FT Health: Decision time at Global Fund

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Next week is crunch time for the Global Fund to Fight Aids, TB and Malaria. The agency, which channels donor money into lower-income, higher-burden countries for the world’s three big killer infectious diseases, is set to select a new executive director.

After mis-steps in the spring that forced it to abandon and restart the process, the board must this time make sure it agrees on a strong candidate.

The shortlist is not the best showcase for diversity. Only one of its four finalists is a woman: Frannie Leautier from the African Development Bank and the World Bank.

All three men have significant personal, educational and professional roots in Europe or the US, albeit with extensive experience in poorer countries.

Three are also from the public development sector: alongside Ms Leautier, Anil Soni worked at the Global Fund itself as well as the Clinton Health Access Initiative, while Simon Bland is a career international civil servant from the UK’s Department for International Development and UNAids.

Mr Soni has some corporate experience, notably in India with Mylan, the generic drugs company which has become a very large supplier of antiretroviral therapies in Africa, as well as provoking probes in the US over its pricing practices.

The wild card is Peter Sands, the seasoned former head of Standard Chartered bank, which has extensive reach in emerging markets, notably in Asia. Mr Sands was engaged in debates around health policy but was ousted in 2015.

Absent in all four candidates are the skills of a politician able to speak to governments. Whoever wins should in any case brace for tough negotiations, notably given the frostier climate in the US and UK.

As Mark Dybul, the previous head of the Fund, told FT Health when he stepped down, his successor should reflect on the governance of the Fund, on fresh ambitions to end the “big three” epidemics and on new models for financing health, including a focus on inequality. 

FT Health event

Join us in London on November 21 for discussion, drinks and networking on HIV developments. Guests include Deborah Waterhouse of ViiV Healthcare and Yusef Azad of the National Aids Trust.

Three questions

We spoke to Thomas Cueni, appointed earlier this year as director-general of the Internatisonal Federation of Pharmaceutical Manufacturers and Associations, the industry trade body.

Do you agree with the pharma industry so aggressively defending patents?

Suing Nelson Mandela [to defend HIV drug patents in South Africa] was about the dumbest thing the industry ever did. We’ve moved a long way in 10 years, including with the Medicines Patent Pool. But if you want innovation, you need intellectual property. If you want to find new solutions for antimicrobial resistance, dementia and immunological disorders, you need the industry’s business model. I believe the industry is now more open to thinking out of the box, engaging in public-private partnerships, testing alternative models. 

What are your top priorities at the IFPMA?

The biggest health threat right now is antimicrobial resistance. If we don’t get our act together, instead of 700,000 people dying each year we may have 10m by 2050. A second focus is universal health coverage. You will not be able to make much progress unless you address the funding issues. You need functioning health systems. But as long as two-thirds of the world pays out of pocket, you will struggle to reach universal health coverage. We as an industry can contribute. A third area is ethics and integrity. Since the healthcare environment is extremely dynamic, there is constant need to reflect the changes and echo them in our programmes such as compliance training.

So how best to tackle anti-microbial resistance? 

We need a holistic, comprehensive approach: antibiotics in animals, improving stewardship of drugs including ethical promotion practices and finding new ways and means to improve access and affordability. Unless we get incentives sufficient to stimulate investment in R&D that are targeted to public health priorities and linked to appropriate use, we will not get the new antibiotics we need. We have some great “push” incentives to stimulate early-stage discovery, but so far there has been far more rhetoric than action on “pull” incentives.

Chartwatch

Boomer boozers  UK data show a big jump in alcohol-related deaths in the over-50s since 2001. For males the most affected group is 60-64 years old and for women 55-59. Men, Scots and those from poorer areas are particularly affected. (Office for National Statistics, Guardian)

News round-up

Global nutrition A new report highlights the global problems of childhood stunting, anaemia in women of childbearing age and obesity in adult women. Of the world’s 2bn overweight or obese people, at least 41m are overweight children and 10m of these live in Africa. Donors have pledged $640m in new commitments. (Global Nutrition Report, FT, Devex)

Climate change hurts  G7 health ministers — including the US — agreed that “climate and environmental-related factors can aggravate existing health risks and create new threats” but the US now stands alone outside the Paris climate agreement. The Arctic's thawing permafrost could bring forth "zombie diseases". (ABC News, The Independent, The Atlantic)

Cholera cash Members of the UN Security Council came under fire for blocking UN spending on cholera in Haiti. The UN's own peacekeepers were responsible for the outbreak of the disease in 2010. The outbreak in Yemen — as well as the threat of mass famine — is being exacerbated by a Saudi blockade. (The Guardian, FT Health, CNN)

Plague fears abate Officials are optimistic that the outbreak in Madagascar is waning. Experts dismissed the idea that “dancing with the dead” ceremonies — where locals remove deceased relatives from family crypts for festivities — had helped spread the disease. (NYT, Newsweek)

What now for the WHO? The World Health Organization's "draft direction of work" highlighted its goals of “1bn more people with essential health services coverage; 1bn more people made safer; and 1bn lives improved” but details were scant on internal changes and a new emphasis on country-level action. (Devex)

Health fraud The Red Cross confirmed that $6m meant to fight Ebola in the 2014 outbreak in west Africa was lost through fraud by its own staff. Blockchain technology could be one way of preventing the $455bn in global health spending lost this way each year by allowing donors to track money, goods and treatment in real time. (Guardian, Foreign Affairs)

Toilet training Dawn patrols in India are using shame and fear to rid the country of open defecation and encourage the building and use of new facilities. The "good-morning squads” are part of “the largest behavioural-change programme anywhere in the world”. (Washington Post)   

Where's the Brexit bonus? Simon Stevens, head of NHS England, demanded the £350m weekly bonus for the health service promised by Brexit campaigners while the head of the NHS finance watchdog warned patients could die without more cash. (BBC, Telegraph)

Brexit and pharma The European pharma industry highlighted the disruption to trade if the UK left Europe without an agreed deal, meaning manufacturers would have to pay for duplicate testing to make sure their drugs stay available. (EFPIA)

Digital doctors The UK's “GP at Hand” service began offering NHS patients consultations by smartphone. Critics say the pilot project, with tech company Babylon, could create a two-tier health service by “cherry-picking” younger and healthier patients, leaving traditional practices with the frail, the elderly and the mentally ill. (BBC)

Redesigning hospitals Hospitals are still laid out as if isolating contagious diseases was their only priority, but prolonged bed rest can be unhelpful — or dangerous — for many patients. Institutions should be redesigned to make walking around — a key part of the healing process — much easier. (Politico)

MDMA for PTSD Victims of post tramautic stress disorder in the US could soon have their therapy complemented with MDMA — the party drug also know as ecstasy. The FDA has given the psychedelic substance the status of a potential “breakthrough therapy”. (New York Times) 

Sniffing out disease A new breath test could help diagnose malaria: sufferers exhale a compound identical to a natural smell that attracts mosquitoes. Researches say a new device — the Na-Nose — can identify Parkinson's and other diseases with 86 per cent accuracy. Research suggests the sense of smell in our (real) noses fluctuates with our body clocks. (BBC, CNN, New York Times)

The living specimen Steve Ludwin has been injecting himself with snake venom for 30 years, helping researchers develop a new anti-venom using his own blood. He's a “living specimen” at a new exhibition at London's Science Museum — Venom: Killer and Cure. (BBC video, Guardian)  

Best from the Journals

HIV goals Keeping control of HIV needs a rapid expansion of those on treatment, more engagement with those at risk, an improvement in the quality of services and the redesign of treatment programmes. (PLoS) 
Discuss HIV developments at the FT Health event in London on November 21.

Antibiotics in animals Antibiotics used in healthy animals to promote growth are aiding the spread of antimicrobial resistance, the WHO said, citing new research published in the Lancet. Even when not used for growth, many countries still use more antibiotics on animals than humans. (WHO, The Lancet)

Sleeping sickness The first oral treatment for sleeping sickness has been shown to be safe in clinical trials. The disease — usually fatal without treatment — is transmitted by the tsetse fly. (The Lancet)

Stem cell breakthrough Researchers have regenerated a young boy's skin that was being destroyed by a rare disease. The landmark case involved generating stem cells from human skin, replacing the genes causing disease and then growing sheets of healthy in the lab. (Nature, Stat) 

Killer mosquitoes The Food and Drug Administration authorised the release in 20 US states of bacteria-infected mosquitoes to kill their wild counterparts that carry Zika, dengue and yellow fever. (Nature)

Dementia development E lectronic probes that can record the activity of masses of neurons across the brain at the same time could help scientists better understand conditions such as Alzheimer’s. New data showed dementia has overtaken heart disease as the UK's number one killer. (Nature, FT, Telegraph)  

Podcast of the week

Sleep disorders What happens when the brain wakes up — but the body doesn’t? And what is ‘exploding head syndrome’ where people experience abrupt and very loud noises when going to sleep or waking? (BBC Health Check, 8m)

In case you missed it

Previous edition: Pneumonia — the biggest killer of children

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Final thought

Dementia and design Sainsbury's supermarket has become the first to introduce “dementia-friendly” toilets. With the disease now confirmed as the UK's biggest killer and on the rise worldwide, is there more the corporate world could do to address the difficulties of sufferers? (Telegraph)