The shortlist was circulated, the voting tallied, the guests gathered and the winner was . . . certainly not the Global Fund to Fight Aids, TB and Malaria.

On Monday, the board of the world’s largest multilateral donor to tackle infectious disease issued a deeply embarrassing statement that it was restarting the selection process for its new executive director. As Rob Yates at Chatham House tweeted, it made the 2017 Oscars organisers look competent.

The official reason given, during a retreat to select the successor to Mark Dybul when his term expires in May, was “issues encountered in the recruitment process”. Marijke Wijnroks, his deputy, will step in as interim head until a replacement is found.

Some criticised the method: too rapid, with inadequate due diligence and leaks of the findings (NYT). Others highlighted disagreements on the board over the three finalists, who all had their critics.

Helen Clark, the former New Zealand prime minister and outgoing head of the UN Development Programme, pulled out when she was ranked third (Science). The new Trump administration may have had little sympathy for her politics and links to the UN system — nor for Muhammad Pate, a former Nigerian health minister, who retweeted articles critical of the US president.

Civil society groups were uncomfortable with Nigeria’s human rights policies. They also had mixed views on Subhanu Saxena (PharmExec), a former “big pharma” industry executive and British — as is David Nabarro, who is running to lead the WHO.

There are two lessons from the process. One is to reflect on the unwieldy governance structure (CGDev) of the Global Fund, which must take responsibility for the failed nomination process. The second is the risk of declining income from its largest supporters, notably the US under its new president, which contributes about a third of the budget. In 2016, the organisation received $13bn in pledges for the next three years. But with the political mood shifting, even these payments are not guaranteed while future donations may not be so generous.

Some argue that companies and new taxes (IHP) should make up the shortfall. In reality, low and middle income countries with high disease burdens will almost certainly need to pay more for their own populations or face the consequences.


Three questions with . . . 

Vytenis Andriukaitis, EU Commissioner for health and food safety. Watch the FT video discussion.

February 28 was International Rare Disease Day. Is Europe doing enough to help patients with these conditions?
This week we launched 24 European Reference Networks (ERNs) that connect 900 medical teams across Europe for the benefit of patients. We also support research, incentivise pharmaceutical companies to produce orphan medicines and we have established a European platform on rare diseases registration. When it comes to patients, we always strive to do more, to do better.
Given the importance of British academics, drug companies and expertise, will Brexit be a big blow to healthcare across Europe?
The UK is still a member of the EU. Article 50 has not yet been triggered and the negotiations on the terms of Brexit have not yet begun. When the UK officially leaves the EU, it should still be able to collaborate with ERNs as a third country. For me, science has no borders and no country is able to tackle issues like rare diseases alone.
Are you in favour of sugar taxes and other legislative measures to cut unhealthy ingredients to boost prevention?
Taxation is a matter of national competence, but I favour any measure that leads to healthier lifestyles and reduces the burden of chronic diseases. Reformulating food products to contain less sugar is important. We also need education on how to keep ourselves and our families healthy. Finally, the healthy choice needs to be the easy and affordable choice.



Orphan drugs Medicines for rare diseases are 10 times more costly per patient than their equivalents for more common illnesses, but their sales growth is far greater. Worldwide sales in 2016 hit $114bn or 16 per cent of all prescription drug revenues. By 2022, EvaluatePharma forecasts this will rise to 21 per cent.

The FT’s full Combating Rare Diseases (no paywall) report looked at investment returns, the use of genomics and the pressures on pharma companies to reduce costs.


News round up

Superbug battle The World Health Organization on Monday unveiled a list of “priority pathogens” — the bacteria for which new antibiotics are desperately needed. The superbugs could cause up to 10m deaths a year. TB was notably absent, to the anger of specialists. (FT, StopTB)

Chinese breakthrough Chi-Med’s cancer drug fruquintinib — developed jointly with Eli Lilly — could become the first modern drug developed in China to be sold on the global market, following positive trial results. (FT)

Hepatitis spat The fight over patents for the costly treatments for the virus is intensifying in India, where manufacturers are seeking 20-year monopolies. (Nature) 

Trumping Obamacare The US president said reforming the health system was “unbelievably complex”, but told Congress he would replace Obamacare. He seemed to move closer to Speaker Ryan’s House plan with a new emphasis on “access” to care and tax credits, but more conservative Republicans remain unconvinced. Hospitals are anxiously awaiting details of the reforms. (NYT, NPR audio, Politico, Kaiser).

Regulatory wrath Mr Trump hit out at the FDA, berating the drug regulator’s “slow and cumbersome” approach to approving treatments. Others argue the problems are caused by payers of prescription drug benefits, such as health insurance companies and self-insured employers. (Forbes, Stat)

US aid The president’s attack on foreign aid drew fierce criticism while opposition to his “global gag rule” — blocking assistance for family planning services linked to abortion — gained momentum with a summit in Brussels to support organisations hit by the restrictions. Separately, there were calls for the FDA to allow the abortion pill to be sold in US pharmacies. (Devex, Huffington Post, Stat). 

Vaccine alarm Falling vaccination rates in the US are unscientifically linked to autism, but in Pakistan and Afghanistan there have been fears they are part of a western plot to make Muslims infertile. (National Geographic)

UK trials GSK is using “real world” studies in the UK for its asthma drug Relvar, as it tries to prove the value of medicines to cash-strapped authorities before they have been formally approved. The country’s competition authorities alleged generic companies Concordia and Actavis had fixed the UK market for hydrocortisone tablets. (FT)

Tackling disease An epidemic tracking tool has won the Open Science Prize. The Next Strain system can chart the real-time progress of epidemics such as Zika, Ebola and Influenza (Quartz) 

Mosquito alert New research showed Zika could be carried by up to 35 types of mosquito. The WHO reported cases of chikungunya in Pakistan for the first time. There are links to climate change (Lancet). The WHO noted Sri Lanka’s efforts to remain malaria-free while specialists in the BMJ’s “head-to-head” section disagreed over the equitable case for malaria eradication and whether the money might be better spent elsewhere.

Cameron focuses on fragile states Re-emerging from his decision to trigger Brexit at home, the former UK prime minister says he will help advise weak countries on how to grow. (Guardian)


Best from the journals

Cancer There has been a sharp rise in colorectal cancer among US millennials, who are four times more likely to develop the disease than young Americans in the 1970s. The study has prompted concerns over poor diets and sedentary behaviour. (FT, National Cancer Institute)

Embryos Scientists at Cambridge university claimed a world first by creating “artificial embryos” using stem cells from mice, with potentially significant implications for fertility research. (Science)

US policy The Trump administration and the environment: Heed the Science (New England Journal of Medicine)

Skin disease Mapping the global burden of a major cause of disability worldwide. (JAMA Dermotology)

Ebola Individual versus group rationality — should a suspect confess or not? (The Lancet)


Podcast of the week

Mirror man How a one-legged Canadian cycling around Cambodia with mirrors is helping amputees with “phantom pain”. (Mosaic, 27 mins) 


You may have missed

FT Health: last week’s issue

It’s science Jim, but not as we know it Scientists are racing to build a Star Trek-style medical tricorder. (Stat)

Public health 100 objects that shaped public health. (Global Health Now)


Coming up

WHO Join us online on Monday March 6 for a public discussion with the three candidates for the top job at the World Health Organization.

UK Next week’s Budget may include an option for a death tax — remodelling inheritance tax to recoup costs when elderly people die. (FT)

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