The Global Fund–Heineken partnership continues to reverberate, and Global Fund Executive Director Peter Sands has been caught up in its vortex.
In a profile of Sands, dated 10 March, in The Lancet, Pamela Das quotes Sands as saying that he will focus on “the internal effectiveness of the organization, and will look for partnerships to strengthen existing capabilities, such as helping to address logistics and supply challenges to reach key populations and to reduce new infections.
Sands went on to say:
“The global health community needs to engage the private sector more rather than less. And must do so more effectively than it has in the past. Because if we really want to achieve the SDGs and build more resilient health systems, we need to partner with the private sector to leverage their resources and their capabilities to innovate.
“Partnership does not equate to uncritical endorsement, and in my experience the best partnerships involve a combination of collaboration and a willingness to challenge and be challenged. I have been listening carefully to the concerns that have been raised on the partnerships with the private sector companies, and I agree that the benefits of any partnership … have to be weighed against the risks, and I am open to hearing different perspectives and engaging with dialogue on these trade-offs.”
Also on 10 March, in an editorial, The Lancet wrote: “Within the space of a few short weeks, the reputation of Peter Sands, incoming Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has gone from respected to reckless according to some critics.”
In a column in The Lancet last November, editor Richard Horton had offered an unreserved welcome to Sands, praising his “credibility” and “refreshing new vision.”
In its editorial, The Lancet said: “Sands had assiduously built a compelling argument for governments to take the economic costs of infectious diseases more seriously. His background as the former CEO of Standard Chartered strengthened his case still further. But then Heineken hit the headlines.”
The Lancet said that Peter Sands’ response to the criticism has been robust. “He accepts that the broader global health community is skeptical of the value of partnerships with businesses such as Heineken. He is willing to listen to critics. But he is also unapologetic about engaging with the private sector. Partnerships with business will be his signature raison d’être.”
“Sands is pursuing a strategy of constructive disruption at the Global Fund,” The Lancet said. “A shake-up is welcome. The Global Fund needs new energy and thinking.” However, it said,
“alienating large parts of the global health community, with whom the Global Fund should be forging productive alliances, is an error. Sands needs to take a remedial course on global health diplomacy and balance his passion for the private sector with respect for the pluralism of the global health community. The diversity of global health is a strength for the Global Fund. Draw on it, don’t dismiss it.”
On 13 March, Peter Sands responded via Twitter:
On 2 March, in Geneva, Global Fund Interim Executive Director Marijke Wijnroks met with representatives of IOGT International, the Global Alcohol Policy Alliance, and the NCD Alliance. These are the three organization that objected to the Heineken partnership in an open letter to the Global Fund sent on 1 February (see GFO article).
“The civil society representatives present at the meeting welcomed the frank and constructive nature of the discussions and the Global Fund’s openness to review its criteria and due diligence processes for partnerships in light of concerns and evidence raised,” the NCD Alliance wrote on 9 March in a post on its website. “The Global Fund also expressed interest in joining a dialogue on commercial determinants and (in-)compatible partnerships among global health and development agencies and international organizations.”
“We are committed to supporting the Global Fund in both crafting better risk assessment guidelines and in tackling alcohol as major risk factors for people and communities affected by TB and HIV/AIDS,” said Kristina Sperkova, International President of IOGT International.
In the post, the NCD Alliance said: “Comments made by incoming Executive Director Peter Sands in the days since the meeting” –– referring to The Lancet profile by Pamela Das –– “indicate that he doesn’t sufficiently heed the concerns voiced in the health and development sector about partnering with a harmful commodity industry, particularly relating to benefits realised by these businesses, such as implied endorsement and access to high level decision makers.”
In an article on 15 March on the website of National Public Radio in the U.S., Seth Faison, director of communications at the Global Fund, responded to the criticism about the partnership.
Faison said that the Fund needed to get away from “business-as-usual” if the world is going to reach its goals of eliminating AIDS, TB and malaria by the year 2030. And he said Heineken can help them reach those ambitious targets. “Specifically,” Faison said, “Heineken can provide expertise in demand forecasting and quality control during shipment, data management and supply chain logistics. Bottom line, it's about getting lifesaving medicines and other health supplies where they are needed, when they are needed.”
Jason Beaubien, author of the article, referred to a program that the Global Fund set up with Coca Cola called Project Last Mile that is very similar to the Heineken arrangement. Project Last Mile offers logistical support for the distribution of medicines and health-care supplies in Africa.
The article quoted Erika Linnander, senior technical officer at the Global Health Leadership Institute at Yale University, as saying that “the perception that Project Last Mile is about putting meds on Coke trucks or putting condoms in Coca-Cola cases, that is not really what the project is about.” Linnander said that Project Last Mile is about transferring institutional knowledge from a private company, Coke, to the public health sector in eight African countries. For instance, she said, Coke’s supply chain managers in South Africa helped the ministry of health set up a new network to distribute HIV medications. The goal was to allow patients to pick up their government-issued meds in more convenient places, like post offices and private pharmacies.
“Of course, that’s what Coke does really well,” Linnander said. “They engage with all these kiosks all across the country and get their product onto all different kinds of shelves. So, they helped with the strategic planning on how do you push your product, these meds, out to other pick up points.”
Linnander has written evaluations of Project Last Mile. She said Heineken would probably bring similar logistics expertise to its partnership with the Global Fund. Linnander added that the partnership with Coke has also been controversial at times. Some local politicians have questioned Coke’s motives and whether the program is appropriate. Coke has been criticized by public health officials in many parts of the world for contributing to the burgeoning diabetes problem.
Linnander said that she has given this a lot of thought herself. “You know, I work in a department of global health. I think it's useful to be transparent about the potential business benefits to Coca-Cola, mostly just in terms of goodwill and branding and things like that. If this were a nutrition intervention, I think I would feel very differently and very uncomfortable. But this [Project Last Mile] typically is about supply chains.”
In the NPR article, Beaubien quotes John Norris, a senior fellow at the Center for American Progress, as saying that these associations can be difficult politically. However, Norris argues that global health advocates are better off engaging with the beer industry rather than declaring Heineken too toxic to stomach.
“A lot of the philanthropies that are now very much mainstream sprung up from robber barons who made their money in lots of unsavory ways,” Norris said. “I can certainly understand a legitimate grievance coming from the community that deals with noncommunicable diseases worried about a company that sells alcohol being involved with the Global Fund. But you know, we now live in a world that is so interconnected, we need to figure out how to have companies inside the tent.”
Meanwhile, the United Nations Institute for Training and Research (UNITAR) announced a partnership with Anheuser-Busch InBev, the world’s largest beer producer. The two organizations plan to collaborate to improve road safety.
Editor’s Note: Incidentally, Peter Sands tweeted that his first day of work as the Global Fund’s new executive director was 4 March 2018.