risk of losing much of what we have already achieved. this is not time to relax our guard. we cannot afford to accept partial success. to fight malaria we have to maintain momentum carried we are either gaining ground or we are losing it. resistance to the drug is an insecticide is a very real threat. we have come too far to accept on the fight against malaria. in the face of today's challenges there's one primary reason that i am optimistic for the future of malaria, and that is the commitment and dedication of so many people here in the u.s. and around the world from scientists and researchers, program managers in the field, political leaders and partnerships including face based organizations and non-governmental organizations that have emerged to fight this disease. i am optimistic that we must face the current situation with the urgency. malaria fights back and the recent gains could be lost.

we need to be smarter and act faster. we must continue to fund the president's malaria initiative and the global fund. the funding saves the lives of children, women and entire families. we also recognize the funding is needed to develop new treatments and methods of prevention and to deliver more effective and affordable interventions. the gates foundation long-term objective is the eradication of malaria but we could only achieve revocation that we have urgently and maintain attention and funding today. we are committed to fighting for the long haul, commitment and leadership by divers partners including the u.s. government, african leaders, non-governmental and face based organizations and the private sector is critical. it has been an honor to appear before you today. i appreciate your time and i look for work to a productive conference. >> stifel as much dr. rabinovich for your testimony and leadership. we will now turn to dr. bate.

>> mr. chairman, members of the committee, thank you as much for inviting me to testify on this extremely important topic. just over seven years ago i testified before the committee on what was then a relatively weak effort against malaria. the united states government had over -- listened funding measures the most politically charged was the lack of these insecticides ddt that important was the lack of support for the better malaria drugs. of long after that hearing, the reforms and the funding began in earnest. the government started implementing all the interventions, the ramp spending on preventive and treatment efforts including the best drugs to fight malaria and it has already been mentioned progress was swift and impressive particularly in the locations and we have already heard about the president's initiative targeted the island of zanzibar and for those efforts and other efforts the president's malaria initiative in my estimation is deserving of continued increased support the south african -- the

southern africa is determining in eight countries starting with botswana and south africa with enough political will elimination as a possible that the relatively thinking it is good news. i would echo africom meant that has been made by every speaker so far, and i stress that it's good news because of intent on spending my time discussing some of the significant challenges that i see remaining and those discussions are going to revolve are not problems related to drug resistance and i could mention the agency's procurement problems which is increasing volatility and in certain locations we may get to those in the questions to read as it has already been mentioned the accommodations are the best treatment available, resistance is being noticed on the cambodia borders and resistance is likely to increase them and i'm going to go up and cover a few reasons as to why i see that to be the case. the first is the fake and a sub

standard medications or is significant and probably growing problem. it's uncertain how many there are on the market in africa but it is certainly not a negligible amount. many of these are inferior products that are not illegal in the countries in question. of the research team and a colleague read the world has done we found roughly about half of the drugs of the so-called controlled test contained so they are directly contributing to the resistance. they're also and increasing proliferation of brands and other allies in the many countries around the world nigeria has been mentioned nigeria and kenya have over two different brands of therapy on sale. i am working at the american enterprise institute he would not be surprised to know i'm in favor of the free trade and open market, but this is not a quality-control market. there is a considerable free-for-all in those markets and the quality control is bad

because the medical regulator of 40 in those countries are have limited capacity. there is a significant positive note that the u.s. government is supporting by the u.s. agency for the international development the very excellent program of the project on the quality of the u.s. from here which is combating fecund substandard drugs, helping develop the country medical regulator of for these to identify illegal medicines with the because problems most will on the market. again from the different research colleagues of mine have undertaken of the registered meds and the whole quality control test than the registered simply getting the medical regulation authority to control what is in the market for them is important. the u.s. program to the tune of $35 million his in my opinion continued increased support. the second major problem related

to increasing resistance has already been mentioned as the feel of the therapies. according to a deduction and attend the last six years to remove these from the market's in a friend in particular had some success but there's still some companies a few companies in china, vietnam and a lesser extent india still producing them, and this is again a major contribution. in order to combat those sales and replace them with act the team at the institute for medicine, institute of medicine mentioned subsidizing in the private sector were most people buy their drugs in the region around 70% of drugs are privately. the affordable medicine facility for malaria is currently being piloted by the fund in the country. this is an interesting idea. it may have significant impacts where it works well. but for my assessment of this, this is a project that has run ahead of itself.

it is not achieving its aim even though we are in the first year in the first pilot phase we are already beginning to see significant problems. for instance it is exacerbating existing problems with diagnosis. this is not unique by any means but it is increasing the number of people being treated with malaria drugs who do not have malaria. second, there are ordering practices going on. we've already heard zanzibar's eliminated the disease get to the hundred 40,000 treatments, act treatments were authorized by the global fund to zanzibar and 70% of all of the orders are for adult treatment, 70% for adult treatment. malaria is criminally a childhood disease. so there are significant problems that we are noticing out there. the subsidies are to massively reduced the price of the drugs looking in 37 pharmacies in nigeria and ghana and my

research team found the drugs were two to five times higher than it had been expected if they are lowering the price which is good they are driving up some of the therapies that impact is still worrying. perhaps worrying is that all countries kenya, nigeria, tanzania account now for 80% of the annual global act production capacity of all of those orders are fulfilled. that is a major problem. the united states government so far has been boycotted the a mfn and i think for good reason, and what you might wonder why i am mentioning this is the u.s. government isn't funding it i think that the u.s. government procurement programs of malaria treatment are going to be seriously detailed buy already know that there are serious problems in procuring medicines over the next six months. all in all the am/fm this reducing systems and causing medicine to operate on a first-come first-served basis creating huge problems.

the global fund already doesn't have enough funding to conduct round 11 and its publisher of funding for the amfm. it should be stopped now before it completes the initial phase. i like external like to find out when things work force. this is an innovative idea, and i, you know, if it continues for a fleeced through the first phase we might learn enormously interesting information but in my opinion in the u.s. government should press harder to end amfm or limit its scope before greater damages done to the distribution systems and is not going to much resistance. i could go on the potential challenges but i will end there. >> thank you para dr. bowen, please proceed as you would like. >> transnet, ranking member of the committee think you for the opportunity to testify on the great strides we have made and are making a jury eliminating malaria as a public health

threat. members of the committee on both sides of the or champions in the fight against malaria and your support has helped save countless lives. i would like to echo ambassador gray's comment that this is an under publicized and under appreciated success story against a disease literally as old as humanity itself. i am david bowen, the ceo and efficacy organization established five years ago at the white house summit on malaria. thank you come in bus or green from of that introduction. yours are very big shoes to fill. malaria no more works to raise awareness and build support for the fight among malaria and policy makers, the public, businesses and we have helped provide 2.7 million lifesaving mosquito nets. thanks to a global partnership of the government, the private sector face this organization and community leaders across the world, there of that remarkable advances in the fight against malaria. global malaria deficit fallen by over 20% in less than five years malaria cases have been housed in over 40 countries and

childhood death from malaria fell by 200,000. yet tax remained the unacceptable fact remains that malaria still kills a child every 45 seconds. to address the major health threat the president's malaria and a shift was launched in 2005 by president george w. bush with strong bipartisan support from congress and has been continued and expanded under president lot. since the founding, pmi has distributed over 30 million insecticide triet mosquito nets, provided over 67 million lifesaving antimalarial and treatments and more than 27 million people protected as a result of the indoor residual spurring. the success of the pmi have been many and a list of examples is provided in my written testimony. but here i will mention just two. pmi documented the 40% reduction in child deaths between 2005 to 2010, and in tanzania child debt fell by 28% in the same period. the success of pmi is inextricable link to the effort of the global fund.

an annual report the leader stated, quote, coordinating the pmi investment with local initiatives financed by the global fund is critical to the success of both the global fund and pmi. under the leadership of president george w. bush and with the bipartisan support in congress, the u.s. pledged the founding donation to the global fund in 2001 and the u.s. continues to be the largest single donor. by law, the u.s. does not contribute more than 33% of the total funding. there by leveraging $2 from over donors invested by the tax payer. the global fund provides nearly two-thirds of all malaria funding and has approximately 200 -- has provided approximately 200 million bed nets and treated 200 million cases of malaria. free pmi and its contribution to the global fund, the u.s. is hoping to win the battle against malaria today. u.s. support is just as indispensable to the effort to develop new ways of fighting

malaria in the days to come. a remarkable innovation in the fight as you have heard and you will hear further is the vaccine which is proven that additional protection against malaria is possible. since the days of walter reed himself the u.s. has been a leader in the malaria research and this tradition has been carrying on with distinction by the walter reed army institute of research which worked with the path to develop this impressive new vaccine. sustained support from malaria r&d is crucial in developing new ways to prevent and treat malaria as well as in combating the spread of drugs and insecticide resistance. it's made critically dependent on the robust funding we are making major progress toward the in which the world can say malaria like smallpox is the disease of the past. it cannot be realized unless the u.s. bilateral and multilateral funding remains strong. for the investment of less than 1% of the budget the u.s. saves

and improves millions of lives, helps build robust current and future trading partners to around the world and contributes to the national security. africom published a statement indicating that malaria remains a direct threat to the u.s. personnel in that command. more indirectly the justice widespread disease can contribute to the destabilization of the society leading to the failed states according to the national intelligence strategy published under president bush in 2005, quote from a field states are in refuge and breeding ground for extremism. investing in global health is critical to evidence in the economic interest in building jobs at home. history has shown the today's aid recipients often become tomorrow's consumers of american goods. 11 of the 15 largest importers of goods and services are for recipients of the u.s. aid including south korea, taiwan and brazil. the recent african development bank report report the income is

expected to triple the next 50 years. african countries as potential markets for american products can only be successful if the consumers are healthy and productive. the road to eliminating malaria deaths will not be easy. a fundamental requirement is the property of taxpayer funds we must and will work against misused funds in any form and will simply every mechanism to guard against counterfeit substandard medication. malaria no more is dedicated to achieving a measurable results. that's why we partnered with the african leaders malaria alliance to which african nations are holding themselves accountable by scoring their progress on country led efforts and sharing best practices. you've already heard from ambassador greenup of the leadership it's shown in the fight against malaria. i just want to highlight one thing which is the scorecard that will produce drinking each country on the progress against definable measures. these kind of score cards provide a clear public evidence about who is doing well and who

needs to improve. we are optimistic with robust support from the u.s. government we can continue the remarkable momentum of the last five years and bring forward the date on which no child dies of this preventable disease. as the result of u.s. leadership more children than ever before are surviving to see their fifth birthday and spending more time in school giving them hope for a brighter tomorrow. more parents are able to spend time working to improve the lives of their children, their families and communities. thank you for the opportunity to testify, and i would be happy to take any questions. >> dr. bowen, thank you. now the final witness. i do thank you for your leadership as well. please proceed. >> thank you very much, gerrans smith and ranking member payne. it is a pleasure to be here, and i appreciate all the number of strong reports from each of my colleagues at the table.

let me highlight a couple of things. one thing is this progress has shown an incredible speed of change and innovation as we've gone forward, and it's been done through remarkable partnership broke with in this country and across many nations. the second issue i will come to is this progress is fragile and we need to pay attention because while there is change and progress, holding that and going forward with it will be the true test for all the fuss. just a little history a thousand years ago we had just a name for this. malaria comes from bad air and that is what we thought caused it. it was just over 100 years ago that we actually identified the parasite and recognized the human transnet to miskitos and those mosquitos transit to other humans. it was just over 50 years ago that we embarked upon the

malaria revocation program will globally with actually huge success and you may hear different stories about that. but included in that was the united states eliminated malaria, and i was 19-years-old when a certified its malaria ratification in the united states when with the who. since that time we had a hiatus after that global revocation program. the scientists didn't stop working, but there was essentially no resources. and it was in addition to that the global malaria ratification program had never really gone to africa. it had left of the hardest place in the world. and at the end of the 1990's, particularly with the attention from the leadership in africa, we ended up with new leadership among the u.n. agencies, and then that followed with resources.

so this last decade the first five years was essentially countries coming together and getting better plans and we have that document, but the subsequent five years when the money came, that is the global fund was developed the initiatives in the world bank program all came together and funding went from about $100 million a year of external assistance to malaria in 2000 to $1.6 billion in 2009 and in 2010. unfortunately, $1.6 billion is actually still relatively small. but it has made an enormous difference in what has occurred. that is a more than tenfold increase in the funding and that's been followed by essentially the tenfold reduction in the incidence of infection, and that has led to the savings of essentially 1.1 million child lives in

sub-saharan africa in the last decade almost all of which has occurred since 2007. the hospitalization and the outpatient visits for malaria has been reduced by 50% in at least ten african countries and essentially almost all of the countries outside of africa. that burden of all of those health visits actually saves money. the number of blood transfusions has remarkably reduced and walked into the world that used to be full of children getting blood transfusions and today seeing that word with one or two patients sometimes empty is the remarkable progress that has occurred. the country should their ability to deliver this and that is a part of the partnership that has gone forward. we have had many interventions out there. we've always had concerns about whether or not this could go

forward with actual country leadership and countries demonstrating they could do the work. and as the doctor rabinovich mentioned the concept of the 190 million bed nets into homes is a remarkable logistics effort. it's not perfect. there is still much work to be done but that is truly remarkable. another issue in this is the fact that this money has gone widely and it's come from white places. so, u.s. leadership in this and particularly the president's malaria emissions at the combined contribution to the global fund has allowed us to do the right thing as americans and the right thing to influence global donors because it is through the global fund that we have additional leverage to encourage other donors to come forward, and that has proven to be remarkable. in addition to that, the global

fund has reached out and essentially supported programs and i believe 82 countries for the malaria control. and that is 82 out of the 100 nations that have malaria and with all due respect to the 18 that didn't get resources they're the ones almost ready to eliminate. in addition to saving more than a million child lives in the last decade we also have eliminated malaria transmission in the countries and certify that under the who leadership. we've set goals between now and 2015 to eliminate the additional countries all of which is thought to be entirely doable as long as resources are available. another aspect to be aware of is that some companies have invested in this and we've actually been able to document that.

some mining companies both for copper or precious metals where the company provided prevention to the work force and the families of the work force and then realize the decreased number of calls and visits and to improve productivity of the workers meant they got the return for every dollar invested they essentially made it back an additional dollar in the lower cost to improve the productivity , and that is a pretty good return on investment so there has been a huge amount of work and investment by many people. the financing nations, ourselves included, the many agencies, the scientists and the countries themselves we have a little bit of trouble counting the money of the individual countries that put in to malaria control. that is a hard number to come up with because the salaries of all of their health workers they

support the facilities they work in and it's true that in the logistics systems supported by external funding and the commodities that are supporting that actually allow them to deliver really and parchin services. this demonstrated a remarkable success is just as fragile as it has been innovative and fun. what we do today is actually categorically different than what we did just one decade ago. we didn't use insecticide treated nets and hardly any homes. we knew what the indoor residuals bring we were not doing it. we didn't actually have act to provide us the best drug, and we didn't have a good rapid diagnostic test which we have today. we actually have many of them today we can take out into the

communities and know where the malaria is. that is and as was mentioned earlier we have the cell phones that allow people to send text messages and their alert us of outbreaks or tell us about cases and their needs for those supplies tirso important. but that progress is an incredibly fragile and while the speed of changes remarkable, if we let our guard down and stop the resources flow, the speed of the reversion will be i'm afraid in our face. so, as has been mentioned this has been through bipartisan leadership in our country. it's actually been bipartisan leadership across the globe for the multi partisan leadership across the globe. it's been an incredible success and let me just highlight the roebuck malaria partnership produced and launched just two and a half months ago this

document on a decade of partnership and the results in malaria control. and i look to the committee to this should there be additional questions about the extent and the numbers related to the success. we do this as people and the number of us have actually come down from the american society of tropical medicine and the annual meeting begins held in philadelphia. that is actually a remarkable meeting. many of the people there are malaria experts, certainly not all of them. others look at particularly the neglected tropical diseases. but they provide huge leadership and have for a generation and will continue to do so for subsequent generations. that leadership in the science site is turned to the incredible success on the program side and that is what makes me proud as a scientist, as somebody that

cares about malaria and as an american citizen of our country's investment in this because i don't think there is any better. thank you very much. >> thank you very much, doctor. let me begin with questions and finnegan i want to thank all of you. you're full testimony without objection will be made a part of the record, and they are very much filled with recommendations and good data under the subcommittee and all interested parties in the congress want to become very well acquainted with. let me begin with ambassador grain if i could. you spoke of leadership of the importance of its and others who might want to step in and speak to this as well please do. how much u.s. funding is needed on the immediate term this fiscal year and going out into the near term to ensure that there is no, as you said, doctor, no speed of reversion. i think we have to be very concerned about. this -- we are in combat as

dr. rabinovich said. this terrible parasite as you put it malaria fights back of the recent gains could be lost. there was very telling and obviously very true. so if you could, start with that. and then secondly, ambassador green, you talked about the mali area early epidemic detection system. you talked about how the meds have been created and how well it works, and i'm wondering if this best practices being replicated and quote if anyone else would like to touch on it anywhere else it seems to be that when you prove something and present well it will be rolled out as quickly as possible and you also spoke about the importance of the face based collaboration, and i, too, believe that with the aids pandemic without full cooperation with the faith based community particularly in africa represent over 70% of all of the health care that is delivered through the health care

institution or clinic to bypass that would mean fewer people get the antiretroviral and hiv/aids and as well as testing and the other important things. but you highlighted how the catholic bishop, how the catholics and the muslims are working so well together to train 300,000 imams, priests and ministers to carry out the messages to villages throughout nigeria. if you could maybe an elaborate on that a bit because it seems to me that is not only an important health care initiative, but also mitigates some of the unnecessary and deleterious animosity between muslims and christians in nigeria where there has been a flare-up as we know in recent months and years. >> thank you, mr. chairman, and i will attempt to partially dhaka the first two questions you asked with respect, particularly with respect to the

funding i would rather defer to my colleagues and dr. bowen can talk to you a bit about the state funding and the funding request. what i can say is the what separates the malaria challenge in our approach to it from some of the other challenges and choices that respectfully you face and you face here in congress is again we know precisely what to do. that this is a question of our willingness to invest in the necessary resources. again, the technologies are fairly proven. it is a financial challenge and a challenge in our commitment of leadership. andy that has come up a couple of times in the testimony that i would commend to you is rear admiral tim on the initiative who i believe is an outstanding leader and not just a global health but in logistics.

.. he is able to tell you precisely what we need to be able to go into certain countries and add them to the list of those nations that will see a reduction in malaria of 50% or more. and the same is true with respect to your second question. meets was a project developed and piloted through the

cooperation between the presence malaria division and the country director dr. mcelroy working in tanzania with public health leaders and tanzania and zanzibar and particular and it was launched just a couple of years ago but again has already showed remarkable progress. went vegan count on is that he will in fact take and use those best practices and spread them wherever we can. one of the things that may be, one of the reasons it was pioneered in zanzibar is because 's because we had seen such progress down to the point of below 1% affection rate and the question was what the success looked like. when is it that we can say we have crossed the goal line? meets is an effort to do just that. it is an effort to take the remarkable gains that have been made in lock them in and to take those final steps to stamp out whatever god willing minor infection outbreaks that we see. with respect to the faith-based

story, nigeria in particular but in other parts of africa it really is remarkable just as you pointed to. it's remarkable for two reasons. its advantages are really twofold. in terms of being able to deliver a product, i was always amazed as ambassador win organizations from the west with come to me and talk about reaching out to other parts of the country and having no concept whatsoever about the logistical challenges that presents. these are remote areas that are oftentimes completely cut off in terms of modern media access, in terms of the traditional infrastructure that we have become accustomed to. faith leaders of course are well-established in every corner of the land and so when you are able to enlist the armies of compassion that come from our faith leaders you have built-in distribution networks that can move products very quickly. the other part to it that i

really want to focus on is faith leaders are able to pierce through the lack of education and knowledge that in some ways is the most daunting challenge that you are facing in some countries. when i taught school in kenya, my students were absolutely convinced you got malaria from rain and you can see how they would jump to that conclusion. that would be relatively harmless except if it comes from rain why would you sleep under a bed net? and so enlisting respected faith leaders whose voice and opinion is held in high regard and trusted and listen to, they were able to pierce through that. i faced a similar situation last year when i went to liberia and part of the reason for that was with malaria no more, where we did a focus group and we asked the young mothers why they

didn't sleep under a bed net, and a lady said to me that she couldn't sleep under a bed net a cassette night when her spirit left her body and went out into the village, that if she slept under a red net it might not be able to come back. and american recovering politician can say over and over again that is not what happens and that of course is to no avail but when the local faith leader comes and says, this is what, this is why we need to do this, that's the voice that makes a difference. the nigeria story is the most remarkable in terms of numbers and it really is a model to hold up as a success and i think we all owe a debt of gratitude to the center for interfaith action against global poverty, another gates funded institution which has spearheaded this from my perspective of the but the best news is it's not just confined

to nigeria. the story is in many other parts of the continent as well. >> if i might just pick up on two points and first very briefly on the faith-based organizations, until recently i worked for the gates foundation and one of my most memorable experiences there was traveling to northwest nigeria and working with the sultan and the emir's and i had the privilege of being able to address a meeting called by the emir of kwon do in our room that felt like it was about 120 degrees where the entire leadership from northwestern nigeria was there and win the emir said please cooperate with the polio vaccination campaign, that message went from the emir to the district heads to the village heads. it's an extraordinary reach. just on the funding we certainly strongly support the president's request of 691 million for pmi and 1.3 billion for global fund.

the math here is grim but inescapable. for every 50 million-dollar cut under the 2011 levels, that means 1 million fewer of bed nets distributed and 2.5 million combination therapies. >> thank you. >> i would concur with my panelists that the funding requests from the pmi should indeed be met as best as possible. i think we also need to think tangentially about funding efforts that will improve malaria treatment and so i will refer to the remarks i made before about usaid funding and their -- extremely important role in the confidence to help the medical authorities in this country. that is very important to control for quality of drugs. the funding of the global fund, think the global fund is a

fantastic organization but recently the high-level independent review panel recommended the global fund and i quote, mandate the outsourcing of drug storage and delivery is the norm except with local institutions according to international standard and the global fund's board of the 24th board meeting merely decided to give consideration to this recommendation rather than to give it implementation. in certain parts of africa where my colleagues and myself to a certain extent have looked at the private sector markets where there is a ct. in one study we did, 28% of the drugs, the at&t sale projects stolen from the public sector. that's because of poor management. i think that the u.s. should be restrained the global fund as hard as a canned -- can to not only look into their recommendation but actually enact them or perhaps essentially restrict the funding from the u.s. government.

>> dr. schmatz you identify the growing threat of persistence. as a key challenge to controlling malaria, dr. bate you talked about monotherapy and six years ago demanded the manufacturing stop making and selling monotherapy's and it.out that producers in china come india and vietnam in particular ignored policies and continue manufacturing these drugs. and dr. bowen you talked about drug quality in your testimony and you note, i think some progress being made, but what about those countries that continue? it seems to me that china which increasingly is garnering the market on the manufacture of drugs of all types, this could ea serious detrimental effect of trying to use the ac tsu talked

about in your testimony. why are the w.h.o. policies teeing ignored and resisted by the manufacturing companies? >> the extremely good manufactures in china and india and perhaps in vietnam, i know them less well, our getting there products into the market and that is one of the reasons why there are so many different rants in so many good acumen aerials out there and i should have stressed that before. the problem is that you identify correctly some of the manufactures are not adhering to that. the only immediate thing i can think of doing is to in every sense limit donor support for any manufacturer that is selling the monotherapy even if it is selling in a ct so do not fund the a ct from manufactures that still are in breach of the guidelines.

that's the only short run thing i can think of to do. >> one aspect of that i think that does work is for global funds and other donor organizations in many cases countries cannot buy drugs that are not prequalified via w.h.o. so i think that is really important standard to set and to stick with. not that you can enforce it everywhere but the funding use from these donor organizations can't be used for those other products won't be an at least it will focus you towards the ones that are better quality or drugs. our mandate and everything we to do is to focus on the quality of drugs approved by the rigorous regulatory agencies and all the things we are bringing forward in the future and to make sure those quality standards are met and again, those drugs would be prequalified by the organization to be the ones that could be bought with those funds. it's much more typical of course in countries that deal with drugs coming from other sources.

>> and i would add just one comment which is that the ultimate response to your resistance is really two-pronged. one prong is to implement the safeguards that were identified against the use of counterfeit and substandard medications but this is ultimately an arms race with a disease itself and you can slow the pace of that erratically controls and we certainly should. but the other prong of the response is robust research and development so there is a constant stream of new approaches and new treatments. >> mr. chairman, just a couple of quick additional thoughts. you have put at the right way with respect to monotherapy's and that is focusing on the producers. some might be tempted to ask, why is it, why can we ban these in country? of course the difficulty is if you are a poor family in tanzania and you have access to a monotherapy which you are told will in fact address malaria for

you, although in the future it may lead to resistance, but it's months less expensive. it's very difficult to expect that family not to take the less expensive drug because of course in so many cases there are profound challenges of poverty so you are focusing on at the right way. secondly, i would hearken back to the african leaders malaria alliance and really the banding together of heads of state from all across africa has been a remarkable development and they think offers great hope in this area. dr. bowen put up a scorecard. i have been very impressed with how strongly they have tried to share best practices and quite frankly hold themselves and their colleagues accountable are those standards. so again, think the emerging african leadership does offer some real hope in this area. >> dr. steketee in your testimony and you raised so many

questions in you all do. time does not permit. we will submit a number of written questions for all of you but dr. steketee in your message number three you talk about prevention in pregnancy and point out the coverage of women with intermittent preventive treatment for pregnant women has been slower and not as well supported as might have been possible. efforts in this area need to be doubled to protect susceptible women and their newborns. as we all know malaria contributes to an eight to 14% of low birthweight. obviously that decreases significantly in a child's chances of survival and i'm wondering what your recommendations would be there. is that something that from a policy point of view has not been emphasized? >> thank you very much for that question. i actually spent much of my science career looking at malaria in pregnancy and its prevention. it's interesting, this is actually a relatively easy and

low-hanging fruit and where people have paid attention to it, the programs have done quite well. that is we have gotten both the insecticide treated nets and the intermittent preventive treatment to those pregnant women. it's typically administered through existing anti-natal clinics and anti-nato clinics actually are some of the best attended health facilities by the target population so the women, and one of the challenges has been that has been just a little off the radar. it hasn't been as important as the insecticide treated nets and the spring and everyone of course needs drugs to treat the -- its two doses or maybe three doses in the course of a pregnancy of sulfadoxine which is one of our least expensive drugs out there and we are looking for new drugs as well but in the scheme of things, having said that, this was

actually raised at the malaria forum last month and it was highlighted and there is a process underway as we speak about looking at some of those policy issues and some of the performance issues and solving them and experience says that they are actually relatively easily solved. it's just a bit more attention needs to be paid. >> yes, actually tomorrow morning at 7:00 in the morning in philadelphia a meeting of the partners will occur because they think this one is so off the radar due to lack of attention. the drug is cheap. this is really doable. prenatal care is happening. it should be delivered and the resources exist because of the global fund and pmi funding and countries. we just need to make sure we pay attention and work with the leaders and hold ourselves accountable. tomorrow morning, we are on our way. >> thank you. i just want to comment on the

resistance question that you asked earlier and that is that i think one of the big roams we have with the current resistance of the ac team now is the drugs that are the combinations in those six dose combination drugs, both components at one time or used as monotherapy well before the time people decided, actually with hiv that led to the understanding of putting two different drugs in two different mechanisms together you can delayed resistance and extend the life of both of those drugs. we unfortunately didn't have that luxury in the malaria world because the ones we had available to do these combinations with started been used quite freaked only before that for many years as monotherapy resistant to both of them and the parasite populations. so even when he put it together there still that potential. the gold going forward is the new drugs we develop need to be made immediately and never be sold or available as a single entity. that would definitely extend the life of any of those new drugs developed going forward.

>> dr. rabinovich you mentioned we are much closer to having a malaria vaccine that works through significant efforts by the malaria vaccine initiative and many partners. you said it's possible the malaria vaccine will be available by 2015. now is that possible or probable and how far are we in terms of, and dr. subtwenty talked about this and all of you did really, the whole resistance problem. at what point does our current azt treatment or whatever the best treatment is become obsolete? we are in a race with time. how much of a razor weekend and finally to the doctor rabinovich but could you said the gates foundation invested new drugs and methods to control mosquitoes. the bbc in august and i'm sure you all saw it, did an article about a mosquito holding the promise of -- and of course it talked about developing 10,000

mosquito embryos and tiny fragments of rna designed to turn off the chain that is essential for normal development in mosquitoes. is this something that is promising or do you give much weight to this as a way of controlling the very population of mosquitoes? >> thank you are those questions. let me take them one at a time. the first question you asked is about a vexing and the results that were published in october are the pulmonary results, the one-year results of the rts's vaccine which has been tested at 11 sites, seven countries in africa. that trial is ongoing and they think for full transparency the first year results were presented but really we need the full results not only from the toddlers but from the babies and we are going to have those results available to look at in

2014. now it needs to be evidence-based. if it works, and protect children for a number of years we want to made sure there is no rebound. it's something the advisory committee, the w.h.o. and the countries will consider for use but it's not a perfect vaccine. the evidence so far is that it's about 50 or 55% efficacious in preventing malaria and preventing clinical illness from malaria. so we are going to have to figure out how that compares as to bed nets and the other measures that are available when those data are available. so the story still is, still be told that it's a first time we have really shown a large enough population that you can have an impact with a vaccine. the second question you asked was about resistance, and the place where resistance has been shown has not been in africa. we are all scared to death that it will actually move over to africa. historically resistance for

reasons that are not totally clear to us i think have begun in vietnam, cambodia, asia and then migrated over to india and hopped right over into africa. it was recognized by plant studies looking for resistance. these have to be small pilot to studies to evaluate how well the drugs are working. it was recognized along the thai cambodian border and the partners of bilaterals have gotten together to actually work to decrease the amount of malaria there and ideally eliminated because of fear that it would move onward. that really is a global crisis that they did. we did lose azt's. we are very excited about the portfolio. i call it odd because it would really be a wonderful thing to have. but, they are not available yet and so we really have to pay attention to resistance to a cts today. the third thing you asked was about mosquitoes and i think

that it is important to consider not only new drugs and vaccines but also in ways to control mosquitoes because we know that bed nets right now, that nets and spraying are at the core in africa today. there are several approaches. the one that you referred to is the genetically modified mosquitoes so they cannot reproduce. that is one idea being tested and another is having actually an infection within a mosquito that requires approaches and their may be other innovative approaches not just insecticides, that would ultimately help us decrease the risk at being bit and infected mosquito. all i can say is we need to look at their safety. we need to make sure that they work and then evaluate them to see which one gets introduced.

and there will be concerns in the global stage about genetically modified organisms and i think that is why i'm saying that the data needs to drive the full of valuation for inclusion in the global program. thank you. >> dr. bate. >> just 1.which, on the research agenda. although this is a hearing primarily about treatment i think it is somewhat worrying that i think only 4% of the global malaria budget is spent on areas of insecticide research them regardless whether it is residual spraying orb bed nets we are going to need better insecticides and with the exception of the gates foundation which there's very little effort in that area. is probably more contentious. people don't like insecticides but i think that if that is going to be an area in the short run that needs to be ramped up the coast until we have and i mean this is not to downplay the vaccine.

i think that would be fabulous but until we have a much more effective vaccines and i think we are going to need to continue to need insecticides and new ones at that. >> just one last question before yielding to my friend, mr. payne with regards to -- control which doc or steketee talked about in his testimony. are malaria bearing mosquitoes spreading despite all of our efforts? obviously bed nets protect individuals during the most fearful times at night during sleep, when children and adults could get it, but are the mosquitoes that bear and carry malaria spreading in their borders? i mean i chaired a lyme disease caucus here in the united the ud states congress and we know that you know, the lyme disease bearing tech particularly the deer tick, every year expands

and unfortunately now affects people with disease. what is happening? should americans be concerned that malaria has come to our shores for example? other countries that are abutting africa and endemic areas? >> thank you very much for that question. you also raise the issue of borders and which becomes an interesting thing. and i just highlight this because i think one of the potential progress is here in particular with elmo, the idea of african leaders actually banding together for leadership purposes and allowing them to cross their own borders with the right ideas. so i would just put that as really a critical issue. so the movement of mosquitoes, so most mosquitoes actually, they would like to move as little as possible. it's a pretty tough life out there for them. it's a fragile little woman

mosquito because those are the ones we care about. she would like to go and find a very close body of water to lay her eggs in and then returned to the house where she came from. and so she has very little incentive to go across borders. so for the most part, the mosquito itself will not be the big transmitter going across borders. it's actually as people that moved the parasite and make us concerned about that. having said that, we think of populations of mosquitoes and if you have a very good intervention, which we do with insecticide treatment and residual spraying, that intervention has been shown to essentially kill all of that population that has the particular behavior of feeding indoors on those people sleeping at night and essentially kills all of those. now there may be in the midst of that population a few that didn't read the textbook and they go out and they have write somebody outside and they get

their blood meal and they are able to continue. they stay outside of that immediately targeted area of insecticide. so we end up with actually an evolving population because of how good our interventionist. we have left remaining those few that don't have that behavior and they start to look like we have created the wrong thing. that is, we have now allowed them to survive but we killed some of the others. mind you those are the ones that are less likely to bite endorsed and a little less likely to transmit on going so they actually become a weaker and weaker transmission for the malaria. we may need to go after those and as insecticide -- evolves in the because we are learning to discuss and it's going on again as we speak, there is -- w.h.o. has produced a draft document

for controlling insecticide resistance which includes the idea of rotating which is a lot like using combination therapy for drugs, rotating insecticides so that we are not allowing a population of persistent mosquitoes to evolve. so i think there is actually a lot of work being done on that and as long as we don't lose sight, and i will highlight the idea that research on going on insecticides is actually critical in the midst of this and we do need that. >> thank you. dr. dr. bowen did you want to comment? speech is one brief comment. a lot of previous comments have focused on the high-tech methods for mosquito control and those are all very important that there is a lot of low-tech work that can be done. for example we we are working with an organization and senegal with the french acronym which trains people to the community leaders and just do very simple things to stop mosquitoes from breeding, making sure that there are tires lying around that can

serve as pools of standing water in a sort of thing so it is a partnership of high-tech transgenic mosquitoes with a very low-tech making sure there are tires lying around in the village. >> mr. payne? >> thank you very much. a very in depth discussion. according to w.h.o. and anyone can answer, insecticide treated nets that were distributed between 2007 in 2008 need to be replaced. what steps does your organization take to ensure that the nets will be replaced as needed and in your opinion, what should they -- what steps should the donor community take to ensure that the nets are replaced? and also, if you could even,

preceding that question, there was always some concern about the treated nets and there was i think the initial opposition in some countries. could you tell me how that has been overcome? i suppose it has been but do you still find some resistance to that and secondly, how do you keep account of the replacement needs for the nets after several years of use? >> let me take that question. we have actually worked with a number of countries now in that process, and this is where the the country logistics systems have really dramatically changed in the last few years. i would say that in 2005, 2007 we had a hard time understanding exactly where the nets were

needed, where they were, where they weren't and how do you understand when to replace them? we have now gotten to the point where almost a village by village in many countries, they have a roster of nets in households, which ones are short of nets, which ones are ways of measuring or of picking up on who lost the net? maybe it earned last night under the stove for the kitchen. maybe it's just now torn too much and registering its laws. so the systems are categorically better. for example we have been working in zambia a lot. zambia has district by district regularly updated numbers as to how many nets they haven't stopped. how many nets are in households. how many they anticipate needing to replace in the coming year and with the resources are.

i will just highlight one challenge in the midst of that and that is unfortunately, it's the ups and downs of funding that determine that tranche of insecticide treated nets that come to the countries. if the country doesn't have the money to procure, they hold off and because this is so seasonally tied in many places, if you miss one season you allow your entire population to just be inadequately protected for that season. so one of the challenges for the countries has been to take that information and try to match it with some consistent funding so that they have got supplies when they need them. >> thank you very much. so, the question, just listening to your answer, really has a lot to do with the matter in which the individual countries have

worked on their health systems, delivery systems and how have many of your organizations worked with the basic things that you are mentioning, keeping inventory, making sure that people know that a program is going to start? is there any program, and i'm sure you do, that's going to communities to build that kind of very basic infrastructure? >> one of the areas that we are working in is again, innovation doesn't just happen in a lab. we are trying to buy an innovative ways to communicate with communities and having cell phone technology and other kind of mass media to let people know about the need to use that that's properly is another way

to make sure that families are using the bed nets every night and are using them adequately. and i'm sure others can comment on some other things that are being done to build up the health systems. but also i think your question highlights the fact that ongoing funding really is needed because it's not adequate simply to buy one tranche of that nets as you pointed out. there's an ongoing need to replace as they get worn as the long-lasting insecticide ultimately wears out. >> i think first off the most important thing to remember is that no program, no plan will be successful if it isn't a partnership between donors and leaders in country. i mean i think a basic rule is you can't want it more than they do. in other words, these programs have to be built around in country, innovative leadership

that is committed top to bottom to getting this done and when you take a look at those countries where they success has taken place, those are the countries. in tanzania, when the president talks publicly about sleeping under a bed net himself, when he takes to the stage at concerts with malaria messages. when that kind of leadership is shown and when clear signals are sent her out the ministry of health and leadership all over the country, where faith leaders are enlisted, that's where it takes place. also in terms of our response to malaria interventions, i think a very innovative program that really hasn't gotten enough attention is the involvement of the peace corps. the peace corps volunteers, in some ways this was pioneered in senegal and malaria played a huge role in that. peace corps volunteers have been very effective in using the typical volunteers ingenuity and

sense of can-do in malaria messaging and working with leaders in keeping track of the logistics front. so, his partnerships across borders and across oceans and his partnerships across cultural sectors inside the country that is make in the difference. >> there is the debate i think in the millennium development goals, the question of control versus illumination and when we get into you know, limited funding especially now that we understand that the lovell health fund, the number in spain and italy, some are going to be unable to reach their goals across their financial situation. we have the 2-1 and bios that actually reducing our appropriations supposedly.

we restrict how much the others can give. how do you see this, us being able to kind of get through with a combination of the european problem and the possibility for the global fund in particular, of the cut in funding? yes. >> i think they're a number of things that can be done and are being done. the first is to look for efficiencies and countries in the global fund has prioritized those. they call it value for money but it is actually looking for the most efficient way to use the dollars and to make sure that you are getting the impact that you want. the second is, and they think was announced that the lovell fund board a couple of weeks ago, which is to focus on the most fragile countries so that

lower middle income countries are no longer, or few of them are receiving funding. brazil offered not to receive funding but china will not receive funding, allowing them to focus on the poorest countries that actually don't have a lot of alternative ways of funding the sustainability of bed nets and the treatment. and i think those things go part of the way toward dealing with the temporary gap in any single country to be able to get but i think we have to look at the bigger picture given the impact not only on malaria fight hiv and tb, that this is a priority program that has really been recognized for its effectiveness and ford's impact and to figure out how to sustain it for the longer term and i think that must be a priority. >> yes? >> looking at whether it is nets

or springer treatment, it's a bit like garbage disposal. is only sustainable if it's paid for in the real question is how it's paid for. anle i do concur with many of the remarks made in answer to these questions i do think that there are some african countries that are in a parlor state and really are not able to contribute as much, but some of the countries have significant wealth and have significant corruption problems. maybe we have an opportunity here, i'm thinking of nigeria and angola with her considerable oil wealth, to step up with more than what is currently the situation. that is not to deny that there aren't major problems and that the eight communities should not do what i can but given conditions these may be opportunities to press harder for the nation's most effective to step up a little more themselves. >> yes, dr. bowen. >> just to pick up briefly on

that, there clearly is a great need for financial transparency. that's why one of the things that alma is doing is, measures and not just about public health measures. there things like financial transparency, removal of tariffs on antimalarial goods and preventive bed nets and products such as that, so i couldn't be more supportive of ambassador green's leadership and we are delighted that ellen johnson sirleaf is coming in as the leader of alma and i would also agree with dr. sethi's comments that it's important to squeeze the most value for money out of every dollar, euro or yen that goes into the global fund but ultimately of course the united states is the indispensable nation in this and if the united states isn't there, the effort will be significantly in peril. >> if i can, just a couple of thoughts that i think are

important to put on the record. remember this challenges unlike some of the other development challenges we are taking on. half measures don't work. this is not a situation where you can extend out filling the jar with couples over more years. there really is a premium on the mobilization of resources. you either do it or you don't do it, but sort of crawling along slowly, you won't get the return on investment. one of the remarkable things about the malaria challenge is again, we know what to do. and in zanzibar and other parts of the world, there is clear evidence of that in one of the things we have learned is, an integrated mobilization of resources is what makes the difference and so one of the things i admire about what tmi is doing is when they take a look at those countries, they can go into, they don't simply take their resources and divided

up a 50. they instead look and say okay here is leadership, here is a definable challenge. we look at the math. we can do this. let's do it. what that means in some cases is there are terribly impoverished countries, where there are huge problems that we would like to go into and try to make a difference but we are resource constrained. there are other countries that we look at and perhaps they aren't as poor, but we look and we say okay, we can do this. we can defeat this here and as you take a look at the overall challenge, those are the choices you have to make. but it's important that we understand, you have to mobilize, you have to mobilize fully. you can simply extend the south and go on the cheap. if you do sadly, we won't get there. we won't be able to fill the promise.

>> with the new alma project that you mention, and i was very impressed just looking at the schematic there. how long have they been putting out that report, that thorough? >> this is the initial scorecard but the plan is to keep it going and to use this as a touchstone for responsibility and for accountability in the fight for gus. >> i think that you know, nations like that are supposed to be a move in that direction and it kind of had some stumbling blocks, but i think that once nations are held accountable, that they are compared to others, i think what mode abraham is doing with his whole question of raising heads of state, i think is really putting the spotlight on and i do believe that we will get to the point where you know, 10

years ago people wouldn't even discuss corruption and these things that have been going on. you know, for decades and of course we also have to work more on the european countries as many of you may know. the corruption has not been illegal in most of those countries and as a matter of fact i think it was in germany, you could make it a tax-deductible item. you just have to declare it, but it was not, it was not considered criminal. it was considered the cost of doing business. so if we can work more on the corrupters, you know it's a two-way street. it doesn't condone those who take corruption, but i think that those who are offering it, and like i said, traveling in

africa for decades and decades there was a practice that was just part of it business portfolio for a number of the european countries. so i think that it's a two-way fight. we have got to continue to work in exposing it, having reporting, have things that are verifiable and having things that are out in the public so people can be judged on what they do or do not do. just lastly, how rice has a problem is the sale of counterfeit adore adulterated or poor quality drugs? do we have any fixed on that? is there anybody who is really monitoring that? do we really know how bad it is? >> the short answer is no. we don't have a good handle on the problem. a lot of the data that has been collected is not easily

comparable. there is no -- . there is a significant substandard and falsified drug program, products of which are either intentionally there to mislead people are or more likely i think in the poorest countries in africa, drugs which have been made legally but are just not up to the standards and also in addition to that you have a problem of storage and transportation which leads to degradation of the product so it depends on how you define it as to the numbers you get. but most of the studies that have been published, we should do any level of comparisons from one location to another, followed reasonably tight protocols. you are seeing at least 10% of the products failing quality control and in some markets and some drugs and antimalarials it is considered behind that but we don't really have a good handle on and these numbers. >> if i could give you an

example from the diagnostic field, we funded the foundation for innovative diagnostics to work with w.h.o. to evaluated diagnostics and of the first more than 100 diagnostics only about one third were working the way that they should. no that information was sent back to the global fund and pmi and other funders as they focus on the use of good diagnostics which then becomes a the basis for credible diagnosis at the field level, which is necessary for adequate and appropriate use of drugs. but it is the quality systems, not only -- the same thing can be said or control tools. did they really have an insecticide that will really last three years or whatever the advertisement reveres? these regulatory systems, the validation systems are really important to the ongoing credibility of the program and really needs to be part of what is maintained. >> thank you very much. we will certainly continue to focus on this issue actually thursday of this week.

we are going to be cohosting an event with path and roll back malaria where the whole question of rts and the discussion about malaria vaccinations continues on and the 15th anniversary celebration of i abi and where mr. gates and some of his folks were about a month ago, where the whole question, as you may recall, dealing with the vaccine. i think that is the goal, the goal that we need to continue to move forward on and then we won't have the debate. the question that i almost asked about, should we spend money on trying to prevent or should we put it on research? we should get a vaccine and then we don't have to worry about it.

once again let me thank you all and i yield to the chairman. >> thank you very much. mr. bate just a few follow-up questions and our final questions that we could. dr. schmatz, could you discuss more of a single dose cure for malaria that was in your testimony that's in development? how long are the trial phases? >> currently in phase 2a, getting to do bigger trials down the projection is that if everything goes smoothly, we are very hopeful from what we have seen that product could be potentially available around 2016 going through all of the steps along the way and the process. and pulling all the stops out as well to get there. >> let me ask dr. steketee. you in your testimony point out that poor countries over the past four years united arab emirates morocco morocco afghanistan and our media

certified by w.h.o. is having eliminated malaria, the first countries to achieve this distinction and 28 years. are there other nations that may be getting close to that distinction? or any of those nations in sub-saharan africa and if anyone would like to talk about this, which countries in africa and i know dr. bowen did it raise up a very detailed chart, which i will read carefully later as i'm sure this will but which countries are doing the best across the whole broad range of combating malaria and who are the laggards? dr. steketee. >> thanks very much. because this issue of eliminating malaria is obviously where many many nations have put that in their current plans, that is what they're they are wanting to do. in the discussions that led to the updated roll back malaria goals for 10 countries to eliminated in the coming five years, they actually did that

because there are nine countries that are in the w.h.o. european region. now this is not western europe. this is a set of relatively small countries that have almost no malaria but they have little pockets of it and those are slated within the next five years to hopefully eliminate their malaria. armenia was actually part of that group and just acquired elimination two months ago. so yes, there are a number of countries in that stage. in terms of other places, you asked specific we about africa. as ambassador green has mentioned, a small part of tanzania, that is islands off the coast, are actually not very far away and this is the case of making the decision, do you go for it and when you go for it? in that sort of subnational setting but because they are islands, clearing islands tends

to be both easier and something that you continue to sustain. now, the other places in sub-saharan africa, first of all south africa still has transmission but in focal areas along its borders with zimbabwe and swaziland and mozambique, and that is alive because not the mosquitoes moving across the border by people moving across those borders and they are in particular trying to pay attention to whether not they can eliminate it. this is actually a pretty important discussion because that's southern cone of africa, swan swan swan and maybe a, zimbabwe, once a gift beyond its political strife it has an incredibly strong health system and -- or did and it's been hampered in their recent years particularly from the political strife, but that could turn around and if that does, you could have namibia, botswana,

zimbabwe and swaziland is actually quite close. just north of that, i mentioned we worked a fair amount in zambia. there are parts of zambia where you can now count cases and districts on your hands and maybe hands and toes. that is new and that is why i'm talking about this budha will change and the innovation has got us thinking and got countries talking about what it takes to do a lemon nation. the other place in sub-saharan africa is over in west africa particularly senegal and gambia have recently shown remarkable progress. northern senegal has districts where over the past year they have had trouble finding any malaria. so this elimination happens in these countries step i stepped, district by district that both senegal and gambia are meeting and talking about how they can work both across their borders and jointly against the

parasite. and then lastly i will mention outside of africa. in the americas, you know, the americas have been incredible progress and if you look country by country, particularly in central america, of that also in south america, we are not very far away. we are talking about a few deaths left. mexico, just as an aside, mexico is a huge place for u.s. visitors to go on holiday and we used to identify that we would recommend from the u.s. that our citizens take prophylaxis when they go to mexico and that was actually the largest number of the use of prophylaxis for the citizens of our country. that malaria in mexico is almost gone. so the progress and the possibilities out there are really exciting, and they take attention, but but that group of south american countries, they

formed a coalition to try to do this and they are close. whether it is just moral support and applause from the sidelines or ways of figuring out how to emphasize that will be hugely helpful. and lastly, outcome again back to the island issue and in the western pacific there are a number of islands that are working towards elimination. so well we haven't called those countries out for the next five years, it is -- this is what is in advance here and that is, if the global community backs off of the malaria as it priority, then you can imagine that these places will say from, not sure where the help is coming from and maybe we have to go and do something different. >> thank you very much for that very extensive answer. let me just ask you, obviously

we have talked a lot today about the importance, the efficacious in this of insecticide treated bed nets indoor residual spraying an intermittent preventive treatment for pregnant women. three of the best tools that we have for prevention. and i'm reminded, dr. steketee when you mentioned earlier that the bed nets actually the treated bed nets help kill the mosquitoes, which i think is a very important point to underscore. the mines been the whole fight against the pandemic of hiv/aids that antiretroviral arv's actually have the capability of producing the viral load which becomes a way of defeating that terrible virus as well. here you are defeating the actual parasite in the carrier of the parasite but let me ask you how and by whom anyone who would like to answer this, or decisions made regarding what preventive strategies to promote in any particular region, country or specific area within

that country? who makes those decisions? is that the health department? is that the corroboration of the partners are what? >> i think any of us could answer that. there is a global process, and w.h.o. is entrusted with technical assessment of the data, making policy recommendations for the countries. but then there is regional w.h.o. offices and the responsibility really sits with the country to figure out how it is and what it is that is going to implement. and, there are differences. malaria is not a single entity. demonstration has different patterns of transmission and different things that must be emphasized in different places. trying to segment that into a pattern that would be easier to attack is something that the w.h.o. is doing but it really is a partnership between the many partners, including w.h.o., a rollback larry a partnership which brings everyone to the table and most important of all,

the countries because that is where the key decisions not only at the national level but down to the district level must be made. i don't know if anyone has anything to add but a little comp located but it works. >> i might just add that you know this is an example where the u.s. president's malaria is -- sits with the country, country by country where they work and look at their plants in them up to see how they can help support the implementation of those plans. and it has been that set of years actually where there was very little money where people spent a lot of time figuring out what the strategy should be that got us a solid set of national programs that could speak to this as their strategy. and then does evolve over time as we get new information. so for example if we got a new vaccine or if we got a new drug that was a single dose therapy with a high cure rate, those would be rapidly discussed at

w.h.o.. may be rapidly discussed with the regional offices and then country by country. experience has shown that we now have enough people with enough knowledge at country level that the uptake of that information is both thoughtful and relatively expeditious. >> yes, if i can say i think the immediate approach in reaction to dealing with malaria is procurement, optimizing the current interventions you have and in country activities. all those are critical in there are many huge impact as you can see already. the long gain is clearly going to come from r&d and we look at the actual investment in r&d it has to be the long sustained spence of process but i would argue and i think most would agree with me, without that the endgame won't, you want when they and again. so while the immediate interventions are critical you are saving lives today with the tools we have nowcome he won't win the long game without sustained effort to really support the r&d that is out there. that's a small component of the

investment made today on the actual r&d part of it. >> appreciate that. just one note for the record come mention was made of the 691 million-dollar question for fiscal year 2012 but in 04, with 89 million, 05, 99.5 million up to 111 million. in 07, 256, 358 in 2008, 391 in and 2009 and wind up rather significantly to thousand 10 to 2594. said the glide slope is very, it a buildout and needs to be sustained and i think all of you have made your case is extremely persuasively and backed by your knowledge and your expertise but a very important information. my final question and mr. payne might have a final question as well but ambassador green again getting back to your original point about leadership and the importance of it, you did talk about coca-cola partnering with the global fund on technical

assistance for the supply chains. .. currently run by barbara bush, george w. bush's daughter in which he came up with the idea that we have lots of

business expertise here in the u.s. but we have lots of young business executives who are dedicated to changing the world, so we've got expertise, we've got challenges and what do we do? and the global whole fellows which is the name of our organization matches of young business executives with development opportunities overseas on zanzibar a young executive from the gap spent a year helping the minister of zanzibar doing some management and was able to put his expertise and experience to work in remarkable ways. you have coca-cola doing things on a grand scale and you have entrepreneurs, business executives doing it on a microscale and the combination is uplifting because at the end of the day it is going to be leadership. it's going to be that sense that we are all very proud of that

that will make all the difference. >> just really appreciate the fine or call if you do the individual country and the community three or four years ago i went to rwanda where they were starting this big initiative may be two years ago and they started in the churches and in the community centers and the of someone discussing it every week this event was going to start i was going to be there when they were out in the village everyone had to take their furniture out of the house and they had to put their curtains up and i put on a suit and they thought i was the guy that had the job but they were worried because a local guy was supposed to do the job so they thought that i came and bumped him out or something. but i put on my sood and we did the spraying a round the house

and was just like a community event. everybody was involved. they knew what was going on, when they were alerted, they knew how long it had to be. they had the kids out while the spraying went on to put them accept and so i think it is very important that we work on the local communities and one other issue that shows how i think it is catching on. i was in djibouti at a military installation and there was a border dispute with the other country. i won't mention it because they denied there was a border dispute but there were 21 prisoners of war from the opposite country and i wanted to me to them to see how they were being treated, and they were being treated okay and so forth and we had a conversation with

them but the thing that was most impressive is when i went into their housing facility lo and behold they had bid next to -- bed nets and the government thought it was important enough having been around prisoners of war this was an important issue at the same way in rwanda where we have seen i talked to the chambers as i mentioned he was from newark new jersey and he talked about going to some of those pediatrics words in rwanda where they were packed with kids and now they have virtually no one there and in certain parts its workings of what you are doing is fantastic and i commend the chairman for having this important hearing and we are going to keep on pushing for the elimination of the vaccine. thank you very much.

>> would you like to make a comment? evin gracious with your time and this couldn't come at a more timely period of time during the consideration of the 2012 budget, so thank you for that. yes, dr. rabinovich? >> on behalf of this group i would like to thank you for holding the session. we are but a fraction of the partners involved and when i think about the libertarians and zambia as the recipient of the goals on the award, exxonmobil talking about malaria at the olympics, nothing but nets bringing in every sport that has a net of any kind. under the partnership modeled this has really been already an incredible decade, but really there is so much more that needs to be done over the decade. when i visited ten years ago there were three children to a bed for a disease that has almost disappeared from ten years later.

this is possible, but it takes that kind of partnership, a commitment and steadfast attention to make it happen. thank you. >> on that final very wise note the hearing is adjourned. [inaudible conversations]

former senator arlen specter, who advocates allowing cameras in supreme court, will testify before the senate judiciary panel tomorrow. before he left the senate he introduced legislation in 2010

mandating the supreme court televised proceedings. that hearing gets underway at 10 a.m. eastern on c-span3. leader also on c-span3, a hearing will examine the proposed merger between pharmacy benefit management companies express scripts and medco. it will get antitrust concerns over the merger. live coverage begins at 2:30 eastern. [applause] last week president obama and former president george bush participated in a forum to mark world aids day. this is 40 minutes. >> i'm glad to welcome you to the george washington university to commemorate world aids day, to participate in a very important discussions titled "the beginning of the end of aids." i'm especially pleased and honored to acknowledge presidents obama, bush, clinton, after rubio, congressman lee as well as bono, the founder of one

and red and the panelists to relieve the like to welcome leaders who are here, board of trustees german russell ramsey, dean goldman of the school of public health and health services and two of them were distinguished faculty members who are leaders in the fight against hiv and aids, dr. alan greenberg, dr. gary sign in coming and finally students representing the one chapter here at george washington. gw was proud to perform its role in the battle against hiv and aids, both globally and right here in the district of columbia. we have the privilege of hosting the nih founded d.c. development center for aids research and exceptional partnership of institutions across the region. we also work closely with the d.c. department of health and the centers for disease control and prevention on the front lines of the fight against aids, providing testing and treatment the district's most highly affective populations.

thanks to the work of many in this room and in the feeling audience, this nation in the world have made tremendous progress towards in eradicating hiv and aids. discourage will come to an end. we had george washington remain committed to staying playing our part in the struggle and there is much more to be done. thank you for joining us for tonight's important discussion. [applause] ♪ ♪ ♪ ♪ ♪

♪ ♪ ♪ ♪ ♪ ♪ >> ladies and gentlemen, please welcome doctor dr. gupta.

>> i'm delighted to be here but me say at the beginning because i care so deeply about the same thing that you will care about in this room, and i'm not nervous at all. [laughter] and usually in a studio, very dark nobody is there. seeing a lot of people was a little jarring but i'm delighted nonetheless to be here. you're going to hear a lot of numbers today, a lot of stories and you're going to be asked to think about this all means for you and for our country and our world of large. 30 years and 30 million generals is the reality of the past and part of our history. but today in the 23rd anniversary of world aids day we acknowledge that and look towards a more hopeful future. the beginning of the end of aids. i like the way that sounds. like the way that sounds when i first heard it. some problems here in d.c. at times seemed too big, too

difficult. this devastating disease we can tackle. we can put hiv/aids on the run so to speak to the beginning of the and aids is something that allows us to stand up that must perfect union of audacity and chief ability. think about what is audacious, achievable, but intersection, that's where we want to be. the truth is in many ways we have already started over the last ten years there's been enormous progress, but this is perhaps the worst time to sit back and say job well done instead of is it time for recommitment, is it time to look forward, a time to double down. so that in our lifetime, all of our lifetimes aids may no longer exist on the planet. this morning the campaign known as one and (red) are hosting this incredibly high level talent discussion to answer a very specific question: how do we get there? over the next two years we will hear from leaders of the doctors, patients come ceos from activists, members of congress, wrote stores and even

presidents because we are united in this belief of the world comes together over the next few years and we build on the progress we have already made we can finally see the beginning in the end of the aids pandemic. as a medical reporter, i would love to announce that headline monday. it's something i dreamed of, that this is the beginning of the end of aids. with the help of our incredible guests and all of you today, we may soon be able to do that. so we are going to get started. it's going to be fantastic day. again, we encourage you to be engaged and listen. we will have lots of questions for the panelists. let's get started life from the hiv board in tanzania is the president of the united republic of tanzania. many of you know he's been a strong supporter of hiv/aids prevention and testing programs, and he launched a nationwide program back in 2007. he's led by example. having himself tested and nearly 4 million tanzanian follow suit after he did so course of these,

warmly welcome him. [applause] 64, sanjay. we are honored to have your president george walker bush and laura bush with us and a number of visitors from the united states and of course. two years ago during a visit to tanzania the had the attendee to visit the hospital where you were able to see how the plan for aids relief was making progress with men, women and

children infected with hiv/aids. [inaudible] to give momentum in the fight against cancer. we thank you so much. the commemoration of the world aids day i am pleased that using modern technology we are joined in washington with many dignitaries there: president clinton, officials, members of congress as well as members of the aids community and the media to share both. it was 1983 when hiv/aids was first known to exist in tanzanian. three people were then diagnosed to be infected with the disease on the western shores of lake 42

to victoria bordering ugonda. since then, the disease spread like a brush fire to every corner of the country. today it is estimated 1.3 million people are living with hiv/aids, and in last year alone, 86,000 died of the disease. from hiv related death of their parents. years ago for someone to be diagnosed with aids was like the announcement of a death sentence. also being hiv-positive because of being isolated, shunned by society and even family members.

the person affected as spouses and children because of the fear associated with the disease. the advancement and research and technology now the disease is no longer the death sentence it used to be. many infected people can live a normal life as well as the observed doctors and the same with pregnant women can bring up health the hiv-free babies. the edification increases awareness of the disease. more and more people are hot for testing and is on the decline as a result of the development and the measures tanzanian has a steady progress in the fight against hiv/aids.

indeed thousands of tanzanian is who died of the disease are alive today. the rates have declined from 18% in the 1980's to 5.7% today. as i speak of the tanzanian have been infected with hiv since july, 2007 but my wife and i launched a nationwide campaign. as more and more people don't hide to volunteer and as more and more people now come forth to announce their status. they can now get requisite care and treatment. 740,000 people living with hiv were enrolled in the clinics out

from the 84th thousand 816 are of. the for those of 301 provided services for prevention of transmission. this is the 93% of all facilities in the country. so far a total hiv-infected -- the percentage of the total have received care and treatment likewise 948,000 children born with hiv infected mothers

[inaudible] to prevent them from the transmission of hiv/aids. of the statistics we are suddenly on the mark to doing better. for us in tanzanian whenever we talk about the success of leading the fight against hiv/aids, we cannot fail to recognize the support we've received and continued to receive from the people in the government of the united states of america. allow me to mention in particular the plan which president bush initiated which is now being continued peace an excellent president obama, the clinton plan has been assisting us with the novation for hiv/aids plague nurses and treatment for children. we've been assisted with the innovation and the creating in

the hospital's and the capacity for hiv/aids and others. in 2007 when we launched the nationwide campaign, i would find provided. it is from the aids foundation has been assisting with the house polls we have before the counting machines. we have johns hopkins universities and other persons from the united states. to all of them i say thank you please accept my apologies but we appreciate and value your support. pipe like to underline the fact need the support as you've seen

from the statistics we have made achievements but there are still gaps. we need to continue to work together to save lives and i would like to assure you tanzania is committed and stands ready to play its part to the best of our ability to the state for ourselves and those by the united nations for 2015. i'm pleased in tanzania we've made progress on all of these objectives although we are committed to do our best in this regard. meeting these challenges is a responsibility for every one of us, the government foundation, ngos, person of good will as well as the corporate sector. i applaud your commitment and therefore it is in the fight of hiv/aids.

it's set by one complete, i'm very sparring, we trust you. i have no doubt in my mind. but you will hear to the logical conclusion. i pursue my government's corporation and the efforts. with people like you, mr. president i believe today we should fight and win the war mike against hiv/aids and achieve the target of the free generation. [applause] thank you for of law and what you see on the ground. from tanzania the man who has

done so much infighting hiv is committing $15 million over five years to combat these coolly. everybody welcome the first of the united states, george schoeppel you bush -- george w. bush. [applause] thank you, thank, it's also good to be here with my friend, no question tanzania has made progress in the fight of aids and requires a strong leadership to do so. mr. president you have been a strong leader with your dear wife, selma off. we are honored to be in your presence, mr. president obama, mr. clinton. ambassador, thank you for being here. all the families here in tanzania we want to give them a

loud shot to their friend bono. we call him the real deal. thank you for supporting this conference. we are actually here in africa to announce what we call the pink ribbon, red ribbon campaign. we will be doing so in zantia tomorrow. the bush center along with the state department and the foundation as well as private partners are working to extend the reach and cervical and chemical initiative. women with hiv are less likely to get cervical cancer and it's long enough to say. world aids day in tanzania. a frontline mac of the battle against hiv/aids. today laura and bayh and par were and general we are honored to see firsthand the great success of pepfar.

world aids day is a day to celebrate success and so we went to a clinic and we were a able to hold a little baby that five years ago would likely have died or contracted aids who has benefit of from the grassroots efforts here in tanzania and the enormous generosity of the people. we went to a beauty salon were the entrepreneur decided to use her business teach about hiv/aids and how to prevent it. the world cancer institute was not only deals of a is polls show no. it's a time to say thanks, thanks to the thousands of people who are motivated and people like bono and the people on the audience that continue to care about the spell this battle

that can be won. i was asked earlier what you like to come to tanzania on world aids day. i said it's a day to celebrate success but also renewed commitment, to making sure we all use our god-given talent to say. the notions are going to budgetary struggles. when you go to budgetary struggles seems like the best thing is to focus as effective. there is nothing more effective than pepfar. i'm not guessing. i thought it only talked to presidents.

this is something all american citizens and the government must understand. there is no greater. we are a blessed nation in the united states of america, and i believe we are required to support. [applause] >> thank you mr. president. the united states has made great strides. the obama administration has been a priority to focus national attention as an emden next ret. recently as zero in this room the administration implemented a national hiv/aids strategy

provides and help. who better to talk about all of this than the 44th president of the united states, please stand and welcome. [applause] >> thank you. thank you so much. thank you, everyone. please, have a seat. welcome from president bush to bono, to the campaign, thank you for bringing this all together. because of your work all across

africa there are children who are no longer starving, mother's side of treatable disease, falters for against providing for their families. because of all of you, so many people are now blessed with hope. we've got members of congress who've done so more and we want to thank them. for being here in this bold leadership on this issue i have a feeling for aids relief as one of his greatest legacy is. and that program more ambitious than even the leading advocates thought was possible with the time have saved thousands and thousands and thousands.

will impact the lives of millions and we are proud of the we have the opportunity to carry that forward. today is remarkable today we come together as a global community. if we are off continent, across across the base and culture to end the commitment to the aids pandemic once and for all. if you read them one after another, you will see the story of how the human race has confronted one of the most greatest panamax in history. you will see that in those early years we started losing good men and women to a disease no one truly understood. was about ringing the alarm, calling for collection, proving that this deadly disease was not isolated to one area or when a

group of people and that's part of what makes to the remarkable because back in those early years you could have imagined these days, though we would be looking at the beginning of the and marking the world aids day that has gone on from that early beginning when people were still uncertain to nalorphine getting to zero. if you could have imagined we would be talking about the real possibility of the aids free generation. that's what we're talking about that's why we are here and we arrived here because of all of you in your unwavering belief that we can and we will be to this disease. because we invested in antiretroviral treatment people who would have died from aids, some of whom are here today because they're living full and

vibrant lives. because we develop more tools, more and more mothers are giving birth to children free from this disease. because of the persistent focus on awareness, the global rate of new infections is declining. make no mistake, we are going to win this fight but it's not over, not only a long shot. the rate of new infection may be going else down where but it's not going up here in america. the infection rate here has been holding steady for over a decade. there are communities being devastated still by this disease. when new infections among new, old, black, gay men increased by 50% in three years we need to do more to show them their lives matter.

when latinos are dying sooner than other groups, when black women feel forgotten even though they account for most of the cases among women, we've got to do more. not for the 1.2 million who are living with the treaty right now, not for the americans infected every day. the fight is not over for them or for their family and as a consequence it can't be over for anybody in this room and this certainly is not over for your president. since i took office the national dialogue on hiv/aids members of my administration have kendal across the country. the private sector partners. we've spoken to over 4,000 people. out of all of those conversations we have a plan to

combat. the national hiv/aids strategy. we went back to basics, prevention, treatment and focusing our efforts where the need is the greatest and we laid out a vision where if every american regardless of age, race, gender, ethnicity, gender identity or socioeconomic status can get asked that to the life extending care. and i want to be clear about something else. since taking office we've increase overall funding to combat hiv/aids to record levels. we have bipartisan support. we have reauthorize act and i was proud to announce my administration as ending the ban that prohibited people with hiv from entering america. [applause]

with porth for the national aids conference. [applause] we've done a lot over the past three years, but we can do so much more to read today i'm announcing some new commitments. we are committing an additional $15 million for the ryan white program that supports care provided by the hiv medical clinics across the country. we want to keep the doors open so they can keep saving lives. we are committing an additional $35 million for state aids drugs assistance programs. the federal government can't do this alone so and also calling on state governments and pharmaceutical companies and private conditions to do their part to help americans get access to all lifesaving treatments.

this is a global fight and it's one that america must continue to lead. looking back at the history no other country has done more than this country and that is a testament to the leadership of the country, but we cannot be complacent. this is an area we can look back and take pride with republicans and democrats in congress have consistently come together to fund this fight. not just here but around the world and that is a testament to the values that we share as americans to read a commitment that extends across party lines as demonstrated by the fact the president for joining you'll today. since i took office we've increased the global fund to fight aids, tuberculosis and malaria. we've launched a global health initiative this approved access to health care helping bring down the cost of vaccines and over the next five years helped

save the lives of 4 million more children and all along we kept focusing on expanding our impact. today i'm proud to announce that as of september the united states now supports antiretroviral treatment for over 4 million people worldwide. [applause] just the past year we provided 600 falls of the hiv-positive mothers with access to girard's so that 200,000 babies could be borne hiv free. [applause] and nearly 13 million people have received care and treatment and putting more than 4 million children, so we've got stuff to be proud of what we've got to do more. we are achieving these results not by acting alone but by

partnering with developing countries like tanzania and with leaders like the president kikwete. we have to define our strategies we are saving as many lives as possible. we need to listen when the community focuses on prevention. that's why as a matter of policy we are now investing in what works for medical procedures to promoting healthy behavior. that's why we're setting the goal of providing the antiretroviral drugs to more than one-and-a-half million hiv-positive women over the next two years so that they have the chance to give birth to hiv freebies. we are not going to stop their tree we know that treatment is also prevention and today we are setting a new target of helping 6 million people get treatment by the end of 2013. [applause]

[cheering] [cheering] >> that's 2 million more people than the original goal. and on this world aids day here is my message to every one of their. to the global community, we ask you to join us. countries that have committed to the global fund that need to give the money they promised. [applause]

countries that haven't made a pledge, the need to do so. that includes countries that in the past have been recipients but now are in a position china and other major economies are in a position now to transition in a way that can help more people. to congress, keep working together, keep the commitments that you have made and attacked at the time so many in washington divide us. the fight against the disease united us across the president's and shows we can do riggings when republicans and democrats put their humanity for politics so we need to carry that spirit forward. and to all americans we have to keep fighting for every person who needs our help to the but also fight for every person who didn't live to see this moment.

every person who goes up to the reality of hiv/aids. we have to fight for ryan might and his mother, brothers and every person that forced us to face our misguided use. fight for magic johnson and mary fisher and every man and woman and child who when told they were going to die from this disease they said no we are not we are going to live. keep fighting for all of them because we can and this pandemic. we can beat this disease and win this fight we just have to keep at it, steady, persistent, today, tomorrow, every day and as long as i have the honor of being your president that's what this administration is going to keep doing. that is my commitment to all of you and that's got to be a

promise to each other because we have come so far and saved so many lives we might as well finish the fight. thank you for all you've done. god bless you. god bless america. [applause] ♪ ♪

♪ ♪ ♪ the panel will begin in approximately five minutes. thank you. ♪

♪ ♪ ♪

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up next a discussion on the challenges facing young adults 18 to 34-years-old. topics include health care, jobs and education costs. from the center for american progress this is 90 minutes. >> good afternoon. welcome. thank you for coming today. we are happy to have you. i am the director of the

progress 2050 progress that seeks to promote new ideas for the increasingly diverse america and we are excited to have this event today. i want to be quick because i know you are looking for to the conversation and i will introduce the wonderful speakers the of very long by jooss sowing grain to try to be brief and i will start with jamelle over here he's a fellow at the nation institute. he's a blogger and journalist in washington, d.c.. he has been a fellow for the prospect and his work has appeared at the washington independent, cnn dhaka,, 21 and a number of other outlets. next i'd like to introduce eduardo, an advocacy associates a graduate of california state university where he majored in american studies and psychology. he will focus on the the local economic development issues and impact on immigrant working

families and advocating and organizing affordable housing living wage jobs door redican interest in the role of the coming of these played in shaping the just public policy. next to eduardo we've ronnie cho. aprendo to sheldon whitehouse he was an editor at the "newsweek" daily company in new york city where he wrote and edited social justice innovation and social entrepreneurship. in 2009 he worked to the federal communications commission as part of the team that wrote the national broadband plan and also served as associate director of affairs that the u.s. department of homeland security. next to him we have had their mcghee the director ralph demos who develops and executes this strategy for increasing the organizations in the policy debate in d.c.. previously she was a policy

director of the domestic economic policy for the 2008 campaign and the program and the economic opportunities program. finally with aaron smith, the executive director and a native of yonkers, new york and an honors graduate of college and graduate of the center. at the office of congressman chris van hollen and then worked for the surface with the nonprofit to keep seniors in their homes in d.c.. he went back to yonkers in 2006 to be the campaign manager of the state assembly and they went on to become the chief legislative aide for the council president please welcome the panel and we are looking for work to the conversation. [applause]

>> thank you. with the recession as a backdrop it's easy to read a report like this and come away with the sense things are terrible. you can go down the list of facts to pills young americans are graduating in an economy with much more opportunities their parents had. for those fortunate enough to obtain college it's likely they will leave college and the will to deal with the fact they have yet over the next several years. for those who are in college but haven't graduated there's a chance they might have it for young students who have the high school education the job market is terrible as a result of changes in the cool the economy, the kind of unions, so long, so we know the story. likewise there is a host of disparities among young people that have also disbanded

millions. young african-americans especially are less likely to finish high school and obtain college and less likely to graduate from once they are independent and more likely to earn below the median wage for people in that age group. less likely to have health insurance and less likely to be employed. then if he would turn to the undocumented immigrants in addition to the problems they also deal with the fact they don't have censorship and the political culture is becoming increasingly hostile in their interest it's just easy to read this and come away thinking things are terrible, what can we do, but i think would be wrong to treat this as another exercise in despair.

these are solvable problems, these are things we can approach as a country, as a community and so the right rating to look at this report is not so much as look at all these problems or the doom and gloom but as a diagnosis of sorts for the patient being america that is sick and ailing but has a lot of bigger and is still up for the challenges ahead. with that in mind, i want to start of the discussion here with aaron who is a part who helped craft this report. there is a survey attached to the report, and aaron if you could detail some of the information from that and give us a sense of people were thinking and how the deal with their future. >> absolutely. first let me say thank you for the center of american progress for having appeared to the tremendous opportunity.

quickly the national advocacy organization we partnered with the most because we wanted to understand the judge's young adults face and i mean 18-34 not only in response to the recession but the long-term trend, and i'm going to talk about the pool section and have her about the report itself, but one thing i want to highlight this yes there are some sick much can challenges but we also can't reasons for optimism and hope and a set of priorities for congress young people have got to think can prove. the poll was conducted, the bipartisan with research partners in the bellwether research and consulting about 872 people surveyed and i'm

going to give the high level results in a few different categories and you will see first of all the tremendous challenges of young adults so first we know the unemployment is very high. many people don't realize how low it is, so over 50% of young adults earn less than 30,000 in year and when we pulled them even the ones who are employed 53% were in their chosen field. many of them struggled with their personal financial situation, and it was particularly an acute issue for people of color suffered sample 60% of young latinos said their personal financial situation was fair or poor and 55% for young african-americans. across-the-board young people have seen the level of debt increase over the last few years. the biggest reasons are still in debt, credit cards and medical

bills that's the consistent problem and the economic conditions are causing young people only hardship right now but causing them to delay things they would otherwise want to do, but simple 46% of delayed purchasing a home. a quarter have delayed getting married, 3% delayed starting a family. these are decisions will have a tremendous impact not only in those young people but the economy and the society. so just to talk a little but education, in the poll one-third had neither of the young adults either had a college degree or associate's degree which many people don't realize is the norm for the population only about one-third of young people actually get that degree. not surprisingly about 76% say college has become even harder to afford in the past five years, and while they are concerned about how they're

going to pay for college we found they were even more concerned about how they were going to send their kids to college, said they had that sort of long term set of concerns and all these economic trends are having an impact on their view of the future so 40% of yong adults think their generation will be worse off than their parents. ..

in. >> >> that is an example of how congress can step up to address these big long-term challenges speculator we will talk about priorities so i will save those remarks for then. thank you very much civic i knew you have dealt with that would you like to describe it? >> just to say more about

the dmos research advocacy organization working to advance a more robust enough make prosperity in america we have been around 11 years and for most of that we have focused on the issue of this generation thankfully my generation the youngest of americans which is the most diverse the most likely not to do better than their parents we really see this generation roughly as the bellwether for the results of a series of economic policies most of which remain around the time we were born that has made it a lot harder to make their way into the middle class. of the economic choices

affecting everyone for this exclusively for that paradigm it is not having an effect and a broader generation all story lucky and data of five different areas of people are doing today would never the latest data of how their parents were doing at the same point* in their lives in 1980 that allows us to shove this generational comparison and the first factor the picture was quite disturbing because around the same time many of us of this generation was getting its

star policy makers in corporate makers decided through labor policy tax policy to transform our country's economy from one that was a good economy but didn't layman's terms we have transformed the past 40 years from the economy or the largest employer was gm to support a family on one and come to the nine you get a low wage no career ladder job. 712 drill the young americans but today the typical young man makes $0.10 less on the dollar than his father would have. >> young women make $0.17

more on the dollar than their mother but there are too important caveat. one, of course, their mothers her much less likely to be in a work force or have a college degree so making progress also meant the gender but not economic security and importantly, young women today although they have made progress, is still earn over $8,000 less with inflation adjusted terms than the young man in 1980 so we're seeing a generational decline in terms of wages. they're more likely not to have benefits and pensions and health care the only ones that have had increase of wages are those with a college degree. that is fine have the trade-off from the goods producing economy from of

service economy come hand in hand with a robust investment of education. but now it is harder sinew think they would say you'll be easier for people to get a college degree but unfortunately that is not what happened purpose same time that became the ticket to the middle-class life it shows the country pullback of the investment training on a per capital at -- for capital level college tuition is three times higher than it was 1980. we know that the budget in 1980 the maximum pell grant covered 69% of the cost of attendance today it only covers 34% so not as a result to have three students graduate with still

on that with the average of 24,000 last year the total student loans debt eclipsed credit card debt of the entire nation of over $1 trillion because of the recession and the joblessness the college students go up over 30% over the past two years. we also looked at because we think of young people just as students but they are also parents and people who are likely to start a family and buy a house so we try to look at the cost of living, to raise a family and found some startling statistics there as well but it is a time i will say quickly that to over 40 percent of young households spend more than one-third on rent the cost

of child care which since the adults issue because people are on average 25 and have their first child the cost of child care actually exceeds the cost of rent in most areas and college education. >> i know dave white house has tried to help the students alleviate their debt but what else is it pursuing along these lines? and to what extent is the administration were cane to help young americans find work can develop still taste develop skills and the whole 9 yards? >> so what we find what we are acutely aware of the

common win you go back to the career of the president won a community organizer of this house side of chicago he has been an advocate on behalf of the unpeople to share the special relationship with the young police. so we tried to get past as of late we can wait fifth initiatives going back to raising the pell grant benefits at historically high numbers but as you have mentioned not enough to cover most of the cost of the higher education but doing what we can to mitigate that with interest rates trying to cut out the middleman with the lenders and borrowers to increase the savings there. also payment reform for

those to have the ability to pay off their debt to four theron situation but if you're not working at this moment she you should not have to pay $5,600 per month until you can pay that back then after you go into public service the debt is forgiven after 20 years we tried to make these steps toward creating a fairness in light of the situation to go with the health care with a 1 million additional people are insured because of the affordable care act that is an insignificant number but would not ordinarily not have access to that. may go at this from the multifaceted way through the executive order as a part of

the broader agenda going forward. >> to ask the along those lines, the election and is going up but there seems to be a wide discontent why don't you think those things you have outlined to reach their consciousness? why do think that is correct >> >> i think the folks in this room cancer and they talk about the accomplishments of this the administration to communicate that and we can certainly do a better job that is a program that

existed for a while that very few people know about that is the response of eight days the responsibility for the federal government for those who are eligible that exist are aware of them through the office of public engagement they talk about our strategy that the media may not be getting the message across call the office of public liaison so primarily a political office in the diapies, business leaders and elected officials have a chance to interact with the white house and obama was elected january 2009 and rebranded office of public kennedy's rid to create the same opportunities others had enjoyed to the general public. as we can vain a series of events with community

leaders from virtually every industry to the white house. not only in form to what the president is working on but to be informed to create a dialogue and in the same spirit of the accessible response of government to infiltrate communities to know they have a seat at the table to see what we are behaving day stewing of those issues that we don't care about that there is an open door to have that kind of discussion but to talk about why there is the discontent around young people, as the story says

says, the report shows pretty hard hit by the economy that is something we are all very concerned about and i think the policies of the president pushing fourth to make sure we are continuing to work on their behalf but no one is satisfied with the unemployment numbers it is high across the board. >> one of the big questions is one of action and would they do to influence the political process? what recommendations do develop? >> going off of what was just said what the administration is doing on those issues they care about

the most there has to be a point* made the role that they play the young invincible sen other organizations that the national and local level. the role that they play to develop leaders and why that is so important for the future of young people in politics. but organizations to have a responsibility to provide people with the skills they need to learn and in general there's a lot of excitement and energy people have right now to get involved with the occupy a staff with the young face is really starting to come out to challenge a lot of the issues that they come up against that are highlighted in the report. on our end, organizations like other youth organizations campus progress, but they have to be aware of what those needs

are with regards to education, the economy i were gone immigration issues to would vance local policies. it comes down to programming they need to be aware who they are developing and who they are geared towards. what skills price of a putting them in experiences of where they are working turning the office of the legislator or getting experience organizing or doing policy work? that excitement is there and a pipeline for a leadership development that needs to be further developed that is on top of what the administration and a lot of ways that is why they're so frustrated but to really

take advantage of the energy in the space to develop the talents and leadership of those who are most disenfranchised by 80 days to be a the economy it just seems like nothing is happening. so really being aware of having program may developing in the skill sets setting them up for future opportunities to be involved in national politics breathtaking a chance for those who are disenfranchised by from those cuts to education and the unemployment rate to to take advantage of that opportunity to develop their skills sets as leaders.

they will be leading the country. >> one of the hardest things about doing what i do with tremendous opportunity with that version for young people of huge coalition the organization's sole intent is to protect those programs geared toward young people and then to fill the space that is challenging of course, to get the non campus youth from those of this generation not in college to be a part of the process of civic engagement, beyond from

checking the box it is about citizenship to be a part of the process of. we don't market democracy very well. the harry potter movie comes out how much it will cost o the weather and not there is a strip club opening one block from here who wears the reformation? it is incumbent upon all of us to our the public at of how to be involved. >> that point* of the question of democracy i say we action day go further in that to there's a real war

going on for those who have a vested interest particularly in targeted raised. in 2008 the watershed year for participation of people of color they will be the rising american electorate and then 2010 across the state come in 31 states was in turn to some sort of legislation for voting rights. the piece that is particularly hard hitting for young adults is the voter i.d. laws. a lot of people think it makes the ton of sense of course, you should see show of picture id but those who are eligible to vote too not have a government issued by the. the numbers are similar for

older citizens and low income citizens and people of color who have to do with the bureaucracy of getting a photo id that creates cost and inconvenience to make it that much harder for people to exercise. >> as the economic situation becomes more precarious there seems to happen a reaction or backlash against programs to expand opportunities three anger people and it seems to coincide with the fact that young americans this minority majority demographic and it is very diverse. to what extent can progressives use the tools of civic engagement with his zero some view of the world? to see now what said g.o.p. political debate they get

the sense these are people friday against the changing times. gunboats and progressives have a tremendous amount of opportunity to capitalize on the debates that are happening in the upcoming elections to push the kind of change in the country, but we see that already with the occupy wall street move it is shifting the base to focus on issues like jobs and the student debt crisis. so absolutely there will be the opportunity of people need to be engaged. one thing is the responsibility is to put forth the specific solution how are we going to create more jobs for young people? how are we going to make

college more affordable? i think 10 people need to be a part of that conversation and we saw in the poll overwhelming support across party lines regardless of your affiliation for creating jobs and number one priority making it affordable was never two am health care services for low-income people to protect social security was one of the top priorities and this is across party lines. i think there is a broadly held an undue among young adults in a shared sense of principles it is incumbent to find the specific policies solutions for, for example,, take entreprenuership with no young people want to start businesses can use start a student loan relief program?

that is something we have been talking about with members of congress. can you do a better job to make sure money and% goes to a bank to apply for a loan come monday can take into account other factors other than just credit history? or if you are 19 years old you don't have a credit history but that doesn't mean you don't have potential to start a viable business. but if you look at areas of higher education and talk about telegrams, once again they are on the chopping block. that is an absolute embarrassment if we cut pell grants at a time when we know we desperately need to educate young adults but we need that bigger comprehensive solution to address higher education and there are ideas floating out

there to push them whether it is better access to information about whether to get out of going to college or whether it is a race to the top for those models that promote colleges that keep the costs down. there are ideas out there in 2012 it is the opportunity to close the gap with dead grass roots and the energy and policy makers who don't have any idea what young people are thinking or doing >> to the plight that i made earlier, there will be organizations play, to make sure their part of the policy conversation, that is the reason why we now see

young people coming out four other moments but we do have to be more rackauckas and about who we are developing if we know young people of color are the most disenfranchised from the political process regarding high education or lack of opportunity for jobs so those of the need to be doing the most outreach the organization's providing skills to be better organizers and have a better or dennis -- organization, a political system. >> on your questions we have seen a major question and it is a question of in freedom

as defined it has been fraught with basic social science with the committee that if it is represented becomes more diverse with part of an amazingly huge country geographically, the most diverse nation of our size on the earth and and

and the willingness is setting it it g.i. bill which is the resoundingly middle-class of the nation, there were racial aspects that kept a certain people out of that social contract as there were more contracts through the decades when about having a conversation we need to have to make sure racial anxiety which is natural to have for all races and backgrounds, that does not stop our desire to do the kinds of investments and shared sacrifices to make sure our future is as bright as our past. there is a report maybe five

years in a note -- years ago lourdes that existing home data but it it was about their public attitudes and the young people are more oriented toward quote -- publix solution to pay higher taxes for higher degrees of service and in a generation since the depression. that has to do with a period of time rehab gotten the message from certain sectors of the political sphere that you are on your own credit cards, no regulation of that, higher education, child-care, and there is a backlash from and people saying we would like to have a society where people took care of each other aids little more to ve