The Business of Government Hour


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Ambassador Randall Tobias interview

Friday, May 20th, 2005 - 20:00
"The President’s Emergency Plan for AIDS Relief is very unique. Not only does it emphasize prevention, it also emphasizes drug treatment and care and does so in a much networked way through multilateral partnerships."
Radio show date: 
Sat, 05/21/2005
Intro text: 
Missions and Programs; Leadership...

Missions and Programs; Leadership

Magazine profile: 
Complete transcript: 

Tuesday, April 5, 2005

Arlington, Virginia

Mr. Lawrence: Good morning and welcome to The Business of Government Hour. I'm Paul Lawrence, partner-in-charge of the The IBM Center for the Business of Government. We created the Center in 1998 to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about the Center and our programs by visiting us on the web at

The Business of Government Radio Hour features a conversation about management with a government executive who is changing the way government does business. Our special guest this morning is Ambassador Randall Tobias, the U.S. Global AIDS Coordinator.

Good morning, Ambassador Tobias.

Mr. Tobias: Good morning, Paul.

Mr. Lawrence: And joining us in our conversation, also from IBM, is Kim Hintzman.

Good morning, Kim.

Ms. Hintzman: Good morning, Paul.

Mr. Lawrence: Ambassador Tobias, perhaps you could begin the segment by setting a context for our listeners. Could you tell us about the mission of the Office of the U.S. Global AIDS Coordinator?

Mr. Tobias: The mission is really very straightforward and flows from the announcement that President Bush made in his 2003 State of the Union, when he laid out his own concerns about the fact that HIV-AIDS is really destroying the world; 8000 people dying every single day around the world.

And so in that State of the Union message, the President committed $15 billion to be expended over five years, and to be done in a way that really is not business as usual, to bring resources from the American people to attack this issue. And so what flowed out of that is something called the President's Emergency Plan for AIDS Relief.

Mr. Lawrence: I am curious about the size of your organization, sort of the people who work with you and their skill set.

Mr. Tobias: One of the things that are really unique about the approach the President took is that I have been given the authority and the responsibility, and more importantly, the very direct support from the President, to create what is really a virtual organization. I have 50 or 60 people in my office in Washington.

But all of the people in all of the agencies of the United States government here in Washington, and in over 100 countries around the world, who are in any way engaged in HIV-AIDS activities on behalf of the United States government, now fall under the umbrella of this Emergency Plan.

So we've put together a unified strategy. I've asked people to leave their uniforms at the door to be now a part of the team supporting the President's Emergency Plan. But at the same time, because we have left people organizationally in all of the various agencies, we were able to get started much more quickly, and take advantage of the contracting mechanisms, the ordered-in mechanisms, all of those kinds of tools that exist in USAID, or Health and Human Services, or the Department of Defense.

If it works, it really represents the best of both worlds, and is in some ways as significant in changing the way that government works as the mission that we are engaged in.

Ms. Hintzman: Ambassador Tobias, can you tell us a little bit more about your role and your responsibilities as the U.S. Global AIDS coordinator?

Mr. Tobias: The President, as I said, announced this initiative in January 2003; the Congress passed the legislation in May of 2003. The President announced his nomination of me for this position in July, and I was confirmed with the Senate in October. At that point, the President's Emergency Plan had one employee. No office, no organization chart, no strategy; a lot of very good thinking that had been done by half a dozen people or so, but a great deal of work to do to operationalize it.

So the first thing that I had to do was to begin to get a group of people together and to draw together a strategy, and then put together an organization to begin to think about how we are going to implement that strategy. And beyond that, it's been kind of the typical leadership requirements that one might find in a startup organization.

Ms. Hintzman: And what were your previous experiences prior to your appointment as ambassador in October 2003?

Mr. Tobias: Well, this is my first experience working for the government. I had spent about 40 years in the private sector. I spent a long time in what used to be known as the Bell System, and was the vice chairman of AT&T, and went through the break-up of the Bell System in the early '80s and was there until 1993. And I left then to become of the chairman and CEO of Eli Lilly & Company, the pharmaceutical company, and was there for six years.

In the meantime, I've served on a number of corporate boards. But I also had experiences as a trustee at Duke University, where I was the chairman of the board, and in a number of philanthropic activities. And the combination of those things, I think, in many ways prepared me for this particular assignment.

Ms. Hintzman: So can you give us then a comparison of how that work in the private sector compares to the work that you are doing in the public sector?

Mr. Tobias: I think the biggest difference is that in the government, there is a broad range of interested parties, both inside the government and outside the government, who have some stake, some genuine interest, in what it is you are trying to do. And often those interests are not necessarily in alignment, and so interfacing with all those various interests, bringing that input and those insights together, and at the same time staying focused on the fact that I work for the President. I report to the Secretary of State, and I am really carrying out the President's vision. And so it's necessary, with all the pushes and tugs that come along, to stay very focused on that mission.

Mr. Lawrence: Is there any downside to working so closely with the President? I imagine it expedites a lot of things that might otherwise take a while, but is there any hidden surprise that you've uncovered?

Mr. Tobias: If there is a downside, I certainly can't think of what it is. I would not be here were it not for my having become convinced during the recruiting process of the President's enormous personal commitment to this particular initiative, and his follow-through has been terrific.

Mr. Lawrence: I was going to ask you what made you accept his invitation.

Mr. Tobias: Well, I was sitting at home having breakfast one morning, minding my own business, this not having been how I planned to spend this part of my life. And I got a message from someone who used to work for me who is in a senior position in the government, saying that my name had appeared on the radar screen in the Presidential personnel organization for a job that was very important to the President, but that it would involve going to work for the government full-time, and hypothetically, would I be interested in talking about it.

I said, "Well, hypothetically, I am willing to talk about it, but I'm really, you know, not looking for something of that nature to do." But over the period of a few weeks that followed, including discussions at some length with the President, with Colin Powell, who was then Secretary of State, with Condoleezza Rice, who was then the National Security Advisor, and others, I became convinced of not only the depth of the commitment to this initiative, but I became more fully aware of the magnitude of the problem that HIV-AIDS presents in the world.

You know, there is an old saying that when the President of the United States asks you to do something, it's hard to say no, and it is. But I have come to believe that this is really the greatest privilege of my life, that all of the other things that I've done in my corporate career I now think in many ways were preparing me to give back and to do something of this nature, and it's a real joy to be here.

Mr. Lawrence: How did you think about the time frame over which this problem would be addressed? You talk about the legislation being five years, but I'm just curious how you thought about the time frame for the total problem.

Mr. Tobias: Well, I think it's important to think about this as the first five years of a long-term journey. I think the title of the program, the President's Emergency Plan, was very correct. We need an emergency response. Things that in the government sometimes take months or years to get implemented, I've been trying to do in days or weeks, because it is an emergency and 8000 are people dying every day.

But I also think that this is not a problem, it's going to be certainly totally addressed during the time I am in Washington, and probably during my lifetime. But I think we can build a very important foundation for addressing HIV-AIDS globally, and we are making progress in that regard.

Mr. Lawrence: What was your perception of the confirmation process before you went into it, and how did it match your expectations?

Mr. Tobias: It was much more a complicated than I had expected. The requirements for providing information -- for example, in my corporate career, for probably the last 25 years or so before joining the government, I was running large organizations doing business in 120-130 countries around the world. And one of the requirements in the forms was to provide information on every trip I had ever made outside the United States, every government official that I had ever talked to on any of those trips. There was another question asking for copies of every speech I had made in the last 20 years or something. So it is simply assembling of that data.

I think probably this is a process that would benefit, first of all, from some technology, so that there was a common database of the questions that are needed by various arms of the government, where today everybody can answer their same form. But it took a lot of time and energy to get to into that process, but it is part of our system, it is part of the system of the President nominating and the Senate reviewing and confirming. And I think there are lots of checks and balances in there that in the end service very well in terms of the purpose. It's just the process, I think, could probably be improved.

Mr. Lawrence: That's interesting, especially thinking about the amounts of pieces of paper you must have filled out.

What's the history behind the President's Emergency Plan for AIDS Relief? We will ask Ambassador Randall Tobias, the U.S. Global AIDS Coordinator, about this when our conversation about management continues on The Business of Government Hour.


Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, and this morning's conversation with Ambassador Randall Tobias, U.S. Global AIDS Coordinator.

And joining us in our conversation is Kim Hintzman.

Well, Ambassador Tobias, let's kind of start, you know, get grounded in some facts here. About how many people are infected with AIDS, and sort of at what rate is the disease spreading?

Mr. Tobias: Well, there are about 38 million people worldwide who are infected by the disease. And if you look at some very basic numbers, you can see that in current trends, we're losing the war. In 2003, for example, 3 million people died worldwide, while at the same time, 5 million people were becoming newly infected. The numbers of people infected represent about 1.1 percent of the total population of adults between the ages of 15 and 49. So that's one out of every 100 people around the world between the ages of 15 and 49 is HIV-positive. And on a country-by-country basis, it's all over the map.

In India, for example, it's about eight-tenths of one percent of the population, but that's almost 5 million people. In Botswana, the number is 37 percent of the population of the people between 15 and 49. So in some countries, the magnitude of the problem has essentially wiped out an entire generation.

There are hundreds of thousands of households headed by a 12 year-old or 13-year-old taking care of a 8-year-old sibling and 10-year-old sibling, or some circumstance like that; thousands and thousands of children living on the street who have been orphaned by the disease. So the ramifications of this, well beyond just the public health issue, are really quite enormous.

Mr. Lawrence: They're staggering numbers, but let's talk about the treatment. What is antiretroviral treatment, or ART, and how many people currently have access to it?

Mr. Tobias: Well, when we go back and look at the history of the disease, beginning in the early 1980s, when people found out that they were infected and were HIV-positive, they really viewed it as a death sentence. There really wasn't much that could be done for them. And then in the last decade or so, the pharmaceutical industry has developed a class of drugs known as antiretroviral drugs.

People that are HIV-positive, which then goes into full-blown AIDS, and get to a point where their immune system has deteriorated to a particular level, can benefit from being put on antiretroviral drug treatment. There are a several million people in the world today that would benefit from being on antiretroviral drug treatment. It's been slow in being able to get implemented, in part because initially, the costs of the drugs were very high. But now the issue is less that, and more an issue of having the infrastructure and the trained medical personnel.

When the President announced the launch of the Emergency Plan in January 2003, the estimate from UNAIDS was that there were probably 50,000 people or so on antiretroviral treatment in all of sub-Saharan Africa. As we began to scale up our programs, and the first money was available from the Congress early in 2004, we began to get programs up and going. At the end of the fiscal year, at the end of September, we took a snapshot of the results to date. And we were supporting about 155,000 people on antiretroviral treatment at that point in time.

Now that was six months ago, and we've continued to scale up. So I'm sure that the number is somewhere between 200,000 and 300,000 people now, headed toward a five-year goal of getting 2 million people on treatment. So this is only one aspect of what we're doing in the President's Plan, but certainly a very important one.

Ms. Hintzman: We've talked a little bit about the history of the President's Emergency Plan for AIDS Relief. Could you tell us a little bit more about how it was developed, and how it's different from the preceding AIDS programs?

Mr. Tobias: Prior to the President's Emergency Plan, almost all of the emphasis in finding HIV-AIDS was on prevention, because there weren't other tools available; drugs weren't available and there weren't a lot of other things that could be done. The President's Plan is really focused on three things: prevention, treatment, and care. And we are very results-oriented. That was something that was and is very important to the President. And our objective is, at the end of five years, to have 2 million people on drug treatment, to prevent 7 million infections that otherwise would have occurred in that five-year period, and to be providing care for 10 million people.

And included in the care would be people who don't yet need treatment but need some help, or people who are beyond treatment, where drug treatment is too late when they get into program and they need end-of-life care, as well as care for all of the orphans. So the program is unique in that it incorporates all of those things and does so in a much networked way.

Ms. Hintzman: This initiative focuses on 15 countries. Can you tell us about a few of the countries and how they were selected?

Mr. Tobias: Well, you're right that principal focus of a large part of the money is on 15 countries: 12 in Africa, 2 in the Caribbean and 1 in Asia. Taken together, those 15 countries represent about 50 percent of the people who are infected in the world. At the same time, we have put the emergency plan umbrella over all of the U.S. government programs, so there are 85 or so additional countries where we have bilateral programs of one kind or another. And the countries were selected with a variety of criteria in mind, but these are countries that are very hard-hit. We took into account the attitudes of the host country government; what they were doing; whether or not there was infrastructure in place that we could work with, or if there wasn't, could we build infrastructure; were there non-governmental organizations that were available, a number of things like that.

Ms. Hintzman: So how was funding determined in the Emergency Plan for AIDS Relief?

Mr. Tobias: Well, when the President announced the program in the beginning, he indicated it would be $15 billion over five years. I think people were surprised and some people were skeptical at the beginning, because in the first year, Congress appropriated $2.4 billion, which was actually slightly more than we had requested, and I think people thought if they divided 15 billion by five years, it would be 3 billion a year. But what we really needed to do was ramp these programs up. We needed less money in the early years while we were building the infrastructure and training people and getting ready. And so in the first year, which was 2004, Congress appropriated 2.4 billion; in the current year, 2005, it's 2.8 billion. We have requested 3.2 billion in 2006 and 2007 and 2008. If the appropriation averaged 3.3 billion a year, you add those five years together, that's 15 billion. So it's been a gradual ramp-up, but the President has certainly met the commitment that he made.

Mr. Lawrence: What's the ABC model, and how is the U.S. promoting this approach?

Mr. Tobias: Well, the heart of our prevention program, and indeed, the heart of prevention efforts being embraced by professionals and experts and experienced people in this area all over the world, is called ABC. A stands for "Abstinence," B stands for "Being faithful," and C stands for "The correct and consistent use of condoms." It really is something that should be thought along a timeline.

The program was developed in Uganda, by Ugandans, for Ugandans, and they have demonstrated great success in following this program over the years. And by following a timeline, what I mean is that we focus on young people with the A messages, trying to get young people to delay the age at which they become sexually active, which in many African countries is really quite young.

Then if people do that, and then get married or get into a committed relationship, but they're faithful to a partner in that relationship, those two things together have been proven in Uganda to dramatically bring down the infection rates. On the other hand, there are people who will engage in high-risk sexual activity, and so they need to know about condoms, to have information about the correct and importance of the consistent use of condoms, and to have condoms made available. So that's where the ABC comes from, and while that is the heart of our prevention program, there are lots and lots of other things that we need to do.

For example, our programs so far have reached 1.2 million mothers who are HIV-positive, who run the risk of transmitting the disease to newborn babies. And we have a fairly straightforward treatment program that has dramatically reduced the infection passed along in that regard. Another, I think, very compelling statistic is that in Africa, about 57 percent of the people who were infected are women and girls.

I think most Americans find that to be an astonishing number, because I think they've thought about this as largely a disease of men. But it's becoming very largely a disease of women and girls. And part of the reason is that the cultures in a number of countries really take advantage of women; women don't have the same rights as men. And so part of our effort is to get laws changed and customs and cultures impacted so that woman have more control over their own sexual lives.

Mr. Lawrence: It's interesting about the cultural differences.

The President has encouraged bold leadership at all levels when it comes to AIDS Relief. What does this mean and how is it translated into action?

We'll ask Ambassador Randall Tobias to explain this to us when The Business of Government Hour continues.


Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, and today's conversation is with Ambassador Randall Tobias, the U.S. Global AIDS Coordinator.

And joining us in our conversation is Kim Hintzman.

Well, Ambassador, we're now two years into the President's Emergency Plan for AIDS Relief; how would you describe the progress to date?

Mr. Tobias: Well, I think that the progress has been really quite positively astonishing. I think we've gotten a lot more done than almost anyone thought would be possible. And while we are two years into the program, it's really two years since the President announced the program. It's just a little over a year since the first money was appropriated by the Congress, and less than a year since many of the programs have been up and going.

But in that period of time, we have reached about a 120 million people with ABC messages either directly or through the media or through other approaches that we are taking. And we are providing support for 155,000 people on treatment, which is three times the number that were receiving drug treatment before we started. And those kinds of numbers: 1.7 million people are receiving care, including about 600,000 orphans, and the programs are going very rapidly.

We are implementing our programs through a number of non-governmental organizations on the ground, about 1200 of them, and about 80 percent of those are indigenous organizations that are local to the countries where we are engaged in this fight, and that's going to be very important to the long-term sustainability. So I think that we are making very, very good progress. I don't even begin to see the light at the end of the tunnel. I wouldn't want anybody to have the misimpression that we have in any way turned a corner, but we are building a very solid foundation in getting the effort launched.

Ms. Hintzman: The Plan encourages bold leadership at all levels, from national statesmen to tribal elders. Given the cultural differences between the U.S. leadership style and the styles in other countries, what is your strategy to accomplish this goal?

Mr. Tobias: One of the guiding principles for our approach to fighting HIV-AIDS is to work very, very closely with the host country government, implementing their strategy. We're encouraging every country to develop a single strategy, and working within that strategy, helping to figure out what's going to work in those particular circumstances.

But one of the characteristics -- even though the countries are very, very different -- one of the characteristics that's present in every country that's making significant progress is the fact that the national leadership, the president, the prime minister, all the way down to -- as you say, to the tribal elders or the people who are traditional healers in the villages -- but the strong leadership, particularly national leaders who are saying AIDS is a problem, it's the number one priority in our country, and we are going to do something about it, and then following through on that; that's the characteristic that seems to make the greatest difference in countries being successful in engaging HIV-AIDS.

Ms. Hintzman: That's interesting how we need to coordinate with other countries and you also need to coordinate in all the departments and agencies in the U.S. government. So how are you leading and coordinating those activities?

Mr. Tobias: Well, I think in putting a leadership model in place in any kind of organization, in my long years of experience, in many cases learning things the hard way, there are sort of the formal ways that things get done and then informal ways that things get done. The kind of the hard things and the soft things, and I think many organizations don't pay enough attention to the soft things.

And so part of what we have done is to put formal structures together, but it's also been important to build relationships between and among the people who are involved, both in other countries, other donor countries, multi-lateral organizations as well as here within the United States government.

I think one of the characteristics that perhaps have made this project move along a little more quickly than it might otherwise have done is the fact that so many very, very good capable, dedicated, people in the United States government have been engaged in fighting AIDS from the beginning, since the early 1980s. And many of them have said to me never in their wildest expectations did they ever believe that any President of the United States would commit the kind of resources that President Bush has committed and put the kind of center-stage emphasis on this that the President has put on this program.

And I think as the result of that, they have seen this as a one-time opportunity, literally, to change the world. And so people are wiling to put some of their parochial interests beside them and come together more quickly than might otherwise have been the case. But it's been a very interesting, and remains a very interesting, challenge in providing leadership across all these dimensions.

Ms. Hintzman: Well, as you've pointed out, partnership plays a large role in the fight against HIV-AIDS. Who are the partners involved with working on this US AIDS initiative, and how is the U.S. strengthening the multilateral partnerships?

Mr. Tobias: Well, some of the principal multilateral organizations that are playing an important role in this include an organization called UNAIDS, which is the lead element of the United Nations family of organizations. Dr. Peter Piot, who leads UNAIDS, is a very skilled scientist and physician as well as a skilled leader. He is credited with being one of the people who identified the Ebola virus in the early days, and so brings an on-the-ground sense of reality as well as some good administrative leadership. And UNAIDS can play, and does play, a very important role in this.

The Global Fund, which is kind of like a worldwide United Way focused specifically on HIV-AIDS, is an organization that is seeking money from donor governments as well as the corporate sector and philanthropy, and anyone else who really wants to contribute. The United States, through the Emergency Plan, is providing about one-third of the funding for the Global Fund, because we think it's an important part of the strategy.

The World Health Organization plays an important role, World Bank plays an important role, and then individual donor governments; the UK for example, has played a very strong role. So there are an increasing number of players coming to the table.

Mr. Lawrence: Speaking of one of those players, one would be of healthcare professionals. How are we training them to serve so many people that need our help?

Mr. Tobias: Well, this is one of the biggest challenges that we face. Mozambique, for example, is a very, very poor country, one of the poorest in the world, with a population of something between 18 and 19 million people. Mozambique has about 500 doctors in the entire country, so there are millions of people who live their entire lives and never have the opportunity to see a trained healthcare professional.

A number of countries have experienced brain-drain of trained medical professionals. The health minister in Ethiopia told me recently that he believes that there are more physicians, Ethiopian-trained physicians, practicing medicine today in Chicago, Illinois than there is practicing medicine in Ethiopia.

There are number of ways to address this. I think one of the most successful activities so far is what we think of as twinning. I visited a program in Kenya not long ago that's a cooperative effort between the Indiana University Medical Center and the Moi University, which is a Kenyan university; the Moi University Medical Center. This program has been going on for 15 years or so. It started with a single Indiana University faculty member coming to Kenya to spend a year and develop programs that involved short-term exchanges of faculty from Kenya going back to the United States, faculty from Indiana University going to Kenya.

And it's developed over the years to the point where this program is now treating about 5000 people with antiretroviral drugs. But the important thing about it is that the clinical care is being delivered by Kenyans, who for the most part, have been trained by other Kenyans, who for the most part were trained somewhere along the way by the Indiana University-Kenyan partnership.

This is not just a matter of delivering assistance in the short-term; we have to build the sustainability so that the people in these countries have the skills and the ability and the wherewithal to take it over for themselves. It's kind of like the difference between giving people fish but also giving them the fishing tools and the skills to learn how to fish for themselves, and that's what this program is about. And it's illustrative of the kinds of things we are supporting.

Mr. Lawrence: It's interesting about twinning.

What work remains to be done, and what are the future management challenges to be addressed?

We'll ask Ambassador Randall Tobias, the U.S. Global AIDS Coordinator, for his perspective when The Business of Government Hour continues.


Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, and this morning's conversation is with Ambassador Randall Tobias, U.S. Global AIDS Coordinator.

And joining in our conversation is Kim Hintzman.

Ms. Hintzman: Ambassador Tobias, looking to the future, how do you see the progression and impact of the HIV-AIDS issues and our ability to fight it?

Mr. Tobias: Well, interestingly, we are already about 40 percent of the way through the five-year program, and we are into the second year, we are planning the budget for the third year. So we need to begin thinking about what comes after the first five years, and we have a lot work to do to determine exactly what the next stage needs to be. But clearly, there will be a next stage, and it won't be exactly, I don't think, like the first stage, but it will very much build on the platform that we have created.

I think we need to be moving more and more in the direction of building sustainability, and focusing our attention on how these programs can be sustained in the countries where the problems exist, and ensure that the things that we are doing are really going to address it in the long-term. But it's a very important question that is getting a lot of attention at the moment.

Ms. Hintzman: So what other new approaches and technology are out there for fighting HIV-AIDS?

Mr. Tobias: Well, a couple of things come to mind. There is an enormous amount of work going on, largely being funded by either the United States government or donors in the United States, including the Bill & Melinda Gates Foundation, on trying to develop vaccines.

Unfortunately, the scientists tell me that seeing something for HIV-AIDS that might be the equivalent of what we think about as the polio vaccine, for example, is not something that's on the horizon. It may be that at some point, there will be early-stage vaccines that if someone who was vaccinated and then became HIV-positive, there would be a much longer period of time between the onset of HIV and the onset of full-blown AIDS, for example. But that's something that needs continuing attention.

We need to ensure that the incentives are there for the pharmaceuticals industry to continue to be putting money into research for next generation drugs. One of the characteristics of antiretroviral drugs and of the virus is that patients will inevitably develop resistance to the current generation of drugs, so we will need replacement drugs out there in the future.

So those are a couple of things that I think are important areas for the future.

Mr. Lawrence: How about in of terms of just other management challenges with this initiative that you see on the horizon?

Mr. Tobias: Part of what was important to the President and appealed very much to me when the President asked me to take this on was to ensure that we were really producing results; that we were measuring the results; that we had clear goals; and that we were funding those activities that were producing results, and not funding activities that were not producing results.

And so we're now beginning, because I think it's timely to do so, a more formal monitoring exercise of using some consulting resources to review programs on the ground to ensure that the programs are being implemented in the way that we and the organization receiving the money intended from the beginning, and that those programs are producing results. If they're not, we need to stop funding those activities, and find the things that are working best, and put money in that regard. So that's clearly one of the going-forward activities.

I think it's also important to recognize that putting two million people on antiretroviral treatment involves far more than just buying the drugs. If Coca-Cola was not being sold in Africa, and someone was given the Coca-Cola franchise, I think it would be instantly obvious to any consumer that it's more than just buying the Coca-Cola. It's building the warehouses; it's buying the trucks; it's setting up the distribution routes; it's finding the places where it's going to be distributed at retail; it's training people on how to do all of those things; it's managing the inventory so that the right numbers of products are in the right places at right times; kind of the fundamentals of any large business.

Well, that kind of infrastructure doesn't exist in many of these countries, and so putting that kind of support mechanism in place, which we're in the process of, in order to really support this kind of a fight on a massive scale, is also a very important part of what we need to be doing

Mr. Lawrence: While the infrastructure is in place, it's clear from our conversation there's a lot of stakeholders in place, and you've had to interact with them. Any lessons learned in terms of managing such a diverse group of stakeholders?

Mr. Tobias: Well, I think one of the things that has perhaps surprised some of the individuals and organizations who, let's say, have points of view that may not be the same as the President's, in this administration, is they have contacted me and wanted to express their views. I have generally said, to the degree that I could, "Great, come on in," because I think we need to be talking to and listening to everybody who has an interest in this.

And I think people who have been skeptical about what we were going to do, by explaining more fully what we are doing and what we are not doing, I think we've been able to put some minds at ease. I think it's also been very important to listen to people who really have something to add to the debate and the discussion.

For example, we are encouraging every country, every host country where we are engaged, to ensure that they are listening to people in their country who are living with AIDS. These are people who've thought about this a lot, who've experienced the problems of stigma, who've experienced the problems of where do you get tested and where do you get treatment and have do you pay for these things, and the list goes on. But I think it's just very important to engage with everybody who has an interest in this.

In the end, we men are all agreed on all of the details; I am sure we probably won't. But we need to get the energy of everybody who is interested in this subject focused on the real enemy, the virus, the stigma associated with it, getting resources together rather than people fighting with each other, because that's really not going to help people who're been impacted.

Mr. Lawrence: You've come to the government service late in your professional career; what advice would you have for someone, perhaps a retired executive, who gets a call or is asked to join public service?

Mr. Tobias: Well, in my own unique case, I truly believe this is the greatest privilege I've had in my life. This is really, in my case, an opportunity to be involved in a very unique program that's one of the highest priorities that the President has. And I have found it very energizing. And at age 63, I found it very energizing to be working with the people who are 28 and 32 and 36, who are making such extraordinary contributions to this effort.

But there are lots and lots of places in the government and in public service in general where I think people who are interested in doing so can find ways to contribute the experiences that they've gained over a period of time. And if people have those opportunities, I would certainly encourage them to give strong consideration to taking advantage of the opportunity.

Mr. Lawrence: Well, that will have to be our last question, Ambassador Tobias. Kim and I want to thank you for squeezing us into your obviously busy schedule and joining us this morning.

Mr. Tobias: Thank you very much. It's a great pleasure to be here. And I would simply say that the American public ought to feel very proud of with they are making possible. Eight thousand people dying every day, we simply in humanitarian terms need to be stepping up to taking responsibility for doing what we can do as Americans. Beyond that, as we have come to learn in recent years, places that may seen far away geographically are certainly not far away in their potential impact, and pockets of hopelessness in the world cause people to do very destructive things, and HIV-AIDS is taking away hope in lots of parts of the world.

So there are lots and lots of reasons why the United States needs to be engaged in this, and I am very proud to be a part of what the American people and the President are making possible.

Mr. Lawrence: Thank you again. This has been The Business of Government Hour, featuring a conversation with the Ambassador Randall Tobias, the U.S. Global AIDS Coordinator.

Be sure and visit us on the web at There, you can learn more about our programs and research, and get a transcript of today's fascinating conversation. Once again, that's

For The Business of Government Radio Hour, I'm Paul Lawrence. Thank you for listening.

Ambassador Randall Tobias interview
"The President’s Emergency Plan for AIDS Relief is very unique. Not only does it emphasize prevention, it also emphasizes drug treatment and care and does so in a much networked way through multilateral partnerships."

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