specifically. number one, i believe we can still accelerate the reduction of commodity prices. i think there is more we can do to reduce drug and lab and test prices and other commodities in the medical system. if you look at the experience we have had, i think if we do more of these things we can get the prices down and make the money go further. second, i think we do have one new source of funds and we should not forget it. after the global fund and the gates foundation, the best thing that has happened was funded by the french airline tax on every overseas trip out of france -- a couple of bucks. about a dozen countries have followed suit and a dozen more kicked in funds from the general revenue. we are the purchasing agent for

pediatric drugs and second line antiviral drugs, but they buy all kinds of medicines to help the poor people of the world. that is why it was set up. the director of that -- the chairman of that, the former prime minister of pfrance, and a global partner introduced something which will allow people in other countries, beginning in the united states, to make a voluntary contribution on their airline tickets to buy medicines for poor people. we have all the big ticket sellers, including online sellers, signed up. we announced it to the un a few days ago. we have a study that says it can produce between $600 million and $1 billion a year, and that is before we get chinese -- before we get china in. i believe they will participate,

and many other countries. it is totally voluntary. they just give you a chance to check a box when you buy an airline ticket. that is the only new source of funds i am aware of that will help us with the problems that not just the united states of america but other countries are facing in purchasing madison. i think the non-commodity cost can be better managed with greater reliance on nurses and community health care workers and other delivery chains which are "too obscure to spend a lot of time on today. fourth, i cannot emphasize strongly enough how much i believe we should use this moment to send a clear signal to the world that we are moving away from a dependency model toward an empowerment model.

we have to build capacity. 24% of the health-care problems are in africa and only 3% of the medical personnel are. we have to train and retain health care personnel in africa. fifth, prevention is still the key. if you look at the caribbean, where we started our aids work, in the last two years there have been no mother to child transmissions in at the bahamas. we are still reaching no where near the number of pregnant women who are hiv-positive with a medication that will -- it is 98% effective. bill is going to talk about vaccinations. they work and they are cheap. it is the best. i think that it is very important that we continue that.

the third thing i would say is we ought to do more on clean water. 80% of the people who die from waterborne diseases -- cholera, dysentery, diarrhea -- our children under 5. my biggest worry in haiti is that the sanitation problem in the rainy season will lead to a second round of death. those children will just a surely be casualties to the hurricane as anything else. procter and gamble has a pill costs 10 cents that will clear water for a family of four for three days. finally -- i know people say this and nobody ever does it. you're being given an opportunity, this committee is, on a bipartisan basis, to look at whether we can substantially lower the overhead and transaction cost of our farm

assistance program. i think you get a heck of a value for the dollar. i think we should spend more money on foreign aid, but i think we can get more value out of the money we spend. we need a higher percentage of the aids dollars being spent in countries. i think we can lower overhead. i think our aid projects relate to local countries -- i think you should look at requirements to put on that add to the cost of applying to these grants, complying with these grants, filing reports. a lot of these reports are never read because they are not consistent with a nation's own health care plan. let me say -- the way we do business, i do not go to any country i am not invited. i will not start unless the country has adopted a plan. if they want us to help with the plan, we do it.

the only other requirement i have is that we keep score and have strict no corruption plans. that is it. i have only had to pull out of one country because of this. i think that you really should take this opportunity of budget constraints to see how we can get a much higher percentage of the aids dollars spent in the countries that are affected. i think you ought to do it on a bipartisan basis. finally, on this food issue -- since 1981, the united states has followed a policy and for the last year or so we started rethinking it. rich countries that produce a lot of food should sell it to poor countries and relieve them of the burden of producing their own food so they can leap directly into the industrial era. it has not worked.

it may have been good for farmers in arkansas but it did not work. it was a mistake. it was a mistake i was party to. i did that. i have to live every day with the consequences of the lost capacity to produce a rice crop in haiti to feed those people because of what i did, nobody else. i personally believe that this whole food security issue -- that this ought to be something we can do on a bipartisan basis. when president bush tried to change the way we give food aid and saw that 25% of it was bought by farmers there, i supported it. i was one of the few democrats that supported it. it was beaten by a bipartisan majority. the canadians have agriculture more subsidized than ours and they give have their food out that way. anything you can do to support agricultural self sufficiency

will reinforce your health initiatives. thank you very much. >> mr. gates? >> members of the committee, i want to thank you for having me here today. >> is the microphone on? can you pull it closer to you? >> i want to thank you for having me here today, and i want to thank you for your commitment over the years to investing in the health of the world's poorest people and for holding this hearing today. i would especially like to acknowledge senators kerry and luke are for their longstanding leadership and commitment to america's investment. i also want to acknowledge the crucial contribution and partnership that we have with president clinton, who is a tireless champion for this cause. i am grateful for the opportunity to discuss the success of past investments and the opportunity to make more

progress. i will try to make my comments brief. i have additional material in the written testimony that i submitted. this is my first chance to testify in congress since i stepped down from my full-time work and microsoft and began full-time as co-chairman of the gates foundation. the foundation has been doing work for over eight years to drive these health issues and i have been very excited to be able to get more involved in the work and make sure the money that we spend has the greatest impact possible. global health is the major focus of our giving. we also have been working on other issues and one that focuses on education. about the same time as our foundation was getting going, the u.s. government started a

significant increase in global health spending. this committee has been instrumental in making that happen and making sure the money has had a huge impact. i wish that every american understood how well the investments in global health are working. the success with polio, where we are quite near to eradication, the success with malaria, where deaths in many countries are down 50%, including rwanda and zambia, the 4 million people receiving aids treatment that would have died just years ago. one of my favorite statistics is that since 1960 the number of children who die every year has dropped from 20 million to less than 9 million. things like new vaccines deserve a lot of credit for that. the united states is the biggest funder of global health. we deserve a lot of credit for

these advances. just over a quarter of the money given for global health comes from this country. and yet in total it represents only point to 5% of the federal budget. as we get the successes to be understood, i think we can get strong support. the image of foreign aid that people had during the cold war, where much of the money was political and there were not controls to measure how the money was spent -- those days are gone, particularly in the health area. we can look at the outcomes. if people do, the conclusion would be inescapable. these investments are the most effective we can make for improving and saving lives. this is the reason that melinda and i have decided to make this cause our primary focus for our foundation.

we know these are tough times in the budget, as president clinton alluded to. if the budget was not so constrained, i would come here and success -- i would come here and suggest that this budget be increased substantially more than is the current plan, but there are tough tradeoffs and i know that you have to consider those. but if you do that, i hope you will remember the impact and the success of these investments. in terms of the global health initiative proposal, i supported very strongly. i think it is very well done. i think you have some great people involved, not only in formulating the plan but who will also be there to make sure that the money is spent well. it increases funding for global health and this is important

despite the incredible constraints. it has new strategies to make the money more effective. it focuses on particular countries. it focuses on the health problems where we have known interventions. a bill on the success -- it focused on the lives of mothers and children. we know a lot more about the integrated approaches that could help there, including things like micronutrients, support for community health workers, promotion of breast feeding, or voluntary family planning, and better vaccination coverage. there are two initiatives here where i would hope congress would be able to increase the funding even beyond the current proposals. one is the vaccine allocation, which is money that goes to the

global alliance for vaccines. it is phenomenal in terms of how effective it is. it is working now to get new vaccines out -- a rotavirus -- that will save over a half-million lives a year. i know the countries involved want to get these vaccines, so our generosity will make the difference. the other area to highlight that i hope would be increased is the funding for the global fund. the global fund is a well-run organization. the united states has been the biggest contributor. whatever generosity we provide there, other countries will respond in kind. the current approach does have a small cut in the money for the global fund. i hope that is fixed, particularly because this is a

replenishment year and those other donors will be looking at us as they make their decisions. overall, this is very important work. we have evidence about the great impact that these investments have. we have a chance to increase them and make them more effective. i appreciate the opportunity to talk about this and engage in a conversation. thank you. >> thank you very much, mr. gates. mr. president and mr. gates, let me ask you the first question, if i can. you both alluded to the budget pressures that we face, and you are both passionate about the importance of the united states being committed to this and to this particular initiative.

can you help some reluctant member of congress, who is feeling the intensity of the pressures of people unemployed in his or her state and the pressures of the health-care bill here, a deficit budget -- we of this committee are powerfully committed to this, but we have a lot of members who spend most of their time not necessarily thinking about this as much as you do. could you reduce to simple terms for the average person in this country why this is so important? what is the difference it makes for the united states and why does everybody need to care about it no matter where we come from or what we are doing? >> apart from the moral claim that we ought to save every child we can, we live in an interdependent world in which we have learned the hard way that no matter how brilliantly our forces perform, we cannot kill,

jail, or occupy all of our edgar said -- all of our adversaries. we have to build partners. that is what foreign-policy is about. this makes a world with more friends and fewer enemies. if people think you care whether their children live or die you do not have to send our young people to war as often and you can have -- it saves money. the most expensive thing you can do in modern society is go to war. every other investment is better. the second point is, as bill gates has said over and over, this is a good deal. these things work. you have decades of evidence that public health investments of the right kind work. just think about haiti. if we can build a healthy haiti,

one where the economy works well, it is less incentive -- in less incentive for it to be a drug shipment point for america. we live in an interdependent world. whether we like it or not, we are affected by what happens elsewhere. the final thing i would say is this maybe a fool's errand, but for 25 years i have seen surveys which showed that large majorities of the american people actually support programs like this and would support spending a higher percentage of our budget on this sort of thing. the reason we cannot get support for it is that they think we spend five or 10 times what we actually spent on foreign assistance. it may be that because so much attention is being paid to all these budgetary issues you would be able to help people put this in proper context. if they realized how little it was, i believe it would make a difference.

>> to add a bit -- we talk about lives being of equal value, but the health interventions in this plan typically save lives from something like $10,000 per life to something like $100 per life. in fact, we are talking about spending less than 2 percent as much as would be spent in a bridge country. -- in a rich country. we have to treat these lives as if they are worth 2% of other lives. that is not the only argument. as you improve the health of the societies, the amazing thing is that the population growth goes down and therefore the ability to educate, to feed, and to provide jobs becomes possible. in the 1960's, when we thought

about aids it included countries like brazil and mexico. those countries today are actually providing aid. i met with the president of south korea at davos. he talked about how usaid came to their country. their aid budget will be over $1 billion next year. the countries we are talking about have terrible health problems. we have got to solve those problems to get them on the path to self sufficiency. finally, diseases do not know any boundaries. both the science and the interventions to reduce these diseases prevent them from becoming a worldwide problems. finally, in terms of how people think about the united states, the idea that our health budget would be 1% of our military

budgethe global health budget -- that is a logical to me. i would argue it should be a higher percentage. this is america at its best -- helping people and putting them on a road to self-sufficiency. >> my time is almost up. the balance between prevention and treatment -- one of the things that struck me when i was in africa was the sort of recruiting system -- the farm system that was being run to fill the next treatment center. obviously, there is a tension in the community about this. i wonder if you would speak about that for a moment. >> obviously, whenever you can do prevention is preferable and almost universally less expensive. my own view is that you have to make the decision -- you have a

policy. that should be our policy. the implementation of the policy should be informed by what is practically possible, country by country. for example, you do the right sort of bug nets with malaria, it really helps you to get to 0, say the money on the madison and you do not have as many people getting sick. i think we can eliminate malaria. to get to 100% of the hiv- positive mothers with the medication to stop mother to child transmission, you get 98% effectiveness. you are arguing with people about not having sex and abstinence and all that. i think you really have to do it, but it is far less effective than bed nets for malaria. from my point of view, there is

not a one size fits all argument. you should always prefer prevention and always be prepared to do what actually will work, a condition by condition and country by country. >> the toughest disease in terms of both treatment and prevention is aids. the tools we have for prevention today our education, changed behavior to get people to either abstained or use condoms -- we're hopeful that new tools will be [inaudible] recently, it was proven that male circumcision reduces male to female transmission 60%. i was a skeptic about whether there would be a demand from adult males to be circumcised,

but in fact in the key countries in africa, both in kenya and south africa and botswana, it has been shown that there is significant demand. and so that is a new prevention tool. you are involved with our foundation in funding a lot of that circumcision. that is good news. the ultimate prevention tool would be a vaccine. in the budget, the u.s. has to get the can money for aids vaccine research. the u.s. is the biggest funder of aids vaccine research. although we do not have a timeframe there has been good progress. that would be the ultimate tool. there is another tool that may come in a couple of years and be important in the high prevalence countries. that is the idea of either using a gel or taking a pill daily.

it is an aids drug but if you take a it prevents you from getting aids. it is a prophylactic. those trials report out in 2011. if things went well we could start to use that in 2012. the ghi proposal does put energy into prevention while maintaining commitment to treat the people who need it. as president clinton said, they're going to have to be more efficient to drive those numbers up. not only u.s. money but the global funding for this is not growing the way it used to. efficiency will be very important for them to balance those measures. >> senator corker wanted to apologize for leaving. he had to go to the banking committee but he wanted to thank you both for being here. >> i want to discuss for a

moment the foreign-policy implications of the work both of your foundations do. you mentioned this in your testimony. specifically, you are one of the few foundations that conducts polls annually with a very broad question -- do you like or dislike americans or questions to that effect. the survey has come back with a very large number of countries in which the majority of the population for some reason or another does not like us or does not approve of us. most of us feel hurt by the rejection because we feel that we are doing a lot of good in the world. the moral equivalence you talk about today as well as to retain peace -- whatever. but that is the way the world works. you have been in a situation where 12,000 people came out for a celebration and announcement

and they liked us. they liked what was going to happen. they had a good feeling about that announcement and those who were responsible. but i am wanting to trace what the foreign policy implications -- but of their foundations or either of them, did they consult with usaid or the state department about your objectives and how you are going about it? what do they believe to be the foreign policy implications? in international conferences where things are progressed -- the mexicans, the south koreans, now are pleased to talk about foreign policy gestures they are making. you personally have discussed this with leaders of these countries. to what extent are you aware of your foundations doing good?

i ask this of both of you because i said in the opening statement the obvious. the amounts of money and personnel that you are contributing to these objectives is impressive with regard to everything else our government is doing and the governments of other countries. it is not that you are separate states in these foundations. nevertheless, the impact of the shared billions of dollars is enormous. discuss, if you could, how you have taken the initiative or what sort of consultation occurs so that the net result is humane for those who receive but likewise you are perceived as americans who really have the best interests of these different countries of heart and working with other countries who likewise want to pursue that

feeling with regards to themselves. president clinton, would you speak? >> i think i can say without fear of contradiction that no ngo leader in american history has been able to consult as much as i have with the secretary of state. [laughter] >> that is an important point. >> let me say quite seriously -- you alluded to some of this with hillary in her confirmation hearings. i think this is really important. when bush was president, when i started all this, we tried to do the following things. we tried not to go to any country where doing so would cause real conflict with american foreign policy interests. i think it was more important to me than others because