The Global Fund: no longer a frontrunner in the SDG era (and what to do about it)

It’s been a while since the Global Fund was considered a splendid innovation allowing global health funding to go from millions to billions, at the start of the MDG era. So it’s sad (though perhaps not entirely surprising) to see that the Global Fund leadership doesn’t recognize times have changed.

I was reading Peter Sands’ case, this morning in a Stat  Op-Ed, in which he (rightly) claims the private sector should shoulder some of the responsibility for improving global health, but fails to draw the obvious conclusion.  

I understand his argument that the private sector can bring quite some expertise and resources, in a number of areas (and so global health would indeed be dumb not to make use of them).

On “SDG era / holistic global health thinking”     (see for example the rather “interesting” relationship of the GF with Big Alcohol – till recently? - and Big Soda), the Global Fund is certainly not a trailblazer anymore (as has been pointed out in detail by many, elsewhere), with superior service delivery expertise as one of the weak excuses used for these sorts of partnerships. Let’s hope that with time, the GF will become wiser in this area.

But here I’d like to focus on the fact that Sands fails to see the writing on the wall, in many countries, in terms of mobilizing resources. He still seems to think corporate “peanuts” will suffice: “  While in Davos, I called on private sector leaders to mobilize at least $1 billion (i.e. out of 14 Billion) of that target.” 

It’s worth quoting his final paragraph in full:

“…we also need private sector leadership in mobilizing financial resources. The Bill and Melinda Gates Foundation is by far the largest of the private foundations supporting the Global Fund, and (RED) has raised more than $600 million for its fight against AIDS in Africa. Business leaders should heed Bill Gates’ words that the foundation’s investments in global health funds (including Gavi, the Vaccine Alliance; the Global Fund; and the Global Polio Eradication Initiative; [Gates also added the GFF]) are “the best investments that Melinda and I have made in the past 20 years, and they are some of the best investments the world can make in the years ahead.” Gates said these investments have generated returns of 20 times the amount invested….”

So why, on earth, do Peter Sands (and also Bill Gates, for that matter) then not draw the obvious conclusion? That it’s high time, for (global health) public-private partnerships to mobilize a big part of the money via taxing of the private (and global finance) sector? Put differently, let’s take ‘partnerships' to the next level 😊.

I heard Sands say, in response to a similar quote from Sania Nishtar, at the Davos session on ‘financial innovation for global health’ that ‘tax’ is “actually his favourite innovation”. Why not put this, explicitly, on the table then, also at global level (now, Sands & others mainly seem to consider tax key for domestic revenue mobilizing), for global corporations? As in: taxing the winners of globalization, and so let them really be ‘stakeholders’ in/towards a better future, and really “shoulder some of the responsibility for improving global health”.

A suggestion for the replenishment of the Big Global Health Funds (& then one more)

The same goes for Bill Gates. If, as he rightly states, replenishment of these Big Four Funds is very important to prevent  global health (outcomes) backsliding in the years to come, why not seize the current momentum in countries like the US (with AOC’s tax proposal) or many European countries, where many citizens understand damned well (and totally agree with) Oxfam’s  third key message in its annual Davos report,   to “End the under-taxation of rich individuals and corporations. Tax wealth and capital at fairer levels. Stop the race to the bottom on personal income and corporate taxes. Eliminate tax avoidance and evasion by corporates and the super-rich. Agree a new set of global rules and institutions to fundamentally redesign the tax system to make it fair, with developing countries having an equal seat at the table.’”

Jeffrey Sachs & others made an interesting suggestion in this regard, a few weeks ago, ahead of the Global Fund Replenishment – “hundreds of the super-rich could easily pledge $5 billion per year for the period 2020-2022”.  But it’s not going far enough (as he linked it to the Giving Pledge, and refrained from using the word ‘tax’, still a “toxic” term in Davos I understand). I also don’t understand why it should be limited to the GF replenishment only.

Why, instead, not explicitly, as part of the SDG 3 Global action plan, foresee taxing of multinationals ( or a similar proposal) as a way to (help) fund “the Big Four”? And of  course, WHO as well, no doubt the biggest global public health good of all?

It’s not rocket science. All global health leaders of big organizations actually believe in (more and progressive) taxing (and even Bill Gates does so, in his latest reincarnation).

The time seems certainly more than ripe. And trust me, if Global Health fails to do so in the years to come, it will suffer, funding wise and in terms of legitimacy. That would be a shame.  Conversely, global health (funding) could once again be an inspiration for other (SDG relevant) sectors.

How it needs to be worked out in detail, that’s something for (health) economists, tax experts (and lawyers), I’m not qualified 😊.

I suspect, though, that the current global health leadership is too close to Davos men & women to draw this – in my opinion, rather obvious – conclusion on “global health funding for the new SDG era”…    Let’s hope they prove me wrong in the years to come.  

Davos 2019: a Global Health 'Garden of Eden' no more, let alone a Planetary Health Garden of Eden

Hmm, what can I say about Davos that hasn’t been said already? Arguably, not much, after Anand Ghiridaradas has described  "MarketWorld" in extensive detail, and "Davos" is widely seen as "in decline".

Having said that, (too) many with power in global health still don’t seem to get it.   Indeed, as Stat puts it, “some of the biggest names in science and medicine are in the Swiss ski resort town of Davos this week to rub elbows with world leaders and one-percenters — and talk about the future of health care.”

So let’s try one more time.

Maybe you think I’m not very objective (and you would be right 😊), but my sense is that the annual meeting in Davos is by now fully delegitimized. Whereby in the past, western political leaders got away with the mantra ‘we need to go there to attract business to our country’, increasingly you’ll see political leaders make the same calculation as Macron - a smartass by all means - this year. Davos has become no less than “toxic” in the eyes of big parts of the population, certainly in the West.  

Moreover, Guy Standing probably has a point when he says that the ‘yellow vests’ movement is a sign that the precariat is (finally?) waking up as a class. If global (especially within-country) inequality is not dealt with substantially in the years to come, that trend will only increase. Standing already estimates the precariat in Western Europe at 40 %, and as he rightly mentions, even if that estimate is too high, many among what he calls the 'salariat' fear that their own children will be part of the 'precariat'. If these two classes were to ally, that could put a lot of pressure on political leaders in the years to come, and 'going to Davos' won't be a badge of honour anymore, to say the least.  Whether Klaus Schwab likes it or not, if political leaders stay more and more home (for good reason, in my opinion), that will jeopardize his lofty dream of a ‘multistakeholder’ platform “for the progress of the world”.

Yes,  the WEF talks all the time about inclusiveness and sustainability, and this year even more than ever before, but the ones who still believe that the Forum will be instrumental towards both key aims for the 21^st century, are probably an ‘endangered species’ themselves, anno 2019 :) 

Speaking of inclusiveness, for example: does anybody among you truly believe that ‘millennials are taking over Davos”, presumably because this year they are co-chairs?  If I were a millennial, wanting to change the world, the last place I’d want to be seen is Davos. Even if I were a 'Technology Pioneer' or 'Global Shaper'.   Instead, it’s mostly in countries that political fights for a more human and sustainable global economic system will need to be fought in the years to come, and the millenial generation is indeed taking the initiative in more countries, encouragingly.  

Over to sustainability (or dare we call it, ‘planetary health’), then.  I’m probably not the only one wondering why the Davos crowd would be listening attentively to David Attenborough’s wise words, when he pointed out this morning, “Growth is going to come to an end, either suddenly or in a controlled way’ – we need to get on with practical tasks.”   No, who really matters in Davos mainly listens to the IMF Global Outlook report (which came out the day before, setting the scene for the Forum), in which the global ‘growth’ percentage was wat really mattered. Yes, Christine Lagarde might call it ‘inclusive’ growth, or use some other politically correct term, but ‘growth’ is what still turns most of the Davos participants on. The “Globalization 4.0 era” is not different in that respect from the previous ones. Making the link with post-growth thinking is clearly beyond Schwab and fans. So no, I don’t expect much ‘planetary health’ progress to come out of Davos, as everything in terms of potentially useful initiatives kickstarted there, is somehow ‘overruled’ by the persistent overall (discourse) focus on growth. Unless, of course, you believe in the fairytale of green growth, Davos will not make the planet more sustainable. The many private jets at Zürich airport probably already gave you a clue in this respect.

Global health

So there’s not much to be done in Davos for the ‘planetary health ‘community  (although I hope Greta Thunberg proves me wrong), what about the ‘global health’ community?   While I appreciate the efforts from many who try to ensure global health financing (for example, for the “4 Big Funds”) for the coming years, I wish they’d make the link with tax justice much more explicitly. The latest Oxfam report (see their third key message this year) could be an obvious entry-point for that. And I’m sure the precariat would appreciate it, if for example the Global Fund and other global public goods got at least half of their funding from corporate Fat Cats (corporations & high net-worth individuals, enormously undertaxed according to the latest Oxfam report).  But I figure Sands, Gates et al didn't mean that, with ‘Financial innovation for Global Health’, the name of their session today….  ?

As for pandemics and global health security, “à la limite” i can understand why global health big shots want to go to Davos, to make that case towards political leaders & business people from multinationals, and get some ‘result’. See for example CEPI recently. But again, why not calling for a global wealth tax to help finance all these efforts ? 

On mental health then: I appreciate the efforts done by the  Wellcome Trust   and others to get this issue on this year’s agenda, as mental health should indeed become far more important on the global agenda. Two small remarks perhaps: (1) given that many WEF participants play key roles in sustaining this - by all means, insane - global economic system, maybe Davos is indeed an appropriate place to discuss ‘mental health’ 😊  (2) On the other hand, I’m more than a bit worried that this focus on ‘mental health’ in a place like Davos will mainly tick global business boxes if it leads to even more productivity. As in: “staff who feel well will also perform better for your company!”.   ( a bit the mental health equivalent of a global health “investment case”) I, for one, doubt whether big corporations truly care about the wellbeing of their staff (see Amazon and many other examples), and for the ones that do care, they probably don’t care much about the wellbeing of the many people who can’t find good jobs in the first place.  In short, I have some doubts about the relevance of the ‘mental health at the workplace’ agenda, if it’s not soundly linked to post-growth thinking (which also includes “decent jobs for all”, as far as I am concerned). I still dream about a world whereby everybody’s contribution, one way or another, would be appreciated in the economy and society (without all of us having to fit the harsh ‘efficiency’ laws of the global neoliberal economy).  But once again, I hope I’m proved wrong and that “The Duke” and others will make a real difference in Davos on mental health.

Davos Partners

Last but not least, I invite you all to have a look at Davos’ “Partners”. It’s quite an insightful list. 

Credit where it’s due, the WEF is quite transparent about it.

Quite a few of these Partners are actually led or owned by people on that notorious Oxfam list (the 26 billionaires owning as much as half of the world’s population). But there’s more.

Besides the Gates Foundation, the Wellcome Trust and the Rockefeller Foundatino, you also find there for example: Chevron; Lukoil; Shell, Saudi Aramco (Big Oil); Goldman Sachs  (global capitalism’s 'Darth Vader') ; Facebook, Google (surveillance capitalism), Deutsche Bank (crony capitalism); PepsiCo; the Coca cola company (Big Soda)); the Volkswagen Group (remind me again, Germans, what was wrong with these guys?).

Fortunately, we read, from the WEF’s info page:

“The World Economic Forum is an independent and impartial International Organization for Public-Private Cooperation. Its objective is to improve the state of the world. It does not promote any political, commercial or personal interests, nor does it use the names of its participants for promotional purposes. The Annual Meeting aims to be open and inclusive. Transparency and public inclusion are achieved through broad international media participation, televised sessions and webcasts, and through the Forum’s millions of followers social media. …”

For some reason, I trust the assessment of Nick Hanauer, entrepreneur and venture capitalist, more.  He says in the Foreword of the Oxfam report that if we don’t get this right, “eventually the pitchforks will come out”.

So here’s my humble advice to Seth, Peter, Katja and all the other global health bigwigs in Davos:  you might want to keep these ‘pitchforks’ in mind, when dealing with the current “powers that be” in Davos in order to get global health ‘results’ 😊.   And start thinking of a different 'Theory of Change' to make global & planetary health progress in the SDG era.