[Ip-health] Richard Horton (Offline) in The Lancet: Offline: Who should lead UNAIDS?

Thiru Balasubramaniam thiru at keionline.org
Thu Jul 4 22:19:20 PDT 2019


COMMENT| VOLUME 394, ISSUE 10192, P12, JULY 06, 2019

Offline: Who should lead UNAIDS?

Richard Horton

Published:July 06, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)31563-6

Who is best qualified to lead an organisation—UNAIDS— that has not only
suffered severe reputational loss, but also faces threats to its continuing
existence? UNAIDS is a jointly sponsored UN programme that has, in its own
words, “led and inspired global, regional, national, and local leadership,
innovation, and partnership to ultimately consign HIV to history”. But some
observers believe this glorious history is just that—history. Rob Yates was
recently appointed head of Chatham House's Centre on Global Health
Security. He wrote on Twitter last week that a new Executive Director of
UNAIDS should have the “courage and ability to wind up the organisation and
integrate it into @WHO”. Kul Gautam, a former Deputy Executive Director of
UNICEF, argued that “now it's time to question [UNAIDS] continuation”.
Anthony Costello, most recently a Director at WHO, commented, “No one
questions the need for a strong and distinct body for the HIV response.
It's whether UNAIDS would function better under the democratic
accountability of the World Health Assembly which might have prevented its
shameful recent history”. Laurie Garrett, a Pulitzer-Prize winning writer
on global health, noted that those selecting the next Executive Director
“MUST define clearly why the world needs UNAIDS & how it should fit in the
global health landscape.” Is it time to choose a leader who will close down
UNAIDS? Maybe one day. But not now. Predictions about the end of AIDS have
been badly misjudged. According to the Global Burden of Disease Study,
there were almost 1 million deaths from AIDS in 2017. Those deaths occur
throughout the lifecourse, but the toll is especially severe among
15–49-year-olds (676 100 deaths). There are almost 37 million people
worldwide living with HIV. And the incidence remains shockingly high—1·9
million people newly infected every year. Although the number of
AIDS-related deaths is projected to fall, even by 2040 those deaths will
still be unacceptably high (742 million, with a worst-case scenario of 2·3
million deaths). The AIDS epidemic is at a critical moment. Decelerating
the political response by extinguishing UNAIDS now would be a catastrophic

There are five candidates: Salim Abdool Karim (an infectious diseases
epidemiologist and Director of the Centre for the AIDS Programme of
Research in South Africa); Sani Aliyu (physician, infectious diseases
expert, and Director-General of Nigeria's National Agency for the Control
of AIDS); Chris Beyrer (physician, HIV specialist, former President of the
International AIDS Society, and Professor of Public Health and Human Rights
at Johns Hopkins Bloomberg School of Public Health); Winnie Byanyima
(engineer, politician, diplomat, and now Executive Director of Oxfam
International); and Bernard Haufiku (physician and Namibia's former
Minister of Health and Social Services). Each candidate has strengths.
Aliyu spearheaded Nigeria's AIDS response under difficult political
circumstances. Haufiku has ministerial experience. Byanyima knows how to
run a complex global organisation. Karim is a highly respected HIV
scientist whose work has transformed clinical practice. And Beyrer, whose
partner died of AIDS in 1991, successfully uses human-rights approaches to
protect and advance the health of marginalised communities in Asia, Africa,
Latin America, Russia, and the US. There are disappointments. Only one
woman? No forum for public debate and scrutiny? Appointment not election?

The next Executive Director of UNAIDS must fulfil five criteria. First,
s/he must have the personal integrity to restore trust and credibility to a
damaged organisation—and to give governments confidence to invest in the
AIDS response. Second, s/he must have proven scientific understanding of
the AIDS epidemic in order to be able to use evidence as a platform for
political advocacy. Third, s/he must have demonstrable ability to represent
and engage with civil society. Fourth, s/he must be able to point to their
commitment to key vulnerable populations. And finally, s/he must be able to
show transformational leadership of a large organisation. The Programme
Coordinating Board of UNAIDS met in Geneva last week and “commended the
strong competencies of all short-listed candidates”. After interviews, a
Committee of Cosponsoring Organisations will deliver no more than three
names to the UN Secretary-General, António Guterres. It is no exaggeration
to say that his choice may determine the future fate of the AIDS epidemic.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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