Executive director of the Global Fund: ‘There is an alarming erosion of the commitment to human rights, particularly health’

The global elite recently swarmed around the Alpine resort of Davos and drew up the lines of the global agenda for this new year, at the World Economic Forum. Peter Sands was there, too. He is the former British banker who since 2018 heads the Global Fund, the great international organization that Kofi Annan contributed to creating 20 years ago to fight AIDS, tuberculosis and malaria; the major infectious diseases that kill millions of people in the world. The developed countries have given more than $60 billion to this fund, and according to the organization’s own calculations, 59 million lives have been saved.

Although the diseases that affect the poorest people in the planet are not the top priorities of the politicians and business leaders that met at the World Economic Forum, the decisions made there will impact the Global South, which is at record levels of debt and on the front line of the climate emergency.

This year, artificial intelligence was the main focus of the event, with politicians and businessmen warning of the danger that this technology poses for democracies. Sands agrees — speaking via videoconference — that the risks must not be downplayed, but also stresses that this innovation brings unprecedented opportunities, especially in the field of global health. At the same time, he believes that it is advisable not to take any achievement for granted. He warns that political volatility makes it harder for the international community to act in a coordinated manner on key issues such as the climate emergency, and states that “there is an alarming erosion of the commitment to human rights,” in addition to a demonization of the other for political purposes.

Question. Techno-optimists believe that artificial intelligence will be able to bridge the inequality gap and improve global health. Do you think it represents an opportunity?

Answer. For global health, I think AI is definitely an opportunity. One of the critical constraints is the availability of health practitioners, people with expertise in particular areas, and AI allows us to replicate our expertise in a relatively low cost and scalable way. For example, we have a partnership with Siemens Healthineers, using AI to interpret scans, either x-ray or ultrasound. This enables us to get around the fact that we don’t have a lot of radiologists, particularly in Africa. AI enables things like the diagnosis of tuberculosis to happen quickly. I know that there are also risks and dangers concerned with AI, but certainly in global health there are some immediate opportunities where we can see real value.

Q. The perfect storm of Covid-19, the war in Ukraine, together with the climate emergency, has resulted in a historic debt of countries in the Global South that prevents them from investing in health. The voices calling for a new financial architecture are increasingly louder.

A. I do think it’s urgent, because if you look at some of the poorest countries and communities in the world, they face a fairly daunting combination of climate change, conflict and economic issues, including over-indebtedness. Geopolitics is extremely complicated at the moment. 2024 has seen a huge number of countries around the world having elections. So the politics has been made fluid, and when you have so many divisions or fissures within geopolitics, it’s hard to find a common approach to some of these inherently global challenges. Pandemic preparedness, climate change, these are inherently global in the sense that they are affecting us all. And getting consensus on priorities, and ways of dealing with these challenges, is very difficult right now.

Q. In Davos they talked about “disease X,” one that is much more lethal than Covid-19. You yourself have said that the next pandemic may already be among us, and that it will be exacerbated by the climate emergency. To what extent can the climate overturn the progress made in recent years in health?

A. There are some things we already know about the impacts of climate change, and there’s a whole lot of things that we don’t. We know that it’s going to have a direct impact on some of the more climate or environmentally sensitive diseases. Malaria is a very good example. We’re seeing malaria appear in places where it was previously too cold for the mosquitoes. We’re also seeing surges in areas with extreme weather, cyclones or flooding and so on. One of the impacts of climate change on health is through disruption of agriculture and, therefore, nutrition. And a malnourished child has a lower survival rate from malaria than a well nourished child.

There are also things we don’t know. We don’t know how climate change is going to affect interspecies competition between different types of mosquitoes. There are 30 or 40 mosquitoes that carry malaria, but with climate change we’re seeing some interesting dynamics around the prevalence of these different types of mosquitoes. And I cite that as one example; there are going to be second and third order consequences of climate change that are going to be extremely difficult to predict. And that’s where diseases or outbreaks can appear in places we don’t expect, either existing diseases or totally new pathogens. Climate change has such a profound impact on the environment in which all these viruses and bacteria and parasites live that it’s extremely difficult to know what actually is going to happen.

Q. Covid-19 took aid funds away from other diseases and development priorities. Will we return to previous aid levels, or does the weakening of multilateralism signal a permanent regression of international aid?

A. we have to continue to make the argument for multilateralism. It’s perhaps become a bit unfashionable, but the fundamental logic of pooling donor resources and turn them into effective interventions hasn’t gone away. What kind of world do we want to live in? Do we want to live in a world where thousands of small children and pregnant women are dying of a disease like malaria, which we know how to tackle and where relatively small amounts of money would make a massive difference? There is a sense of common humanity and global solidarity, and that still fuels the way the Global Fund partnership works.

Q. The attitude of some countries in the Global South has also changed. The war in Gaza has put the final nail in the coffin in terms of distrust and distance from the West, while they have created new alliances with China and Russia. What impact will this have on the development of those countries?

A. Many countries in the so-called Global South want to have more voice, more ability to decide what their priorities are, more control over their resources and how they should be spent.

Q. During the pandemic, the countries of the South confirmed that they cannot count on the developed world in case of emergency, and they launched vaccine production initiatives, also thanks to the messenger RNA technique. To what extent is the health self-sufficiency they aspire to possible?

A. Localization of manufacturing is important, but it is only part of the solution. There are many countries within the low and middle-income country category that have the opportunity to build more capabilities, but there are other countries which are not in that position at this stage. There’s not one single answer that is going to cover all the countries.

Q. Meanwhile, the homophobic crackdown in Uganda and other African countries, partly financed by global ultra-conservative groups, prevents access to treatments. Politics once again endangers scientific achievements.

A. Achieving equitable access to life-saving treatment services and diagnostics is critical to beating these diseases, particularly diseases like HIV and TB, which disproportionately affect key and marginalized populations, and policies, laws, discriminatory approaches, stigma, those kinds of barriers that stop people from getting access to these sorts of services actually reduce the efficacy of all the innovative medicine and technologies that we have available. We do see the threat to LGBTQI rights and the stalling of progress on gender equality in some countries.

Q. We also see among donors that the regression of human rights and sexism are also part of the populist agendas of the North.

A. There is an alarming erosion of the commitment to human rights, particularly related to health, in both rich countries and poor countries. If you see the language around immigrants, or the language that’s used to describe different religious groups or LGBTQI communities, there are many echoes across the different groups that people are discriminating against. They all run against the spirit of global solidarity that has been a fundamental principle of the Global Fund partnership.

Q. Was that not the case 10 or 15 years ago?

A. There have always been parts of the world where there’s been stigma, discrimination, and in some dimensions we have made great progress. There are many countries where gender equality is in a far better position than it was a decade ago. But right now, when we look across the world, we’re very concerned about the LGBTQI rights in particular, but also, more generally, about notions of equality and access to health as a human right. I think if you did a word search, you would find that terms such as “common humanity” and “global solidarity” are, I suspect, much less prevalent than maybe a decade ago.

Q. How did we get to this point?

A. The ripple effects of the global financial crisis, of the pandemic, have put a lot of pressure on communities, even rich countries. We’ve seen a polarization of politics in many parts of the world, and I think we’ve seen, in some of the populist approaches, that the demonization of the other has become a route to power in some places. And I do think that there’s a need to rediscover that sense, or spirit, of common humanity. The world is actually not that big, and has financial resources. We have a huge amount of shared obligations and shared interests on this planet.

The impulse to create the Global Fund was, first, the disaster of AIDS, particularly in Africa. We had a situation where very few people in Africa had access to antiretroviral treatment. They were dying. And those who did, it was costing something like $10,000 a year. Here we are just over 20 years later and, in the countries in which the Global Fund operates, you’ve got 24.7 million people on antiretroviral treatment, and the cost per year of those drugs is now about $45. And the number of people dying has come down dramatically. And it’s required a massive effort by donor governments, implemented governments, philanthropy, private sector, community, civil society and technical partners; but in a way, it’s a proof point that you can actually take a massive challenge and get on top of that.

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