In Brief

Former Banker Looks to Boost Global Fund Resources as New Director

At a time when deft financial negotiations can seem almost as vital as basic research in providing access to lifesaving treatments and vaccines, Peter Sands may be a logical pick to head the Global Fund to Fight AIDS, Tuberculosis and Malaria. The former chief executive of Standard Chartered PLC, a global bank headquartered in London and involved in an unusually broad variety of financial businesses, comes into the job as a respected figure in both finance and public health.

“It’s an outstanding appointment,” says Ngaire Woods, founding dean of the Blavatnik School of Government at Oxford and an expert in global economic governance. Woods worked with Sands on a World Bank/Wellcome Trust project proposing ways for governments and development partners to finance and strengthen pandemic preparedness. She lauds his commitment to the effort. “He put in a huge amount of time, analysis, and writing. He’s low-key, listens extremely well, is a fantastic analyst, and a terrific communicator.”

Sands, a onetime non-executive director to the UK Ministry of Health, is slated to take the reins as executive director of the Global Fund in March. He will be taking charge of the world’s largest funder of anti-AIDS, tuberculosis, and malaria efforts. The Global Fund has distributed more than 795 million insecticide-treated bed nets in the fight against malaria, is supporting antiretroviral (ARV) treatment for nearly 10 million people living with HIV/AIDS, and has funneled more than US$17 billion in paid pledges from international donor governments to public health initiatives.

Long the front-runner to take the leadership role at the Global Fund after Mark Dybul stepped down last May after a four-year term, Sands takes over from Marijke Wijnroks, who has been acting as interim executive director and has been on the IAVI Board of Directors since 2011.

There were some hiccups in the process of selecting the Global Fund’s new executive director. Even before Dybul left as planned when his contract expired, the Global Fund suspended and then re-set its search for a new leader because donors were unhappy with how the process was being managed. It was then reported that Sands had taken his name out of the running only to re-enter the race just days before being appointed. And The Lancet recently reported that Sands received near-universal backing but did not gain support from the US—apparently due to Standard Chartered bank’s business transactions with Iran (Lancet 390, 2338, 2017). The US is the top contributor to the Global Fund, with its $13.2 billion pledged contributions ($12 billion of which had been paid as of 2016) making up 32.4 percent of the total pledges, according to Kaiser Family Foundation figures. This makes the relationship between the US and Global Fund a vital one for Sands to manage.

Ron Waldman, a global health professor at George Washington University who, among other things, once led the United States Agency for International Development preparedness unit for influenza and other pandemics, says the Global Fund is in a period of transition. “It was created to fill a void that the WHO [World Health Organization] allowed to develop, and as far as I can tell it did that. If we were starting from scratch and rebuilding the global health architecture, would it still have that place? I’m not sure,” he says. “There has been substantial donor investment in it, so that might be called a success. Will replenishment continue? That will depend on a lot of factors including perceived need and, if the need is there, to a large extent on Mr. Sand’s ability to convince donors that the Global Fund remains a worthwhile investment. He should be good at that.”

The Global Fund is a player in the recent price support deal struck by the Bill & Melinda Gates Foundation and the Clinton Health Access Initiative to bring the integrase inhibitor dolutegravir to 90 low- and middle-income countries, where it is expected to have a big impact in not just convenience and effectiveness but in beating back a worrisome threat of viral resistance to existing ARVs.

In a statement provided by the Global Fund press spokesman, Sands describes his background in economics, finance, and management as relevant to the challenges facing the institution, including sustainability. His priorities, as laid out in a recent commentary, are to raise the ambition levels for the Global Fund and deploy greater resources (Lancet 389, 2086, 2017).

“The most powerful argument that the Global Fund can bring to donors is impact: millions of lives saved along with a massive economic burden lifted and significant economic development in communities that have been held back by these diseases,” Sands says in the press statement. “We need to continue to make the case of proven delivery: that donor’s resources are well spent and delivered. We also need to make the case of the escalating benefit of being able to eliminate and stamp out these diseases both in countries and in key populations. There are always going to be pressures on government budgets and competing priorities, but the Global Fund starts in a strong place. We have shown we can make a huge impact.” —Michael Dumiak

Michael Dumiak reports on global science, public health and technology and is based in Berlin.

 

A New Wave of African Researchers at Work on HIV

Marianne W. Mureithi, lecturer and postdoctoral scientist at the University of Nairobi and chief research scientist at the Kenya AIDS Vaccine Initiative (KAVI), knew she wanted to be involved in the sciences, even from childhood. She recalls being fascinated by the human body, needing to know every organ’s function and purpose. “When I was really young, I was fascinated by biology,” Mureithi says. Yet it wasn’t until the 1980s, when HIV/AIDS hit her home country of Kenya, that she understood she had a calling. She lost several family members and friends to the epidemic. “I wanted to know why HIV was affecting people in sub-Saharan Africa. It was killing families and no one could understand why.” Even then she recognized that the lack of research centered in Africa would be a major detriment to solving HIV. So after receiving her PhD in Immunology & Microbiology at the University of Bristol in the UK, and pursuing her post-doctoral studies at Harvard University, Mureithi returned to Kenya with a plan to contribute however she could in defeating the virus.

Now she is part of a new wave of African researchers that is making steady progress in understanding HIV transmission in an effort to develop new and improved prevention strategies. She is also part of the surging movement to create sustainable, self-sufficient research in the areas hit hardest by AIDS. For Mureithi, her part in this movement is driven by both personal and intellectual concerns.

The HIV/AIDS epidemic is having particularly devastating affects among young women in Kenya. According to the latest data from the Joint United Nations Programme on HIV/AIDS, there is a significantly higher prevalence of HIV/AIDS among women aged 15-49 in Kenya than men of the same age—almost seven percent among women, compared to around four percent for men. This high prevalence among women necessitates a focus on prevention, Mureithi says, which is why she became involved with KAVI.

There, Mureithi is studying mucosal transmission of HIV by analyzing tissue samples collected from hysterectomies performed on HIV-infected female volunteers. This work is being done in partnership with Thomas Hope, professor of cell and molecular biology at Northwestern University’s Feinberg School of Medicine (see page 9), who mentored her. Mucosal surfaces are the first point of entry for the virus during sexual transmission. Understanding the role proteins, known as mucins, and other components of the mucosal environment play in providing a barrier—or welcome mat—to HIV is critical to attempts to block the virus. By observing how the tissues of the uterus and cervix obtained from HIV-infected women reacted to the virus, Mureithi and her team can more clearly illuminate the mechanisms by which mucosal immune responses slow HIV, with the hope that understanding and eventually triggering these responses can create a pathway to vaccine development.

Now Mureithi and her team will be able to conduct this research with cutting-edge technology. The newest addition to her lab is a high-powered deconvolution microscope, the same one that Hope’s lab is using in Chicago. It is one of the first of its kind in Kenya, and the region. It was provided through funding from the US Agency for International Development. This state of the art device allows Mureithi and colleagues to observe living cells, helping them understand in real time how HIV interacts with immune cells in various tissues. —Max Dorfman

Max Dorfman is a staff writer at IAVI based in New York City.