips the regular budget of the WHO I remember at my time the WHO an ambassador moves. I think that was just when you were there The voluntary contribution kept coming up and right when I was there it cut the 50% So the majority of double HL spending came from voluntary sources governments mainly and The rest the other 50% from the regular fees sort of say Norway was a case in point because Norway is a small country So our our fee was small but our voluntary contribution was high today. I learned it is 80 20 and That is you know in a way a good news because double year chose butchers has I learned in fact increased So dr. Brunnen and dr. Lee and dr. Chan have been able to convince governments very hard not to have zero Level but to have a slight increase because the health tasks are daunting But even with an increase in the regular budget it is 80% voluntary 20% regular So it shows something about the volume, but it also tells us something about the governing bodies of double HL Having influence basically only over 20% of what the organization does I think it is a huge challenge to the international system. We need to discuss it because the alternative is not a rollback The alternative is to innovate the way we run this landscape Norway's Consistent approach as we support new partnerships because there is no alternative and we fought in 1998 and Jim will remember The nostalgic view inside of the HL saying that it says in our constitution Enjoy you came when when this all started to change it says in our constitution that we are the lead agency in health So why should we engage? Why should we engage with Gavi when we can do immunization ourselves? Why should we even accept unates when we can do AIDS ourselves? And I think that is one of the achievements of dr. Brunnen actually that she forced that through There is no alternative if you want to mobilize resources competence skills and engagement But we have had a consistent approach to keep focusing on the need to strengthen the UN and the double year show and UNICEF and to keep a strong double year show at the core as a standard setting and normative agency respected and I think dr. Chun is doing a good job about that these days although it is it is a hard hard job Let me then move on to the MDGs the Millennium Development Goals and make a few reflections on our progress Norway has kept the MDGs as the guiding principles for our development cooperation and Let me say that our development cooperation with this government and the same government program. We adopted in 2005 Now has reached 1% of GDP It was a goal we set and we have been gradually climbing and for this year for the first time we have reached 1% Three of the MDGs are on health and there is where we have tried to maximize our contribution Important progress has been made on MDG 6 on Halting and reversing the spread of HIV AIDS tuberculosis and malaria and making effective treatment available The US engagement under President Bush has been essential for success so far and will be equally essential in future efforts There has been some success on MDG 4 on reducing the mortality rate of children under the age of 5 Primarily due to the immunization campaigns But the drama still unfolds far too many children still die of causes that are easy to prevent This is not high-tech. It is low-tech and it's a challenge of really distribution and logistics as a contrast to these relative success stories or at least progress We have failed miserably on MDG 5 Reducing maternal and infant mortality The goal set in 2000 was to reduce maternal mortality by three quarters by 2015 and making reproductive health accessible to all Today one mother and eight newborn babies die every minute Hardly any different to the situation ten years ago It is a terrible figure It is still the case that the first day and hour in the baby's life is the most dangerous one And for millions of women nothing can be more dangerous than giving birth On reproductive health there has been some progress on the availability of prenatal care But the huge unmet needs for family planning undermines other goals So what are the main reasons it boils down to the discrimination against women and their nutritional social and economic needs and rights and the lack of available and reliable quality health services and On these factors of course women will be extremely vulnerable now with the economic crisis hitting and Even where health services do exist they tend to be poorly adapted to women's needs and out of reach in practical terms We have worked to find some practical ways of addressing these issues Reaching the pregnant woman following her through the her pregnancy with enough assistance to make it safely to deliver It need not be too complicated In India together with the government of India and selected local governments We are focused on the need to get the pregnant woman to deliver in the health facility and not on some dirty floor That simple the method has been to make available a small financial incentive to the woman in short paying her To choose the health clinic over the family Which is in itself may be a liberating Activity and I said mother-in-law because in some of these special District that that really has been the challenge not a small burden to overcome in many settings We do these programs in Pakistan India Tanzania and Nigeria We have established a partnership to promote maternal health What we have seen is a tenfold increase in the number of poor women delivering their babies in health facilities From less than a million to ten million achieved in just four years. This is India thought that district simply by paying for them to do so and Consequently, we have seen a dramatic drop in both babies and mothers dying This was one concrete example What should then be the way forward promoting effective and viable health systems is key We all know that and we all know how complex it is We must provide accessible primary health care services educated health workers available and affordable medicines and Diagnostic services and the governance structure that is efficient and reliable. This is not news to you. It is not rocket science either To reach the MDG goals by 2015 We will need to do even more for women and children Invest more and more work smarter and more strategically together. I am pleased to see the new US Administration give high priority to maternal and child health and I was pleased yesterday In my one-hour meeting with the secretary that we spent a lot of time on this And then I could really see her geared up and motivated and stimulated about it One example Norway and the US will now both be candidates for the UN Human Rights Council There's a lot to be said about that council. It's better than the Commission, but it is not good enough But I think that Norway and the US and Belgium will be three countries joining on that Western ticket We will already now start preparing to work closely together on human rights as we know them But also on these issues because they need to be brought on on for they are more important Than statements on the formation of religion that we see this body now now dealing with and The secretary was geared up for that, so I'm happy to see that one major challenge is money Especially now that we are in the midst of the financial crisis Eight budgets private budgets for those purposes. They will go down for certain although it is highly regrettable We need to protect the health sector to the maximum In Europe work is progress is in progress to identify innovative finance mechanisms to help reach these goals We need to develop new opportunities and take these initiatives further Promising work is on the way unit aid brings in additional millions by modus taxed on air tickets We support new initiatives that would stimulate other innovative financial mechanisms from governments to individuals In addition as I started we should also see foreign policy in the broader sense through a health lens I learned this at WL show all about all the links between foreign policy trade policy and health And as you mentioned in 2006 I invited six other foreign ministers from Brazil France Indonesia Senegal South Africa and Thailand To join me in declaring that global health was quote a pressing foreign policy issue of our times Some of those ministers had changed in between But they didn't hurt to get Bernard Kushner and The one I launched it with those to bless II is now the UN Secretary General's special representative on innovative finance mechanisms geared up on this So health does more to people you know when they get into foreign policy. They tend to stick to it in March 2007 We adopted the Oslo declaration that states that investment in health is fundamental to economic growth and development Threats to health might compromise the country's stability and security building capacity for global health security Facing threats threats to global health and making globalization work for all all depend on conscious use of foreign policy instruments and on political will and I think a similar point was made by then senator Barack Obama when he reflected on American national interest in global engagement This was back in April 2007 and I quote since extremely poor societies and weak states provide optimal breeding ground for disease Terrorism and conflict the United States has a direct national security interest in dramatically reducing global poverty and Joining with our allies in sharing more of our riches to help those most in need. I agree Encouraged to see this policy put out in practice in the budget proposal from the US State Department in which global health is a priority area and Encouraged by the potential for taking this forward after my meeting with Hillary Clinton yesterday The foreign policy and global health initiative as I mentioned is all about engagement and outreach building political alliances among states with different outlooks in different regions And that's why Indonesia, South Africa and Brazil are important Different priorities and different geographic affiliations But with a strong and consistent political will to promote global health as a common cause Our method of work is not to form a separate organization or a fixed structure We meet from time to time as ministers and our experts meets regularly to address new issues So these are Some of my reflections I have this famous quote that health is simply too important to be left to health ministers alone. I Say that to my health minister colleague, you know to keep him geared up This is not to underestimate health ministers, of course But to highlight that finance ministers prime ministers presidents and foreign foreign ministers are needed as well They cannot point to the health ministers say this is your business because so much of what we do is also part of that bigger health landscape So thank you for listening and thank you for engaging in this and I'd like to applaud the CISS for really putting this program This new program about smart interventions is nobody called it smart smart global health policy. I would like to be part of that Thank you I'm inspired So, thank you very much. Mr. Minister that was for me truly inspiring but also a very pragmatic way of thinking about this very complex world And I have at least three or four questions. I could put to the minister But I'm gonna have to exercise some self-restraint here because our time is limited I think you probably have about maybe 10 minutes or so for questions so 15 wonderful, so we will take them maybe in groups of three I'd ask you please to identify yourself first My name is joy I wanted to first of all, thank the the minister for for this very very Not not fresh because it's not new but a very very Forward-looking because he has taken a new concept and really pushed it. I think to the limits particularly During this time when we need a real Dedicated leadership to keep us on track in the health sector. I We have been working with the other I work for the World Bank. We have been working with the PEPF, UNA's The global fund WHO etc to to see to to assess the impact of this crisis on the HIV-AIDS treatment and prevention and care programs in countries What we are finding is that because of the budget cuts to ministers of health They are not a lot of countries are not able to continue to enroll new patients into the HIV-AIDS treatment programs And we have had very very you know a I mean aligning copy mechanisms some patients are sharing tablets Some some mothers are refusing to continue treatment if their husbands and children cannot assess the treatment so we are really having a huge crisis which has the potential of of having a resistance building to the first line of treatment and Which is therefore going to wipe access to first-line treatment at a time when second-line treatment is totally Unaffordable for developing countries now. I was very interested when you talked I mean it is something that I'm familiar with about the conditional case transfers in That are enabling access in India and in some other countries, which your country is helping to finance Do you think that there's a possibility to restructure? temporarily the financing of The global fund and Gavi to be able using mechanisms such as that to be able to meet this new threat To global health that has a potential of a totally disrupting the health systems and Reversing the gains that we've made in the recent past Sir, how are you Tom Colson in the Deputy Surgeon of the Navy? Our Navy and our other military Forces in the United States have been carrying out health diplomacy and humanitarian assistance throughout the world Sometimes a very visible way is when our ships go to the Pacific and to South America and other in other times in more Smaller association with other countries. I was wondering you mentioned Health as a security issue and I was wondering about your opinions when military forces carry out humanitarian assistance missions such as we're doing I'm Judith Coffman an independent consultant formerly of the State Department and WHO When we talk about health diplomacy a lot of what people talk about is that providing health programs doing health programs Helps generally in security and foreign policy I'm curious about the way you and your foreign your fellow foreign ministers have conceived of ways That foreign policy can help support global health and the role for diplomacy in global health well First to joy, I mean I I think what you point to there is very scary Because what we actually see is that there are very hard-won gains that are extremely vulnerable than fragile And when when we have this this dip that we have now It is not simply that they will be out of of Function for some months and then come back. Hopefully when things Turn something will be destroyed Which cannot be put easily together Whether you know this kind of approach that that that I Illustrated here with the Indian example can be used with a global phenomenon. I don't know I remember the World Bank. I think it was in 2003 the world development report had a lot of reflections on these financial incentives Which are very very minor and and becomes you know for a Norwegian if you if you keep an Norwegian perspective Something very questionable Because our approach will be the universal rights You don't pay somebody that will take the money and go and buy the service The government will secure the service by universal care and it's your right and Remember I was advising that report and I was brought that perspective into the debate because I felt it that he was lacking But I think it is a very important point that that report raised Because here what you do with that woman who gets that small incentive where you actually pay her to go and give birth in the clinic Is something different because universal care cannot be even envisaged under those circumstances. I Think still is an interesting approach and as I said, I think it had a double meaning It was a liberating effect for her being able to exercise a choice In a very difficult situation at the same time it took her to the clinic and not to the floor But maybe you know and we would be ready and I think we are already working with bank Colleagues to see if there are lessons learned from the way we well evaluate this project Which can be you know extrapolated and used for for others But I you know we have to be cautious because there's not one size fit fit all in in the setting But let us you know share lessons learned both success stories and and Failures failures can be as useful to share because we will we will get some Some lessons for it. So, you know, I would be be ready to be very direct here to say that That that we come to the bank and share the experience if we haven't done it already We will look into that On the Navy perspective here, you know, you also trigger me as a former secretary general of the Norwegian Red Cross Where we always would be very, you know puristic in our view about military and humanitarian aid And the need to have very separate mandates I know how tempting it is and you know, we see it in Afghanistan that you have this kind of Country X ink approach is to say that we go in and we are Army and then we bring in the NGOs and we bring in development and we put put it all together And we win hearts and minds and it all ends up And the Red Cross would then say the ICRC would say that, you know, we are neutral and We provide aid to those who are in needs and we don't distinguish between friend or foe You need that humanitarian space and I adamantly believe that is right and We try at least as as Norway when we are in Afghanistan with troops that we don't bring Humanitarian aid as part of the mandate of the troops and it's it's it's highly possible To separate and distinguish those mandates and carry it out with doesn't which doesn't blur because once What you risk doing? This is another story but not another issue, but what you risk doing is that if you mix it And it and the circumstances on the ground change The ones you have helped will become perhaps the minority if the power of balance changes And and and the ones who then were helped will be vulnerable when the new guys come in and so on But that being said, I remember I spoke about this as at the British Military Academy and one of them who were serving in Iraq was saying that I will not stand next to somebody suffering Saying I can't help them because I wear a uniform for of course you can't and most of the the aid Organizations and humanitarian organizations had to get out of Iraq simply because it was too dangerous So what I really believe is that our our commanders and our officers and those who plan just have to be very aware of these issues And it should be part of the training knowing what obligations the Geneva Conventions put on us when we do provide aid and Then of course, I think the Navy and the Army can be very important and abling forces To create the environment in which we can give aid But I am among I think more on the purist side that I would very much caution against mixing this together now to Judith You know the the the project I I I urge you to read that Oslo declaration You have well and and maybe also the follow-up papers for me That initiative was first and foremost to get colleagues engaged and have a debate and you know sensitize ourselves about what this would mean What what I now have is Bernard Couchner coming to me to me and say why don't you and I Norway and France? Quickly see to it that the the hospital in Gaza is being rebuilt Because we all see that if it isn't This is the Al-Quds hospital and there's the chief hospital But the Al-Quds hospital is has been destroyed and if we don't there's going to be more suffering and and the way we build it We build it can perhaps be a Project which can bring together parties who wouldn't be brought together under other circumstances Now he has of course his background from from the sense of frontier. I have my great cross background. So we aren't in a way doing this a bit in disguise, but but We have a greater sensitivity to those issues And it's it's a bit like the previous question. I think we have to be able to see to not Not mix it together so that we reward that side in the conflict with humanitarian help help as Part of our total total project But that we as I said try to see foreign policy also through a health health lens And what I'm encouraged by is that that our experts when they meet regularly now start to bring these issues up in a different perspective One example just to mention You know Indonesia has been wary about sharing the virus of some of these bird viruses And I remember last summer Ambassador Holbrook wrote an article where he was very very harsh on Indonesia saying that this is really holding the world hostage and I have worked a lot with my Indonesian colleague, Minister Birayuda on this and Norway has tried in Geneva to Help and bridge those gaps Because what he is saying is that I'm not stupid. I know that that virus has a value It's worth something and I know they are those who would like to get hold of it to be able to produce vaccines and Then have income from that source and I'm not against that but I want to fair share And until there is a system for doing that We will be difficult this I think and remember ten years ago We had that in WTO on all these patent issues And this is highly ideological and controversial and WTO is constantly in a row with the US on this We had Ambassador Moose coming in protesting and being very angry with us But we have WTO has to push this issue and we have to push our you know Awareness and readiness to bridge that gap Because it can be bridged I believe and I think through this initiative we have launched It has given us access to Indonesia in a way we wouldn't have before and perhaps then we can help in Geneva To to find find a solution Hi, I'm Jim Sherry. I'm the chairman of global health at Georgia Washington University Jonas, thank you for your continued sharp thinking and your tenacity on these issues A question on on the World Health Organization and the related organizations your continued Conviction on the centrality of WTO and the international System is one I share But it's one that is not broadly shared And it's probably much less shared on this side of the Atlantic than on the other side of the Atlantic with the emergence of other entities How how would you what what is your thinking about how we approach improving the governance? of the international system in particular that the relations between these now separate giants that are moving on the international scene, whether it's a Global fund or a WHO etc. And how to do that to try to have the WHO not by declaration, but re-earn its centrality Could you elaborate a little bit more on the conflict where there's a lot of discussion here Well to Jim, I think you know the first point Which is the easy answer is to say that let us agree that this is an issue and Let us let us convene in in loose circles You know like this and then bring bring together The key players and and agree why it is an issue and why we need to deal with it there I think one can come Some way without challenging the integrity of those who participate. I know that among these Seven or eight or ten giants there have been ideas of agreeing on on the map If I understand correctly What what do we see and what would be the kind of division of labor and there are there are some objections to that And there are some who are in favor of it I think that the W. H. O.'s role will Change for good Because it will no longer be the organization doing health at the global level That was in a way by an explosion simply broken around 2000 and it will not come back into the old way But I think still double H. O. Has and that I haven't been you know into that for for some years probably Fundamental strategic we thinking about how double H. O. Would do is do its work When I was there remember it was an and draw you remember it was a combination of being strong on standards and norms In Geneva and with the governing bodies, but also with the field activities advice to health ministries and The argument was that unless you are out there in the field doing all these things you cannot play the role as the norm and normative Organization which is probably true At the same time with your experience at urn aids Perhaps urn aids was as it best before it got engaged in the field. I don't know But but you know during during this decade the discussion has come, you know Unates has to go into the field. There's a kind of a law of nature that that happens But maybe double H. O. I don't say this as Norwegian policy I just say it on the basis of one own reflection. Maybe double H. O. Should purify that role as norm and standard set there As the convener among those giants to agree on broad maps of strategy Where the Gates Foundation and where the different foundations and initiatives can come in and and agree on some of the main main main Main avenues, maybe something along along those lines On Afghanistan What you say in your question Does not seem to fit with Obama new strategy because here and as I have spent time in Washington during these days to learn We are there to to to fight and eliminate al Qaeda and Then what happens in Afghanistan is a bit of a different issue. I Think that this is going to be an issue. We have to discuss that because I believe that in order to succeed on the first goal We also have to see to it that Afghanistan hangs together and that it has a state and something which which is Meaning for its its citizens and there there are major achievements on health in Afghanistan The number of children being immunized has gone from 10 to 80 percent The number of children who go to a clinic and have primary health care has gone from 10 to 70 80 percent. I Went there up in the Northwest Afghanistan in October and I went to these schools Which used to be in these tables for the Taliban horses. It's now a School for girls. So so I believe, you know, we will have we are not there without troops to do that But in order to pull those troops out We have to do that because that is what is going to bring at least some stability and ownership On on on the health side. So but that is probably the easy part, you know But we have to do it the challenge here and I say this very openly when I'm in this country that is that The US is critical of his allies are putting too many restrictions on his troops I think that is a valid criticism criticism. If you are the commander of troops in Afghanistan You would like to have your troops with as few caveats as possible But if you move into the civilian side in the way you give civilian aid The number of caveats and special arrangements that donors have is just making this a nightmare 80% of money coming into Afghanistan is going outside Atkin budget There's between a half and one billion dollars that goes unaccounted for and I think the US for one which is the biggest provider No money is going through those channels and there are good reasons because there is corruption and there's all the rest of it But we know from 50 years of development cooperation But if you don't do your aid by building ownership, it's a short-lived thing So, you know, we have the strength and and we go all go to conferences and say we need more coordination But the readiness to be coordinated as a part of that statement is very weak So I don't know what is worst caveats on your military troops or These mass split in the way you give aid. I Probably think the latter is the worst Because you have 40 or 50 major donors and they all go about it their own way splitting up national priorities We have decided from the Wheatsons side that We we give now as much aid as our military contribution costs About a hundred and forty million dollars So we have a hundred and forty million dollar worth of military. We haven't to find that equation But it's it's reality now and we we have decided that 20% of our aid will go to the province where we have our troops But 80% will then go according to Afghan and UN priorities But if we all bring all our money to the part of Afghanistan where we have our troops There will be a huge distortion according to the needs and Everything will be more difficult And that brought me to Afghanistan So, I think Mr.. Minister, we could keep you here much longer having discussion, but we can't so on behalf of our guests I want to thank you very much for sharing your experience sharing your view of the world Sharing the really the wealth and the very broad perspective that you have on these issues and giving us a lot to think about In the United States certainly is this debate So please join me in thanking them