 Well, that was certainly a stimulating panel and some phenomenal insights from leaders of our nation who have spent many years working problems around the world. Thank you very much, Secretary Rubin and the rest of the distinguished panelists and also those from the previous panels for your terrific discussions. We're now going to be joined by Gail Smith, who is well-known to many of you here. Gail is the senior director at the National Security Council, where she energizes global development, stabilization, humanitarian assistance issues, and a special assistant to the president. She's critical to White House policy formulation, interagency coordination, and other foreign aid matters. She's been extremely generous to the commission by participating in our deliberations, offering our thoughts and advice to us on several occasions. She had a 20-year history of working in and on African matters. Was a senior official in the Clinton White House. When we were thinking about the best way to launch this report, I requested from General Jim Jones that senior personality from the National Security Council might be able to share with us today. And he immediately and strongly endorsed Gail. And so we're very grateful to General Jones for his support, and particularly honored to have you with us, Gail. Thank you very much for joining us and I invite you to come on up and take the podium. Nothing's working. Now it's working. I have two microphones, so I may be in stereo. Let me first of all say thank you first and foremost to members of the commission, but also to a whole lot of other people who are here. I think that we have in the room many of my colleagues in the interagency, without whom frankly I would be useless. We have members of the NGO community and the philanthropic community who make unbelievable contributions of members of the private sector, and also the advocacy community. And I think that without all of these groups we wouldn't be where we are today. And I think where we are today is something that early in our process within the administration I referred to as kind of a phase two in the global surge on global health, that we've had a solid decade of leadership, of activity, of the introduction of a lot of new actors to the field of progress, but we're at a point now where we've got a lot of facts, a lot of evidence and a great deal more experience than we had, and we have a good opportunity to move forward. We also have something that has been referred to up here on the stage since I've been in the room, which is extraordinary, I wouldn't even say bipartisan but nonpartisan support. When we made an announcement in May, just four months into President Obama's first term on the Global Health Initiative, one of the things that was stressed with absolute sincerity and at the direction of the President was the contribution made by President George Bush. And that was quite meaningful and I think quite serious, one of the most enjoyable things to me is that we have been able in the process of developing our own effort to work with our colleagues who served in the Bush administration to see how we can build on that foundation and move forward together. We have the same reality, I think, on Capitol Hill and it's these things that will allow us, I think, to really fulfill our potential as the world's champion on global health. Now let me say something about this report. When you're, I've been on a lot of commissions and things when I was outside government and had a whole lot of fun saying, you know, they ought to do this and this and this. And then you hear that somebody is doing a commission when you're inside government and you say, hopefully they'll have some really good ideas and we'll come out okay. And I don't know whether it's because we're all smart, we're all thinking in the same direction or some of this is inevitable, we're looking at some of the same facts and evidence, but there's a remarkable coincidence, I think, of direction pointed to by the commission and some of the conclusions that we have come to as well. And let me just comment briefly on your five pillars. Maintaining the U.S. commitment to fight against HIV, AIDS, tuberculosis and malaria. That's a commitment that is absolutely maintained and a commitment that will grow over the course of the initiative. We've added to that as well a focus on neglected tropical diseases given the very high infection rates, given the ability while you are treating one set of diseases to also treat another set. Prioritize women and children to build stronger families and communities. One of the new, very prominent and indeed ultimately central elements of the Global Health Initiative is a focus on maternal child health. And there are a number of reasons for that. There was an absolute gap worldwide when we looked at the facts and the evidence of what this global surge had registered over the last decade. But I think we also know as members of your commission obviously know that you get an extraordinary return when you invest in women and girls. Bolster prevention and emergency response capabilities in poor countries to reduce premature deaths and build the capacity to prevent, detect and respond to health hazards. This one we're coming at in a lot of ways and there are a couple of really interesting points here. You've heard mention of and I'll say a little bit more of our desire to help build the capacity and capabilities of partner countries to more effectively manage more of their health systems and their health challenges broadly. This is driven by the Global Health Initiative. But it is also driven by, for example, the strategy that our Health and Human Services Department puts forward on things like how do we manage national health security and global pandemics? Think about H1N1. Think about the other challenges we will face or what some of our national security colleagues think about when they think about bio threats and managing bio threats and bio hazards. The common denominator in all of these is you've got to have good surveillance. You've got to have good detection. You've got to have trained people. You've got to have the ability for skilled people to communicate with one another and you get multiple benefits. So this notion of prevention and detection and this common element of surveillance is something that I think through the course of this initiative but also the other things this administration is doing in global health will be able to do a great deal on. On the capacity issue at large our hope and plan is to be able to do two things at once. One is to save lives, but the other is again to invest in the ability of our partners. We've seen two trends over the last decade, one positive and one negative but absolutely correctable. On the positive side, we've seen the emergence of some extraordinary leadership in the health community on the ground. Whether it is health ministers that have taken the charge or health workers on the ground. There is extraordinary potential in the men and women that have taken leadership in their communities and their countries. We've seen governments take health much more seriously than was the case in the past. On the negative side, I think we have seen, to say this politely, I think sometimes we smother our partners with our collective enthusiasm. A rush of multiple actors, perhaps less investment than we might make in capacity building and really focusing in a meaningful as opposed to this rhetorical way on things like country ownership and partnership. And as I think Tom Pickering was referring to this, an enormously high transaction cost for our partners on the ground. So that if you were to do a diagram, I think I know what spaghetti chart y'all were talking about in here. If you did a diagram of the relative amount of time health professionals in the developing world spend managing us as opposed to managing their health challenges, it would probably suggest to us that we need to make some corrections. So our goal is to help build the capacity and over time start to change our role a little bit from one that is perhaps too compensatory and one that is much more rooted in partnership. Make smart investments in multilateral institutions to demonstrate U.S. leadership and catalyze increased support. This is something we focused on quite a lot in the Global Health Initiative strategy and not just with respect to the Global Fund. But with an eye to the multiple multilateral institutions, private sector organizations, private philanthropic organizations and NGOs with whom we partner and with whom we can partner more strategically. Tom raised a really important point about donors standardizing some of their operations and methodology. That may seem like a bureaucratic, boring thing in the world of headlines, but I think anybody who's served in the field knows how important that is. Leveraging is another extremely important piece of what we can do, is using our leadership to call on and challenge others to join in the game. And that's something we very much intend to do. Let me shift from there and I will say one thing, on the comments on structure, I'm not going to touch it, but I am going to say this. Because I think we learned a couple of things in the evolution of this initiative. And one of the things that we did at the beginning was we got all of the people together across the interagency that are working on global health. Importantly and significantly a lot of these people are the career men and women that serve successive administrations and make sure we've got the continuity and also have a great deal of knowledge about our history and the genesis of certain policies and programs and practices. And what we said is everybody take off your agency hat. And let's not be HHS in state and AID and DOD and CDC and NIH. I am an acronym expert at this point. But let's just all think together about if this were a phase two and given the facts that we have about the last year, there have been some incredibly important studies that have been done looking at global health over the last year. Whether at donor performance, at the role of assistance, what's worked and what hasn't at the nature of interventions, at results on the ground. Given all of that, what should we think about? It took no time for people to start thinking together and to want to seize the opportunities to work together. Now none of that suggests that you don't need some kind of structure that's clear about roles and responsibilities and who's on first. And I'm confident that we have a way to do that. I'm also confident that we've got extraordinary points of very senior support and leadership across the executive branch to carry this forward. But I think there's another element we sometimes overlook. As important as structure is that the entire team across the US government that is working on this initiative have a common vision. They may come at it from different perspectives, different areas of expertise, may have different programmatic roles and responsibilities. But if we have a common vision going forward, and I can leave the room and my colleagues who are here from AID and state and NIH can answer the question in my absence. But I would wager that part of what we have been able to do is forge a common vision and a common plan against which we can align the multiplicity of resources, agencies, departments, offices and individuals we have across the US government working on this. Couple other things about what our focus has been. I think these are reinforced by your report or perhaps our initiative is reinforcing your report. But I think they're going to be really critical moving forward. One of those is this notion of being able to evaluate, learn, create a foundation of knowledge and be nimble enough to make mid-course corrections. There's been a lot of focus and I think absolutely correctly on results. We want to put a premium on sustainable outcomes. But what we also want to do is enable our people as this initiative progresses, as the world makes more progress in global health, to be able to take stock at every stage of what we're doing, see if it's working, make sure there's not gaps in duplication, see if there are ways we can do it better, see if we can bring innovation to bear in ways that we might not have thought of in the planning stages and be nimble enough to make those adaptations. I think there's certainly a desire that we'd be able to do that. I think there's an understanding on the hill that it's important to be able to do that. For us to be able to do that, I think we're going to have to put a much greater premium on evaluation, on metrics, on results, on outcomes, and on being tied to facts and evidence every step of the way. I think we're in a very good position to do that. We've spent a great deal of time on that in the interagency. We've got great expertise on that in certain parts of our government. We have a new aid administrator who knows something about that and is very committed to that as are the secretaries of health and human services in state. But that's going to be a key challenge. I think that's going to be something a little new and different. And I think we hope it'll be new and different. The second is to keep our eye on the notion of building capacity and saving lives at the same time. We want to invest in those places where we can help build systems, but we don't want to do that at the expense of assisting people in countries where that's less possible. Finding the balance there, we're going to try with a number of countries to give them a head start to make some extra investments to really fast track kind of the reorientation of the program and see where we get. Hopefully that will have a big impact on the other countries, but it will allow us to maintain a balance between these two objectives. I think the last thing I would mention is working as we do this on the global architecture for global health. During the campaign, President Obama spoke about something called global health architecture 2020, which was a vision of a world in which we would be able to better manage our common security and our common humanity. And I think one of the experiences that we had a few months ago was with H1N1. And realizing very quickly that we had a number of challenges to address not just for our security, but for the security of men and women around the world, given that there was a limited supply of vaccine, given that some had access and others didn't, given that limited supply, given that we needed an international mechanism to make sure that countries could access vaccines, given that we needed mechanisms on the ground to make sure it could be distributed effectively. On the management of HIV-AIDS over time, I think we've absolutely learned we've got to have a global architecture that serves all of us. So one other piece of this that I think is very important is a vision of building over time an increased number of communities and countries that are able to manage their health challenges, but also participate and work with others to reinforce that collective security and collective humanity. Those are the big challenges. We've set an ambitious set of targets in terms of outcomes. I am extremely, extremely proud of the fact that the State Department and USAID put a consultative document on their websites, asked for comments, and are in the process of taking them. We've done a fair amount of outreach and I think we've gotten some really wise advice, which you'll see reflected, and this won't be the first or the last time. I mean, this won't be the last time. Yeah, something. This won't be the last time that we ask for that. So as we move forward, I would simply say we very much want to do this in partnership with all of you. We've talked to the Commission and very much look forward to working in partnership with the Commission. And it is our hope that together we can build on that humanitarian instinct that runs all across this country and ensure that at the same time we save lives and we invest in people and make this country proud. Thank you. Well, Gail, thank you very, very much for joining us, sharing your thoughts and observations. And I can tell you that I strongly endorse and confirm your idea of a common vision. It was clear that the Commission came to this point pretty early on and that it's critical for us moving forward. As we wrap up today, I would encourage each of you in the audience and those online and those that can access it online to read the report. We want your inputs. We value them, and particularly those that would help us to move forward as we try to get these recommendations implemented. Thanks to everyone. Thanks to our Commissioners. Thanks to those of you who are here today participating. And we wish you the very best. Enjoy the rest of the beautiful day. Thanks.