the numbers are really extraordinary. the program is responsible right now for about 2.5 million people who are on therapy, close to 1 million babies that were saved. 10 people who are under care including aids. so it truly is one of the landmark programs that the united states government has implemented. that's the really great news. the sobering news is that when

you deal with such an enormous problem such as this, and aids is a classic example of that, but as i'm sure you'll hear about malaria and tuberculosis and others is that the solution to the problem is just not treating people, you've got to treat the people who are infected but if you look at the totality of people from countries, 30 to 40% of the people who need therapy are getting it, which means that 70% of those who need it are not. for every one person that we put on therapy, two to three people get newly infected. so if you just do simple math, the number of new infections are outstripping our capability of not only initiating therapy of newly infected people, but even sustaining the people economically not feasible. we need to try as best we can. the answer, and what we really

learned is that you've got to prevent it. that's the thing we need to do. we have well proven, biologically proven modalts of prevention ranging from condom distributions to mother to child transmission to circumcision to a variety of things. the sobering news of that is that only 20% of the people who would benefit from those preventive modalts actually have access. so the lessons we've learned is that when dealing with a disease like that, prevention is a major part of what we need to do. and also, you have to get the countries themselves involved in making these types of things part of their own programs. and that's what the global health initiative is trying to do, not only by having the larger umbrella, child health et cetera, but making it a part of development that countries

have an investment in the health of their citizens as opposed to the united states and other depped countries coming in and continuing taking care of them. so an amazing amount has been accomplished but there is some very important lessons to be learned. i'll stop there because there may be questions. >> i'll try to make this not just about money, and we'll come back to this question about whether, by changing the approach, strengthening health systems in these countries, whether -- countries, whether in fact you can do these things more effectively with the resources that you have. before we go to that, as i noted in the beginning, we started out talking about 300 million or so a decade ago and now we're up to about 25 billion with this administration proposing 48 billion over the next -- i guess it's 63, being 3 billion

with all of the programs included over the next three years. then you have a whole lot of other groups. you have bill and melinda gates foundation. we've seen a lot of actors coming in. the u.s. is the largest contributor, but it contributes 40%, but then there are all the other folks. and we have people saying is what we really need is not $40 billion, but we need probably about twice that amount. you've got lots of different people with their hand out for one thing or the other. and i don't want to say hand out. that's probably not a fair description. i'll allow laurie to kind of put that in some kind of perspective for us. japan, the united kingdom, along with bill and melinda gates. what is being asked of all of the players and what is everybody doing? and what can we expect them to

do? the u.s. is not doing this alone. >> as we all know here in the united states from our own experience is that health costs money. you can have all the good will in the world, but unless there's cash, to purchase the necessities for cleaning up water supplies, distributing pills and bed nets to prevent malaria and infection, you can't accomplish very much. it's just good intentions and albert switeser like zeal. the good news is that between 1998 and 2008, the total pile of cash out there for what we grandly called global health increased exponentially. it went from somewhere in the ball park, depending on whose numbers you're using, between 4 and 500 million. that's for everything that we call health, from clean water supplies all the way to pills

being handed out, training doctors, and all sorts of things. and we are now well into the ball park of 45050 billion if you include all the -- 45 to 50 billion if you include the range of things of the bigger number. the biggest without a doubt is the united states government. and if you combine private and public giving to the whole pot of global health, we are by far the biggest donor. i mean, in the scale of 60 to 70% of cash that's out there for what we call global health. so this puts us in a difficult moment in light of the rest of the discussions that you've heard today. general ode earno said you cannot succeed in this new vision of iraq or by implication what he was saying where we're going with afghanistan if you can't increase the level of the

civilian engagement in what we're dealing with in foreign assistance. you have to -- that means you need a strong u.s. agency-international development, a strong global health initiative and a strong account 150 to put it in budget determines. but we're in a different world from the elections and from the one in which tony played a pivotal role in the conception of pep far. that was the post 9/11 world, and it was a world in which there was an awakening among christians at a very grass roots level across the united states to the need to engage as christians in including the health and the lives of people outside the united states. and so you had literally from grass roots churches kind of a movement in the united states

that supported president bush's very surprising announcement. i think tony was one of a handful that knew what he was going to say when he stood up at the state of the union address and announced, by the way, i'm going to throw billions of dollars at the hiv aids eepdepic. and now where we are, look at the constant nudging the u.s. government is giving to the rest of the donor community to step up to the plate and collectively at least combine all of them to match what we give. just to accomplish that we'd have a he will of a fight for global health care. look at where we are now. first of all, we have an enormous wealth gap that has occurred that was already in process of occurring before the 2008 financial crisis. just here in the united states in 2005, the bottom 50% of our population earned 12% of the wealth of our country while the

top 10% earned 21%. but according to the 2009 census, that got much worse. the bottom, about 3.4%, and the top 41.5%. that sort of widening of the gap of wealth and slinking of the real -- shrinking of the real income of the middle classes is not a uniquely american problem. the most extraordinary gap widening of wealth occurred in the uk. what this has meant is that our own middle class is shrinking has experienced tremendous financial pressure and is in a less altrustic and generous mood at the moment. and this is going to make for a real challenge trying to go forward pushing congress, pushing the g-20 and various

other places for cash dedicated to global health or, frankly, food policy, water policy, any of the what i call transnational threats. in addition, we are shy, americans as individuals collectively are shy 4.6 trillion for our personal retirements. so if it looks bad now, it's really going to look bad in about 5 to 10 years as the baby boomer generation marches off into retirement. and health care most rapidly inflating sector, not just in the united states but all over the world in terms of cost, so that in the oecd overall health care costs in 2000 has inflated roughly 70%. but here's the interesting fact, it's inflated 16%.

so they're feeling the pinch on the home front that is an additional pinch that is going to constrain the sense of generosity. we have a currency war going on that essentially involves countries trying to devalue their personal labor forces more than the other gice's labor -- guy's labor force. this doesn't bode well for middle class anywhere. and the liquidity crisis with roughly somewhere between 5 and 10% of the $70 trillion global wealth locked up, not out there at the moment, in general circumstance lace. so when you put all this together, what it means is that we have less cash in circulation, we have a shrinking middle class, and most of the wealthy countries that wealth has really shifted to the top 0.1% weltsiest and

the most large economies in the world. and we're shifting from a g-8 world to a g-20. and here comes the big catch. most of the countries are actually still recipients, not donors, for global health. china is a major recipient of funds to fight aids, tuberculosis and malaria, india is a major recipient country. brazil is still a recipient country. so the latest g-20 summit happened two weeks ago, if i remember right, south korea -- thank you very much. south korea tried to push for -- south korea tried to push for a real discussion of the donor role of the g-20 and the rest of the g-20 nations, besides the original g-8 said, off the agenda. we're talking currency wars here, we're talking trade and market policies.

and when you really get locked down, you can argue about how do we deal with global health governance and the intersection between governance and donations to support such things, if all those people, the 4 million plus that successfully gotten the treatment but need to stay on it for the rest of their lives, you cannot stop the pills from flowing, when we look at that big picture at the level of the g-20 and the emerging market countries it all ends up being we're not talking about this same conversation with you, we're talking about trade, about technology transfer, and who controls pharmaceutical patents. so we don't really have a collective conversation that where we're talking on the same plane, when we say global health among the potential donor states except the original traditional wealthy

nations. and the original traditional wealthy nations are feeling a lot less generous today than they did four years ago. >> admirals, it seems like a good place to segway. i noticed on pbs you had spoken about the generosity of the american people. how they're willing to be generous if they can see in fact that their contributions of the global health of developing countries are in fact effective. and i think an important point that might get missed by some of the g-20 countries is the link between prosperity, product tivity and hethsdz. and you're talking about 450 million people. many of them children. the children die from the illness but the adults doesn't make for a very vigorous workplace. so i guess the question is,

against the scenario painted by laurie, do you believe that the legacy of president bush will be protected by the sort of the new dimension forming in congress? >> that's a good question, because everyone is asking. we have set tremendous expectations in the world today with the success of the programs. and i'm referring back. there is one of the major shifts that have allowed us and collective multilateral countries to work is the increase in resources. and what we're facing now, while it's quite dramatic and causing a lot of questions, i think we need to remind ourselves that we have been at a place like this before. so the question is, what do we

do? and we don't know yet because dollars and comics will become a bit clearer -- economics will become clearer here. and we have to look at the realities of what congress appropriates and then look at our national commitments and priorities and make appropriate adjustments. you referenced the generosity of the american people. laurie mentioned that in a number of her comments. and i feel that's a trait that we have embedded in our dna as citizens of this great country. and if i can get personal for a second, i have come to that conclusion based on a number of things. i grew up in asia and my parents were missionries. much of their work had to do with medical missions. and in many of the countries today, 50 to 60% of health

deliveries is done through n.g.o.s, the private sector, and missions. along with that investment comes a lot of passion and personal sacrifice, and that's going to continue. that is marginal when you talk about the billions of dollars needed to sustain programs. but it still exists. and then there's also the private sector. and the private sector has been extremely commited and involved. let me speak for malaria. it has been an inclusive community internationally and the u.s. where we've seen whole sports teams, soccer leagues, motivating. maybe not -- have raised billions of dollars for nets, but we certainly have advocated in front of the american people the significance of engaging on a chronic international problem that we call malaria. we have had major contributions

motivated and driven by ray chambers, the u.n. malaria envoy who has mobilized private citizens as well as foundations to come together and work with government. and then there is the donations that are being solicited through the global funds and world bank to boost the program and then our own programs. so as we look to the future and we look at the commitments that we have communicated to the most indemic countries, most in subsahara africa, and think the challenge for us now is as budget realities become clear, then we're going to have to make adjustments, because we have made significant progress over the last four years in many of the countries in malaria. the challenges that we have with malaria are much different than what the hiv-aids community has. we have proven effective

interventions. our program, i call it my ppp program. public-private partnership, of which we have significant ppps, like prevention, prevention, prevention program. because three of the four interventions are all about preventing people from getting malaria. so there's a significant investment up front. as we have seen the incident rate drop as much as 50 and 60% in some countries and child motality drop by 30% in seven countries, there's a lot to be -- to celebrate. so regardless of the amount of money that we get, we're going to have to rally the forces around the wagons and do everything we can just to sustain the progress we have made with our multilateral

partners as well as international govements and work toward sustaining so when the dollar changes we can build capacity and move forward. >> you said it well. we've been here before. in fact, there was a time back when john f. kennedy was president of the united states when the u.s. congress voted to try to eradicate malaria. and american people set out to get rid of malaria. not just in the united states, that we had done. the whole world. and at that time ddt was brand new and there were no resistant insects. and color form was brand nu and there was no significant parasite problems. so these both worked tremendously. and we got out there all over the world, the campaign went full bore.

and countries that had lived with malaria, horrible levels for centuries suddenly went almost malaria free. jack arta went to a state of no malaria. and then congress said, well, we gave you a deadline and you haven't finished it yet, so the money is cut off. and boom. malaria soared everywhere. and one of the thing that is soared with it, the resistance. so the lesson i take from that which i think is really where we need all of you on our side, if i could use that sort of rallying cry, is that this surge in global health interest concern and funding is still in an infant stage. the money's poured out but a lot of the programs are just still making mistakes, finding their way, trying to develop the right relationships with

governments, trying to balance, where does the n.g.o. fit in, where do the faith-based groups fit in? we cabinet just as things are starting to work pull the plug. >> doctor, we're not just talking about aids, tuberculosis and malaria. i mean, most people in these countries die of the same thing , so the question is how do we do it? with less resources, i guess. >> all three of us have alluded to it in one way or another. a couple years ago i wrote an article that was a commentary on the success of the programs that we've had with malaria and hiv aids and to some extent

tuberculosis. and the point that i made in the commentary is exactly what, with laurie and with tim and you have been saying, and the catch word is really sustainable. health is there. you don't fix health. you have to keep with it because weep keep getting sick and -- keep getting sick and diseases continue to emerge. so the answer to your question is how we deal with it is, true, putting more money in. but putting it in a way that it becomes sustainable. sustainable within the countries that we're dealing with, and make health part of the national strategies of the countries that you are working with. it's no more -- secretary clinton gave a wonderful speech a few weeks ago where she was talking about getting rid of the words aid to and talk about partnerships and development.

and health is part of that. it's a fundamental part. we were talking about this panel that was here before us that was talking about the political events and foreign policy. well, health is one of the most important components of foreign diplomacy. so i think this is all part of the big picture. so the way to do it is to take an approach that we're not just going to be doing something in the short term, like laurie said, here, congress gives us a five-year appropriation and that's it. it's an almost indefinite commitment. and not a commitment of giving, but a commitment of building sustainability. >> i think what's interesting, is i referenced president obama's speech, the millen yam development comments in new

york in september and he specifically said we should not think of development as charity, which i think we do. we think of it as something that we goif. i think it would help if you -- i mean, i would be curious to know from you how building health systems, how do you build health systems that for long have depended on assistance. and can you make this trade-off with countries? >> we can do it but you have to have cooperation from the country. we can train people, but they have to have an environment in their own country where it is an attraction for them to stay in their country as opposed to training people who then go off to other countries because you train them. and we can't fix the economic system in the -- country or the attitude about how much of their total gross national

product they're going to put in. and that's what part of the goals are. that's really part of it is to deal with countries who are taking seriously their own contribution to what's going on in their own country. so it's not going to be easy. it's just not easy because some of the countries that have the greatest needs have leadership that don't see it that way. it's presump shoes for us to think that we're going to go in and change the culture in the countries but we have to at least try to train the people. >> admiral zimmer, a lot -- reviewing what people were talking about, the three pillars of development, defense, diplomacy, and development essentially, i think a lot of people consider the path that we've gotten it wrong and so much emphasis was on the military. and so the people bringing aid

and people bringing care were in uniform. so they might have colored their impression of what the u.s. is doing and why it's doing it. how do you sort of link aid to diplomacy? >> i think that's an important point and i would defer back to what the president himself himself has said, policy decisions in global development where he addresses the whole idea of sustainment, innovation, and incent vise, partnerships. secretary clinton has followed up in saying we've all heard the three ds, defense, diplomacy, and development. and it's clear to those of us in development business that development is a core component of diplomacy, health diplomacy, and we can talk about that all day. i think the defense department does understand their role and their mission, and they have

been mobilized successfully over the last number of years to do tremendous work because of the capacity in disaster relief situations. floods, earthquakes, the tumesie. -- tsunami. i think there's an awareness by the defense department that what they do is not long-determine development. that is an industry and sophistication that they understand needs to come in parallel to the whole of government approach, the effective development. and again, one more thing. underneath global health initiative, the principles that we see, in addition to focusing on women's health, leveraging an inner agency process, which includes looking for innovation, leveraging resources but focusing in on, as tony said, it has to be owned by the country itself so

that the donors and all of the players look at one basic common plan by which we engage and can leverage the country. so i'm optimistic that the playing field is coming together in a clearer way, even though the finance is going to be a little bit fuzzy. >> that's a big irony actually of the moment we're in. as i said, this whole global health and development and the linkage between the two and sufficient funding to do something meaningful is a relatively new phenomenon. and we just get to the point where we have this sort of perfect alignment of an administration, a leadership in the house, a leadership in the senate, all agree that there that is to we b a strategy before, that it had to be linked in some way with defense, in help development, and now that leadership on the house side is out, we'll have

to see what the g.o.p. leadership will feel about all of this. and kerry-lugor, never really got beyond the level. so we don't know where all that's going. but one of the things again i think we all take away from general oid no's talk, such an inspiring conversation today, was that you're not going to win over support for good governance and we're working out differences between tribes, ethnic groups, various kinds in iraq or afghanistan if the only american presence is a combat presence. and that he also used the phrase whole of government. the whole of government approach in afghanistan, hillary clinton has said over and over again, starts recognizing that an afghani woman has several orders of

magnitude, greater probability of dying in child birth than an american. and very few women here probably ever had to worry that they would die in child birth. but if you were in kabul or out in the rural area, it could be a very real concern every time you got pregnant. what does this mean to u.s. interests? and u.s. foreign policy? if more and more women in afghanistan recognize that because of programs brought by the global health initiative from the united states, fewer of them are dying in child birth? and more of their newborns are likely to live to their fifth birthday. what does that kind of engagement mean? and i think that goes to do you build a health system and so on, but it also just goes to what are you trying to do as foreign policy? and why do we for so long think that all these issues -- i

notice how much of the room has left because this is -- this is the soft stuff. we already had the hard stuff. >> and i'd like to ask each of you to answer the question why should particularly in the current economic climate, why should we continue to -- granted, it's a small percentage to begin with. >> for all. >> so why should americans not let this drop? and why should we continue to invest in the global community? and global health care. >> there are at threes two reasons, probably four. i'll give you two. one that i used to work on long before people got interested in global health and the globalt

of what we do, and that is the pure humanitarian reasons. human beings we should feel a moral spobblet if it is possible to help take care of people who need as human beings in general and particularly as americans. that has been the spirit of america for a very, very long time. that's one reason. the other reason is that we li in a -- live in a global community and we are all interconnected and a healthy work is a world that would be economically viable and we depend on different countries back and forth. and we know that. that's an economic discussion that can go on and on. but also from a security standpoint. i would venture that if afflingen were not as poor -- afghanistan were not as poor a country, it's one of the most unhealthy countries in the world, i'm not so sure that we would have had al qaeda go in

there and room free if that was a strong, healthy nation. so it's everything from humanitarian to economic interest to pure security. >> i would go another level to add on to what tony said. i agree with, as long as folks in gaza and the west bank have children that contract measles and israel goes decades without ever seeing a case of active exponentially lower than an israel achild living to age 10 you're not going to reconcile. expand that globally. we have this clarne call a year and a half ago with h1n1 twifle emerged first in the u.s. and

then explosively in mexico. and fortunately it was it was a relatively benign virus, not anything akin to the 1918 horror of influenza. but everything that we had always warned would happen in a pandemic that would aggravate tensions between nations and misunderstanding between nations really did happen. overwhelmingly, the very slow and eventually available vaccine concentrated in the wealthy countries. overwhelmingly, the only effective drug tami flu concentrated in tockpilse in the wealthy country. and overwhelmingly everything was far more available if in very rich countries. by the time most of the vaccine supply for africa reached

africa, the epidemic was over. so what that said is to the rest of the world is you know what? why should we partner with you on anything? because when the really big one comes, you're going to walk away from us. you're going to hoard everything. you're only going to take care of your own. if we can't demonstrate that we think the health and survival of a baby boy in bay route is as valuable as a baby boy in los angeles, we're never going to have any big conversation. >> it's the right thing to do, as tony has said, the programs that the u.s. government are investing in are saving lives. it's a life saving mechanism. but now we're saying that it's building capacity and sustainment. in addition to help from the united states government is spending, one of the presidential initiatives is the future. so in addition to health, we

have nutrition and food, to move towards this whole development commitment. and i'll jump back to what tony said. the millenium development, you hear a lot of chatter. but getting back to malaria, we address reduction in inif he can shs disease. we address maternal health issue but healthy communities means kids in schools. so we're touching education. in mall owie, a mother making less than a dollar a day spends 30% of the disposable income on antimall aerial drugs. that'sport in action. if we can eliminate that from her discretionary income kit, that will help her that day and that moment. and so that then drives us to millenium development goal poverty alleviation. so while we do excellent work in health where we are saving lives, the united states government can show the data

that this is a good return on investment, and it dreist us back to the ultimate goal of poverty alleeation, community development, which is what we're all seeking to do. >> if there are questions. certainly. weem start here. -- we'll start here. >> can you hear me? i'm from the western mass council. i know it's not a very economiccal -- economic conversation or a militarily important country, but for purely humanitarian reasons shouldn't we be doing more about haiti, which is a country in our own hemisphere?

i am very concerned about the recent outbreak of cholera and the fact that what i read about that we had helped initially and then we pulled back. and i would like to know from you folks is there any kind of ongoing help in our own hemisphere for countries, especially like haiti, who have nothing really to offer? to us economically, militarily? but from a humanitarian point of view. thank you. >> haiti, last spring, captain mendsa from the u.s. navy and i co authored a piece saying the national weather service was forecasting 16 major tropical storm events would hit the caribbean with a reasonable odds that at least one would slam haiti. didn't we need to immediately as a matter of urgency for the survival of the people of port

ah prince build some structures that could withstand storm and flood conditions to which the people living in tents could flee? build an early warning and radar system which they didn't have for distinct local weather detection, build an emergency alarm system with warning and training of the populous so they knew where to run? and now, hurricanes come and hit haiti and none of that is in place. and people are literally holding little pieces of plastic over their heads while the wind and rain are pouring down over them. and we saw similarly with cholera. it's axe yo matic as we go into a far more globalized -- which is good news. humanitarian and peace-keeping response, that the humanitarian responders and peace keepers themselves can become vehicles for microbral hitch hikers from all over the world.

if you're moving u.n. soldiers, they're in congo one week and the next week napal and the red ross workers are the same, you have the potential for every single one of them to be a disease carrier. we know the cholera was introduced from outside. it certainly didn't naturally arise out of the water of haiti. and it doesn't matter, i don't want to blame anybody for that introduction, but i think that our inability to respond very effective and very rapidly once it did emerge and keep it very localized is disappointing. >> i think the initial response and perhaps -- was dealing people who were injured. that was the initial concern. the question of why we have not been able to rebuild haiti or get around to doing it, .

i know this is not exactly health per se, but -- >> no. >> it is in a sense. >> it encompasses health. it isn't fundamentally health. it's really a commitment problem to our neighbors about doing something about getting that country to be self-sustainable. if you look at some of the heroes of the health areas in haiti, people like bill pop and guest po and bill farmer who spent so many years there, it is clear that you can accomplish an extraordinary amount with relatively little investment. it's not as if you have to put billions of dollars in there. so the shorter answer is we should be doing more. >> because they're in our hemisphere. >> well. >> and for humanitarian reasons. >> i think humanitarian reasons

also. and also because the whole issue with cholera, you know, if you look at again very briefly, if you look at the cholera map, the belt of cholera, cholera occurs in regions. so if you think it's going to stay, as laurie said, in haiti, once you introduce it into a region and people go back and forth to different countries, you're being presump shs and naive to think that it's guaranteed it's going to die out there. it likely will and i hope it will, but it may not. >> the greatest cholera outbreaks in the united states were all related to the slave trade and the movement into the caribbean and back up again. so we constantly had cholera reintroduced into our waters, especially in new york city. sometimes with devastating results. >> i appreciate your interest in haiti. just to address the what are we doing right now with the storm and the cholera outbreak.

you go to the website you see that there are 20 members of a disaster response team that's there right now and there's a significant aggressive amount of work going on in conjunction with the health organization, c.d.c. and u.s. aid. just for the immediate update i would invite you to go to the u.s. aid website. that would give you at least today's information. >> thank you. >> over there. >> my question is on hiv in subis a harne africa. -- subis a harne africa. my question is what funding the u.s. government and ngo is available for prevention in sub is a harne africa and how much funding would it take to have a preventable, sustainable program for hiv and africa? >> when we put together the

original pep far program, 20% of the total amount was in prevention, 55% in therapy, and the rest in care, between 20 and 30% in prevention. what would it take? and that's just the pep far program. there are other components of it for prevention. it really would require access to the modalts of prevention that we know work. and that's the point that i made that is so frustrating. even under the best of circumstances, when you have health africas that don't allow any more than 20% of the population who would clearly benefit from a proven prevention modality don't have access to it, that's a very serious problem right there. so it's the whole issue of what all three or four of us were talking about, about building sustainable health system. because if you don't have a health system, you're not going

to get anybody into the system to be able to counsel them or to give them the care about how, what they need to do to prevent. that's the structural function answer. but there's also another answer that we're dealing with a sexually transmitted disease in cultures in which you have flage rant and egregious disenfranchisement of women in which they really don't have the human rights to be able to protect themselves in a society that really demeans them. and that becomes very difficult. and we as my friends in africa tell me all the time there, with a smile to my lips, you don't want a white guy like me going into africa and saying you have to treat your women better. what you have to have is the leadership in the african countries realize that they have to turn around centuries of cultural issues which have not allowed their population, particularly the women, to be

able to protect themselves. that's one of the really important stumbling blocks in prevention. >> and immigration and homophobia even in this country, hostility towards gays has contributed to a resurgence in certain communities among gay communities here of hiv. but we haven't managed to get it under control and make prevention effective here. i think this administration is focused, zeroed in on certain groups. we have time for two more questions, and then we'll wrap up. >> i want to shift to another topic. as i recall with the h1n1 we did not have enough vaccine even here. and it got into the whole complex of vaccine production and which companies are going to do it and how much lead time do you have and knowing exactly what virus you're dealing with, and then distributions. so i wonder if you would address that part of the

problem. >> well, the problem with not having enough vaccine for influenza is that we have at the root cause of that, really, is that we as a nation and the world has not taken seasonal influenza very seriously. we say, well, i have the flu. and then when you think about a pandemic you get nervous. but seasonal influenza is a very serious issue. it kills about 36,000 americans a year, about a half a million people die a year. but we take it in stride. the incentive to make a vaccine in a way that you can quickly ramp it up and get it in a matter of a couple of months, and i'll take it one step further. the incentive to make a universal vaccine that you don't need to change from season to season, that you give it once every several years and

protect not only against strains that change dramatically as the pandemic strain. we haven't had that incentive on the part of industry or on the part of our leadership to encourage industry to do that. the good news about the threat of the h 5 n 1 bird flu and the reality as laurie said of the relatively mild h1n1 is that it got everybody all exercised about, my goodness, are we really dealing with antiquated ways to make vaccine growing it in an egg? we'll do one better. we'll grow it in a cell. no we have mole eckclar biological techniques to get the virus see quensed and immediately start making it instead of having months delay. so what is happening now is that the federal government to their credit is now sharing the risk with industry by doing

things like helping with the advanced development production. the federal government is financed a plan of no varts in north carolina to go from egg-based to cell-based. we're making extraordinary investments in trying to develop molecular based flu vaccines and ultimately a pandemic or universal flu vaccine that essentially covers everything. so we're really way behind. and i think the jump start that we're seeing now because we all got frightened by the threat of a pandemic, everybody looks to 1918, we can't have another 1918. so i think it's going to change. but ub fortunately it took several decades of really meed oakor responses to influenza. >> thank you very much. >> yes. >> hi. we've had rankings of countries over the last two days in the

u.s. is not in the top so i just wanted to say thank you for putting us at the top of the list for giving around the world. we did not have i think one category br we were number one in the last two days. so thank you for that. that's a good feeling. my question is i think part of that is because we trick or treat with unicef boxes and we have rallies and we have telethons and we raise a lot of money in the private sector and i think we support our government in doing the same around the world. how do we get the emerging market countries that have huge savings to do the same and they could they love to golf in asia so can't they do raleas? do they do that? and i don't think you can do it with the government. it has to be a populous topic that makes the government give more money so that i hope we maintain our number one status but i'd like to see china

number two. >> it's a great question. this goes to what i was talking about in the early part of this discussion, that shift from the g-8 to the g-20 world. and how do we talk about all the priorities of global health. and for that matter food and agricultural prolssizz, climate issues, all of that in this shifting political landscape. actually, interestingly what is slamming the successfully emerging market countries is this sudden surge in chronic diseases that are typically seen in wealthy worlds. so suddenly they're experiencing an obesity explosion, diabetes associated with it. more and more of their population is living long enough to develop serious cancers. cardiovascular disease, strokes. and every one of them has a administer of finance that is sitting down doing the demographics and the long

forecast and saying, my goodness, if we don't do something, we're going to be bankrupt trying to deal with all this end-stage disease burden down the road. so what we see now is an increased level of concern in china, in brazil, in mexico, in south africa and so on that is in part spurred by this sudden anxiety about the chronic disease in aging populations. it doesn't get to the fact that so many countries, south africa being a prime example, are experiencing both at the same time. a transition to the chronic disease burden while they still have this enormous inif he can shs disease burden that was akin to what we were going through perhaps 150 years ago in the united states. that is where we have a log jam. is in a continuing commitment from the global donor

population and the g-20 countries generally to that remaining inif he can shs burden. just to put a data point on something that the admiral said. since 2007, the amount of money put into fight malaria globally has increased 166%. that's an astounding figure. and what that means is people in whole parts of the world that absolutely had nothing to do except accept malaria as part of life or death as the case would be, now actually have tools at hand to save their life, to get infected or prevention infection altogether. but those same people, as brenda said about an hour ago here, will eventually then die of cardiac arrest or cancer or lord know what because they don't have any health service for that at all. so the -- i guess i would say the big momentum is to try and

sustain and even increase the commitment to conquer the old disease burdens of infeckshs disease while at the same time reving up for this explosion that's going to hit most of the countries of the world in the next 20 years that would be aging and chronic disease perfect storm. >> and one would hope that emerging economies, with growing economies and growing middle class, which would also have an active citizenry which would begin to demand that. and this administration has said that it's going to link its support even to the second tier or middle income. it's going to link assistance here from the u.s. to governance, to democracy, and one hopes if these efforts are supported by the current congress, we will have . and that's all we have time

for. [applause] thank you. a very big thank you to our panel on this very critical topic in u.s. foreign policy. thank you very much. i hope we've achieved our goal. our objective of engaging you, our leadership, across the country on the critical issues of foreign policy with the critical players of foreign policy so you could take this back to your local communities and determine what type of programming and educational work you want to do in your communities with this. and i would like to thank our speakers for the past several days. our donors. shev ron, tomple son reuters, rates i don't know, north rup grummand, most importantly, i want to thank you for taking the time out of your very busy schedules to come here and engage on these very critical issues facing our country.

you spend your lives trying to build our democracy by ensuring that americans have the opportunity to learn more about global issues. thank you for what you do. thank you for coming. and we'll see you in the east room for the reception and dinner with larry summers. thank you. [applause] >> next, live, your calls and comments on "washington journal." then, "newsmakers" with michael bedroom witch, director of the bureau -- bromwitch.

after that we'll have post election remarks from senate and governor races from around the country. beginning with the arkansas senate race. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> it's harmless if one is making a star out of brit any speers or cher. but when one takes this motion of stardom into the national security realm, then lives are at stake. americans after a while get wise that the stars and the wizards, the dream teams and the best and brightest really might not be what they're cracked up to be. but in that fateful amount of time, chaos and mayhem can come to rein.

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