United Nations Secretary General Kofi Annan was interviewed by Carrie Gracie in his New York office for the World Service's The Interview programme.
Kofi Annan: "I feel angry, I feel distressed, I feel helpless"
CG: Over the past two weeks the BBC World Service has been running an Aids season, and we've heard many aspects of the illness. But today, we want to get a sense of your personal contribution and whether you think that you're winning the battle. So I want to start by asking you about the enemy. When did you first realise what a serious enemy you were up against with Aids?
KA: I think it was when I discussed the issue with the World Health Organisation... and looked at the figures and the statistics and the devastation it was causing in many African countries, and the attitude of the leaders. We needed leadership, we needed leadership at all levels, but it was most important to get the presidents and the prime ministers speaking up, and that was not happening. And I thought we should do whatever we can to raise awareness and to get them involved.
CG: And has your sense of the problem, is it all from talking to leaders and talking to officials, or have you been out there on the ground, talking to sufferers?
KA: I've been out there on the ground talking to sufferers. In fact my wife and I were in Lima just last week, and we had a rather painful experience with a group of women who had set themselves up to help Aids sufferers. They had with them a nine-year-old. The mother and the father had died of Aids. She was left with her grandmother, who was illiterate and didn't know what to do. When we met them she was getting no assistance at all, so I called my UNAids (Joint United Nations Programme on HIV/Aids) colleague, the resident co-ordinator, and I said, "Can't we do something for this girl?" And of course, he's going to try and see if PAHO, the World Health Organization's regional organisation, can help her, but we were both quite struck. We knew this was happening, but we hadn't expected it. And I have seen the situation in other parts of Africa where I visited Aids patients, in villages where you see grandmother and lots of grandchildren, no mother, no father. And yet you go to a place like Mozambique, a small clinic which is doing a lot, which is following pregnant women and ensuring that their children are born free of Aids, and following the mother to try and protect her so that they can have their mother as well, and they do not become one of the 14 million-plus orphans. And I've also lost some very close friends and even people who worked here in the UN, and that also hits you.
CG: So you've watched individuals struggle through the course of the illness.
KA: Exactly. For me it's not just statistics. It's not statistics. I've seen the human suffering and the pain, and what is even more difficult is when you see somebody lying there dying who knows that there is medication and medicine somewhere else in the world that can save her. But she can't have it, because she is poor and lives in a poor country. Where is our common humanity? How do you explain it to her, that in certain parts of the world Aids is a disease that can be treated and one can live with and function? But in her particular situation, it's a death sentence. It's a tough one.
CG: And how do you explain it?
KA: You try to explain to them about what you are trying to do and what you are trying to get the governments to do to increase assistance, not only in areas of treatment, prevention and education, and getting the youth and the women's organisation involved. It may not necessarily help her particular situation, but at least it's good for her to know that action is contemplated, action is under way. If it will not save her, it will save others. That in itself is consoling, but it's not good enough. This is why I am rather pleased with Dr Lee's approach of trying to get the Aids medication to three million people in five years. Today we have 300,000 people on the medication.
CG: This is the World Health Organization initiative. It's called "Three by Five" - three million by the year 2005.
CG: We'll talk about that in a moment, but first I want to get a sense of how you feel when you're faced with these people asking you, "Why can't I have the drug?"
KA: You know, it is extremely difficult and I can tell you, I have really tried very hard. You may know that I have had several meetings with the chairmen of the seven top pharmaceutical companies to press for reduction in the prices of these medications, to get across to them that whilst I respect and support their intellectual property, it is extremely difficult not to make the medication accessible to the poor and that we need to be able to balance it. And they have reduced some of the prices. And in some cases, like Nevirapine in some countries, they are giving them away for free.
CG: This is the drug for mother-to-child transmission, given to pregnant mothers.
KA: Exactly, which I consider the cruellest of all transmissions. And so you press and push and try and get as much as you can, and governments are becoming engaged. But for the person who is lying there, in some cases like the child I mentioned in Lima, you are able to give them some assistance. But it doesn't always happen that way. With others, you cannot immediately get them assistance.
CG: And does that make you feel angry, or does it make you feel distressed?
KA: Both. I feel angry, I feel distressed, I feel helpless and I also feel that, to live in a world where we have the means, we have the resources to be able to help all these patients, what is lacking is the political will. How do you generate that political will to ensure that assistance reaches them? And of course, with somebody like myself, who try to speak for the poor and the voiceless, you sort of feel you are failing, you are not getting enough done. And it is, you walk away a bit depleted and upset - really upset, if not depressed.
CG: What more can you do though? When you ask yourself: "What more can I do?", what answers to you come up with?
KA: I think we should continue our efforts to mobilise the societies to play a role. We should get the leaders to speak out against discrimination, the stigma that is attached to it. We need resources. We need resources to assist these people. We are operating at a relatively low level. We estimate that, by 2005, we will need $10bn worldwide per annum to fight the disease. Today I'm trying to see if we can get $3bn a year for the next five years going into the Global Fund. I would want to see $1bn from the European Union per year for the next five years, $1bn from the United States government and $1bn from other sources. But multi-year commitment over the next five years, and of course the rest of the resources will have to come from elsewhere.
CG: But that money is not forthcoming, is it? I mean, people started off with great protestations about how much they were going to contribute two years ago, but it's not coming.
KA: It's not. I am disappointed. We've got the $7bn. I'm grateful for that, but that is not enough. We need much, much more.
CG: Because you said, when you launched the Global Fund, you said you needed $7-10bn a year. At the moment, over two years the Global Fund has been able to hand out $2bn over two years.
KA: That's correct.
CG: You're miles short... You talked about a sense of personally failing. Does that make you feel there's some failure on your part?
KA: Failure on my part, and insensitivity on the part of those with the power and the resources. Insensitivity on the part of those who should develop the political will to do it. And I'm badgering them, I'm talking to them, I'm pushing.
CG: And how do you do it? I mean, say I'm sitting across from you now. I'm George Bush. I've just announced that I'm going to provide $15bn for Aids over five years, but I'm only going to give a small part of that to the United Nations and the rest I'm going to hand out piecemeal myself. How do you persuade me?
KA: I have explained that, if you want to start from scratch and develop it yourselves and build the necessary administrative structures and mechanism, obviously you're not going to be able to spend the $3bn or so in a year. But if you were to use assistant structures, which the Global Fund and the UN family has established, you should be able to use as much of that money to reach the needy who need it today and not tomorrow. And that I'm also encouraging them to put as much of the money as possible into the Global Fund. Initially, they have said $1bn to the fund, and I said, well... this $1bn initial is not too bad, but then I discovered it was $1bn in five years. But I think we haven't given them. I've talked to senators, I've talked to others, I've spoken to President Bush himself, who's very sensitive to this issue of Aids, for us to raise the level of contribution to the Global Fund, which has today given grants to over 93 countries, and wherever I go they tell me how helpful this has been and of course, they are all looking for additional support. And if we do not replenish the funds and the Global Fund were to fail, I think it would be a very serious indictment of the leadership in the world today.
CG: And is it an indictment of them on a humanitarian basis, or is there an argument from self-interest that you can use to persuade them?
KA: Both. You have it from a humanitarian, from a moral grounds and a self-interest basis. It is a security problem. I mean, in some of these countries, if you take some of the African countries in southern Africa, Aids has taken away not just the present but the future. It's taken away some of the most productive men and women. Schools are losing teachers, hospitals are losing doctors, the civil service is depleted. In the past we talked of training people and the civil service here. In some of these countries, we may have to talk of replenishment, or perhaps even bringing in people from outside. Aids is decimating the security forces and the police. It is a really serious problem and it's not just in Africa. It's spreading very fast in Asia, in Eastern Europe and in the Caribbean and even in this country it's on the way up. So those who think Aids is over are dreaming. It is one of the most serious epidemics the world has ever faced, and we need to really really get serious about it.
CG: We talked about what you want from the developed world. Now let's talk about the leadership in those countries faced with epidemics emerging. What's the problem with leadership, why isn't it coming?
KA: Some refuse to talk about this because of cultural reasons. We had a situation where one African leader was going to give a speech - I don't want to embarrass him by naming him - and a speech was prepared for him where he was urged to encourage the young people and the population to use condoms to protect themselves. He said: "I can't utter the word condoms. I'm the father of the nation. You can't ask me to encourage the youth to be promiscuous." But this is saving lives.
CG: And is that what you said to him?
KA: Yes, I've said that to him. I said: "This is saving lives." I spoke to another African leader who was also entirely against the use of condoms and said: "Mr secretary general, we don't want to associate you with the word condoms. You shouldn't even be using that word while speaking about it." I said: "Mr President, I've even written to the Pope about it, to see how we can work with the Catholic Church on prevention, on education, on treatment and care." And he looked at me and said: "Mr secretary general, when it comes to condoms, the Pope and I are one." I said: "Mr president, but your people are dying. We are talking about saving lives. And this is a very serious business. And God will understand."
CG: And did you change his mind?
KA: I didn't. And this is a frustration. This is the painful experiences you sometimes have to go through. And then if I walk away to see one of the dying patients, and they were to look and say: "Help me. Get our president and the leaders to help us," you can't tell them the attitude the president has. You say: "We are pressing the president, we are going to push." Sometimes you have to speak out to put them on the spot. At the same time, you want to be able to work with them and encourage them to do what is right and what they have to do, and not to turn them off. And it is really, really very, very painful.
CG: So you can't shout at them in public. You have to apply this pressure privately.
KA: I do both. I apply it privately, very bluntly. In public I speak out, and push them, push the leaders to act, push them to lead, push them to think of their people, push them to save lives, but without naming them individually.
CG: It's very hard, isn't it, because a lot of the groups most affected by Aids are very marginalised groups anyway. I was just reading The Epidemic Update, published by UNAids, and the stories are horrific of the rise in the problem - injecting drug-users, the male-to-male transmission, homosexuality, the sex workers and of course, all over Africa, sub-Saharan Africa, the stigmatisation of people who have Aids. If you have a people who are marginalised, they can't speak up for themselves and if their governments aren't going to speak up for them, then who is?
KA: This is the real test. This is why I speak out as often as I can. That's why I became engaged in the fight and made it my personal priority and I fought very hard to make it the priority of the UN family of agencies. But I think we need to also get civil society. NGOs have been very effective partners and they've been active and sometimes embarrassing and pushing the governments to do the right thing. We've seen women's organisations at the grass-roots level, and this is very important, because today, in Africa, Aids has a woman's face. Over 50% of the infected are women and often they are the innocent victims. And we really need to also empower the women to take care of themselves and get the young people involved. And I have seen, in countries where the campaign is mounted by the head of state and it goes down all the way to the village level. In Senegal for example, where they're even using Creo - Creo is an oral historian - to tell the story, to talk to the people about it. We visited them a couple of years ago and my wife asked this woman Creo, she said: "Are you embarrassed to talk about sex, and all this so frankly to the people in the village?" She said: "This is death. There's no embarrassment in death. There's no embarrassment in trying to save lives." And she has that kind of spirit that I want to see in the African leaders and the leaders around the world whose populations are threatened. I want to see them adopt that attitude of this Creo in Senegal that we met. She was very inspirational.
CG: So Mr Annan, are you winning the war?
KA: Well, I would wish to think so, but I'm not. I'm really not winning the war. I'm not winning the war because I don't think the leaders of the world are engaged enough. I also appeal to communities and societies everywhere to become engaged in the struggle. They cannot leave it to their leaders alone.
CG: So in a way, you're talking to people over the heads of their governments.
KA: I'm talking to people over the heads of the governments. They should take on this fight. They should not be afraid to speak up, and they should not be afraid to challenge their governments to do something about the epidemic. It is their lives. It is the lives of their children, and their sisters, their mothers and their brothers and fathers. And they have the right to demand support, they have the right to demand action from leaders whose main and major responsibility after all is to ensure the safety and welfare of their people.
CG: Because obviously that has happened in the Developed World, people with HIV, with Aids-related illnesses are getting anti-retroviral drugs. There are prevention measures in place. Is that in your view then, because they have political rights, because they are vocal, or is it because these societies are rich?
KA: I think you have both here. We shouldn't forget the history of the disease. At the beginning, the community that was hardest hit by HIV/Aids, whether here or in Europe, organised themselves very effectively to get attention from their governments. They had a voice, they organised, and they also knew how to use the media and the press. When you go to the developing countries, you don't necessarily have that capacity. You described them as the voiceless and the poor. And they need others to speak up for them. But given a bit of help, a bit of encouragement and a bit of organisation, they can surprise all of us.
CG: I want to bring up with you an example of someone with a voice. We talked last week to a Ugandan woman who's been HIV-positive for many years, and she did feel angry about some things. And she asked me to ask you when we can expect as many people who need medication in the developing world to get it. When will they get their medication?
KA: That is a difficult question to answer in terms of a time-frame. The media campaign which has been launched by the World Health Organization is Three by Five - three million people by the year 2005. The estimates are that about six million people need it today. So that is half of the six million people. If you were to get it to the three million by 2005 and you were to extrapolate from there, hopefully you would be able to give it to them by 2007/2008. I'm also hoping that there will be developments, that the medication will be cheaper. We'll be able to come up with one three-in-one tablet to be able to assist them. I'm also hoping that the world will wake up and realise that we need to get the medication to those who really need, and lessen our self-interest. Some - many - governments have described it as a security problem. And yet we are not giving it the kind of attention we are devoting to terrorism and weapons of mass destruction. For people in some of the countries we are talking about, Aids is a real weapon of mass destruction. And what are we doing about that?
CG: On that point, your special envoy on Aids in Africa, Stephen Lewis, has called spending on the Iraq war and the war on terror obscene. And he mentioned a figure of $200bn and set it alongside the annual spending on Aids - a total of possibly $3bn. Is that obscene?
KA: My view is that we need to fight all the threats. I call the fight against terrorism and weapons of mass destruction the sort of hard threats - hard threats because people see immediate blood, immediate war... but the soft threats - poverty, the Aids epidemic, environmental degradation, are also with us and in many societies they are wreaking much more havoc than terrorists are. And we need to tackle all these threats. We don't have a choice, we don't have an option.
CG: Some say there was a tragic missed opportunity, that the world was gearing itself up to tackle Aids, that is was facing up to the soft threats in the year 2000/2001. But then on September 11, the twin towers came down, the attacks on the Pentagon, and the whole world changed. It became war on terror, it became then weapons of mass destruction, war in Iraq, and the world lost its focus on Aids. Is that how you see it?
KA: Let me put it this way. I hope, if we had not had 9/11, how much more resources would have gone to Aids. But I can't be sure. I can't be sure because I have seen other situations where it has not happened. Let me give you the example of Somalia. When we mounted, the international community mounted that major operation in Somalia, the US forces withdrew and we put in a UN force, the blue helmets, to take over. The military expenditure was about $1.5bn a year. At one point, we needed $150m for the humanitarian operation and the deployment was seen as humanitarian intervention. We couldn't get the $150m. So really, when you ask me, had there not been a 9/11, had there not been war in Iraq, would we have got all the resources that we needed for Aids and the fight against the epidemic, I really can't answer that, and I must say I have to be honest there, because what is more important? The fight against the epidemic that saves millions or the war and the fight against terrorism? This is why I am saying we need to draw up a balance. We need to tackle these issues right on, and I think the capacity and the resources are there. We have to develop the political will to get it done.
CG: Three million people, we think, died of Aids this year, more than two million of them in Africa. If those kinds of numbers were dying in the rich part of Europe or in North America, then all of this would be different, wouldn't it?
KA: All of it would be different, because the population would have demanded action, the politicians would want their votes and would act to be able to tell the mothers, the brothers and the sisters that we are fighting your fight, we are saving your children and yes, and vote for me. But this is distant, and not everybody sees it the same way, and yet we have common humanity, and we need to be sensitive to needs and concerns of others.
CG: And as an African watching so many people on your continent die, does that feel like injustice?
KA: It's worse than that. It does feel like injustice, but it does indicate a certain incredible callousness, that one would not have expected in the 21st century.
CG: And how will history judge us for what you describe as this incredible callousness?
KA: Harshly, very harshly. And I don't think we will have any defence.
CG: What about you? How will history judge you and your role?
KA: That is for others to decide. I think it would be utterly improper, or perhaps even immodest to talk about my role. I would prefer you and others to tell it. As the saying goes: "A man cannot see himself except through a reflection of a mirror." So be my mirror, and tell me about my contribution.
CG: We mentioned talking to people over the heads of their government. What would you like to say to all the listeners to the BBC World Service about Aids, about what they should do to help?
KA: I think what I would want to tell them that we face a real serious epidemic, an epidemic that is destroying societies and countries. And the leaders of these countries, if they're going to have a country and a country with a future to lead, they'd better pay attention to this epidemic. They'd better pay attention to the youth, the vulnerable groups in society, particularly the women, who are not empowered, who are often abused, and are often subject to violence which also leads to increase in the Aids epidemic. They should speak up, they should end the silence and the stigma and the discrimination that is attached to the disease, and that when it comes to Aids, silence is death. And if they do not speak up and help their people, their death will be on their conscience.
CG: Kofi Annan, Secretary General of the United Nations, thank you very much for joining us on The Interview.
KA: Thank you very much.