PHM-Exch> The Lancet: Global health and the private sector

[Claudio Schuftan]

From: Amit Sengupta <asengupta at phmovement.org>
*From:* Thiru Balasubramaniam <thiru at keionline.org>


Richard Horton
Published: 02 June 2018

DOI: https://doi.org/10.1016/S0140-6736(18)31253-4

I crossed paths with Peter Sands at the World Health Assembly last week. I
greeted him warmly, I thought, and asked how he was settling into his new
role as Executive Director of the Global Fund to Fight AIDS, Tuberculosis
and Malaria. He looked uncomfortable. His manner was frosty, possibly even
icy. Our conversation, such as it was, faltered. We parted awkwardly. I
understand why. After we published a laudatory welcome following his
appointment, we criticised the Global Fund's partnership with drinks
manufacturer, Heineken—a partnership endorsed by Peter himself. We were not
the only ones. The NCD Alliance called on the Global Fund to “immediately
end” its collaboration with a company that contributes to 2·8 million
deaths annually. The Fund did eventually sever its ties with Heineken. But
Peter was clearly upset by the controversy. He told The Lancet, “the global
health community needs to engage the private sector more rather than less”.

There is no question that WHO is different under the leadership of Dr
Tedros. He has opened up the agency in unprecedented ways. He views
partnership as the third key to WHO's future success (a “transformed WHO”
and “political commitment” are two more). We have felt this profound change
in culture at The Lancet. Under Tedros, our Task Force on NCDs and
Economics became a formal input into the WHO Independent High-Level
Commission on NCDs. WHO is endorsing work on creating an accountability
mechanism to monitor and review progress on preventing and treating NCDs.
And WHO has supported publication of the High-Level Commission's
recommendations in The Lancet. His view is that WHO is stronger by forging
alliances. Another example: the signing of a memorandum of understanding
between WHO and the Institute for Health Metrics and Evaluation (IHME). For
over a decade WHO has been engaged in a Cold War with IHME's Director,
Chris Murray. No longer. IHME and WHO will now work together, ending their
rivalry, strengthening the science of health metrics, and using the
agency's political legitimacy to put metrics to better use in countries.
But, as the case of the Global Fund perhaps suggests, are there limits to
collaboration?

The World Health Assembly is under attack. It is under attack by a private
sector that seeks to exploit the growing calls for more partnerships in
global health. In particular, the pharmaceutical industry is slowly
colonising global health in the same way that it has colonised clinical
medicine. One satellite meeting illustrates what is at stake. AstraZeneca
held a breakfast symposium at the Intercontinental Hotel on May 21. This
side-event was dedicated to “Driving novel partnerships throughout the NCD
life-cycle”. Badged under the label of “multi-sectoral collaboration and
innovative partnerships”, the meeting was a promotional opportunity for
AstraZeneca and a means to import some of the worst practices by big pharma
into global health. The goals of AstraZeneca's strategy are “Access to
healthcare”, “Environmental protection”, and “Ethics and transparency”. The
company distributed literature advertising their Healthy Heart Africa and
Healthy Lung Asia initiatives. They made big claims: “Conducted over 6·6
million blood pressure screenings, identified over 1·2 million people
living with high blood pressure; and trained over 5800 healthcare workers.”
The reference for these statements was given as “data on file”. I learned
that an evaluation of this programme had been done, but the company has not
disclosed the results. AstraZeneca's goal is to “Reach 25 million people
around the globe through our access programmes by 2025.” As Katarina
Ageborg, AstraZeneca's Executive Vice-President for Sustainability, noted,
the goal was “putting medicines within reach”—that is, creating new markets
for AstraZeneca's products. Where is the independent monitoring of
AstraZeneca's programmes? When will they broaden access to their
intellectual property? Is the company investing in scientific institutions
in the countries they are colonising? What is their commitment to
establishing drug-donation programmes? The private sector is a core part of
the global health ecosystem. But if it is to be a trusted partner, the
private sector needs to be transparent and accountable for its claims and
commitments. It needs to submit its work to independent evaluation and
publication. And it needs to be subject to rules for participating in
global health events, such as the World Health Assembly.

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