Peter Sands: “Wars kill more people from infectious diseases than from bullets and bombs”
Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.Vincent Becker

The British Peter Sands (Plymouth, 1962) admits to being extremely busy. The Global Fund for HIV, Tuberculosis and Malaria, which is the largest and most important global multilateral organization fighting these pandemics, will hold its donor conference in September. During it, the governments of different countries will announce their financial commitments to this entity.

As executive director of the Fund, a position he has held since 2017, Sands is the visible head of the success or failure of this appeal, which is not going to be small: he requests 18,000 million dollars – some 17,300 million euros – to continue during the next three years with a task that, according to his calculations, has managed to prevent 44 million deaths, since the beginning of his journey, 20 years ago. It is 29% more than in the previous round, in 2019, when they raised 13,300 millions of euros. And the biggest request in its history. The increase is justified by the lack of financing in recent years; but, above all, due to the arrival of covid-19, which has caused enormous setbacks in the fight against these three ailments and endangers the advances of recent decades.

Sands gives an interview from New York, the city that will host the donor conference, with US President Joe Biden as host.

Ask. Seeing the impact of covid-19 and the war in Europe on world economies, this time it seems especially difficult to ask donor countries for financial support. How is the campaign going?

Response. We always say that each campaign is the most difficult, and this is the seventh. But it is true that it is a very difficult time to ask for such a significant amount of money, 18,000 million dollars. And there are many requests that compete with each other as a result of everything that happens in the world. Donor budgets are under pressure. However, people understand that investing through the Global Fund has a huge benefit; we could save 20 million lives in three years. But we won’t really know how successful we’ve been until the end of the conference.

P. Does the fact that a strong country like the United States is hosting the conference and has promised great support help?

R. Having the United States as host is important. It has promised to provide a third of the total -6,000 million dollars-, as well as to give one dollar for every two contributed by other donors. Also Germany has announced that it will increase 20%, and we are still trying to persuade them to add another 10%. And Luxembourg has assured that it will rise by 30%. Most of the other countries and private sector donors are still in the process of deciding, but we are trying to broaden the donor base and have those in the middle range improve their contribution by more than 30%.

P. Spain returned to the Global Fund three years ago, after leaving it in 2010, and committed one hundred million dollars. Precisely, this week different civil society organizations have sent a letter to the Prime Minister, Pedro Sánchez, asking him to allocate a larger amount for this new period. Specifically, 180 million euros. Is Spain one of those countries from which you expect more?

R. We would love for you to make a significant contribution along the lines of the letter sent to the president. If you look at Spain’s contribution to the Global Fund relative to many other European countries, there is clearly room for a considerable increase.

It is imperative to scale up and intensify efforts around adolescent girls and young women, especially in Eastern and Southern Africa

P. Since the start of the pandemic, we have seen a decline in HIV prevention and screening programs, and tuberculosis deaths have risen for the first time after eight years of decline. Also progress against malaria has been stalled for some time. What are you especially worried about?

R. They all face significant challenges. Tuberculosis has suffered a marked setback in 2020, with one million fewer people accessing diagnoses and treatment than in 2019. In malaria, good collective work was done to maintain control measures against mosquitoes that transmit the disease with the distribution of mosquito nets, indoor fumigation and so on… But we have also seen an increase in mortality: in 2020 there was 12% more than in the previous year. And we are talking about children under five, pregnant women… It is very worrying.

With HIV, a lot of work has been done to maintain antiretroviral treatment and, in fact, the number of people receiving it is greater than before. But prevention programs have been massively disrupted and I am very concerned. It is imperative to scale up and intensify efforts around adolescent girls and young women, especially in Eastern and Southern Africa.

P. At the beginning of the pandemic, there was talk that, in the worst case scenario, deaths would double. Later, the annual reports of the World Health Organization or the Global Fund itself showed that the impact had not been so great. Are you afraid that the worst is yet to come?

R. The reason the impact was not so severe is not accidental: many measures were taken. We have deployed nearly $5 billion – on top of our normal investment – ​​to help countries respond to the pandemic, and there has been a lot of innovation to enable continuity of services. But we have regressed in prevention, so I think we will see a further increase in deaths in 2021 due to reduced testing and access to treatment in 2020, as there will be a long-term impact.

This is something to be concerned about, especially in the case of HIV, because once someone is infected they can live well, but they will have to take antiretroviral treatment for the rest of their life. And what really matters is the return on investment. Preventing a 16-year-old girl who lives in South Africa, Zambia or Mozambique from becoming infected is tremendously beneficial for her, for the community and for the health system because, if that girl contracts HIV at 16, this means that she will have to live 50 or 60 years more depending on a medication and that will be more vulnerable to other diseases. This is why it makes so much sense to step up prevention while treating patients quickly.

We have regressed in prevention, so I think we will see a new increase in deaths in 2021

P. What can the Global Fund do differently to try to have a greater impact in the control of these pathologies?

R. For all of them, new technologies, drugs, screening tests and ways of doing things are being developed that can make a difference. One of the positive aspects of the pandemic is that it has helped stimulate innovation. If we take the example of tuberculosis, advances in molecular diagnostics and the use of mobile X-ray devices allow us to find the disease earlier and more quickly. Because the biggest problem with this pathology is that four million people a year in the world contract it and are not detected. And we will not be able to reduce infection rates if there are people who are not being treated.

P. Can it be said that covid-19 has brought us lessons that we can use on other battlefronts?

R. Advances in diagnostics have come about in part because many of the tests for Covid-19 have built on the infrastructure and tools that existed for tuberculosis. Then we expanded them by buying hundreds more instruments and training more technicians. Now some of that extra capacity can be used for tuberculosis.

There is also the growing use of digital tools to support people in treatment against infection, which is long. With covid-19 we saw an increased use of digital consultations, digital support groups and other ways to help patients. And, really, they improved treatment and adherence rates.

P. Do you think the private sector should get more involved?

R. Much more. Normally, when we talk about global health and the involvement of the private sector, we end up thinking of the pharmaceutical companies or the people who run private health centers. But really, what we need is for the broad spectrum of private sector companies, whether they be media, mining or transportation, to realize that they have a role to play in health. It’s something we haven’t been that successful with so far.

The next pandemic will not come from a new pathogen, but from the consequences of rising energy and food prices

P. Do you think that the increase in hunger in the world will affect the fight against tuberculosis, malaria and HIV?

R. The countries most at risk of food crises, according to analysis by the World Food Program, are virtually the same ones with which the Global Fund is most engaged. I am afraid that we are going to see people starve, but also a much larger number that are going to be malnourished. And the problem is that this will increase the mortality rate from infectious diseases. In the case of tuberculosis, there is a higher risk of death if people do not eat well. Don’t underestimate the impact of rising energy prices either, because if people can’t get warm or can’t cook, that also aggravates health problems.

P. Could a next health crisis come around here?

R. Our next global health crisis is not going to come from yet another new pathogen, as people think, but is driven by rising food and energy prices, and the consequent unavailability of both. In other words, it is not that we are going to have a new pathogen, but that the existing ones are going to kill more people.

P. That’s a very pessimistic way to end this conversation…

R. Well, that’s why we need $18 billion. Talking about a food crisis does not mean that people will die exclusively from starvation; in fact, it will probably kill more people due to the impact on the mortality rates of the sick. The same with wars, which kill more people from infectious diseases than from bullets and bombs. We have to analyze all these phenomena from the flexibility and be very dynamic.

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