come in a couple of years. that is the idea of using a gel or taking a pill daily. it is in aid drugs. it protect you. it is a prophylactic. those reports come out in 2011 from t. to be using that in 2012. the proposal does permit new energy into prevention while maintaining a commitment to treat the people who need it. they will have to be more efficient to drive the numbers up. not only the u.s. funding but the global funding is not growing the way it used to. . .

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 nevertheless, that is the way the world works. as you mentioned, president clinton, you have been in a situation where 12,000 people came out for a celebration and announcement, and they like this. they liked what was going to happen. they had a good feeling about that announcement and those who were responsible. but i'm wanting to trace, with the foreign policy implications, do both of your foundations, or either of them, consult with the usdid, the state department or others, about your objectives, how you are going about it, what they perceive to be the foreign policy implications? and beyond that, the point you have made in international conferences in which things have progressed. the mexicans and south koreans

are now pleased about the had you main gestures they are making. you have personally discussed this with the leaders of these countries. to what extent are you aware of your foundations, and/or our government or a combination are doing good. i of both of you. the amounts of money and personnel that you are contributing to these objectives is impressive with regard to everything else our government is doing, quite apart from the governments of other countries. it is not that you are separate states in these foundations, but nevertheless, the impact, the sheer billions of dollars is enormous. so discuss, if you could, how you have taken the initiative, or what sort of consultation occurs, so the net result is

humane, but likewise you are perceived as americans who really have the best interests of these different countries at heart and working with other countries who weis -- likewise want to pursue that feeling with regard to themselves? >> i think i can say without contradiction that no n.g.o. leader has consulted as much as i have with the secretary of state. [laughter] >> that is an important point. >> let me say quite seriously. you know, you alluded to some of this with hillary in her confirmation hearings. i think this is really important. -- president bush was president when i started all this, and we tried to do the following things. number one, we tried not to go into any country where doing so

would cause real conflict with america's foreign policy interests. i think more important for me than others because of my previous position. number two, whenever possible, we try to work with pepfor, and we have a very good relationship with them. i argued that he should allow those funds to buy the least expensive generic drug, and we reached an agreement which he honored, which is if the medicines that we sell in 70 countries that serve 2 million of those four million people greg treatment, that if they passed f.d.a. scrutiny, pepfore money could be used. my goal is not to go somewhere

where my being there causes problem for american foreign policy, and working with the country on the ground as well as with the host government. if i might, senator, i think the work that bill and i do, and that many others do, is intrinsically good for america's foreign policy. look, it doesn't matter who is the president. you see now president obama being criticized by some of the people who criticized president bush who said he is not as different from president bush as i wanted him to be. doesn't matter who the president is. the interests of the united states and the challenges we face are sufficiently different from orcountries that we are not going to be popular with everyone. we don't want to politicize our work, but we want it to be reinforcing -- reinfortsing of

the best of america. when people think you care whether their kids live or die, they get along pretty well. this is not complicated. i believe that we don't want to overly politicize what we do, but the best thing we can do for america is do a good job of the things that we do and avoid conflict with american foreign policy by going somewhere or doing something with someone that would trigger that conflict. >> mr. gates? >> well, president clinton mentioned his personal situation. my personal experience is that if you're rich enough, there will be some resentment no matter what. [laughter] >> do you ask -- the u.s. is the richest country in the world. if you look at our popularity,

it reflects many different things. in fact, the countries where the u.s. is the most admired, many of those countries are the countries in africa where this aid is visible and it is making a huge difference. in the meegs, other factors come into play. it is disappointing what those polls show in terms of attitude towards the united states. in terms of the scale of spending, i do want to make sure it is clear that the rich world governments spend dramatically more than all foundations, including my foundation. our foundation as a whole would be 5% of the overall spending. the u.s. government is substantialally bigger. it is amazing how the other rich countries, with very few

exceptions, even in these tough times have maintained their global health spending. there is the incredible countries like sweden, denmark and the neither land that have stayed super strong, 1% of g.d.p. there are countries like germany and the u.k. who have continued to increase their names. it is really that in total that has made this possible. i do think this work has a substantial impact on how the country is view, a willingness to take our science and our innovation and have it benefit the poorest people in the world. >> thank you very much. >> senator fine gold. >> thank you, mr. chairman. mr. president, good to see you again, and mr. gates. you have presented a compelling case about why the united

states must continue in global health initiatives. i have seen the tremendous good will generate bide our leadership in global health. i have seen americans of all ages, and many from my own state of wisconsin, who have been involved in health work abroad. in 1999 when you were still president, mr. president, one of my most moving trips to africa was with your united nations ambassador richard holbrooke. i saw first hand the devastating and destabilizing impact of h.i.v.-aids then. he said then it was thought just a health issue, but a diplomatic and a security issue. this is true today not only of aids, but ma larry ya, t.b., child and maternal health and more. our global health plays an important role in advancing our over-arching national security goals. you both talked about building strong health infrastructure

earlier. as you obviously both know, many doctors and nurses in the developing world emigrate to europe and north america for better pay and working conditions. this so-called brain drain continues to put a real strain on health systems in developing areas, especially in africa where i have spent a lot of 34i work on this committee. i would like to get your views on how the united states government can help in this problem or to make sure we are not contributing to it, and what is the role of n.g.o.'s in this regard? >> thank you, senator. i worry about this a lot. i would like to say, first of all, i don't think that you can eliminate it completely because people will make personal judgments about where they want to live and what they want to do. but i do think that systems matter to the outcome. i think one of the most important things that this global health initiative can do is to intensify the ability of

countries to recruit, train and retain health care workers in delivery models that are affordable over the long run for those countries. and i think there are plenty of able people that will do it. what can we do? we can fund more in-country education and training programs. we can figure out how to help countries over rough spots. as i said, in zambia, the whole thing was breaking down, the health care system, and we did a lot of things. i think it is in the documents that we sent, but we helped them to rehire 40,000 people. we set up a training program for nurses in ethiopia and one in kenya. we built out with the partners in health larger systems in

rwanda and trained community workers. let me give you an example of preearthquake hate versus africa. in many cases, the per-capita incomes are about the same, but one thing is different. most african universities, or a lot of them, collapsed at the end of colonialism because they were supported almost entirely by the colonial governments. the haitian universities, a lot of them, were supported by the church and religious organizationings. before the earthquake, we actually had quite a large number of gifted young haitians able to get a college education in haiti. a young american named connor bohan who went there too teach was so moved by this, he raised money to send kids to school in haiti. he had about 75 graduates before all this happened.  not a single one of them had

left the country to work. 68 of them were already at work in haiti. seven others were doing graduate work. we need to look at how we educate and train people in terms of their attention. i am thinking about haiti because we have to figure out what to do with the kids whose schools were destroyed for the next year or so. it may be that we should offer scholarships to foreign students which become grants that they work off if they go home, just like the rural medical service corps grants in rural america. that helped us so much in our infrastructure problem. if you stay in america, can you do it. but if you get through immigration, have the permits and everything, but you have to pay your loan back then over your time. you can convert your loan into

a scholarship if you go home. i think we really need to think about how you take the life experiences of people and make it work for them. there is nothing you can do about the fact that you are going to be able to make more money here than rural ethiopia in the foreseeable future. but if you make it easier for people to stay and operate at a high level of efficiency, more will stay. you will be amazed much this global health initiative will help in building the infrastructure. people don't like to fail in what they do. they don't want to be in an environment where their efforts are going to be fruitless. that is one of the concepts behind g.h.i. smart peel all over the world, if they think they can succeed, they are more likely to stay home. >> mr. gates, legality me ask you about the ma larry ya -- malaria.

i would like your thoughts on the future of the fight against malaria? >> just to add a thought on the previous thing. the people who leave the country are often responsible for the best things that happens in african countries. remittances are five times all foreign aid. when somebody leaves it is not a bad thing because they are going to be sending money back. that is really the magic. in terms of malaria, these are exciting days. that is, the roll-out of bed nets and indoor screens, the numbers in many areas are quite impressive. there are some other areas where the bed net format doesn't work as well, so we need to deliver a candle or stick type format to get the insecticide there. and there are new tools coming.

there is a vaccine in a phase three trial. president clinton mentioned the idea that getting the powerful medicines out by subsidizing their price will have a huge effect, because the older, cheaper medicines, there is widespread resistance to those. and only by getting these better drugs out will we be able to reduce the number of deaths. there has really been a lot of engagement, great people coming into this field, the malaria no more group that the uses backed and we backed. and so i think you will continue to see a huge reduction in the number of childhood deaths. we have some computer modeling to figure out what areas we could get a geographic elimination. there are a number of countries where malaria's hold on the country is tenuous enough that

it is within the realm of possibility to shrink the malaria map. >> mr. gates is being too modest here. we had this announcement in tanzania, and 12,000 people showed up because we were giving them medicine that works because of the gates foundation funding it. we started in two tanzanian provinces. this maryland sin was selling everywhere between $8 and $10 a dose. nobody can afford that. we got it down to about 50 cents. we are not at the volume levels, given the cost of the component parts, to have the market take it took. with all of the aids drugs, the market took it down. without the gates subsidy, we couldn't do it. now we are in 11 african countries doing this thanks to the gates foundation. huge numbers of people will

live. other people are still taking this old quy nine based medicine. it is like taking an aspirin for a headache. pretty soon you are sick again and going to die. this is part of all the issues. we can get these malaria drugs down in price. but to do it, we have to figure out how we are going to get enough compound and how to get the volumes up so you can get the prices down the way we did in a.r.v.'s. we wouldn't know that without the gates foundation. these 11 countries in africa are doing it. that is the dilemma you face. you wind up maybe getting the price down if you can put a little more money into the medicine now. >> i just want to say in these issues of h.i.v.-aids and malaria, on behalf of my colleagues, this has been a

time that people despair of bipartisanship. bipartisanship has been superb on these issues for years. i think americans should know that is happening here in this body. >> point well made, senator. thank you. senator mendsess? >> thank you. >> mr. president, thank you for your incredible continuing service to this country and the world. mr. gates, thank you for making a difference, an individual using their resources to make a difference in a powerful, pozztiff way. i would like to take your experiences a little bit -- and certainly i am with you foursquare on the global health initiatives. but to try to extend out some of those experiences on how we may do better. mr. president, you as the united nations spernl envoy to haiti have a tremendous amount

of convening power as well as multilateral efforts in haiti. i know that work is only going to get harder. even though we have had a tremendous response, it is only going to get harder in some respects. haiti is not just a technical challenge, but a leadership challenge as well. i am wondering as we look at haiti and our responses there, are we doing enough, whether it be haiti or overall long-term thinking, about how we do foreign assistance and how in that context are we looking at how we develop leadership at the end of the day within countries to help us, whether it be global health initiatives, development assistance or our efforts? we can externally provide resources and make a difference. but at the end of the day, whether it be today's haiti or tomorrow somewhere else, the question is how at the same time do we create indigenous

leadership to move us in the right direction? mr. gates, if you could comment on that as well, as well as you have a unique ability through the foundation to make long-term commitments in which individuals and countries can ultimately depend upon, and that is somewhat transformative versus what we do here in the congress on an annual basis. i wonder do you have any thoughts in that regard as well? i would love to hear from both of you. >> well, first i think it is very important. president proval is here and is meeting with the president today. the secretary of state and i had dinner with him, his his team last night. the haitians have got to settle on one of a few options for a

model for how this reconstruction process is going to play out. i believe the one that indonesia adopted after the tsunami is a good model, something like that, that will give the world question tense that there will be great transparency in the process and that it will be moving in the right direction. secondly, haiti is a bigger job proportionally, but it has got some advantages. you've got a real commitment there on the part of the haitian government to the modernization process. again, i think our goal should be empowerment. and in that sense our model should probably be are you wanted. the row want dan government -- in 1998, four years after the

are wanted ann genocide, the per capita incomes was less than a dollar a day. two years later, $1,250 a year. there is no other country that has quadrupled its income. the haitians adopted before the earthquake a very ambitious long-term modernization plan. it covered education. it covered economic development, health and the whole range of issues. it required them to modernize the government and open it up, and the airport system. their plan. they are sticking with the plan and putting the response to the quake into they're plan to amend it as soon as the post

disaster assessment is completed. i believe we have a real shot to support a successful enterprise there, senator, because they think the same thing you do. they want to retain talent. he want to be held accountable. they want to not need us except as friends, and that is what we intend to do. the key is personnel, but i believe they are going to make good decisions on that. >> there is always the challenge of which countries to help, the ones in the greatest need or the ones that have the best government so that the money will be most effective. right now in ethiopia, certainly in the health area they have very effective leadership. the g.h.i. proposal talks about some of the ambitious goals

they have set for ethiopia. the government has decided to do health workers, and so the u.s. money will allow them to succeed with that program. there are some things like vacks nations that can be done in the worst areas. the vacks nation -- vaccination rates in small are doctor -- in somalia are better than other areas. getting a mother to a clinic to treat conditions that might come up, that is very difficult if you don't have reasonable government and roads. these programs have to be tailored. vaccinations should be done everywhere. training health care workers and trying to get a big improvement there, you want to pick places where you have strong governments. g.h.i. has this idea of picking

governments. with india in particular, you don't want to pick the whole country. you want to pick parts of the country. it is too important to the global health picture to have it not be involved in some way. nigeria is a challenge. you want to work, and yet the government coordination hasn't been very good. from our foundation's point of view, we have to be in nigeria. for polio, that is the last place in africa it still is. we have seen some relief there with a bit better government. >> senator, could i go back? one thing you said relates to what senator lugar asked me on the impact to our foreign policy.

before the current coalition government took office in zambabwe, we were providing pediatric medicine and some other retrovirals. 2/3 of all the kids who get this medicine didn't have any other way to get it. now, we cleared it, but the state department made the right decision. they said even though we are at odds with must guantanamo bay -- mugabe bi, people are still pouring across the border from zambabwe. there is an inherent conflict sometimes between how good the government is and how much the need is. there is no one rule. but you can't walk away from the humanitarian crisis, and it

turns out that is the best policy. >> senator cardin? >> president clinton and mr. gates, thank you for everything you have done, and thank you for beale here. your presence helps in the challenge that senator kerry pointed out about getting the type of support and also the type us focus and priority to this issue. i want to thank you personally. i want to underscore the point you made mr. capacity. it is sometimes to get support to build up the internal capacity of a country. we have a little better time with specific programs. i think the strategy was to use those programs to be able to get the type of activity in that country to build its capacity so it could take care of its own needs. i applaud you for