This guest post is from Robert Marten (left, London School of Hygiene and Tropical Medicine) and Ben Hawkins (LSHTM and University of York)
The new head of the Global Fund to Fight HIV, Tuberculosis and Malaria, Peter Sands recently argued that “the global health community needs to engage with the private sector more rather than less.” Yet even most advocates of public-private partnership will not engage with certain companies, for instance those in the tobacco or arms industries. These sectors are correctly regarded as pernicious. Not only do they sell deadly products, but they are also untrustworthy partners supporting the production of fraudulent “evidence” in their efforts to evade and lobby against national and global regulation.
Although it is often regarded differently to the tobacco industry, the alcohol industry functions in much the same way. The industry’s products kill more than 3.3 million people every year, and trans-national alcohol companies have been proven to manipulate evidence about their products’ harmful effects. Seen in this context, it appears highly questionable that the global health community would engage with or partner with the alcohol industry. And yet this is precisely what the Global Fund has decided to do.
In January the Fund announced a partnership with Heineken, the world’s second-largest brewer. The response from civil society was immediate. IOGT International, the Global Alcohol Policy Alliance and the NCD Alliance with endorsements from more than 100 organizations, wrote “to respectfully urge an immediate end to this partnership.” We argued in the Lancet in February: “The partnership with Heineken is antithetical to the Fund’s core interests. By cooperating with, supporting, and legitimizing the alcohol industry, the Fund is endangering its own credibility and risks losing public trust.”
The Global Fund has yet to respond formally; however, Sands recently seemed to double down on its position arguing that if “we really want to achieve the SDGs [Sustainable Development Goals] and build more resilient health systems, we need to partner with the private sector to leverage their resources and their capabilities to innovate.” This is corporate spin and it is disingenuous. Sands’ response conflates the critique of partnering with Heineken with partnering with the private sector writ large. As public relations consultants will attest, generalizing criticisms beyond their specific target is a key strategy for deflecting attention and muddying the waters of debate and forging alliances with other actors whose interests may be touched up by this more general framing; in this instance, this is corporations in other sectors with whom the Fund engages in legitimate partnerships. Our critique is not about the Fund partnering with the private sector, it is about the clear inappropriateness of its engagement with Heineken, or any other alcohol producer.
Of course, the Fund should consider partnering with the private sector when it is appropriate and helps the Fund achieve its mandate. However, the Fund also needs to scrutinize potential partnerships far more closely than appears to be the case, ensuring that they are aligned with its mandate and the SDGs. In this instance, it seems like the partnership is designed to take advantage of Heineken’s distribution network, enabling the Fund to deliver supplies to hard-to-reach areas. But Heineken isn’t the only company which operates in hard-to-reach areas, and if the Fund wants to improve its supply chain, there is a wide range of legitimate potential partners beyond Heineken and the alcohol industry. Moreover, the Global Fund has failed to argue or explain how these potential logistics gains might outweigh the well-established costs of working with and legitimizing the alcohol industry. Worse, the Fund is overlooking alcohol’s widely-understood effects on HIV and TB – the very diseases the Fund aims to cure.
The partnership with Heineken also contradicts the spirit of the SDGs. Regulating alcohol is ingrained in the SDGs; the SDGs call for strengthening regulatory responses to alcohol. The idea of a Heineken logistics team delivering Global Fund supplies to a health clinic while also delivering beer is absurd – and painfully, even fatally, incompatible with the SDG3 aim to ensure healthy lives and promote wellbeing for all at all ages.
Based on “recent reports of the company’s use of female beer promoters in ways that expose them to sexual exploitation and health risks” the Global Fund announced on March 29 that it was suspending its partnership with Heineken “until such time as Heineken can take appropriate action to address these issues.” But as others have explained, this is not enough. So what should the Fund do about its partnership with Heineken?
The number of injury deaths attributed to alcohol per 100,000 people in 2010. (does not include chronic disease such as cancer or liver cirrhosis)
First, the Fund should announce an immediate and open review of its partnerships, solicit public feedback and declare its intention to develop a new partnership policy in line with the SDGs. The Fund should terminate its inappropriate partnership with the alcohol industry.
Second, the Fund should disclose the records of its interactions with Heineken (and any other alcohol industry actors) so researchers can document this episode and investigate the industry’s tactics and intentions. In the absence of a new partnership policy, the Global Fund’s donors and partners will need to reconsider the Fund’s commitment to global health and the SDGs before the Fund’s next replenishment. Without a new partnership policy, the Fund’s donors and partners will need to turn off the Global Fund’s financing tap.