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Verbatim report of proceedings
Tuesday, 13 January 2004 - Strasbourg OJ edition

14. Health issues and poverty reduction
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  President. The next item is a report (A5-0474/2003) by Mrs Sandbæk, on behalf of the Committee on Development and Cooperation, on the Commission communication to the Council and the European Parliament on the update of the EC Programme for Action: accelerated action on HIV/AIDS, malaria and tuberculosis in the context of poverty reduction; outstanding policy issues and future challenges (COM(2003) 93 – C5-0384/2003 – 2003/2146(INI)).

 
  
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  Sandbæk (EDD), rapporteur. (DA) Madam President, it was in February 2001 that the Commission adopted the action programme ‘Accelerated action against HIV/AIDS, malaria and tuberculosis in the context of poverty reduction’. The Commission has now presented an evaluation of its implementation and given an account of outstanding issues and future challenges.

There is a need for a stronger and more coherent strategy. Unfortunately, enough challenges still remain. Almost 20 000 deaths – not per year, not per month but daily, and it is the poorest countries’ populations that are absolutely the hardest hit. The crisis causes enormous human suffering and brings the possibilities of development in these countries into serious danger.

There is therefore a need for greater concerted effort in a number of related areas. There is a need to develop new medicines. Medicines of proper quality must be produced in sufficient quantities. The prices must be within the financial reach of governments and populations, and the medicines must be available to all.

In this context, I should particularly like to emphasise the need for increased and continued support for the global fund for combating HIV/AIDS, tuberculosis and malaria. Africa is the primary focus for the fund’s work. This continent receives 60% of the resources. This fund provides the best opportunity we have partly for slowing down the spread of these three diseases and, at the same time, for reducing the consequences for those who are already suffering from the symptoms. For example, a contribution from the fund to Haiti in 2002 has put the country in a position to reopen a public health clinic and operating theatre, provide five public clinics with important medicine and provide basic laboratory services to four clinics. More than 600 individuals have received anti-retroviral treatment, and more than 300 cases of tuberculosis have been discovered. In that case, the fund’s resources are not only helping Haiti’s efforts to prevent and treat HIV and tuberculosis but also mean an overall improvement in health in an area of 250 000 inhabitants.

President Prodi earlier gave an undertaking that the EU and the Member States would contribute a billion euros to the fund. I would urgently call upon both the Commission and the Member States to contribute no less than that amount, and I support the amendments by the Group of the Party of European Socialists, which make this undertaking clearer and more precise.

Prevention is still of crucial importance, but this was unfortunately sabotaged by President Bush's Mexico City Policy, which literally killed millions of men and now, in particular, women, for it means that vital reproductive health articles are withheld. That is downright unethical, and the EU absolutely must respond to this catastrophic situation.

It is also crucial to ensure that research and development efforts are directed at the developing countries’ special needs. The Commission’s reflections on specific legislative instruments to promote research and development into neglected and poverty-related diseases could point to one of the solutions.

Once the medicine is developed, it must be delivered to all patients who need it. In order to achieve this, we must support the implementation of the Doha Declaration on the link between the TRIPS Agreement and public health. There is also a need for continued discussion of the TRIPS Agreement’s significance for the accessibility of generic medicine at realistic prices.

There have been major discussions as to whether efforts should be concentrated mostly upon prevention or health. We must quite clearly make efforts in both areas. If there is no possibility of treatment, there will be no incentive to be tested. There is, however, the possibility of treatment. Generic production and competition have brought about remarkable falls in the prices of antiretroviral drugs, and, now, a number of the world’s poorest countries have the opportunity to offer treatment for less than a dollar a day.

The importance of supporting treatment programmes by producing quality antiretroviral drugs at low prices cannot, therefore, be overestimated. In sub-Saharan Africa, treatment is offered to only one per cent of the four million people who need it.

A report recently issued by the WHO and the World Bank shows that no progress has been made in terms of achieving the UN’s millennium development objectives regarding health. The slow progress in the health sphere is particularly worrying because many of the technologies needed to improve health are in actual fact available at reasonable prices. The problem is one of making them available to the people and creating strong health systems in all the countries.

In partnership with the ACP countries, it is very relevant to focus upon the unused resources from the European Development Fund in order to try to help vulnerable countries combat these diseases which have very negative effects on the countries’ economic opportunities and destroy their social cohesion.

I should also like to emphasise the huge significance of the HIV/AIDS epidemic for children. There are now more than 13 million children who have lost at least one of their parents because of AIDS. There is a need for a clear EU policy and for this area to be given higher priority.

I am therefore pleased about the Irish Presidency’s assurances that African issues are high on the EU’s agenda and that the EU wishes to cooperate with African partners in a coherent, serious and consistent way and to support initiatives to meet the enormous challenges faced by Africa.

To that extent, it would be a clear and welcome symbol of the EU’s obligation if, as the report calls upon it to do, it were to appoint an EU ambassador to coordinate and lead the EU’s work in this area.

 
  
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  Nielson, Commission. The Commission welcomes Parliament’s interest in its report on the Programme for Action. We share the overall assessment that substantial progress has been made, but further action is needed – by developing countries, by EU Member States and other donors, by the business sector, by NGOs and by European institutions – to confront and fight HIV/AIDS, TB and malaria.

We recognise that these diseases affect different people in different ways and that women, children and the poorest sections of the population are often most vulnerable and most severely hit. This should be documented, wherever practically possible, by developing countries, with support from the international donor community. At the same time, we should avoid portraying women only as victims and make an effort to recognise the tremendous contribution they make in terms of caring for people living with HIV/AIDS or for children left behind. Women comprise that group of the population which is most affected, in a negative sense, by poverty and disease but strangely, at the same time, that group shows the biggest potential for change and hope.

I note with satisfaction the importance attached in the report to our cooperation with the World Health Organization. This is now recognised more visibly through the strategic partnership which is being developed between our two institutions and which, for example, has led to the signature of an agreement to provide EUR 25 million of Community funding to support the WHO in developing its pharmaceutical policies.

I also understand the emphasis placed by the rapporteur on access to basic health services and on the wish to see increased funding for this sector. The Commission is open to increasing – however we can – support for health and other social services. However, this is a demand-driven process in which our partner countries are in the lead.

As to the Global Fund, our contribution has been steadily increasing, with the vital support of Parliament. We have now secured funding for the next four years, both from the Community budget and from the European Development Fund. Despite this, resources for the Global Fund are still far from adequate. We are committed to working together with the Member States to find a sustainable solution.

The EU as a whole – the Member States and the Commission – have so far contributed more than 50% of the money in the Global Fund. That is a figure worth keeping in mind in view of the complaints made now and then by other donor countries.

Access to affordable medicines is an important element in our Programme for Action. Through tiered pricing and the untying of aid we have managed to contribute to a process whereby prices on medicines have been reduced by up to 90%. Supply of medicines at tiered prices is essential and the European Union has adopted a regulation to prevent the re-importation into Europe of medicines sold at tiered prices in developing countries. That is very important.

The report rightly points to the important role that research and development of new medicines and vaccines could play in fighting these three 'killer diseases'. More needs to be done in public and private research to develop new products which target these diseases. It is clear that pharmaceutical companies could play a constructive role in addressing these needs. The European and Developing Countries Clinical Trials Partnership aims to facilitate such a contribution from industry. The Commission is already contributing to this initiative, but we also expect Member States and industry to allocate resources.

I should like to respond to Mrs Sandbæk's remarks concerning the negative impact of the Mexico City Policy carried out by the Bush Administration in Washington. I agree with the choice of wording put forward by Mrs Sandbæk. We have reacted to this policy, which was announced when President Bush took office, by saying clearly that Europe is ready and willing to fill the decency gap, and that is what we are doing.

 
  
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  Corbey (PSE), draftsman of the opinion of the Committee on Industry, External Trade, Research and Energy. – (NL) Madam President, some of the developing countries are experiencing an unprecedented health crisis, and it is in the interests of the entire world to take the steps that are needed to alleviate this crisis, and, above all, to fight it. Although the Committee on Industry, External Trade, Research and Energy is aware of its limited contribution to the solution of this problem, it does stress that its contribution is essential.

On behalf of the Committee on Industry, External Trade, Research and Energy, I should like to raise three points. First of all, the industrial dimension. Too many diseases are still being neglected, with no research being done into them, because no industry can see that there is anything in it for them. Not only does European industry stand disgraced by this, but it has also missed an opportunity. The European pharmaceutical industry is too lacking in innovation, and focusing on neglected diseases could provide it with a new impetus. The EU must now show political leadership in order to persuade industry to invest in diseases that have so far not been profitable. A directive or framework for neglected diseases is much needed, and we should not shrink back from unorthodox measures, subsidies, protocol assistance, tariff exemption and even the transfer of patent rights. The EU must create a framework on the basis of which it can start the dialogue and negotiations with the pharmaceutical industry about investments in research into such diseases as malaria, TB, African sleeping sickness, among others.

A second point is research. The EU must now attend to its research programmes itself. The platform for clinical trials was a step in the right direction, but what is being done in practice? The EU should draft a research agenda and identify all the gaps. Subsequently, research institutes and companies should be invited to put their names down. Incidentally, the Committee on Industry, External Trade, Research and Energy appreciates all Commissioner Busquin's efforts on this score.

Thirdly, there is the issue of trade. In this respect, the decision of 30 August 2003 on the eve of the Conference in Cancún is obviously of major importance. Our committee would like to see this decision actually implemented in legislation in the pharmaceutical field. We call for the prompt implementation of this legislation. Doha should not remain an empty promise.

 
  
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  Karamanou (PSE), draftsman of the opinion of the Committee on Women's Rights and Equal Opportunities. (EL) Madam President, Commissioner, I should like on behalf of the Committee on Women's Rights, of which I am chairman, to present our opinion on Mrs Sandbaek's exceptional report, which I am presenting in Mrs Valenciano's absence.

Unfortunately, Commissioner, after half a century of promises, analyses and development aid plans, most less developed countries are not only not on the road to development, but are also sinking increasingly into poverty and the fatal diseases of our times. The victims of this situation are, of course, women, the social group which still does not have access to rudimentary medical and pharmaceutical care and sexual and reproductive health services.

Of course, Commissioner, as you said, women make a very great contribution, even in countries in which their fundamental freedoms and human rights are not recognised. However, Commissioner, if women governed, I believe that the world would be a much more humane place. I think it is a disgrace on our civilisation that 30 000 people in developing countries die every day of diseases which are curable in the civilised world. Tuberculosis is the leading cause of death among women of reproductive age, ranking even above death in childbirth. The number of women infected with the AIDS virus is high and is rising constantly. This impacts not only on the women themselves, but also, in the case of pregnancy, on their children. As Mrs Sandbaek said, 13 million children have been orphaned and this number, to the glory of our civilisation, is expected to reach 25 million by 2010.

As the Committee on Women's Rights, we are calling both on the governments of the developing countries and the European Union and other international organisations working in this sector to ensure that the gender dimension is fully incorporated into all health policies, taking account of the leading role played by women.

I should also like to welcome the agreement by the members of the WTO in August 2003, despite the differences and time-consuming procedures and delays which intervened, the efforts of the UN to provide high quality drugs to patients with the AIDS virus and the decision by the Council of the European Union on increased incentives for the pharmaceutical industry, with the aim of selling drugs more cheaply. I think that we should step up our efforts to address this dreadful scourge, Commissioner.

 
  
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  Martens (PPE-DE).(NL) Madam President, the Programme for Action against HIV/AIDS, malaria and tuberculosis dates back to 2001 and has now been in force for two years. The situation has not become any less harrowing. The three diseases combined are responsible for more than 20 000 deaths daily. Over the past year alone, according to the WHO, approximately 40 000 people were infected with HIV/AIDS every day, and based on the latest information, 16 million children under the age of 15 have now lost one or both of their parents to the disease.

Tuberculosis is one of the world's major infectious diseases. One third of the world population is infected, and it is expected that 5 to 10% of them will actually become ill. Malaria is pushing ahead fast; in Africa alone, some one million people die of it every year, most of them pregnant women and young children. The seriousness of the situation cannot be pressed home enough. The death rate as a result of this disease is still increasing and this is set to be the case for some time.

Let it be clear that the least developed countries are hit hardest, and that is why these diseases are termed diseases of poverty. They hamper social and economic development, completely disrupting the societies of many developing countries. Fatalities hit large sections of the working population, and companies and organisations have to do without workers. In many countries, the loss of teachers means that the educational system can no longer function, and as already stated, the number of orphans is growing dramatically. What kind of a future do they have? A whole generation is at risk of being lost.

The diseases are making demands on health care systems over and above the ability of these to handle them. The Programme for Action can be considered a sound programme but can be improved on a number of scores. After all, the evaluation of the European development policy shows that the current programmes have too little impact. The European Union has set itself millennium objectives. One of the points is to stop the steady increase in the spreading of AIDS in 2015, but we are still not doing enough to achieve these goals. I would therefore urge you to set aside more money for this programme and to intensify the research into the causes and reduction of diseases. As is known, the biggest problem with malaria is that due to increasing resistance, new medicines have to be developed all the time. I think that the report gives a clear indication of Parliament's commitment where, as has already been mentioned, the importance of the availability and accessibility of basic health care, of medicines, of prevention, of the possible role of civil society of research and monitoring is concerned.

I should like to highlight one point that deserves specific attention, namely the special position of women. These diseases hit women first, and hit them hardest. In the 15-24 age group, there are nearly twice as many women victims compared to men. Worse access to education and health care, a biologically greater risk of infection and a difficult social position all contribute to this. This population group therefore deserves specific attention and policies, especially as health care projects, among others, appear to be more successful if women are involved. Investing in girls appears to lead to lower mortality rates among women and children, offers higher food safety and benefits the fight against poverty. This was once more evident from the research published by Unicef on 11 December last. In fact, the report states that without, for example, campaigns to get more girls into schools, it will be impossible to achieve the millennium objectives. Moreover, it transpires that when more girls attend school, this does not only benefit the girls, but also the boys and the countries.

Finally, I should like to thank and congratulate the rapporteur, who is an expert in this field and has once again produced an excellent report. There is still a great deal to be done by the European Union and the individual Member States.

 
  
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  Carlotti (PSE).(FR) Madam President, today, like any other day, more than 8 000 people have died of AIDS for lack of treatment. In Africa, more than 4 million AIDS sufferers are in desperate need of treatment and only 50 000 people have access to it. Moreover, AIDS is not the only scourge overwhelming the countries of the South: tuberculosis is on the increase and kills 2 million people every year; malaria is responsible for between 1 and 2 million deaths every year and affects between 300 and 500 million people.

In fact, we have the means to cure these diseases or to significantly reduce the death rate. But the treatment is expensive, too expensive for countries that can only afford to spend derisory sums on their health services, with the result that medicines are for the North and coffins for the South.

Fortunately, things are starting to change. Much progress was made in 2003, giving cause for a glimmer of hope: the WHO initiative to provide treatment for 3 million sufferers by 2005; the agreement reached on 30 August 2003 in Geneva by the members of the WHO; the decision of the South African Government to launch a national treatment programme; the efforts to bring down the price of antiretroviral drugs on the world market and the programme of clinical trials in a partnership between Europe and the developing countries, with a budget of EUR 600 million.

These initiatives are very encouraging, but they are still far from being enough. The Union itself is being slow to deliver on its financial promises and the Sandbæk report is a timely reminder to the European Union to firm up its commitments, setting it a target that is appropriate to what is at stake. It reminds us that the absolute priority has to be access to medicines for all sufferers, in accordance with the Doha Declaration. The existence of patents should not therefore constitute a barrier to the manufacture or purchase of vital medicines.

Furthermore, the report forcibly underlines the fact that the prevention and treatment of transmissible diseases are the concern of everyone, because they constitute a global public good. It sets an ambitious target for the financial contribution of the European Union and its Member States, a target of a billion euros a year. In adopting this report, Europe will reaffirm that it intends to play an important role in the fight against these dreadful diseases.

 
  
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  Modrow (GUE/NGL).(DE) Madam President, I would like to voice my support for the report and, at the same time, my gratitude to Mrs Sandbaek.

This report sends out alarming signals and challenges us, in particular, to combat poverty and devastating diseases such as AIDS, malaria and tuberculosis far more resolutely than before. My group does not underestimate the Commission’s efforts. However, the facts presented in the report tell their own story.

The impacts are probably most severe in Africa. As people die, whole villages die as well. As a result of poverty and disease, vast territories are virtually depopulated, even without war. Of course, the issue today is the adoption of practical measures and programmes to control these diseases. Nonetheless, the general social context cannot be ignored. People who live in poverty have no energy to fight these deadly diseases and nor do they have the money to pay for drugs. The armies of refugees, camping in open fields or in tents, are easy prey to these pandemics. When the market is dominated by the profit motive, it is difficult to supply high-quality drugs at low prices in the developing countries. However, this is exactly where politics must accept its responsibility and do more to meet it.

Regrettably, WTO conferences are aimed more at reinforcing the privileges enjoyed by major monopolies than at supplying the comprehensive and reliable services of general interest that are so urgently required. If we ignore the signals sent out by the World Social Forum now, we will hear them far beyond Mumbai. In light of this emergency, whose roots go back to the colonial era, it comes as no surprise – although it is only right and proper – that the former colonies should now demand compensation from the former colonial powers.

This, as the report says, is where the EU, the Commission and this Parliament have to redouble their efforts.

 
  
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  Rod (Verts/ALE). (FR) Madam President, the battle against AIDS, malaria and tuberculosis has for a long time been one of the principal concerns of the Greens. Moreover we welcome the consensus that now prevails regarding this report, which would not have been possible four years ago.

It is disquieting to learn that deaths are still being counted in millions, particularly if one takes into account the fact that these diseases affect many children or pregnant women. It is sad and devastating to learn that these diseases are still killing even though treatments exist. The accessibility of medicines must be guaranteed. It is necessary to facilitate not only a mere reduction in prices, but also the assignment of patents, because that is necessary in order to enable developing countries to produce these products for their people, or import them at low prices.

The efforts on which we agree must be targeted first and foremost at children and pregnant women. Real assistance must be provided for women, who carry within them the future of the continent. This assistance includes, in addition to treatments, information about these infections, and in that respect it is necessary to strengthen the health structures in these countries.

The adoption of this report will confirm the European Union’s involvement in the struggle for the health of Africa.

 
  
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  Sacrédeus (PPE-DE). (SV) Madam President, there is a moral obligation for the European Union and the individual Member States to make every effort to combat AIDS, malaria and tuberculosis. Twenty thousand deaths per day or more than seven million deaths per year are horrific figures. We are reminded of the Black Death that raged here in Europe during the Middle Ages. The Black Death is back. Forty-one per cent of the world’s population is in danger of being infected with malaria.

In the light of, for example, the UN’s millennium objectives and the G8 Summit in Evian on sustainable development, I want to say to Mr Nielson that no effort should be spared in helping people hit by malaria, tuberculosis and HIV/AIDS, and in preventing these diseases.

We are in actual fact concerned here with rearming the whole of civilisation on this earth. Women must no longer be exploited, sexually degraded and exposed to a form of slavery that is completely unworthy of a society that is both modern and civilised.

Throughout the world, men need to begin recognising the dignity of women. What is needed is a society marked by a new and more potent dispensation in which men show respect for women and for human dignity. I want to call upon Commissioner Nielson to get involved in lifestyle issues, especially when it comes to the male lifestyle that, especially where the spread of HIV/AIDS is concerned, degrades women and contributes to the completely immoral spread of this disease.

 
  
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  Kinnock, Glenys (PSE). Madam President, I thank the rapporteur for an excellent report and for continuing to show her interest in and commitment to these issues. Like her I welcome the Commission's continuing focus on action against and treatment of HIV/AIDS, TB and malaria.

The programme which was launched in 2001 has produced some very important and impressive results. We need in this report and in this Parliament to reiterate the importance of continuing this emphasis on tackling these particular diseases in the context of our poverty eradication efforts. It is absolutely crucial to recognise the importance of this concentration of effort on these diseases, which, as others have said very graphically this evening, claim so many lives and cause so much suffering.

I trust the Commission will continue its efforts to build the necessary political will, based since 2001 on an increasing knowledge of what actually works in the field at this time. There remains a greater need for donor resources and for national resources, and the Commission must continue to argue for more commitments to fight AIDS, to the programme and to the Global Health Fund from bilateral programmes.

I welcome the acknowledgement, as the rapporteur and others have already agreed in the report, of what is arguably the most neglected crisis spawned by the HIV/AIDS pandemic – the plight of millions of profoundly vulnerable children who have been orphaned by the disease. The numbers, as some of us have already seen in the field, are overwhelming the capacity of families and communities to cope.

We are clearly facing a development catastrophe at the hands of the AIDS pandemic. There is no better gauge of its scale and cruelty than the orphan crisis. I urge the Commission to compile data on the impact of all these diseases on children and women.

All of these efforts will not be assisted by the dangerous misinformation pedalled by the Roman Catholic Church with its pseudo-scientific pronouncements about the spermatozoa passing through the net formed by a condom. This nonsense, alongside US views on the need for abstention before marriage, is incorrect and quite simply dangerous. US policies are not saving lives: they are only pandering to the fundamentalist conservative voters at home.

Kofi Annan has described the AIDS crisis as being an issue of weapons of mass destruction. There is a great deal to do, and it will require substantial funding from our programmes in developing countries. AIDS has to be a core theme of our development assistance.

 
  
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  Bordes (GUE/NGL). (FR) Madam President, we shall be voting in favour of this report because it describes the disaster being caused by diseases linked to poverty. For anyone reading this report with the least humanity and reason, the findings alone are a true indictment of our economic and social system, which allows millions of human beings to die of diseases that can be healed, particularly TB and malaria.

The rest of the text is merely an admission of impotence. That is not the fault of the rapporteur, but of the whole system. Parliament is invited to vote, but it does not have the power to affect the root of this evil. It will only be possible to combat diseases linked to poverty effectively if we combat poverty itself and, consequently, combat the flagrant inequalities of a social organisation in which certain individuals can obtain and accumulate more wealth than entire countries possess.

For instance, what is meant by the proposal – and I quote – to involve the European pharmaceutical industry in the fight against poverty-linked diseases? Everyone knows that the pharmaceutical trusts are looking to make a profit, even at the expense of the poorest people, and for them there is no question of distributing medicines, even if the cost of developing them has been written off a hundred times, to sick people who do not have the money to buy them. Moreover, when those trusts have no hope of making a profit because the disease in question affects only poor countries, they stop their research, as the report itself concludes, giving sleeping sickness as an example.

The pharmaceutical industry should operate under the control of society, without bringing in private profits, and it should produce the necessary medicines so that they can be distributed to all those who need them. That would not put an end to poverty, but it could help to ensure a certain amount of equality when it comes to medical treatment.

 
  
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  Schörling (Verts/ALE). (SV) Madam President, I think that the Commission’s update report was very constructive. I also think that Mrs Sandbaek has produced a very sound report. She has produced a whole lot of proposals that strengthen the areas in which the Commission has stated that such strengthening is needed in order to achieve the objectives of combating poverty and these diseases.

I want to take paragraph 26 of Mrs Sandbaek’s report, which is very central, as my starting point. This recalls that debt repayment and servicing account each year for almost 40% of the least developed countries’ GDP. That is incredible. I believe that the EU should take the initiative regarding the writing off of debts. Written off debts could also be earmarked so that they are, in the first place, used for efforts to combat HIV/AIDS, malaria and tuberculosis and perhaps also for education. In that way, the fight against poverty could really be strengthened and given impetus.

 
  
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  Khanbhai (PPE-DE). Madam President, when I wrote my report on HIV/AIDS two years ago, I was not sure what the outcome would be. However, I am delighted that the EU, the Commission and this Parliament have done quite a lot, as many speakers, including the Commissioner, have said.

However, I want you to focus on an African woman who is suffering and dying from HIV/AIDS, TB or malaria. If she were to watch CNN what does she see and hear? She sees the conflicts in Iraq, Congo, Afghanistan, Burundi, Zambia, Zimbabwe and so on. She sees loss of life, billions of euro wasted, including the EUR 75 billion that President Bush has pledged for Iraq's reconstruction. This is essential, but it is a lot of money in relation to the US commitment of EUR 15 billion over 5 years for HIV/AIDS, of which 10 000 people are dying every day.

So, this lady sees terrorism in Istanbul, New York and Saudi Arabia. She sees a natural disaster in Iran – 20 000 people dead, a town flattened – and she says to herself 'I have TB, and yet I do not have ten dollars or ten euro to cure it. I am dying'. How does she feel when she sees all these billions of euro that we spend to renovate buildings that have been destroyed and which are then destroyed again? The pledges – which are very worthy indeed – for the reconstruction of Iraq made by countries like the United States amount to EUR 75 billion. What is their contribution to the fight against HIV/AIDS, TB and malaria? That is where the European Union has been tremendous, very generous and is showing the way for the rest of the world. I also look to the oil-rich countries. What are they doing? How much are they contributing? If not, why not? What about Japan and others?

If we are to address this issue we have to be serious and put it into context, because the people who are suffering are poor, sick, oppressed, not free to work and live in harsh conditions. They have no water or electricity, they have no tools to till their land, and nor are they near the sea. What chance do they have? That is why it is important to refocus EU aid and to go back to the basics of life such as water and access to energy, because these people are already spending their whole day looking for water and firewood to cook their next meal.

I know the Commissioner is committed. He is brilliant. I know this Parliament is behind him. Let us go for it and make sure that this year and beyond we can achieve what we set out to do.

 
  
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  Junker (PSE).(DE) Madam President, ladies and gentlemen, I will confine myself to making a number of comments about HIV/AIDS.

Although a great deal has already been done, it is certainly not enough, and in the long term, the costs will be higher if we fail to act than if we provide massive assistance now and spend what sounds like a lot of money. However, HIV/AIDS is not just a health problem. HIV/AIDS is a threat to society as a whole. The death toll from AIDS reverses the modest successes achieved in the past.

In a number of countries in sub-Saharan Africa, life expectancy is falling dramatically. Men and women of working age are dying in increasing numbers, and this leads to educational deficits, for there are regions where the number of teachers dying of AIDS is higher than the number of new teachers who can be trained to replace them. The result is a drop in the standard of education. This is exacerbated by the fact that young girls are no longer able to attend school because they have to care for their parents who are sick with AIDS. In Swaziland, for example, school attendance among girls has fallen by 36%.

HIV/AIDS also causes malnutrition and starvation, for a rural population which is sick cannot cultivate its fields, or can only do so to a limited extent. In Burkina Faso, agricultural production has therefore fallen by almost a fifth. Millions of children are orphaned, facing an uncertain future. These examples could be continued ad infinitum.

They show that HIV/AIDS worsens the plight of the poor immeasurably. To put it another way, every euro spent on prevention, treatment and healthcare infrastructure is worthwhile, not only to benefit the individuals but also to boost economic and social capacities. To this end, the EUR 1 billion being demanded is money well spent.

 
  
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  McAvan (PSE). Madam President, I agree with most of what has been said tonight. I should like to focus on the EU contribution to the Global Health Fund. Two amendments have been tabled to make it clear that we are talking about the EUR 1 billion from both the EU and the Member States. I am pleased that Mrs Sandbæk will accept that amendment. President Prodi has supported this target. It sounds like a lot of money, especially at a time when public finances are tight, but it is not unrealistic. In fact, it is about one third of the increase announced this year for the farm budget in the EU, so it is not unthinkable that we can achieve this amount. We can afford it and so can the other developed countries.

Mr Khanbhai asked what the woman who had these illnesses would think. What would she have thought, turning on her television last week, to see President Bush announcing a multi-billion-dollar space programme of truly astronomical amounts? It is about time that we resolved the problems in this world before flying off in search of others.

 
  
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  Paasilinna (PSE).(FI) Madam President, we are hardened to the fact that people are still dying of hunger and disease in this developed, globalised community of ours. They could be saved with modern medicines and food that is thrown away. Cheap aid programmes would mean the lives of six million children under the age of five could be saved each year.

We accept the fact that people amass huge sums in profits worldwide. It is common to steal billions. It is not true that if individuals amass wealth on a colossal scale it will benefit the community at large. There is a limit to hunger, but not to greed. The best remedy is taxation. The rich oppose it. It means sharing. Charity is not solidarity; sharing is. Capitalism thrives on greed, and so does poverty. Ladies and gentlemen, let us resolve the problem of deprivation in the same way as with the wars in Europe: through cooperation.

 
  
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  Nielson, Commission. Madam President, Mrs Sandbæk referred to the unspent EDF money that could be used for this. The amount of commitments not yet spent on the budget part of our development cooperation is EUR 11 billion. For the EDF it is EUR 8 billion. We are now at a point where it takes the Commission and the Member States pretty much the same number of years to implement things. Today we are not slower, but we have a mountain of old decisions to implement. This is true for both budget and EDF areas. At the end of 2003 we found that we had reached a level of EDF spending of around EUR 2.5 billion: the highest ever, around 60% higher than the level when this Commission took office.

It was announced to Member States that they had better be prepared to pay up for the last quarter of that year so that we could deliver on this better performance. Unfortunately, however, some Member States did not pay their contributions, so we had to ask them to make up their minds as to whether they were serious about their wish for the Commission to perform better. The Commission is serious about that.

The TRIPS Agreement is being addressed by the Commission. We were pleased that it was possible, before Cancún, to have concluded this agreement, after waiting for the US since December of the year before. We are now in the process of working out how to implement this in terms of legislation. We look forward to doing this. We will give this a very high priority.

The money being committed by the Union, Member States and the Commission for the Global Fund is EUR 2.6 billion. All in all, the total amount pledged to the fund is EUR 4.8 billion. I agree with those who said that this is still not enough money, but it should be considered that our budget support for the health sector and even our general budget support makes it possible for our developing partner countries to increase the effort in basic health services.

The annual spending per capita on public health services in sub-Saharan Africa is somewhere between two and six dollars. So even with antiretrovirals becoming very inexpensive, the system to administer them and to make sure they are correctly handled is not there. I do not mean that we should give up on treatment, but I insist that prevention, to put it quite clearly, is the only cure in terms of HIV/AIDS. I would tend to agree with Mr Sacrédeus regarding lifestyle change, especially for men. This is why the whole agenda on reproductive and sexual health and rights is the key to getting it right on HIV/AIDS.

More people in Africa – especially children – die from malaria than HIV/AIDS. These are poverty- and ignorance-related diseases, so the whole link with fighting poverty and the challenge of meeting the millennium development goals makes a lot of sense.

I wholeheartedly thank Parliament for its cooperation and the backing that we have received. Let us continue to make this a team effort.

 
  
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  President. Thank you, Commissioner Nielson.

The debate is closed.

The vote will take place tomorrow at noon.

 
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