Learning lessons from HIV for Ebola – STOPAIDS AGM, 2014

The need to reform the R&D system was the stand out conclusion drawn by panellists taking part in a discussion at the STOPAIDS AGM.

IMG_9820On Tuesday 18th November, 50 people joined STOPAIDS staff and trustees at our Annual General Meeting at the London School of Hygiene and Tropical Medicine. A panel of speakers – Dr Mit Philips (MSF), Dr Edwin Mavunika Mapara (LSHTM), Professor Jill Lewis (Salamander Trust), and Dr Mohga Kamal-Yanni (Oxfam) – was chaired by Baroness Barker, and discussed the 2014 Ebola outbreak in West Africa and the lessons learned from the HIV response.

“HIV and Ebola are different sides of the same coin”, argued Dr Kamal-Yanni, “and that coin is how R&D for medical products are financed. We have a system that totally depends on the market… Drug pricing policy is unsustainable and it’s about time that we look as a global community, at the politics of R&D and put public health before commercial interests.” Panellists’ emphasis on the need to develop non-commercial funding for R&D was echoed by members of the audience.

IMG_9871Aaron Oxley of RESULTS UK, referenced the “glacially slow” progress of R&D in relation to tuberculosis, and highlighted a recent report issued by the All-Party Parliamentary Group on Global Tuberculosis, Dying for a Cure – Research and Development for Global Health. The need for a new R&D model was also highlighted this week following the international parliamentarian TB summit last month.

Health Systems

Panellists went on to discuss the fragile nature of health services in West Africa, noting that this was in part because the region has not seen the same levels of investment as in southern Africa where rates of HIV incidence are higher. In this context, Dr Kamal-Yanni called on DFID to re-consider its plan to end bi-lateral funding to support the development of healthcare in Liberia, a country where there are just 50 doctors for 4 million people.

IMG_9876Dr Mapara drew on his experiences of working in Botswana during the early AIDS response, noting that to control epidemics what is needed is swift, decisive political leadership, and investment in infrastructure and education.

Dr Philips observed that, as with the early days of the response to AIDS, the response to Ebola is taking place largely in the communities themselves, away from the health centres. But Dr Philips went on to say: “although we talk about fragile health systems locally, MSF would also argue that the international health system of support for those countries is not working well”, points made in MSF’s recent ‘Where is Everyone?’ report.

There was considerable criticism of the World Health Organisation both from panellists and audience members. “I have no respect for WHO”, remarked Dr Edwin Mavunika Mapara. “I was happy when they admitted they were too slow in responding to Ebola but they are too academic.”

Treatment and prevention

IMG_9834Professor Lewis, a Trustee of the Salamander Trust, argued that, as with HIV and AIDS, Ebola was having a disproportionate impact on women, who are at the forefront of caring for people dying of Ebola. In an impassioned speech Professor Lewis argued: “We see in the Ebola situation something that is echoing what is happening with HIV and AIDS. There is a need for western bio-medical intervention such as MSF, but that whole approach is flawed in long-term sustainability”. The world needed to be better at respecting the agency of people themselves, building the capacity of people to respond to challenges, and that gender transformative approaches should be at the heart of this. “I believe passionately in comprehensive prevention. ARVs are key to stemming and supporting this. But I argue that the response has been skewed in favour of treatment at the expense of prevention.”

Dr Kamal-Yanni cautioned against arguing in favour of treatment vs prevention. The real challenge is to secure an expansion of expenditure on global health which could achieve both, noting that she finds herself in the unusual position of agreeing with the President of the World Bank on this. “What I hope we have learned is that health is a global priority, just like terrorism. Investment in free public health and education is a public good for the whole world.”

IMG_9814Drawing conclusions

In concluding the discussion, Baroness Barker remarked: “I want us to all go away with a sense of hope. When I go back and think 30 years ago, things were different… Maybe some thing don’t change. Western governments are more panicked by fear on their own doorsteps. But let’s use that. I have a strong sense that there will be a different approach to global health going forward. We will get there.”

New Trustees

At the AGM, presided over by Georgia Burford as Chair of Trustees, STOPAIDS members also elected two new people to the board: Sarah Kennedy from S.A.F.E., and Rebekah Webb, a consultant who was worked with STOPAIDS and members for a number of years. You can read more about our Trustees here.

To join our ebola working group, please get in touch with Ben.

For more on R&D reform, you can join us at the launch of the APPG inquiry report into access to medicines.