Global Fund collusion with liquor giant is a clear conflict of interest

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?

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?