ROUND TABLE
Global Fund collusion with liquor giant is a clear conflict of interest
El contubernio del Fondo Mundial con un gigante de la industria del alcohol, un claro ejemplo de conflicto de intereses
La collusion entre le Fonds mondial et le géant des boissons alcoolisées constitue un conflit d'intérêt manifeste
Richard MatzopoulosI,*; Charles DH ParryII; Joanne CorrigallI; Jonny MyersI; Sue GoldsteinIII; Leslie LondonI
IDepartment of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
IIAlcohol and Drug Abuse Research Unit, Medical Research Council, Tygerberg, South Africa
IIISoul City Development Institute, Johannesburg, South Africa
ABSTRACT
Alcohol is the third leading contributor to death and disability in South Africa, where SABMiller is the major supplier of malt beer, the most popular beverage consumed. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has recently included SABMiller as a recipient of funding for an education intervention aimed at minimizing alcohol-related harm, including HIV prevention, among men in drinking establishments. Global Fund support for this initiative is cause for concern. It is debatable whether these men are the best target group for the intervention, whether a drinking establishment is the best location, and whether the educational intervention itself is effective. Our experience is that the liquor industry is inclined to support alcohol interventions that will not affect drinking rates at a population level. These interventions allow the industry to simultaneously fulfil social and legal obligations to address the harmful use of alcohol while ensuring that sales and profits are maintained. Providing funding for a highly profitable industry that could afford to fund its own interventions also reduces the funds available for less well-resourced organizations. Do we take it that the problem of "corporate capture" has now spread to one of the largest health funders in the world?
RESUMEN
El alcohol es la tercera causa de muerte y discapacidad en Sudáfrica, donde SABMiller es el principal proveedor de cerveza de malta, la bebida más popular. El Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria (Fondo Mundial) ha incluido hace poco a SABMiller como receptor de fondos para una intervención de carácter educativo con el objetivo de minimizar los daños relacionados con el alcohol, incluida la prevención del SIDA, entre hombres en bares. El apoyo del Fondo Mundial a esta iniciativa es motivo de preocupación. Es discutible si esas personas son el mejor grupo objetivo para la intervención, si un bar es el lugar más adecuado y si la intervención educativa en sí es efectiva. Nuestra experiencia nos dice que la industria del alcohol tiende a apoyar intervenciones sobre bebidas alcohólicas que no afectan a las tasas de consumo a nivel de la población. Dichas intervenciones permiten a la industria cumplir con las obligaciones sociales y legales para abordar el consumo perjudicial del alcohol al tiempo que se aseguran las ventas y los beneficios. Proporcionar fondos a una industria con grandes beneficios que podría financiarse sus propias intervenciones reduce también la cantidad de fondos disponibles para organizaciones con menos recursos. ¿Tendremos que asumir que el problema de «captación empresarial» se ha propagado a uno de los mayores financiadores en el ámbito de la salud del mundo?
RÉSUMÉ
L'alcool est la troisième cause de décès et et d'invalidité en Afrique du Sud, pays dans lequel SABMiller est le principal fournisseur de bière de malt, la boisson la plus consommée dans le pays. Le Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme (Fonds mondial) a récemment ajouté la société SABMiller à la liste des bénéficiaires du financement d'une intervention pédagogique visant à réduire les dommages liés à l'alcool, notamment la prévention du VIH, chez les hommes fréquentant les bars. Le soutien de cette initiative par le Fonds mondial est préoccupant. On est en droit de se demander si ces hommes sont le meilleur groupe cible pour l'intervention, si un bar est le meilleur endroit et si l'intervention pédagogique elle-même est efficace. L'expérience dont nous disposons montre que l'industrie des boissons alcoolisées est disposée à soutenir des interventions liées à l'alcool tant qu'elles sont sans incidence sur les taux de consommation d'alcool au niveau de la population. Ces interventions permettent à cette industrie de remplir ses obligations sociales et légales en matière de consommation nocive d'alcool, tout en s'assurant que ses ventes et ses bénéfices n'en sont pas affectés. Offrir un financement à une industrie hautement rentable et capable de financer ses propres interventions réduit en outre les fonds disponibles aux organisations moins bien nanties. Devons-nous en déduire que le problème de la «capture d'entreprise» s'étend désormais à l'un des plus grands bailleurs de fonds mondiaux dans le domaine de la santé?
SABMiller is a major beer supplier to approximately 34 000 licensed outlets in South Africa and through them an estimated 200 000 illegal outlets (called "shebeens") that act as a de facto distribution arm. It has established an educational intervention that aims to minimize alcohol-related harm in men, and reduce male violence against women and children as well as the spread of HIV/AIDS.
The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has included SABMiller as a sub-recipient of its Round 9 funding in support of the brewery's Tavern Intervention Programme for Men.1 Global Fund support for this initiative is cause for concern because it reflects the successful attempt of a highly profitable industry to position itself as committed to public health objectives. In reality, the liquor industry's aggressive marketing of its products is irrevocably linked with major health harms throughout the world, in South Africa in particular. As the impetus by government and nongovernmental organizations to address alcohol-related harm in South Africa has increased, we have seen an upsurge in efforts by the liquor industry to partner with government and public health agencies. Such partnerships lend legitimacy and provide a platform for the liquor industry to lobby against proposals to reduce the availability of alcohol, increase the price of alcohol through raising excise taxes and place restrictions on the marketing of alcohol, despite the global evidence that these measures are the most cost-effective way to decrease alcohol-related harm.
Alcohol is the third leading contributor to the disease burden in South Africa,2 mainly through injury, particularly from interpersonal violence; infectious diseases, particularly tuberculosis and HIV/AIDS; and neuropsychiatric disorders.3 At face value, a programme that aims to reduce HIV infection as well as violence against women and children is welcome, but it is debatable whether men who attend shebeens are the best target group for the intervention, whether a drinking establishment is the best location, and whether the educational intervention itself is effective. There are two interventions addressing HIV and intimate partner violence that have been proven effective in South African settings and which would have been more fitting recipients of donor funding.4, 5 Neither targets men specifically nor uses the shebeen as a classroom.
Our experience is that the liquor industry is inclined to support alcohol interventions that have limited impact on drinking at a population level. These interventions allow the industry to be seen to be fulfilling social and legal obligations to address alcohol abuse while simultaneously ensuring that sales and profits are maintained. Eliciting funds earmarked for the global public good not only provides the liquor industry with free advertising and a mechanism to achieve its goals, but also reduces available funding for less well-resourced organizations.
Calls for accountability and good governance relating to the Global Fund and similar agencies have been increasing recently.6 - 8 While it is commendable that the Global Fund has a zero-tolerance policy on corruption and misappropriation,9 we would argue that it should also not fund organizations with conflicted interests. In the case of the liquor industry, that conflict arises in that the industry can appear to be dealing with the social responsibility requirement of addressing the harms associated with its products - in itself a form of advertising - with an intervention that does not reduce availability of alcohol or consumption of its products.
We believe this should place organizations that manufacture or sell alcoholic beverages off limits. The liquor industry is already highly profitable and aggressively markets products in developing countries that can least afford the high burden of disease and demand for health services that result from the use of these products. Despite submission of a request for the Global Fund to reconsider the award to SABMiller, no response has been received to date. Do we take it that the problem of "corporate capture", so clearly described in the field of nutritional research,10 has now spread to one of the largest health funders in the world? 
Acknowledgements
Richard Matzopoulos is also affiliated with the Burden of Disease Research Unit at the Medical Research Council, South Africa; Charles DH Parry with the Department of Psychiatry at the Stellenbosch University, South Africa; and Joanne Corrigall with the Western Cape Department of Health, South Africa.
Competing interests: None declared
References
1. Grant no SAF-910-G09-H (grant agreement). Geneva: The Global Fund to Fight AIDS, Tuberculosis and Malaria; 2011. Available from: http://portfolio.theglobalfund.org/en/Grant/Index/SAF-910-G09-H [accessed 15 November 2011] .
2. Schneider M, Norman R, Parry CDH, Bradshaw D, Plüddemann A; South African Comparative Risk Assessment Collaborating Group. Estimating the burden of disease attributable to alcohol use in South Africa in 2000. S Afr Med J 2007;97:664-72. PMID: 17952223
3. Rehm J, Kehoe T, Rehm M, Patra J. Alcohol consumption and related harm in WHO Africa region in 2004. Toronto: Centre for Addiction and Mental Health; 2009.
4. Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C et al. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 2006;368:1973-83. doi: 10.1016/S0140-6736(06)69744-4 PMID: 17141704
5. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A et al. Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ 2008;337:a506. PMID: 18687720
6. Chan M, Kazatchkine M, Lob-Levyt J, Obaid T, Schweizer J, Sidibe M et al. Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med 2010;7:e1000223. doi: 10.1371/journal.pmed.1000223 PMID: 20126260
7. Sridhar D, Batniji R. Misfinancing global health: a case for transparency in disbursements and decision making. Lancet 2008;372:1185-91. doi: 10.1016/S0140-6736(08)61485-3 PMID: 18926279
8. Gostin LO, Heywood M, Ooms G, Grover A, Røttingen JA, Chenguang W. National and global responsibilities for health. Bull World Health Organ 2010;88:719-719A. doi: 10.2471/BLT.10.082636 PMID: 20931051
9. Kazatchkine MD. The Global Fund won't stand for any corruption. Huffington Post, 24 January 2011. Available from: http://www.huffingtonpost.com/michel-d-kazatchkine/global-fund-corruption_b_813285.html [accessed 15 November 2011] .
10. Roberts I. Corporate capture and Coca-Cola. Lancet 2008;372:1934-5. doi: 10.1016/S0140-6736(08)61825-5 PMID: 19059037
Submitted: 1 June 2011
Accepted: 27 September 2011
* Correspondence to Richard Matzopoulos (e-mail: richard.matzopoulos@mrc.ac.za).