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Does drug facility squabble reflect power grab?
STOP-TB’s global drug facility, a good idea that’s been trying to get off the ground for the last couple of years, was the focus of a spat last month between TB experts at the World Health Organization and a "working group" impatient to get the facility up and running.
The idea behind the global drug facility is basically a simple one: to collect a pot of money from various donors and stakeholders and use it to help national programs get through temporary shortfalls that threaten to interrupt the steady flow of TB drugs.
The drug facility, an idea that’s been on the drawing boards for upwards of two years, was supposed to have been run out of the STOP-TB division of WHO. The problem, some say, is that STOP-TB has been too consumed with its own internal politics to devote any attention to getting the drug facility up and running.
Having jump-started the Global Alliance for TB Drug Development, the Rockefeller Foundation decided to call a working group of "interested stakeholders" (including, of course, reps from STOP TB) to get the ball rolling. Once the working group was established, the pace of events quickened. At the working group’s initial meeting back in July, a second get-together had been scheduled to take place in New York early last month. There, the idea was to draw up a charter, which would be presented at a subsequent meeting in Bellagio, Italy, when WHO would officially announce the formal creation of the drug facility.
An e-mail arrives: We won’t be there’
But at the last minute, WHO Director-General Gro Harlem Brundtland dispatched an e-mail to Rockefeller announcing that her organization was pulling out of the New York meeting. TB experts on this side of the Atlantic began to fret about whether that signaled a power struggle that might jeopardize the drug facility’s future.
"If STOP-TB tries to get hold of it, there may be a problem," says Lee Reichman, MD, MPH, director of the National TB Center at the New Jersey Medical School in Newark. "They’ve done this kind of thing before. STOP-TB used to be a partnership, and then WHO said no, they had to be the leaders. It could happen again."
At Rockefeller, the tone was more conciliatory. "In my mind, we are partners with STOP-TB,
and no one is taking orders from anyone because that’s not the issue at hand," says Ariel Pablos-Mendez, MD, scientific director of the Rockefeller Foundation. "All that matters to us is that the drug facility will be established."
Back in Geneva, WHO defended its move by saying the working group didn’t have "all the stakeholders" at the table, and that it is important to be make sure careful control is exercised over how TB drugs are made available and how they are used.
"You can’t just look at one dying patient in East Timor or someplace and decide you have to throw drugs at the problem. That would create a disaster," says Jacob Kumaresan, medical officer with STOP-TB. That was just one of the many reasons WHO decided to bail out, he adds.
For one thing, the meeting "was poorly planned," says Kumaresan. "It was organized
at the last minute, and there hadn’t been any agreement ahead of time about the outcome." Also, high-burden countries weren’t adequately represented. "There was only one representative from a donor country . . . who was going to be there," he says. "Many of the potential donors weren’t there either. It was simply too far to go for just one meeting."
Private industry vs. public sector
The trouble boils down to the existence of two competing visions for the drug facility, which have yet to be reconciled, he goes on. "One is the perspective of private industry, which is the perspective of Rockefeller. It has its strengths, which include independence, flexibility, and responsiveness."
The other vision, that of a public-sector model, has its strengths, too, he adds, and their omission would be dangerous. As far as donors are concerned, WHO’s presence is essential to ensure "credibility," he says. As for the high-burden countries that stand to benefit from the drug facility, only WHO can provide the contacts with technical programs, make sure drug supplies are available "for the long term — at least for the next 10 to 15 years," and keep a tight grip on how the drugs are used. "Otherwise, we’d just create a public-health disaster," he concludes.
By the end of last month, the dust had begun to settle, and conciliatory messages had been exchanged between the two groups. "What matters is that there are good wills around the table, and that things are moving very fast, both on the technical side and on the political side as well," says Pablos-Mendez. "The working group continues to work. And so we are hopeful."