My condom wars with Catholics on three continents

This blog was first published in the Huffington Post on Dec. 3, 2010.

Pope Benedict XVI’s comments last month that condom use can be justified in some cases to help curb the spread of AIDS were surprising to me only because they came from the very top of the Catholic Church. But in my 10 years of managing condom social marketing programs for HIV prevention and family planning, I have come across shocking discrimination as well as enlightenment and compassion from Catholics working with people at the grass roots.

Almost precisely 18 years ago, on World AIDS Day 1992, I launched “Maximum” condoms (“Strong for Maximum Protection, Sensitive for Maximum Pleasure”) in Zambia, a country that had double digit HIV prevalence but no reliable source of high quality, low-priced condoms. Zambia also had a newly-elected president, Frederick Chiluba, who was a born-again Christian and stridently anti-condom.

We had a big launch event at the Pamodzi Hotel with lots of speeches and exhortations on the importance of using condoms. Surprisingly to me, we also had a Catholic priest and nun in attendance. They had come separately and neither was wearing religious attire.

YouTube + Wikipedia = Social Change

WASHINGTON, DC -- What do you get if you combine the video-sharing power of YouTube, the depth of information of Wikipedia and the social change aspirations of an advocacy website? Something called ViewChange.org, as I found out last week when I attended its formal launch at AED headquarters here.

U.S. independent television broadcaster, Link TV, launched “the next generation multimedia platform for global development” that combines powerful video stories with the latest “semantic” technology that allows a person, after viewing one of the many powerful short videos showing "good news" development stories, to extract more information about that issue, and then to take action in a variety of ways. ViewChange.org is funded by the Bill & Melinda Gates Foundation.

After watching a video, you have three options: “Watch More” (as in, watch more videos), “In the News” (to explore an issue in more depth) and “Take Action” (which presents you with a variety of concrete actions ranging from taking political action, donating to a cause or writing a letter to the editor). Every video is tied specific actions that the viewer can take.

ViewChange.org goes way beyond YouTube, where the end point is the merely emotion elicited by the video. With ViewChange.org, the idea is that after the viewer is moved emotionally, the viewer will be moved practically to action.

Two continents, one AIDS epidemic

WASHINGTON, D.C. - The speakers talked about a society with an AIDS epidemic driven by a devaluation of girls and women, young people denied evidence-based sex education, parents in denial about their children’s behavior and religious leaders who sometimes do more harm than good.

They were talking about sub-Saharan Africa.

And they were also talking about the District of Columbia.

The most striking fact to emerge from a panel discussion at Howard University this week on “UN Millennium Development Goal #6: Combating HIV/AIDS” was how similar some of the drivers of HIV/AIDS are in Africa and in Washington, D.C. Indeed, it was said several times that D.C. has the HIV prevalence of a developing country. The event was organized by the D.C. League of Women Voters, Howard University Hospital and the United Nations Association in observance of United Nations Day.

Women heroes of conservation are also improving health

WASHINGTON, D.C. - Earlier this month, I stepped out out of my comfort zone and went to an event on Capitol Hill that had nothing to do with global health, at least not directly. The event, “Women Heroes of Global Conservation,” honored six women who had done extraordinary things to save the planet.

Truth be told, I went to see Wangari Maathai, the 2004 Nobel Peace Prize winner for her work transforming women’s lives and the environment of her country Kenya through the Green Belt Movement she founded in 1977 and which has spread to 15 countries in Africa. Ms. Maathai was ill and could not be present but I heard from five other equally amazing women.

The overall event reinforced my perception that conservation and the environment has a lot to do with health. More and more, I see the links between health, climate change and the environment. We heard from these “Women Heroes of Global Conservation”:

* Mary Mavanza, Tanzania, manager of the TACARE program of the Jane Goodall Institute, has helped hundreds of Tanzanian women start environmentally sustainable business through microcredit loans and training. By improving economic conditions among women in and around Gombe National Park, the TACARE program has protected nearly 200,000 acres of forests and worked with 22 villages to create land use plans.

* Suzan Baptiste, Trinidad, founded Nature Seekers in 1990 and stopped turtle poaching. NatureSeekers is the largest employer in her region of Trinidad and has reforested large areas by hiring women to rehabilitate areas that were destroyed by fires or logging companies. She was named a CNN Hero in 2009.

* Sangduen “Lek” Chailert, Thailand, challenged and transformed traditional wildlife management techniques by setting up elephant sanctuaries and ecotourism program in northern Thailand, a country where there were once 300,000 elephants and now are not more than 3,000. Ms. Chailert has expanded this work to other areas of Thailand.

* Habiba Sarabi, Afghanistan, is the governor of Bamyan Province, the country’s first and only female governor. To improve the lot of women and communities, Governor Sarabi has increased tourism through conservation by creating Afghanistan’s first national Park, Band-e-Amir, protecting 220 square miles of pristine lakes and limestone canyons.

* Lucy Aquino, Paraguay: I was especially keen to hear from Ms. Aquino, who comes from Paraguay, a country where I lived four years and which has a special place in my heart. As the Paraguay director of the World Wildlife Fund, she has improved conservation and empowered women and communities for nearly 30 years. Paraguay once had had one of the highest rates of deforestation in the world in the Atlantic Forest Region, a highly threatened region where indigenous communities have been displaced with the men often going to work on cattle ranches or soybean farms, while their wives and children go to the cities to engage in begging, or worse. Ms. Aquino helped establish a Zero Deforestation Law, which resulted in a reduction in deforestation rates by 85%.

Several speakers, including Ms. Maathai, lamented the fact that the U.S. does not have a conservation strategy. “The U.S. has a thoughtful strategy for improving the well-being of women and girls around the world,” wrote Ms. Maathai in her statement. “It also has a global food security strategy, a global health strategy and a global climate change strategy. It will soon have a global development strategy. But because natural resources underpin each of these goals, there must also be a conservation strategy. None of these other strategies can truly succeed over the long term with one.”

To that end, Democrats and Republicans in the Senate and the House have come together to propose the Global Conservation Act of 2010 to prevent the destruction of our world’s forests, reefs and other ecosystems. On June 17, 2010, Senators Tom Udall, a liberal Democrat, and Sam Brownback, a conservative Republican, introduced legislation that would coordinate the work of all U.S. agencies involved in international conservation and establish a national strategy for promoting conservation.

According to the Alliance for Global Conservation, the main organizer of this event, health is one of the major benefits of conservation. Half of the new drugs created in the past 25 years have an ingredient derived from nature, according to the Alliance, and over 70% of all cancer drugs are based on natural compounds.

As the most senior representative of the U.S. government at the event, Undersecretary of State for Democracy and Global Affairs Maria Otero recounted a personal manifestation of climate change: The mountain she used to ski on when she was a child in her native Bolivia is now brown and barren of snow, she said.

Undersecretary Otero said that the U.S. is committed to international conservation, spending $300 million on it every year, and mentioned one recent example — the announcement of a Global Alliance for Clean Cookstoves, a public-private partnership led by the United Nations Foundation and several U.S. government agencies, to save lives, improve livelihoods, empower women and combat climate change by creating a market for clean and efficient cookstoves. Exposure to smoke from traditional stoves and open fires accounts for nearly 2 million premature deaths annually, with women and young children the most affected, according to the World Health Organization. This is one of the many ways conservation can improve human health.

So if you support global conservation, you are also supporting global health.

What does Syrah wine have to do with pneumonia?

NEW YORK, NY — In June, New York Times Wine Critic Eric Asimov started his wine column with a joke: “What’s the difference between a case of syrah and a case of pneumonia? You can get rid of the pneumonia.”

That column, which analyzed why American Syrah wine, which can be superb, had never achieved much success, has led to one of the strangest partnerships in global health — a coalition fighting child pneumonia and the Rhone Rangers, America’s leading non-profit organization dedicated to promoting American Rhone varietal wines such as Syrah.

Last month, I witnessed the partnership in a wonderful event in the New York Times Center here on the first day of the United Nations Summit on the Millennium Development Goals cleverly marketed as “Pneumonia’s Last Syrah,” a wine reception and photography exhibit, which displayed striking images and stories that provided a window into the human face of pneumonia and the burden of the disease.

After sampling the wares of the 12 Syrah producers present at the event (11 from California, one from Virginia) , which were all excellent, the audience was educated about pneumonia:

* It is the leading cause of death among children under 5, with more than 1.5 million dying from it every year.

* Vaccines against two of the main causes of life-threatening pneumonia are used throughout the developed world. However, millions of children in developing countries still lack access to these vaccines.

* Life-saving antibiotic treatment for serious pneumonia typically costs less than one dollar. However, only an estimated one of every five children with pneumonia receives antibiotics.

Wine Critic Asimov, who helped ferment this partnership, spoke at the reception, saying he was humbled to be part of such a significant issue while he usually spent his time worrying about nothing more than excessive oakiness in chardonnay.

The Global Coalition against Child Pneumonia, made up of more than 100 organizations, will mark World Pneumonia Day on Nov. 12 to bring attention to pneumonia and promote policies that will prevent the millions of avoidable deaths.

The Global Coalition suggests five things people can do to take action. One of those things is to buy a case of American Syrah wine during the month of November from one of these producers, and they will donate $10 to provide pneumonia vaccines to children in the world’s poorest countries.

This will help save the American Syrah wine industry, but it will produce the even happier effect of saving the lives of children who might have died from pneumonia.

Disclaimer: I won a large bottle of Syrah wine in the raffle at the event but these opinions were in no way influenced by that fact. I was going to write this anyway.

High tech TEDx event shows that child health is within reach

NEW YORK, NY — On the opening day of the United National Summit on the Millennium Development Goals (MDGs) Monday, I participated in a most unusual media and educational event organized by TEDxChange, a collaboration between TEDx and the Bill & Melinda Gates Foundation.

The live event from the Paley Center for Media on 52nd Street featured Melinda Gates, Hans Rosling, Mechai Viravaidya and Graça Machel in front of a live audience of, as TEDx host Chris Anderson put it, luminaries and changemakers (Ted Turner was in the audience along with NGO and foundation leaders). A live webcast of the event was viewed my millions around the world, and from 82 TEDx events, several of which we saw on camera in live shots, and and is now available to view online.

I viewed the event from “Bloggers’ Alley,” several floors above the event, with about 20 other bloggers and new media journalists, most of whom had laptops and smart phones to extend the salient facts of the event even further into the world. We viewed the event on two screens at either end of the room. And we had a third screen, which displayed a constant stream of all tweets including the #TEDxChange hashtag. The deluge of the Twitterstream produced a continuous stream of concise Tweets that came about one per second for the entire 90 minutes of the event and even after it ended.

It was a fabulous display of what is possible with communications technology in the 21st century. But the content revealed at the event several floors below was even more compelling.

The speakers were all terrific – Melinda Gates and Graça Machel displayed their passion and commitment to improving the world and Hans Rosling and Mechai Viravaidya (Mr. Condom of Thailand) regaled us with their knowledge, energy and sense of humor.

I particularly enjoyed Dr. Rosling, a professor of international health and co-founder of the Gapminder Foundation, who dazzled us with his computer graphics, which convert international statistics into moving interactive graphics showing us the history of child mortality.

In one part of his presentation, Dr. Rosling showed us the fall in child mortality in Sweden (starting with 400 child deaths per 1,000 born in 1800), Egypt (with 300 deaths in 1960) and Thailand (with 150 deaths in 1960), and ending with all three countries ending with roughly the same low level of child mortality.

Later, he presented a graph of the relationship between child mortality and family size in 1960, with “developing countries” clumped together in the upper right (high mortality and high family size) and the “Western” countries in the lower left (low mortality and low family size). Then, in an amazing and awe-inspiring display of computer graphics, he made the graph come alive and move through time to 2000. Many of those developing countries in the upper right moved rapidly into the lower left quadrant, with Dr. Rosling urging them on: “Come over to our side,” he exclaimed. “Welcome to a decent life.”

The conclusion of his presentation, which made clear the association between child mortality and falling family size: “The MDG on child mortality is fully possible.”

It was an inspiring way to begin the MDG Summit.

NOTE: Some of Dr. Rosling’s amazing graphics are available are available at Gapminder World and on this website.

In malaria prevention, positive change in Mali, and elsewhere

WASHINGTON, DC — As a young development worker for Lutheran World Relief in Mali 20 years ago, I engaged in high-risk behavior occasionally. In my extended journeys around the country, I slept in villages from the Sahara Desert in the north to the Niger River Delta and Dogon Country in the center to the southern savanna, but rarely with a mosquito net hanging over me, and certainly not an insecticide-treated one.

I paid for my sins: I was struck down by malaria after an overnight stay in a southern Mali village in the middle of the rainy season. Malaria made me feel so awful, so lethargic, that I thought I might die and worse, I didn’t much care. In those days, mosquito nets were hard to come by, especially if you were a poor, rural Malian. And most Malians are poor and rural.

But a lot has changed in 20 years. Today, a new report unveiled at the National Press Club shows that Mali is an important part of a pan-African malaria success story. In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, the most of any of the 34 malaria endemic countries in Africa.

And Mali is only one piece of an even bigger story: The new report "Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals" — authored by Tulane University, Johns Hopkins University, the World Health Organization and PATH and published today by Roll Back Malaria — reveals that the lives of almost three quarters of a million children in these 34 countries were saved in the last 10 years through the use of insecticide-treated mosquito nets and other preventive measures.

Most importantly, the report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.

This should provide a clarion call for world leaders who gather in New York next week for the UN Summit on the Millennium Development Goals as they seek ways to meet the eight goals in the five years remaining in the 15-year timeline of the MDGs.

The report shows clearly what is required: U.S. and other international donors should just keep investing in malaria control the way they have been doing the last few years, and 3 million more lives could be saved in the next five years.

Here is the press release on the report.

Male circumcision, a proven HIV prevention strategy, overshadowed by another one years from fruition

VIENNA, Austria – Much of the buzz at the XVIII International AIDS Conference that just finished here was around the encouraging news of a microbicidal gel that trials have shown to be almost 40% effective, although we are still years away from having a product on the market. Meanwhile, male circumcision (MC), a proven and effective HIV strategy that reduces transmission by nearly 60% and is already available, got much less attention, though it finally got some, and for that we can be grateful.

Two years ago in Mexico City, nary a word was said about male circumcision — and certainly not in a plenary meeting — despite its proven effectiveness. I organized a press conference on male circumcision for PSI, which was successful in generating some media buzz and attention, including The Economist, which called it the one bright spot in prevention at the conference. In fact, I think that press conference resulted in an improved environment for MC. However, donors and governments, for the most part, continued to do nothing to scale up an intervention that could have saved millions of lives with one notable exception.

In December 2008, the Gates Foundation became the first donor to scale up MC, quietly providing funding for PSI to expand its male circumcision pilot project in Zambia to two other countries (a third country was added later). There was no fanfare, no announcement, as everyone was concerned about provoking a negative reaction for an intervention that addressed long-standing cultural practices.

However, there was no significant negative reaction and now the environment seems to have changed. MC seems to be going mainstream. Both Bill Clinton and Bill Gates mentioned MC in their speeches in Vienna. In particular, Bill Gates could hardly stop talking about the wonders of MC, calling it and prevention of mother-to-child transmission two of the interventions that “are so effective that in endemic countries it is more expensive not to pursue them.” While more than 41 million men in sub-Saharan Africa could benefit from the procedure, he said, just 150,000 have been circumcised in the past few years.

“I have to admit: When it comes to circumcision, I used to be one of the sceptics,” he said in his speech. “I thought: ‘Sure, it reduces transmission by nearly 60%. But there’s no way that large numbers of men will sign up for it. I’m glad to say I was wrong. Wherever there are clinics available, men are volunteering to be circumcised in far greater numbers than I ever expected.”

The Council attempted to monitor the major media coverage of this conference, and our unscientific analysis showed male circumcision to be the second most covered story on the first two days of the conference (after the microbicidal study, of course), with stories in Agence France Presse, Bloomberg News, Los Angeles Times, The Guardian, die Presse, Frankfurter Rundschau, Le Point, Le Figaro, Prensa Latina, Radio Canada, Radio France Internationale and Reuters, among others.

It wasn’t quite that high profile at the conference itself but it was certainly more evident than in Mexico City, with a number of oral and poster presentations on different aspects of MC. This has not come a day too soon. For every man we reach with male circumcision services that he already wants, the fewer new HIV infections will be produced in the future. It is an intervention whose time seems to have come.

AIDS activists need new communications strategies

VIENNA, Austria — In the history of AIDS, activists certainly deserve a place of honor for their persistence in pushing governments and donors to do more than they would have done on their own or, at least, not done as fast. But the new generation of AIDS activists sure don’t seem to be winning over the rest of non-activists here at the XVIII International AIDS Conference. And they could use some communications training.

At the opening ceremony on Sunday, they annoyed the vast majority of the audience — many of whom had arrived early to secure good seats — by disrupting the screening of a film produced by the Global Fund to shout for more funding. Ironically, the whole point of the Global Fund film was to raise awareness about the need for more funding in this, the third round of Global Fund replenishment. The Global Fund film makes this point more eloquently and convincingly than the protestors. But I know that only because I had seen the film previously, without disruptions; the audience could not hear the film because of the continuous chanting.

Another irony was that the official speakers at the podium continually agreed with the protestors, and agreed with great patience and politeness. And even some of these speakers were shouted down by much less articulate and more impolite activists. When the protestors finally left the state after an interminable period of time, the audience applauded, not in support but for gratitude that they were finally leaving.

Today, in the Media Centre, I witnessed another disruption, this one even more strident. A couple dozen demonstrators were allowed into the Media Centre — I’m not quite sure how the super alert security staff allowed them in when they don’t normally anyone, however inoffensive, to enter without media credentials — to disrupt a PSI press conference on male circumcision.

Now the demonstrators had no beef with PSI, nor with male circumcision. They were offended by the presence of U.S. Global AIDS Coordinator Eric Goosby, who was on the panel and who they blame for “the ongoing harm of PEPFAR’s anti-prostitution pledge requirement.”

Their indignation over the requirement is justified; their tactics are not. They were aggressive, they were rude. One or two of them sounded hysterical, screaming at Goosby, for 10-15 minutes.

This is the same Eric Goosby to whom former President Bill Clinton gave a huge shout-out in the opening plenary on Monday: “This man is your friend. He’s been working on AIDS since before the youngest people in this room were born. He is a good man.” Apparently, the demonstrators did not get that message, or chose to ignore it. The journalists working in the Media Centre were not impressed and mainly just ignored them, and deservedly so.

They need to find a more effective way of making their point, which is actually a point Clinton made in his speech: “You have two options here. You can demonstrate and call the President names or we can go get some more votes in Congress to get some money. My experience is that the second choice is a better one with a far better payoff.”

Yesterday, in the Media Center, the activists won no friends; they might have lost a few.

My take on the G8/G20 summits in Toronto

TORONTO, Canada — It’s been a raucous and, in some ways, surprising three days here at the overlapping G8 and G20 Canadian summits. I was struck by four issues that emerged at the summits — logistics, media access, NGO reaction and media interest in maternal and child health

First, there have never been two summits at the same time in the same country. The G8 ran Friday and Saturday in a remote area two hours north of here by road called Muskoka, in the town of Huntsville. Because of the limited facilities there, very few journalists (and no NGO representative that I know of) had access and those few that did had to be up at 3:00 am to go through security and catch the bus in Toronto for the long trip north to Huntsville. Reporters on these buses did one of two things — sleep and work on their laptops and cell phones — and so the only sound in the buses was the clacking of keys on electronic devices. And the G20 was Saturday and Sunday in Toronto, but the leaders were still separated from the media and NGOs, albeit by one mile instead of 200.

Second, the issue of media access to NGOs has been a big issue for the NGOs throughout the summits and continues to be. At recent summits, including both of those last year in Italy and Pittsburgh, NGOs, for the most part, had full access to the international media. This worked to the advantage of both parties and ensured that journalists had just as much access to civil society as they did to governmental delegations who, understandably, want to spin things in their favor (as does civil society).

For some reason which no one understands, the Canadian government thought this was a bad idea and decided to put the NGOs in an “Alternative Media Center” and segregate the two groups in separate buildings across the street from each other. The difference is that the one for the media is surrounded by a high fence and concrete barriers and NGOs are not allowed in without an invitation from someone with proper media credentials. Most of us in civil society have not been invited across the street, and few reporters leave the comfort of their media center to come to us.

The Global Health Council was one of 12 non-governmental organizations that put out a statement critical of the Canadian government for this “media apartheid” which produced an article in Saturday's Toronto Star.

But another aspect of media and civil society access was less commented upon. At the 2009 G8 in L’Aquila, Italy, we all — journalists and NGOs — had access to the heads of state and the country delegations. That is, we were all in the same facility, inside the same perimeter. Because of that, I was able to attend a press conference with President Obama, Prime Minister Harper and other G8 leaders without going through security again. That was not the case in Pittsburgh. And here in Toronto, even most of the mainstream media does not have access to the heads of state, who are in the Toronto Convention Center a mile away from here. In a press briefing this morning by South Korea, the host of the next G20 in November, we were told that Seoul will revert to the L’Aquila model, where we are all together in the same location.

Third, it was interesting to see the different reactions in the NGO community to the announcement of the $7.3 billion, five-year Muskoka Initiative on maternal, newborn, child and reproductive health championed by Canadian Prime Minister Stephen Harper. Even though this is a huge win for global health advocates, given the relative attention that global health attracted at the 2009 summits, the NGO reaction was somewhat, though not uniformly, negative. Generally, the pure advocacy organizations (like the ONE Campaign) and the large implementing organizations that work in many areas of development (like Save the Children and Oxfam) were negative. But the organizations which focus on health,like the Global Health Council and the Partnership for Maternal, Newborn and Child Health, both organizations representing hundreds of other organizations, were much more upbeat about the Muskoka Initiative. As was the African Medical and Relief Foundation (AMREF), the only indigenous African health organization present in Toronto

The Washington Post, one of the few U.S. mainstream media outlets to give this story any legs, published a story entitled “Aid group slams lack of financial support for maternal and child health initiative.” based on quotes only from Save the Children and Oxfam, two of the NGOs that did get into the media center. Other organizations, with more positive perspectives, were not interviewed because they were not in the media center to be interviewed. The Post later published my letter expressing my concerns about that situation.

In this case, it appears that the Canadian government strategy backfired as they might have gotten a better story out on their flagship G8 initiative if they had allowed full access between media and NGOs.

Finally, the Muskoka Initiative on maternal and child health got very good media coverage in Canada (it was front page news on the front of The Globe and Mail, Canada’s premier newspaper, on Saturday, and it was surprisingly prominent in the Canadian TV coverage that I saw). People on the street knew about it; my taxi driver on Saturday night, originally from Bangladesh, told me it was the best story coming out of the G8 and would improve a lot of lives.

I understand why this initiative was a big story in Canada since it is a Canadian initiative and the summits are taking place in Canada. But I wish that the U.S. media had paid more attention to what may be the only truly positive story coming out of the summits. And I wish the NGO community had been more welcoming of what is a highly positive development and a step — if not a leap — in the right direction.

Stephen Harper said something in his press conference on Friday night about the Muskoka Initiative that I liked so much I put it in our G8 press release: "Of all things we could spend our money on, who wouldn't want to spend to save the life of a mother who would otherwise die?"

NGOs feeling mixed as Canadian summits open

TORONTO, Canada — As world leaders arrive in Canada for the twin G8 and G20 summits, we, in the NGO community who advocate for global health, have decidedly mixed feelings about the annual gatherings of world leaders.

On the one hand, we are excited that Canadian Prime Minister Stephen Harper is pushing for a $1 billion Canadian initiative on maternal, newborn and child health (MNCH), a surprising development when it was announced in January since Harper is not known as a champion of international development, and since MNCH was almost completely ignored at the 2009 G8 in Italy and G20 in Pittsburgh. We are grateful to our colleagues in Canadian civil society for their efforts in making that happen.

At the same, NGOs are profoundly disappointed with the tone the same Canadian government has set by barring NGOs and civil society from the international media center for the first time in recent history. In both L’Aquila, Italy and Pittsburgh last year, NGOs and media shared the same media center in a way that was mutually beneficial for both parties.

We don’t understand why the Canadian government felt it necessary to segregate the NGOS in separate facilities. The International Media Center — the “real” media center — is across the street from the “Alternative” Media Center (where the NGOs are congregated and from where I write this) but the “real” center is surrounded by a wire fence and concrete barriers, apparently to impede aggressive NGO representatives, who have to be invited in by journalists.

The Harper government seems to be going in a different direction from the United Nations, which last week opened its process leading to September’s summit on the Millennium Development Goals to civil society and the private sector for the first time, with informal and interactive hearings to get various perspectives on how to accelerate progress towards achieving the MDGs.

Interaction, the coalition of U.S. NGOs with which Global Health Council shares reciprocal membership), felt so strongly about this adverse development that they decided not to send anyone to Toronto, even though it normally coordinates the U.S. civil society presence at these summits. Yesterday, Interaction issued a statement critical of this lack of access, which makes it more difficult to achieve a “transparent monitoring system” that is needed to evaluate if donor countries actually honor their commitments.

U.S. President Barack Obama just arrived at Toronto airport, the last G8 leader to arrive, and is helicoptering to Muskoka, the remote resort area north of here, for the beginning of the G8 Summit. The G20 Summit starts here in Toronto tomorrow.

For great background information and useful links on the G8 and G20 summits, go to the Council's special G8G20 webpage.

World Health Assembly has its frustrations, but we have to try

GENEVA, Switzerland — My first World Health Assembly closed yesterday and I am trying to assess what difference it made, how the Global Health Council fits in and whether it is worth our time. I don’t even think I knew what WHA was when I was at PSI. I had heard of it — barely — but had no real idea what it did or why PSI should care.

I have since found out that the WHA is the mechanism through which the World Health Organization (WHO) is governed by its 193 member states, and is the world's highest health policy-setting body. The main tasks of the WHA are to approve the WHO program and budget for the next two years, and to decide major health policy issues.

I came away skeptical of our odds of influencing very much the global health dialogue that takes place in Geneva every may. But I also came away convinced that we — as leaders of civil society on global health issues — have to make every effort on behalf of our members who care about these issues, and very few of whom can come to Geneva themselves. That is one of the many things that they pay us to do when they sign on as members.

And just as I now feel that it is difficult for GHC — or any other member of civil society — to influence the G8 or G20, it is a very appropriate role for us to play as convener and representative of civil society on global health.

I was appalled at how civil society was marginalized (or even ignored) in the larger plenary meetings, where we were confined to an area that was way too small and where we could not hear anything if we did not have headphones, most of which did not work anyway.

But I was delighted that in other “special meetings” and “side events,” we could be sitting next to the health minister of Cambodia or Tanzania, and have just as good a chance of them as being called upon by the moderator to ask a question.

And, in the end, the Global Health Council got three minutes to address all 193 country members of the WHO: http://tinyurl.com/28m5kye. Where else would be get that opportunity?

Hillary's ICPD speech was stirring, but short on specifics

WASHINGTON, DC -- My arrival at the State Department for Hillary Clinton’s much anticipated speech Friday marking the 15th year of the International Conference on Population and Development (ICPD) started with a chilly reception – literally. We were required to line up in the 30-something January weather and wait to get into the security area of the main State Department building. My only consolation was that I was in auspicious company: In front of me, United Nations Foundation President Tim Wirth, who led the U.S. government delegation to ICPD during the Clinton Administration, a fact that was later acknowledged by Secretary Clinton). Behind me was Her Excellency Hawa Olga Ndilowe, Malawi ambassador to the U.S. Both of them mentioned to me how cold they were.

However, all of that was forgotten fifteen minutes later when we all – foundation presidents, ambassadors and mere mortals like myself – walked into the splendors of the Benjamin Franklin State Dining Room on the eighth floor. The Ben Franklin Room, the largest of the State Department’s diplomatic reception rooms, was redesigned in the classical manner and completed in 1985. This monumental room has free-standing Corinthian columns along the walls and the Great Seal of the United States, depicted in plaster and gilt, in the center of the ceiling, along with eight Adam-style cut-glass chandeliers. In sharp contrast to the ugly experior of the building we were in, I now felt like I was in Versailles.

This event had already been postponed twice – once when Hillary had to travel to Copenhagen with President Obama for the climate change summit and again when the federal government shut down on Dec. 21 after a historic snowfall. But it finally happened and Hillary did not disappoint.

She delivered a passionate message about the importance of the ICPD goals (“one woman dies every minute of every day in pregnancy or childbirth, and for every woman who dies, another 20 suffer from injury, infection or disease every minute”) and the difference their realization could make not only in health, but also in other spheres of development like education, climate change and agriculture.

But it would have been hard to find a better example of speaking to the choir than Secretary Clinton speaking to this committed crowd of people who had made the ICPD their lives work. Most of what she said, we already knew.

What I wanted to know is: What would we do to achieve the ICPD goal? And I thought that is what Hillary would lay out when she said, early in her speech: “Part of the reason we wanted to have this commemoration is not only to look backwards, but to look forward. What is it we will do between now and 2015?”

But Hillary never answered that question in any specificity. So we wait for the details of President Obama’s Global Health Initiative, which we hope will answer those questions and provide more guidance on how we can achieve the vision of ICPD by 2015.

Hillary gave an excellent speech in the magnificence of the Benjamin Franklin Room and we celebrated afterwards with champagne and hors d’oeuvres. And now we return to the real world, and get down to the business of achieving ICPD in the next five years.

How committed is Hillary to reproductive health?

Last year in Berlin, I attended an NGO forum on the the 15th anniversary of the International Conference on Population and Development which was trying to figure out how to achieve the ICPD targets set in 1994 on universal access to reproductive health. I met several people there who had been delegates to the 1994 summit in Cairo and one of them recollected how the stars had aligned that year to produce something important in sexual and reproductive health amid a sea of “bad years.” She cited three developments that made this historic alignment possible:

- The existence of a charismatic, committed and politically saavy leader in the person of Undersecretary of State Tim Wirth (now the president of the United Nations Foundation), who was unrelenting in pushing forward the agenda of the ICPD;

- A supportive U.S. administration and Congress: Bill Clinton had been in office for less than two years and had given reproductive health higher priority than it had for many years; and

- An increasingly sophisticated non-governmental organization movement which played a leading role in making ICPD a reality.

This unprecedented alignment started falling apart later that same year when conservative Republicans took control of Congress and the Clinton Administration lost its early momentum.

This ICPD delegate told me she saw a similar aligning of the stars happening now – a progressive and supportive American administration and Congress — after eight long years — and an even more sophisticated civil society than was the case in 1994. The only thing missing, she said, was a charismatic and committed leader like Tim Wirth.

Later that same day, I talked to another person who had been in Cairo in 1994 as a senior U.S. government official. He agreed with this scenario and thought that Secretary of State Hillary Clinton could be that leader that some believe will be necessary to finally ensure universal access to reproductive health.

This Friday, Secretary Clinton is making a major speech marking the 15th annniversary of ICPD in Washington. That speech might give us a glimpse of whether she has the passion and the commitment to not only reaffirm the 2015 goals and targets of ICPD, which she will undoubtedly do, but take the cause to the next level, providing the leadership to inspire others to actually achieve the vision of ICPD over the remaining five years. Those of us who care about family planning and reproductive health are looking forward to watching Secretary Clinton this week and are ready to support her in this effort.