Transcripts For CSPAN2 Today In Washington 20130104

Pay 100 per year. [laughter]. Lose. From the council on Foreign Relations in new york city, this is a little more than an hour. Good evening. Welcome to the council on Foreign Relations. I am laurie garrett, senior official for the Global Health program. I am very pleased and excited about our discussion today. We have a very big treat. We not only have doctor peter piot, the founder of the United Nations a program, but we have the current director with us as well. We have a true continuity that stands for several decades. And i think youll have a lively and fantastic conversation. What brings us here today is no time to lose, a life in pursuit of deadly viruses, doctor peter piots memoir. It is not an attempt to write history of anything. But rather an attempt to describe how the world in the history developed through the eyes of a key player who is really on the front lines of each individual step along the way. Because the memoir is far more accessible, it goes through an adventure cycle. I suspect it will be a recruiting device for the next generation of epidemiologists and specialist in Public Health leaders. Because it makes it seem like one of the most fun things you can possibly do with your life. Many of the events that peter described we experienced at the same time, but from a different perspective. We were both on the front lines watching a new disease unfolds, which later came to be known as aids. We both watched as a series of events unfold that brought us to this collision course that we are on now in Global Health. Of course, i wrote in my first book a description of a full outbreak in which peter was a key player. We have a chance to talk about all of these points coming on. What we are going to do today is have a conversation for about 20 minutes. Then we will bring the audience into the discussion and open it up to all of you here in the audience. So if you have questions, try to remember them for later on. So, you were 27 years old. You have finished medical school, but you are just Getting Started with your phd efforts in microbiology in antwerp. A mysterious test tube sample showed up in terrible condition. Can you figure out that there is a new disease in africa. And you said, i know im only 27 years old, but i want to go there. I want to go to africa. I want to be in the middle of this venture. Just. Where did all this come from . Well, my mother always said silence is golden. But i had an incredible penchant for discovery when i was a child. I worked as a travel agent in turkey. The one goal i had in life was to get out of here. It was a very conservative sense of adventure. It was the despair of my mother and whole family. He drove everyone nuts that i always asked why. You know, and i really wanted to know. I did not have much respect for hierarchy and authority. So yes, that is why said yes. Its not because i was 27. Also, later on, most people who had no seniority, they were actually not jumping up and down to go along with this to they knew how hard it would be . Yes, that is true. Coming away from the way you describe the episode, there are four things that are key. Experiences or realization. Yamaha moment out of the a bullet in 1976 episode. Strange test tubes and his 27yearold find africa for the first time, first you experienced africa in a film of epic i. Just to then he discovered internationalism. And all of the difficulties of coordinating and working together with scientists and all sorts of other folks from around the world, you discover the relationship between global inequities and disease. If people the people are so poor, they dont have sterile syringes and then he discovered dogooders. That wed be better that they were there in the first place. Which i think are very underestimated today. When you look across the gdp, their rates are no longer. We see Natural Resources that are there, so i didnt outlaw these things in these days, but it was a combination of the godfearing and the human side, but also to send icon also very upset and angry because it eat inequalities. Zaire was then ruled by mobutu and a group of plutocrats stealing the country to death literally. And on the other hand coming to people, there is a Great University in the old days, but nobody was paid. There is even no let her city. People were denied some basic opportunities. But i cant explain it five. I was bitten by the virus of africa. Theres a lot of dancing in the book if you havent read it. As many times in theaters so ecstatic he breaks out dancing all over the place. This also is your First Experience trying to work with american and they came in and said per charge, particularly carl johnson from the cdc. And you found african colleagues to collaborate with them fellow belgians who came a little bit later after youve been there a while. Tell me what you learned and 76 that guided you forward about international cooperation. I discovered where it came from, that means they had financially intact weekly were far inferior to what was available here in the u. S. Wheres i resented that he had isolated the virus and then the folks cdc came and said okay were taking over, so i resented that. Its absolutely true. But then i saw that i could learn so much. I really still grateful for him. It was not only the u. S. , or deflating some of these jokes, there is a frenchman and a South African and a bridge and a belgian and some congolese and a plain. What happened, what do you do . The power of coming up from different perspectives, but i was very impressed by the technical superiority in strategic superiority of the american colleagues. So why was there i said i want to go to america and learn the next time we find a new virus, i can be in charge osa. Not only for myself, but just to share this cannot rather than to stay in america, i came back to belgium. Is that thing you discovered after seeing patients bleed out, the horrors that are ebola. If you havent seen that, its a very terrible disease, and offer ways for anyone to suffer before dying. A particularly sad thing for you to say flemish skated grownup indulgence at a time when french speakers were the dominant power structure of belgium and the flemish or a whole town. U. K. Htm buco, this very remote village in zaire and discover the responsibility for it all really rested with fellow flemish catholic militaries. Tell us what that meant to you. What did you discover . Im the one hand i was full of admiration for these women, particularly because they had this cool [inaudible] they were hardworking, dedicated, but they were running a hospital and there is not one person who had formal training in nursing or medicine in 110 deaths. So one of the things they learn if its not enough wine to do good. You also need a sick competence. You need some basic expertise of the race he wouldnt give injections to everybody who comes to this hospital when you only have three or four syringes and a few more noodles. So that was one thing. On the other hand, i also discovered it was like time stood still. So these were flemish who had left bell junior speefour and they were still inking of the motherland as if time had stood still and belgium also, which you find also but expatriates. They have an idea of the country of origin that doesnt correspond anymore with how it evolves. So it reminded me of my grandmother, my ancestors and that was something i hadnt expected. Mike winters sues on the equator, just where is very hot, very adaptive. Even today come you are still in touch with one of the priests and a still there . Partner carlos in mumbai on the congo river called now again with the river is 20 kilometers wide, just incredible. Hes fair, but now in contact with him by email. When i talk about this experience, they stare at me as if im coming from the stone age that there is not even cell phone, satellite phones, no fax, no internet, no facebook. The communication was very slow to say the least. But im still in touch with him and he really has started a secondary school. There is the hospital and congo, outside the nations is functional, so thats also the reality. To Flash Forward a little bit them in the last time anybody took a count that i saw in the post2000 era, 60,000 ngos related to a in africa alone have been created. And when you think back to those missionaries who thought they were doing there at thing, but goodness at the door behind these syringes properly and b6 and sterile and hygiene, perhaps it would be better you are at there in the first place. What lesson do you see looking forward to this explosion of ngos that can be informed that experience . The good news is in the Global Health, which didnt even exist until 30 years ago, i try to figure out what needed to appear for the first time. Global health was created by the aids movement and a sense. See the incredible in money is great news. But on the downside and often its not going with the most professional approach. See the keys combine and the csm, dedication, can rent with knowhow and strong evidence that may start as is. Thats not always fair. Thats one of the reasons i was so interested. Even if i said never again in academia, just like never again in the u. N. And now here i am because we want to train the next generation promotes the best institution to do that. In 1979 he participated in an autopsy on a belgian sailor any say in the book, i wasnt smart enough to seal the same reason drum, but i knew wed never seen anything like it before and it was . Gave us a today. What was so stricken that you knew just looking at this body before it that this is a new disease . It was someone who was a fisherman on one of the big lakes and congo and the person died but was called atypical mycobacterial infection. We know microtek curio and tuberculosis causes tb and that causes leper say. But most of an entire french, ubiquitous microtek. Come which dont create any problem. Publicly most of us here have covered it. When you are immune deficient, it can kill you. So weve never seen a good solid chassis car than the mycobacteria you can see under the microscope. Very strange. We started seeing others with other weird infections. Its the same way aids is described for the first time in this country. You decide that its sexually transmitted diseases are acutely important and if someone just are your top that is one of her major major interest in us anybody else would say sexually transmitted diseases and theres all these little cultural and you come to the United States, a whole bunch of training in that area, particularly from king Holmes University of washington who is still there in seattle still a real leader in. And then you go back in 1883 to kinshasa with some of the same same people year in 1876 ebola epidemic waves. During that massive, anybody whos ever been in kinshasa knows what im talking about, massive colonial hospital. You say in the vote, you wrote in your diary, incredible coming catastrophe for africa. This is what i want to work on. It will change everything. What was so incredible . But really cannot . Mommy and that is the way name of the mother. One of the assertion is there the error out there and in all things after them. Id been there in 76 and here i entered the internal medicine, men, women with young men and women in the states of my age and die, nbc did not kinds of infections, meningitis, you name it. We had like 100 cases and patients coming from Central Africa and belgium. Thats when i went with tom quinn and joe mccormick. It was so overwhelming because they knew it was not there before and also the head of the internal medicine manner had put aside for ice 55 patients are ready who had died in the previous month or so and this was the extent of it. The fact that it is slightly more women than men, which is very unusual. Lets not forget and 83 that this was a sub one thing. I never understood why you would care about a orientation. So jump from one host to another. That is the sex is about. I saw that said i cant believe its heterosexual and there are far more heterosexual sex in the world in samesex sex and knowing all set for my studies on sexually transmitted diseases that were very rampant and they said its going to be a catastrophe. Unfortunately, i was right. You together with john admin said percy sita, an aids project in kinshasa. The first time he met with 1985, the First International aids conference in atlanta, georgia, which fit almost in this room. Hard to believe because the coming aids meeting will have about 25,000 people. First of all, i think we could have possibly imagined in 1985 that that meeting that we were at the front end of something that would still be around in 2012, that would by then had sickened or killed about 74, 75 million cuban beans. That in 2012 would be 34, 35 Million People live with this disease on every continent on earth. But what i remember most distinctly about that meeting is there with a moment when this tall white guy was translating for a much shorter sire a fellow, dr. Pizza and a cluster of us were standing around you and the wall street journal reporter, who was absolutely sure that hav was a gay disease wouldnt accept the notion of general heterosexual transmission sent to dr. Pizza, isnt it true that africans have sex with monkeys . And i remember this guy trembling with rage. Your face changed colors and get you near you had to translate. What the capitas response . Yes, i was the tall white guy. Well, capita first pretended he didnt understand english so that gave him time to think. And then he said, well, im not aware. We dont do this or Something Like that. But ive heard about things here with dogs. Dont give a credit tijuana to see donkeys . But if you think about it, and i do want to bring the show and in a moment here, but to Flash Forward and frame that you can insert title is treated to. All through the book you express urgency to respond and regret that the response was a pastor. Feel it back to the critical period in 198790s, before we had effective treatment in 1996, we had many moments when interventions were blocked because of human rights issues so that we never could tackle hiv the way we did or. The rationale for not doing so was there was treatment, but theres no treatment for hiv. If you identify someone as hivpositive they will simply lead a life of discrimination. When you look at, do you feel theres Public Health that we fail to embrace powerful enough, putting aside the blame to public readers, but within the health arena, are there things the new look back that we shouldve done this, that any other thing other thing before we had to send. Would definitely a out of time. We wasted a lot of time by not recognizing in every country when you think how the Prime Minister could simply not even pronounce the word e. Until the very end, which im not a psychiatrist, but in psychology that means something. So the lack of willingness to do with the issue, also in publichealth circles, first dealing with aids because it was in the category of sexually transmitted diseases. But also later on when it came to treatment and i know we were going to talk about that later, but it was the publichealth community that was the biggest problem that they had all these reasons why its not possible. I think there are also some absurd to this demand like i was shocked in atlanta there is the Campaign Come in no test is best, which i didnt fully understand. Im the one hand it is true because of discrimination and stigma that all we can offer with negative comment death sentence, no treatment and discrimination, loose your job, insurance. But i think that retrospectively indeed we should have had a far more adult conversation about what can be done. You cant see publichealth by whats going on in society. We have a case example of tremendous victory and it didnt catch on. It didnt go viral, so to speak as we would say today. And that was thailand. If you look at the late 1980s, the Asian Development bank predicted thailand would collapse under the pressure of aids. The 17yearold person the military were running as high as three. Hivpositive at the age of 17 by the time time they were 22 in the military, the rate was way beyond my end that lets catastrophic and they had no tools and the product completely under control. Why didnt that become the model for the world . Why do we obligate thailand is that there was this isolated case . Is a good example of why did it work in thailand . Because of strong leadership and not worry too much about Public Opinion and said 100 condoms promotion. It was enforced but not only publichealth people, but it was of course to preserve thailands sex industry, which is what billions of dollars. It is something there is no willingness to do. Today, you see an ad for condoms on prime time in this country . On mtv we do. Okay good. But it is this double standard about sexuality and sex and not dealing with the issue. The next even today the example does not resonate. They are now dealing with gay men and injecting drug use for years and they dont want to go for Needle Exchange and methadone, but they were very, very effective, particularly with the office of the Prime Minister. The ultimate success in branding when your name comes thing, you know . Well, i cant have fun without giving you opportunities to hate to have your most remarkable encounters. First, if i remember right, mahogany lined, everything about it seems like youd gone to oxford. As is he jumped in and sipping expensive scotch and smoking a pipe and hes telling you great paranoid conspiracy theories and you cannot wake him up. Who is that gentleman from what did he cost african mice . President mbeki. Yeah, after a very late night conversation, he said dont you know this is a conspiracy of the western pharmaceutical companies to poisonous africans . Its always been a mystery why such an intelligent person whos done a lot of good things, a strategic thinker could believe such a thing. And that cost about 300,000 minus according to study from harvard because it delayed introduction of antiretroviral study, mother to child transmission in the country and maybe also in neighboring countries, although the colleagues, maybe they were sometimes listening pullet the, but they didnt follow him, fortunately. Now today, south africa has the largest hiv Treatment Program in the world and things have changed really to date and he was actually fired as president. But it is a tragedy and it must be i dont know what it is. I really dont know. In a very different mood, you are for somebody who offer it seems like todays avram if i follow the description, but an ample quantity of alcohol is consumed to discuss mandatory quarantine of hivpositive people in cuba and this should be listed out castro. Yes. I went to cuba already in the early days for several reasons. One, there was quarantine because in cuba, most of the cupids with hiv were former soldiers in the military who are fighting in africa and came back infected with hiv were locked up basically. In a conversation with fidel castro, human rights is not something that is discussable, so we talked basically that its not effect the comment that it does not work in today what happens in cuba is when you are found to be hivpositive, youve got to follow a sixmonth scores, this is a few years ago is still the case, to prepare you for life if hav, the drugs out there and then many people become hav educated since everybody is a state employee, basically it doesnt matter what you do. But i came that im the first time i met a gal was in the metal of some kind of tornado and he was talking about how many liters how many theaters per square meter per province. And i said after, dante, i came here to talk about aids. I express my solidarity with people affected by the floods and cuba. And then he started talking about how many cases in jamaica, how many they are, how many they are. Anyway, sometimes seeming to figures better than i do despite the fact is that a professor of epidemiology, i have a hard time remembering these figures. Since then he said okay, lets have a drink in my office. So we went in the office and asked for water because i said said i just arrived from europe jetlagged and i need to make sure i do my best here. He said no, you dont drink water. No detail, okay. We are in cuba. To make a long story short, we then ended up, as he does sometimes, you cant than half of the government and the Vice President and we had dinner and talk a lot about all kinds of things, including the imminent decline of capitalism. It will be dead in a second. My century still hasnt happened. I would like michelle to join us. You end up deciding to go for the job of creating this new agency and the u. N. Called the unaids. It didnt even have the names and come up with this new entity thats going to happen. Theres too african colleagues. Kofi ahmed says the foyer, d. C. Is full of sharks. Hes not secretarygeneral yet at the u. N. At that time. Said also, so dont fall into the water and if you fall into the water, dont leave. [laughter] and then a certain Michelle Dumay who is that unicef at the time to see the story the chameleon. This one if you want to tell, what was the chameleon . What was that of vice . That was when we met at the chateau. What was the story . I think this story when they are 14 years old, they asked them to observe it, don and then ask them, what did you learn . In general, the children would say that changing colors found in portend, the most important is they taught you if you listen for life, they say the first thing is that the commandant is always walking without moving ahead. So its very important to have an object case. Project is set in a very clear manner. Second lesson is its good to have an active, but if you dont put that in there with your strength and your weaknesses, you will never move. That is the second lesson is the third one if you are just as clear come you try to never make people always your target because they can to see once, too, that maybe one day they will not miss you. So what is important to really give some space for people to give you what they know so you can learn more. And thats third. Fourth he says you have to be present in mice. A stepbystep. The fifth one is that even this commandant, if hes just one second before his target, you will never change this space. It will always have selfcontrol. Life is very important to have selfcontrol. The last one is added tatian. Well, this is like the story of creating unaids. What you describe is the entire u. N. System is against you. Its almost an miracle akin to exists. You describe episode after episode where he agency or by a vote that should not have been a rival Agency Representative from within the u. N. System was sabotaging what youre trying to do. Certainly from a number of agencies, you were an exception, but she gave me a hard time at the interview, but the rest was fine. [inaudible] she says she crossed about the list. [inaudible] winged a microphone. That i didnt know. [inaudible] by this time i read up on him. I had crossed him off, but i did interview him nevertheless. And of course the rest is history. No, that is true. There were several levels, particularly midlevel management where people who tell me will do everything we can to undermine you and make sure this doesnt happen. Nakashima was then the director general and basically he thought that in one year time it would be, how to say we will just kill it, et cetera. Too ridiculous to even talk about. When i was writing about it, i said how is this possible . To go beyond personalities, there is indeed an issue in the u. N. System, which is very rich in terms of its diversity and different agencies and everybody is looking for money, fundraising. So there is a lot of turf and all of that going on and i dont think that coordination is actually the solution. But i must also say that probably in dissent aids that we are the most advanced, best integrated. Theres nothing that comes close as far as i can see. So michel, its all one happy family now . What is difficult is it peter is talking about. You have a conflict in interest sometimes that people have to fight for their agenda. They have to make sure that are relevant. So to make the coronation of sometimes very difficult. What im seeing now is that we managed to be a little bit beyond the agenda, to identify and trace and identify key result areas, which is making a suddenly move collectively together. For example, its so important to save lives of people means what . To bring people of the center. We are not talking about unicef and others. We start looking at how we can add together. I think that is helping us. At the beginning it was not possible because it was coming and not understanding that the organization has been created in each organization was fighting their own identity with hiv. So the shop is a very tough one. This system is that its best when its surrounded very concrete outcome of deliverables and then it can. He just concentrates on process, as is often the case in new york, denison lisa time for everybody. So that is, i think my conclusion. Your body language tells me that you agree. [laughter] michel, today at this moment, tg 20 liters are probably drinking tequila and theyve had a day of accomplishing very little and also at this moment in rio, they are probably drinking rum and theres very little optimism for that meeting. We are in a moment where everything seems to convict on the euro crisis. The amount of money on the tivo keeps shrinking. The sense of generosity is shrinking and weve seen, since to decimate the financial crisis, ever greater dependency on one sowers, the United States government, which is now i think about 60 of support for international hav effort. What does this mean for you in terms of trying to court may tickle the response . I think its very important. Peter said something. He said the world is changing. 10 years ago when we were talking about elements, africa was nowhere. Every office seeks 7 , even highest growth rate for thanking god that 15 . Were not talking about emerging nation, china, presale is a key player in the new global government system. So for me, what is important today is what we are trying to push us to share responsibility, saying the world is changing. The Development Paradigm we have been using until now. So what we are trying to push a spring and different players. We have been able to work with the chinese and the chinese now are paying for their own is response, which is very important. We have been working with india. India has decided to pay for all their response mr. , so we are seeing south africa increasing to 1. 5 billion. So we are seeing the world coming in response to different way so many to push that. We need to make sure of course of a base justice that are the of opportunities because if not, we will not build a ticket. As in san francisco. I met someone there. I said to peter and his 72,000. How that can happen, if we know theres 9 Million People waiting for treatment in africa, we need innovation. So i am seeing that what they knew that coming, which is very important. I know peter very well, he was my bios, my mentor, one of the best probably we have. And this also visited community to not show what it has been able to do for the world because today if we save millions of lives, i want to say that honestly we were no knower 10 years ago when looking for result country by country. Why its not working. Today we have almost 7 Million People. That is peter. Peter moved us from million 2 billion in terms of resource privatization, demonstrating individual select to this indispensable to save lives for people and i want to say thanks to peter for that. Thank you. Thats nice, michel. But when you look at the index of this book, its only people i met some purpose. Why . Because i was maybe different person, anything going wrong anywhere in the world in terms of aids was my personal problem. But what i wanted to show was the same movement and there are so many people contributing, all equally important. It is important is making sure its not a movement, which sometimes it looks like going to all directions and trying to align the stars. The politics and science in programs on the ground are in harmony or supporting each other and that is going to be very important. Now, it is not normal to the global funds for your funded programs in argentina, mexico, chile, china and so on and i was actually basically denying money to the countries that are in the greatest need. There are countries, take zambia. According to projections that we did by 2030, 50 years after the beginning of the aids epidemic, we require 4 more of its gdp to treat people just on treatment costs. If we dont have to go to third line therapy. There is no way on earth that can be done without international help. But even poor countries have a budget. So there is in the case for shares solidarity, but also for smarter use of her resources. Let me ask you about the same question. I want a very quick answers so we have time for the audience. And i despair about to have the International Aids Conference in the United States for the First Time Since 1990, in washington d. C. Next month. When we are in the most hotly contested president ial election weve seen and i dont know how long, at this moment most experts you cant call will be the next president of the United States. The last time the aids community convened in washington d. C. , they publicly denounced a Vice President george bush during the reagan presidency and angered him so much that when he took over as president he said i dont want to hear about this. Get out of the room. If there is one message that the American People take from this upcoming conference and you have the ability to wave a magic wand and make it happen as opposed to many other scenarios says to what they very well have been, what with that message be . You know, im just coming from a listening tour, new york, washington, san francisco, oakland. I want just to say that itll be a missed opportunity to not say to americans that they are individual collective effort saved the lives of millions of people and that is not to please them. We cant across party effort to democrats because of a sense of urgency brought by president bush, it is constantly changing all of their response. And then we have president obama grab a bringing the debate to share the responsibility of ownership are just natural movement, which we need to share. That it hoped the same message we will be able to convey because the American People, individually need to hear that they have been saving lives of millions of people we are making effort to share the burden with other countries now. Peter. On the same lines, i would save taxpayers money has saved millions of lives and has also, i think, improved american image in the world to a large extent. Decreasing that effort now is not only going to cost millions of lives because people will die, but also i think would be from a good and smart foreign policy. Now lets see how our friend, the biggest problem at the conference may be how do american aids activists going to handle that. That is i think the biggest challenge. It is a good note to take questions from the audience. I ask that you raise your hand and wait until the microphone reaches you and be sure to identify yourself and give us a real question. I see one right down here quick and come down from. Robert martin for the rockefeller foundation. Thank you, laurie. Would you stand . Sure. Thank you for the book. I flew through it in a few days. Ive are authorities going to inspire the next generation. Following imac, my first question is what advice do you have for the next generation of global or Public Health leaders . The second question is at one point in the book, i think its towards the end when youre leaving unaids coming of Something Like like an Oscar Schindler bowman, where you think i could run more or it could have done things differently. So the question is, if you could go back and redo the last 10 or 15 years, what would you do differently if anything . The first advice is one, that the world is becoming a very global please come and so there is future and work in Global Health. Dont plan your career and detailed because he wanted to be boring and youll miss the great opportunities. I certainly didnt imagine i would ever become a u. N. Bureaucrat for discovery by race or whatever, but be prepared. Invest in your training and skills from all that you can seize these opportunities. There are many open doors that i dare that people dont go through them, so take some risks. Now what would i have done differently . I think probably politicized aid faster any sense. By that i mean that i started at unaids is quite naive in thinking that if we have the facts that this would change everything. Michel, you need this before i did. Of course that was not the case. It should have brought earlier to the big political agenda, that maybe it was not possible. I think that is probably the biggest. I still wonder, could i have accelerated thanks . Was also so. But on the one hand i have no patience for things and not the other hand, you have to go through sort things. I really dont know. Right here, gary. Standup on the police. I was so people am standing. So the question, gary colin for both michel and peter. In my more recent travels in Subsaharan Africa working with fantastic equal from cdc and elsewhere for fighting this battle, you get the sense that we are at a turning point. Out of office quite a tipping point, but the success and cons that given a three generation, use it trt for viral suppression , im getting a clear sense of signs of encouragement to impact the endpoint, if you will, could be in sight for the first time, making this a critical time to enjoy that moment is now lost. The first questions as you could get characterization . Sacking is what could help drive momentum forward . Alternatively, what could rescale . I think its a very good point and you know my optimism. For me, getting to see her with night vision, searing new infections, zero deaths. Of course absolute zero means nothing, but it is a vision for making it more inclusive. Taking the decision to say we dont discriminate people based on their race or based on their orientation or social status, it is their decision and we can get it. I see progress every single day. When i decided to push for syrian infections amongst amongst babies by 2015, supporting me very strongly by 2015, we dont need to have tb hiv. This feature and from where work at that. Today we are seeing again i would share this number with you, from last year coming to d. C. Or decreased by 100,000, the numbers of babies which were born with hiv last year compared to this year. We are seeing also an increase in numbers of People Living in this crisis. We see a new tab showing clearly that if we put people early in treatment, we can reduce by 96 a number of new infections. So for me, i am seeing hope they are. I want to push forward the ideas of getting 20 by knowing it would be multiple serious, but we can be there if we Work Together. For me, its time to really bring this approach because it will be a missed opportunity if we dont do that. I agree with the vision that we cannot accept anything less than a cent, but we also need to be prepared for decades of investment, starting with people who are now on antiretroviral therapy. We hope that will last and the effect is for decades with normal life expectancy. So we need to be prepared for that. And i think we are not prepared for it. Was a rising tide of joke resistance. The pipeline of new drugs is drying up and generic manufacturers are pulling out because the prices have become so low that they dont make and admitting to drug for diabetes and cardiovascular disease and the need for even greater in terms of units that can be sold. Also in terms of prevention. We need to have an ambitious vision, but also we should not we need to be prepared for longer term. There is kind of a momentum dare, where we see a return of the investments of the past decade basically because these things dont happen overnight. I think i agree with peter. We need to be able to manage the response of the perspective of the longterm. But we need now is to change complete their way to do the innovation. The type of innovation we have today, it is impossible for me to believe that she will go to 15, 20 Million People in africa if you have cd for machine everywhere. So the simplification, as i said in my letter to the partner, a red hill will simplify one pill a day and look up how we bring to help us to do no harm or groups to look up how we Work Together to simplify. If we dont simplify its not possible. They may give you an example. Just to make sure that the 9 Million People were waiting for to make that issue needing treatment will cost 700 million most machines are not working. So i reset the institute in australia in melbourne and their testing this will today in malawi with 1 dollar they can take the blood, three minutes later tell you if your cd for its about 350 or below 350. So for me on the can for those of innovation that can help shift the task to work being done by educated ecoand the interface between Service Provider and community and increase the demand. But if we dont ship to innovation, way. I should clarify for audience that the human immune system i very specifically targeted by the hiv virus. So as your cd4 count goes down, youre headed for his part said the case of the disease. We have time for one more question. I think i sought and stars of Family Care International but air. Thanks, laurie. I wanted to ask if you could, specifically in what you see as priorities and transcendent possibilities in Subsaharan Africa, the region where the problem of hiv aids is most severe in terms of population and in particular from the perspective of the longterm potential and the question of the most strategic approach in terms of dealing with hava is more or less of it or to publish your integrate cnet with the provision of basic health services, reproductive, newborn and maternal services, what you see is the most appropriate strategy for dealing with this in africa. I think all built on the peter david when we were working together to demonstrate that it is an exceptional disease and it is very important to bring that under the agenda, but since then, i try to take a set of isolation and that its not possible anymore to do with aids. We need to look at the intersection with the concept and hava. You are talking about hiv and Reproductive Health. If you say africa, three major challenges. One is women, women, but men. The whole issues of violence against women, making sure that when men could get other information on Reproductive Health so they can have less young girls being unnecessarily pregnant and abortion than others is one priority if we want to do with this epidemic. One will be suddenly human rights. On the human rights issues are making sure that all those people who are not part of the mainstream of society and how we address human rights issues, and their access to services unfair orientation. But for me its still education to make sure that young people are equipped with skills. I would go for those three as a major, major challenge. Of course others need to be there, but that is changed, which we need to address. Peter, final word. I agree with that. It can cost of their many africans. Its important to customize a wiki to Reach Society and that is something that is a big challenge for any global movement. We tend to have a bunch of experts come together and thats good for everybody. Frankly thats not how the world functions and thats not how any company works, consumer oriented. So we need also much better at finer analysis of the local technology, cultural, and satoru situation. And then also you mentioned these are generic issues that have to be applied everywhere. But then, lets take southern africa. He still have an incredible incident. Two, three, 4 per year of young women become hivpositive. There you need an allout effort. When you go west africa, a country like molly over senegal, its well within the new york city. They are fully integrated to do it in a different way and thats also the lesson in humility for the global community. Well, what to think peter piot for writing no time to lose. I want to thank transcendent and peter for joining us at the council on Foreign Relations today. Thank you very privacy. This is a little more than an hour. Genetically tackle a timely and thorny traffic of individual freedoms major social media. The Founding Fathers protected import rice from individual freedoms corroborate your privacy, right to a fair trial, for now, social networks create an entirely new set of questions and challenges. Colleges and employers reject applicants because the publicly available information and photos on a social networking site. Juror says details and ask their friends to vote on whether defendant should kota jail. Marketing Companies Face lawsuits for allegedly collecting information about citizens based on our travels on the web without knowledge or consent. How would the Founding Fathers have handled these scenarios . What would have been a social networking sites are subject to the bill of rights . We have a fantastic group of experts tonight to delve in to the subject, starting with lori andrews. Professor andrew strikes science, law and technology at Illinois Institute of technology. Shes also a program in cash or hell is a staff writer affords, where she explores law, to elegy, social media and personal information on the blog but not so private parts. Before joining ford, who is editor of the blog about the loss or she also has worked for such publications as the week in the washtington examiner. Jennifer preston a staff writer at the New York Times come or she covers the relationship of social media politics, government and reallife. Mispricing took on the beach in june or 2011 after the newsrooms first social media editor. A veteran reporter began her career right in philadelphia to bulletin newspaper in philadelphia daily news. She also served as adjunct Professor Club University School of journalism