The withdrawal from this week’s South African Tuberculosis Conference in Durban by high profile delegates, including the World Health Organisation and the Bill & Melinda Gates Foundation, baffled organisers, until it was discovered that the conference’s main sponsor, the Foundation for Professional Development (FPD), had committed the sin of accepting money from the tobacco industry (in 2021).
The seventh SA Tuberculosis (TB) Conference, which opened yesterday, was set to be the best-attended iteration of the gathering to date: more than 1 000 delegates had signed up, writes Joan van Dyk for Bhekisisa.
Public health experts’ enthusiasm came at a crucial time: after the COVID-19 pandemic had undone years of progress with cutting TB deaths, which are preventable.
However, 10 days before the opening of the conference, high profile delegates’ interest in attending had plummeted.
WHO informed the conference chair, Willem Hanekom, that it was withdrawing its delegate’s attendance. Then the Bill & Melinda Gates Foundation (which contributes billions in funds to TB treatment and prevention projects) and an international organisation called Find, which distributes diagnostics for poverty-related diseases such as TB, announced they were also no longer attending.
Hanekom was puzzled — but not for long.
It soon emerged that the conference’s main sponsor, the Foundation for Professional Development (FPD), had accepted money from the tobacco industry (in 2021).
Smoking makes people more likely to get infected with TB, and increases their risk of becoming very ill with TB and dying of the disease. About 360 000 people became ill with TB in 2019, and 16% of them died. A 2011 study found more than half of TB patients smoked.
So one thing was clear, says Hanekom: “Big Tobacco’s money had no place at a national TB conference.”
A tale of two foundations
How did one of SA’s oldest non-profits (FPD) get into this mess?
They accepted money from the Foundation for a Smoke-Free World (FSFW), an organisation pitched as a research body devoted to ending smoking.
But it’s not.
The Foundation for a Smoke-Free World is funded entirely by tobacco giant Philip Morris International (PMI) – an organisation that the WHO and at least 120 others consider to be a front group set up to promote the tobacco industry’s interests.
The Foundation granted the FPD R2m to conduct research on how tobacco use affects people’s recovery from mild COVID over time. The study results had to be published in peer-reviewed journals.
Henk Reeder, the FDP’s chief operating officer, says his organisation didn’t know about the Foundation for a Smoke-Free World’s links to Big Tobacco. In fact, the FPD has a policy not to accept tobacco or alcohol industry money.
He says the grant also passed the internal checks and balances that govern which funding the FPD accepts: “We didn’t pick up any red flags.”
Public health experts also warned the FPD about the Foundation’s links to Philip Morris International, according to e-mails Bhekisisa has seen.
Ignorance, industry’s hottest commodity
Bamboozling people and organisations into promoting the tobacco industry’s interests dates back a quarter of a century as a strategy.
Operation Berkshire was exposed nearly 25 years ago.
It was a decades-long ploy in which seven international tobacco companies conspired to mislead lawmakers and smokers about the health risks of the habit. The science showing that smoking causes cancer, they argued, wasn’t as clear-cut as scientists wanted the public to believe.
Part of this scheme included setting up third-party research groups such as the Centre for Indoor Air Research, so that scientists would be more inclined to accept the money, industry documents show.
It worked well two and a half decades ago, but for the most part, the public health lobby has snuffed out the Foundation for a Smoke-free World — so much so that it can’t find any funding outside Philip Morris. An analysis of the Foundation’s 2021 tax returns shows that the pool of organisations that are willing to accept their grants is also shrinking fast.
The FPD’s seemingly blind faith that it was dealing with a neutral donor is now being used as a weapon. For instance, the organisation is included in international analyses that illustrate how the FSFW uses otherwise credible organisations in South Africa to influence COVID research and to push its broader agenda.
And don’t be mistaken, ignorance is a hot commodity for any industry that the public health lobby considers an enemy. Take the infant formula business. It’s used marketing tactics to mislead parents into believing that it’s better to give an infant formula than breast milk.
A decade ago, the health department wrote rules to combat the industry’s influence, but companies that sell formula have still managed to sponsor multiple workshops for health professionals at various universities. There were at least three such examples between 2016 and 2019.
When immediately isn’t soon enough
In the aftermath of events, Hanekom says he and his committee considered various options, including cancelling the TB conference altogether. “But it was tricky because TB is such a big issue in South Africa. We can’t ignore it.”
The fact that the gathering is taking place at all is because the FPD agreed to end its contract with the Foundation for a Smoke-free World immediately. The study that their researchers submitted to academic journals will be withdrawn and any unspent money will be returned.
The Foundation for a Smoke-free World and FPD both say they follow internationally accepted standards to make sure their output isn’t swayed by funders.
That’s true in theory.
The Big Tobacco-backed research group claims that it adheres to eight rules for accepting money from the tobacco industry. But two of the people who wrote the guidelines argued in a statement that the FSFW doesn’t come close to clearing the bar.
One of these norms says funding decisions should be transparent. The Foundation for a Smoke-free World claims they abide by this, because their bylaws, for example, set out that all funding relationships must be disclosed. But they don’t specify which type of links would be unacceptable.
Other critics from the McCabe Centre for Law and Cancer point out that the Foundation for a Smoke-Free World’s agreement with Philip Morris includes loopholes that would allow the tobacco giant to pull funding if the Foundation for a Smoke-free World decides to fund studies that Philip Morris doesn’t like. This goes against the public health lobby’s guideline of letting researchers decide what issue needs to be investigated.
The real proof of how the rules are flouted came in 2020, when the Foundation for a Smoke-Free World updated its agreement with Philip Morris so that it allows them to share information with their funder. The document now also says the Foundation will be “free from improper influence” instead of just “free from influence”.
The FPD similarly adheres to a well-phrased code of conduct to make sure its research projects remain independent. But it seems to be guilty of having stepped into the trap of ignorance — which is worse because it’s one of the tobacco industry’s favourite tools.
Reeder insists that the Foundation for a Smoke Free World never interfered in the research it funded.
There is, however, no guarantee that it would have stayed that way if the organisations continued to work together.
The fallout of this has been a wake-up call: “We’ll be doing much more to investigate donors in the future,” concedes Reeder.
But their mistake has highlighted the dangers of working in silos: it’s crucial to understand the politics of the field you’re working in.
In short: the moral high ground alone is not enough to shield public health organisations from the insidious world of industry tactics. In the end, it’s making sense of politics, not paper protocols, that will save your credibility.
Call for collective approach
Meanwhile, experts say that the COVID-19 pandemic has put the treatment of TB on the back foot, SABC News reports. Reduced access to TB diagnosis and treatment has resulted in an increase in TB deaths and a notable spike in infections globally. Over 25 000 people die from TB each year in South Africa.
There are calls from some civic organisations for more of a collective approach by organisations in combating the prevalence of TB in communities as opposed to some working in silos.
“TB is everyone’s problem, a lot more can be done if we work together and not in silos,” says SANAC National Civil Society Forum’s Steve Letsike.
South Africa is one of the 30 high-burden TB countries at number 8. India tops the list. Together these countries account for a whopping 86% of the estimated new TB cases worldwide.
“We have more than over 300 000 cases of TB in South Africa every year and 25 000 people died from TB in South Africa every year. During covid in the rest of the world the number of people that died from tuberculosis increased. This was after a steady decline, so basically we are in trouble. we need to take stock of what is going to happen here.”
The National Health Department reported that it has crafted a Control of Tobacco Products and Electronic Delivery Systems Bill. Deputy Health Minister Dr Sibongiseni Dlomo says they are hoping that if passed, the Bill will assist in decreasing TB infections.
“Once that Bill has been passed it will go to Parliament. It will take its root now there is the NHI there. We are hoping that once they are done with this Bill they will then focus on this tobacco control.”
Scientists have raised concerns over a lack of investment in diagnostics, particularly, to reduce the time between testing and treatment.
In South Africa, this can take up to five days and requires a patient to physically present themselves back at the clinic to receive their results.
Dr Harry Moultrie from the National Institute of Communicable Diseases spoke about the progress India has made in reducing TB infections by recapacitating diagnostics in line with COVID-19 testing over the last two years.
SABC News report: Major stakeholders withdraw from TB conference
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