The global elite is swarming around the Alpine resort of Davos this week, busy drawing the lines of the planetary agenda for this new year at the World Economic Forum (WEF). There is also Peter Sands (Plymouth, 62 years old), the former British banker who since 2018 has directed the Global Fund, the great international organization that 20 years ago helped found Kofi Annan to fight AIDS, tuberculosis and malaria; the major infectious diseases that kill millions of people in the world. It is the fund to which developed countries – including Spain – have dedicated more than 60 billion dollars (more than 55 billion euros) and with which, according to the organization's own calculations, 59 million lives have been saved.
The diseases that affect the poorest on the planet do not top the priorities of the politicians and businessmen meeting at the WEF, but what is decided there will end up also having a full impact on the global South, with record levels of debt and on the front line of the climate emergency.
Artificial intelligence is the main protagonist of the event this year, where politicians and businessmen warn of the danger that this technology poses for democracies. Sands agrees in highlighting the threats, but assures that innovation opens up unprecedented opportunities, especially in the field of global health, as he explains in a videoconference from the forum. He at the same time believes that it is advisable not to take any achievement for granted. He warns that political volatility makes it more difficult for the international community to act in a coordinated manner on key issues such as the climate emergency. Sands also maintains that “we are witnessing an alarming erosion of the commitment to human rights” and a demonization of the other for partisan purposes.
Ask. Techno-optimists believe that artificial intelligence will be able to reduce the inequality gap and improve global health. Do you think it represents an opportunity?
Answer. For global health, AI is certainly an opportunity. One of the limitations is the availability of health professionals with experience in certain areas and AI allows us to replicate our knowledge at a relatively low cost. For example, we collaborate with Siemens Healthineers to use AI in the interpretation of x-rays or ultrasound, which allows us to compensate for not having many radiologists in some places, particularly in Africa. With AI, it is possible to quickly diagnose tuberculosis. I know AI also carries risks and dangers, but in global health there are immediate opportunities.
Q. The perfect storm of Covid, the war in Ukraine, together with the climate emergency has resulted in historic debt in countries of the global South that prevents them from investing in health. The voices calling for a new financial architecture are heard increasingly louder.
R. I think it's urgent. If you look at some of the poorest countries and communities in the world, they are facing a combination of climate change, conflict and excess debt. Furthermore, geopolitics are extremely complicated right now. Elections will be held in 2024 in a large number of countries around the world, at a time when politics has become fluid and geopolitical fissures and divisions make it difficult to have a common approach to global challenges, such as preparing for the pandemics or climate change. Reaching consensus on what the priorities are and how to deal with those problems is very difficult now.
It is necessary to rediscover the meaning and spirit of common humanity. The world is actually not that big and there are enough financial resources
Q. In Davos they are talking about “disease X”, 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?
R. There are some things we already know about the impacts of climate change and there are plenty of things we don't know. We know it's going to have a direct impact on some of the most climate-sensitive diseases, and malaria is a good example. Malaria is appearing in places where it was previously too cold for mosquitoes and we are also seeing increases in areas with extreme weather conditions such as cyclones or floods. One of the effects of climate change on health is the alteration of agriculture and, therefore, nutrition. And the reality is that a malnourished child has a lower malaria survival rate than a well-nourished child.
There are also things we don't know. We do not know how climate change will affect competition between species, between different types of mosquitoes. There are 30 or 40 types of Anopheles carriers of malaria, but with climate change we are observing interesting dynamics in the prevalence of different types of mosquitoes. It's just one example that 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 emerge in unexpected places, whether from existing diseases, emerging diseases, or entirely new pathogens. Climate change has a profound impact on the environment in which all these viruses, bacteria and parasites live and it is very difficult to know what is going to happen.
Q. Covid took away aid funds for other diseases and development priorities. Will we return to previous aid levels or does the weakening of multilateralism point to a permanent regression of international aid?
R. We must continue defending multilateralism. It may not be fashionable, but the logic of sharing donor resources for effective interventions remains valid. We have to decide what world we want to live in. Do we want to live in a world where thousands of young children and pregnant women die from a disease like malaria, which we know how to cure and where, with relatively little money, we could make a huge difference? There remains a sense of common humanity, which mobilizes Global Fund partners.
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. The attitude of some countries in the global South has also changed. The war in Gaza has put the finishing touch on the distancing with the West and the reinforcement of new alliances with China and Russia. What impact will it have for the development of those countries?
R. 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 have launched vaccine production initiatives, also thanks to the messenger RNA technique. To what extent is the health self-sufficiency you aspire to possible?
R. Localization of manufacturing is important, but it is only part of the solution. There are many low- and middle-income countries that have the opportunity to develop more capabilities, but there are others that are not in that situation. There is no single answer.
Q. Meanwhile, the homophobic offensive in Uganda and other African countries, partly financed by global ultra-conservative groups, prevents access to treatments and politics once again endangers scientific achievements.
R. Achieving equitable access to life-saving diagnostic and treatment services is critical to defeating these diseases, and in particular, diseases like HIV and tuberculosis disproportionately affect key and marginalized populations. Discriminatory and stigmatizing policies and laws prevent access to these types of services and actually reduce the effectiveness of innovative medicines and technologies. We see the threat that looms over the rights of LGTBQI people and the stagnation of progress in gender equality in some countries.
If we were to analyze the language, words like common humanity or global solidarity are, I suspect, much less frequent than they were a decade ago.
Q. We also see among donors that the regression of human rights and sexism are also part of the populist agendas of the North.
R. There is an alarming erosion of commitment to human rights, especially in relation to health, in both rich and poor countries. If we look at the language used to describe immigrants, religious groups or LGTBQI communities, we will realize that there are many echoes of discrimination between different groups. All of them go against global solidarity.
Q. Wasn't it like that 10 or 15 years ago?
R. There have always been parts of the world where there has been stigma and discrimination and in some aspects we have made great progress. There are many countries where gender equality is in a much better position than it was a decade ago. But right now, when we look around the world, we are very concerned about LGTBQI rights in particular, but also, more generally, about notions of equality and about access to health as a human right. I think if we looked at the language, words like common humanity or global solidarity are, I suspect, much less frequent than they were a decade ago.
Q. How did we get here?
R. The knock-on effects of the global financial crisis and the pandemic have put a lot of pressure on communities, even in rich countries. We have witnessed a polarization of politics in many parts of the world and we see in some of the populist approaches a demonization of the other, which has become a route to power in some places. It is necessary to rediscover the meaning and spirit of common humanity. The world is actually not that big and there are enough financial resources. We have an enormous amount of shared obligations and interests on this planet. The impetus for creating the Global Fund, for example, was the AIDS catastrophe in Africa. We had a situation where very few people had access to antiretroviral treatment and they were dying. Those who had access cost them about 10,000 dollars a year (about 9,200 euros). Twenty years later, there are 24.7 million people receiving antiretroviral treatment and the annual cost of these medications is about 45 dollars (a little more than 41 euros), while the number of people who die has been drastically reduced. That is a huge achievement and has required a massive effort from donor governments, recipient governments, philanthropy, the private sector, the community, civil society and technical partners, but it is proof that challenges can be taken on. enormous and surpass them.
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