← A Shot in the Arm Podcast
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- [00:03]
A
Welcome to A Shot in the Arm podcast and a quick word from me before we get into this episode. I'm your host, Ben Plumley, and many of you will know that I started chemotherapy in the summer of 2025 to help our Eric in the Herculean task of taking care of me. Friends from all over the world have reached out and stayed with us to help out. Now, if you haven't already, check out A Shot in the Arm Media's Cancer Meet Colon podcast where I share my treatment journey. Well, Andy Seal from the World Health Organization was one of those friends who popped over and helped care for me. And while he was here, we decided to record a podcast episode covering the 30 year journey of our personal and professional friendship as the HIV movement enters a new, highly disrupted and continuingly disrupted era. We thought it might be interesting and maybe useful both to colleagues who are as discombobulated as we are in this moment, and to the managers and decision makers who are having to decide what to do with us and whether there is any role at all for us in these unmoored and fractured times. Oh, and just in case you miss it, though I can't for the life imagine that you will. Andy is a huge fan of Taylor Swift. Me less so. Enjoy the pod. Welcome to A Shot in the Arm podcast. I'm Ben Plumley and. And this is a podcast about innovation and equity in global health. Because let's face it, without equity, what is the point of innovation in the first place? Well, today's episode as part of our summer of podcasts, 2025, is a journey through time with a colleague from the whole. But he's more than a colleague. He's actually an old, old, old, old, old, old, old, old friend. Someone I've known since before both of us were working in global health. And it is the very lovely Andy Seal. Andy, welcome to A Shot in the Arm podcast.
- [02:30]
B
Thank you, Ben. I've been waiting for this moment.
- [02:32]
A
Well, you have been on before, remember? I have back way, way, way, way. I think we were in Mexico.
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B
We were.
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A
Oh, no, Montreal.
- [02:40]
B
One of those.
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A
One of those conferences. Anyway, well, we thought we'd call this episode the Eras Tour, because we're going to go back and look at different eras in our lives. But the first question I really have for you is to explain to me what the bloody buggery bollocks with Taylor Swift. How can someone of your vintage be such a fan?
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B
Well, Ben, you know I'm very excited about Taylor. Taylor Swift's 12th album being announced just yesterday.
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A
Did it deliberately, knowing that we were recording.
- [03:12]
B
Yes. I became an accidental swiftie about two years ago. A friend bought a ticket to the ERAS tour for me and so I thought I better learn some songs if I'm gonna go and, you know, see this lady with my very expensive ticket. And that was it. And I just adore the woman. I think she's a talented poet. What can I say?
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A
Well, indeed, what can you say? Because of course for me, pop music ended and started with the Pet Shop Boys.
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B
But that's for a Swedish influences there, Ben.
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A
Oh, absolutely, absolutely. Don't knock the army of Lovers and abba, but which is an entirely. They're not Swedish.
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B
No. They're French.
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A
No, they're not. They're from Croydon.
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B
Oh, okay.
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A
And you know, they're about to release their, what will be their very last album. They're retiring after this album. Just imagine how that makes me feel. Thank you guys, really appreciate it. Anyway, let's start with our first era on the ERAS tour, which is you and me growing up in the 80s and 90s, meeting in the early 90s in London. And we are coming into our sexual maturity, our adulthood in what is essentially the worst sexually transmitted disease epidemic to hit Britain and of course the world, but to hit London, especially for a generation. And I guess we should just explain to listeners and viewers if they're interested, and they might not be just how we met, but you were very close friends, school friends in fact, with a very good friend of mine who I was house sharing with at the time. At the Vicarage. At the vicarage. We gave it other names, but.
- [04:58]
B
Yes, indeed, that's right, Ben, I remember meeting you. So David had moved in with you and I had just moved to London, I think I was working at Hammersmith and Fulham Council in the press office. And in fact I'd moved from Birmingham and in Birmingham our HIV prevention strategies were don't sleep with men from London. And so what did I do? I moved to London. And anyway, from there we explored, didn't we, socially and otherwise.
- [05:30]
A
Yes, yes, yes. And in fact our paths crossed professionally for the first time. And I will never forget this. You ended up working for the Health Education Authority.
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B
I did.
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A
Which was. I mean it no longer exists anymore in the uk. But what did it do?
- [05:49]
B
It was a great organization. So we did health policy, we did a lot of prevention, I mean in terms of health promotion. So we did a lot of work around. I worked specifically on drugs and alcohol. I had a big team sitting next to me in the open plan area. Working on HIV and STIs. So we did all of the well funded. It was very well funded under the Tory government, in fact, health promotion campaigns. So it was a combination of advertising, public relations, outreach to different target audiences. The science behind it, the focus groups, all of that know infrastructure that we had for health was, was, was absolutely
- [06:24]
A
incredible until Margaret Thatcher got pissed off with this sexual behavior study that was supposedly going to be sent round to every, every citizen in the United Kingdom. And again, our paths cross here because the head of the Health Education Authority at the time was the very lovely Susan Pearl.
- [06:47]
B
Exactly.
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A
Midwife to most AIDS organizations globally. And she lost her job as a result of that. But I remember you coming. So I, after a time of working, I also worked for the, for the Civil Service, the government. I worked for the Human Embryology. Human Embryology. Human Embryology and Assisted Conception Authority. I'm getting the name wrong. They'll kill me for that. Hfea Human Fertilization Embryology Authority. We're going back in time here. And my first job in the private sector was to run the positive action program for what was then called glaxowelcome, now VEEF Healthcare.
- [07:31]
B
Exactly.
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A
And we got a panicked call from the operating company of the United Kingdom saying, oh, the Health Education Authority want to meet us and we're scared. Would you meet with them? And so I did meet with you and I don't think I realized you were going to be in the meeting with us until I walked in and there you were. But do you remember the proposal you were putting to us?
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B
I do. We asked you to support a small grants proposal, if I remember rightly, and you and I rebuilt that up into quite a nice little kind of like initiative, as I remember.
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A
Okay, I'm going to call you out on this. That's absolute bullshit. What it was, right, is that you were coming to us with a proposal for us to help you print 5 pound notes or 10 pound notes with H. Yes. With HIV messaging on.
- [08:28]
B
Don't twist it. Don't twist it. If I remember rightly, it was a small grant scheme and we did make, and it was around getting HIV messages out to communities. But we made the big mistake of getting a design for our flyers which was based on, I think it was 20 pound notes, in fact. Yes.
- [08:48]
A
Well, I remember Susan Pell, who was then a consultant to me at Positive Action, taking me to one side and saying, well, of course, dear, we can't fund this because you're not going to prison and neither am I.
- [09:05]
B
Yeah, we found out halfway through the process that it was actually a criminal offense to reproduce any kind of, like, UK money in any kind of like, advertising or any other initiatives. So, yes, it was, it was an aborted attempt to be innovative, Ben. And I know this podcast is all about innovation, but we fail. Forward.
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A
Well, we do. Failure is not in itself a bad thing. We learn from it. Don't go to jail is our first principle of HIV prevention and awareness.
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B
Very successful initial collaboration, Ben, where we both nearly ended up in prison.
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A
Yes, but, but, but, but then thinking more broadly about that era for, for you, and we're both gay men, as I say, coming into our adulthood, into our sexual majority. How did it affect you? Living in a world of HIV, both the iceberg adverts that we saw in the 80s, the more. Yeah. And then the more targeted approaches that happened in the 90s, Ben.
- [10:12]
B
You know, I think what happened was there's several things were happening at the same time, so I think we were all exposed to the same messages and they were horrifying and I think people reacted to them in very different ways. And so I became something of a hedonist, if I'm absolutely honest. I'd really hit the party scene and had a great time and met lots of people who were trying to escape. And this coincided with the big, you know, kind of like explosion of clubbing in the early 90s in the UK. And to be honest, I threw myself into that world. It was an escape because it was hard stuff. I mean, in one sense, I think you and I were fortunate that it really was the generation just before us that was harder hit. So even though I did know people who had passed away from hiv, I hadn't known them long, if that makes sense. And so it was almost like a superficial kind of like experience in, in terms of my own personal interactions. I had, I had some, some family members affected that I won't talk about on, on the podcast. But you know, that was part of also my, my, my upbringing and my experience. But then socially, I got to know a lot of people who were living with hiv. And of course, you know, that was, it was great. They would. They were doing reasonably well at the time, but they were also caught up in the hedonism, Ben, because there was talking.
- [11:34]
A
93, 94.
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B
No, no, real people were expecting to live quite short lives. And so again, this fed into the hedonism. Let's live for the moment, let's live for the day. So I had a partner at the time, and he wasn't expecting to Live longer than three or four years. And so we did a tour of the world. We went around the world for four months, and we had a great time. He's still alive today, and we're still in touch and we're still very good friends. But this really was, you know, we were thinking, we were really forced to be present, I think. I think that was my one message from that time. So the hedonism was part of it, but the other part was be present, take risks, jump around your jobs if you need to, to get experience, fail forward, as we've said, and try things out. And so I think it was a heady mix of experiences for me. I did try and get a job at the London Lighthouse, and I didn't get that job for different reasons, but perhaps we won't go there, but we
- [12:31]
A
are going there because part of my story involves the Lighthouse.
- [12:34]
B
Exactly. So, no, but what about you, Ben? How did you experience those years?
- [12:39]
A
So I'm like the complete reverse of you. My first exposure to hiv, and I've spoken about this in different settings, including on this podcast, was both in 1989, 1990. Coming out as a gay man, my first job was with an Anglican, in fact, social services agency just up the road from Hammersmith and Fulham. This was Kensington and Chelsea. And this organization used an old Anglo Catholic church, hence my interest in it, to provide food and care services and one building Full Body Positive, the HIV community support group for London, and on the other hand, for a group of refugees coming primarily from northern Uganda. And again, this will touch on you later on as we talk about our careers. But these folk were young families. There were no men, there were no male teenagers. They came from northern Uganda who had been at the heart of a really disgusting civil war led brutally by the Lord's Resistance Army. They raped women, they killed men, they either killed male teenagers or brought them into slave soldier roles. And these were women and kids who were developing the same kind of opportunistic infections as gay men I was meeting for the first time, and it was the most horrific Aha moment. Comparable only with one point in 2014 and one that we'll come back to. And so I went completely the other way. Far from hedonism. I got my head down. I thought only in terms of, what do I do to end this? What do I do to make sure that this does not destroy the optimism and enthusiasm? Because our generation was the one coming out of the Cold War. The Berlin Wall came down while 100%, you know, and. And so that really, really Deeply affected me. It also coincided with my diagnosis of Crohn's disease. So, you know, not to get into the geeky details, but sexual activities that might put you at high risk if unprotected were not things that I could either do or frankly had any interest in whatsoever. And so I found myself being really driven to. Yeah, I mean, it seems so naive now, but really driven to. I want this epidemic ended by the year 2000. We must do this. We can do this. We were on track to do it for hepatitis B. We can bloody well do this. Oh, boy. The innocence of youth.
- [15:58]
B
And I remember, Ben, you and I used to go to the same Jimmy Nails Court that Princess Diana used to go to. And we. I don't think we ever crossed her there, but we would. We had a few near misses.
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A
Well, she only went there because we did.
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B
Well, that's right, of course. And yes, and the paparazzi were annoying, weren't they, Ben? But there we are. But I remember, seriously, I remember getting this sense of you and who you were. And that was also helping me reflect a little bit, especially after I met my partner who was positive, who was also part of Body Positive. And I, thanks to your inspiration, Ben, I did become a buddy during that period. And I don't think I was a very successful buddy. I think I only did it for a couple of people, but I enjoyed it. And then, of course, my main buddy ended up being my partner and, you know, and we stayed together for. For quite a long time. But it was really you that started to get me interested in community level, working around hiv. And I did. I did my bit, but I didn't really properly get into HIV too much later. Yeah.
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A
So here's my Lighthouse story, which follows on directly. I became very active in the Terence Higgins Trust, and you will laugh. I made a philosophical decision that no one should ever work in hiv. One should only volunteer in hiv. And that's a philosophical position that has served me well, clearly. And I'm afraid I was. My gosh, I burnt on the Crucible. I buddied a lot. I then got into buddy coordination and then got into governance with parents. Higgins Trust. And, you know, Robin Gorner, Lisa Power, Nick Partridge, these were my mentors. These were the people who guided me through this. Lisa particularly. And, um, the last person I buddied, I suppose I can say this now because the Lighthouse is defunct, doesn't exist. He died while in respite at the London Lighthouse. He died from an overdose of recreational medications and vodka.
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B
Right.
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A
And I blew A gasket, because he was there to be looked after. He was very young. He was in his early 20s. I was 28. And this place was supposed to safeguard him.
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B
Right.
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A
As it happened, I think a couple of months later, that's when I got the job at Positive Action. Glaxo. Welcome. And who would my first donor meeting be with but the London Lighthouse and the poor chief executive officer, having seen me not three months earlier scream and shout at him, and you know me, I don't scream and shout. But for him to see that and then to discover that I might be the person writing a cheque, he was deeply disturbed.
- [18:59]
B
Yes, well, he was the same man that didn't give me a job as a press officer because I. Because I hadn't held the hand of somebody as they died of aids. Yeah. Anyway.
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A
Oh, BLEEP that. I mean that.
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B
Yes.
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A
You know, what a fuckwit.
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B
Ah, well, let's move on.
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A
No, I was gonna say, should have invited you to the London Lighthouse for a weekend. God. Bloody hell. Very strange era because we joked at the start about, you know, HIV advice in the early days to folks from Birmingham, don't have sex with men from London. I mean, we didn't know what we were doing. We had no idea.
- [19:45]
B
No, we had no idea. We had no idea.
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A
And I think we create this impression of ourselves in Europe, and especially the US on the east coast and the west coast as being the forerunners. We were the forerunners of the AIDS response. But again, you looked at these refugee communities, the kind of women led, social support, care, support, feeding your kids. Who's going to look after them when I die? Who's going to write my memory book for me? How do I make sure they remember me? How do I make sure they remember their father? If that was appropriate. And I look back on it now and honestly, that's where the meat of the community AIDS response was happening.
- [20:31]
B
100%. 100%. And it was only after I left the UK to work internationally in Geneva that I got a real sense of how organized a lot of those other communities, particularly in Uganda had to be. You know, it was. It was that or nothing at the end of the day.
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A
Well, let. Let's move on to the next phase of the eras tourist tour.
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B
Yes.
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A
Which is, you know, us really having front seats and actually not in significant roles, occasionally steering. Steering the international response to AIDS, TB and malaria that evolved in the early 2000s. Now you got to the WHO before I got to unas. So just what's your story? How did you end up there?
- [21:25]
B
So basically I was, I love the Health Education Authority and I learned public health there. So and I just, you know, realized that my early start as a journalist had, you know, that was a good phase, but it was a starting point for me and I really wanted to work in public health. So the HEA was closed down by the incoming government. So it was not long after Blair, et cetera, like things were getting better, so to speak, politically. But they had decided that they wanted to shift the resources around health promotion and health policy to community level, which meant disbanding the hea, which was very much, you know, we served the four nations of the uk, but we were very much a London based, you know, national institute that, you know, that put a lot of money into advertising agencies, let's be honest. And I think quite rightly, I think labor looked at that and they thought, well, let's give this, these investments to communities. Didn't work out, but that's a different story. But what it meant for me is that they literally disbanded the organization. And from that I think NICE emerged as well as Health Promotion England and other institutions. But I lost my job. And I saw an advert in a newspaper for an advocacy officer with Rollback Malaria based out of Geneva. So I thought, I'll do that. And I got an interview. I was interviewed in London. And so I'd never even been to Geneva. I got the job and then I turned up with my suitcase to Geneva, you know, in early 2000 and started as advocacy advisor for this new initiative called Rollback Malaria under the recently late, bless him, love him, David Nabaro. And I learned so much from David. And yeah, so I worked predominantly on malaria, but I did a number of health emergencies as well. So I worked on Ebola in Northern Uganda where the Lord's Resistance army that you mentioned earlier were very active. And the thing about the Ebola response that I was involved in there, let me quickly tell you, we were able to do things around health promotion because the local community understood transmission of disease because of their exposure to HIV education. So we were able to actually do a good job of containing the Ebola outbreak, not because we were particularly good, but because the community already had a level of knowledge that was really helpful to us. So, yeah, so that was one of my first jobs, was working on that outbreak in northern Uganda.
- [23:54]
A
Now, Andy, I want to talk a bit more about Ebola because you have at the same time this growing sense that the world has to respond to the HIV epidemic. You have the UN Deciding to create unaids, a joint UN program. I can't remember how many co sponsors back in the early days. 6. Look at you. Well done. But of course, what it meant was that the global program on aids, which had sat in inside the who, lost its sort of core coordinating responsibility to this joint UN program. So there was always a tension in those early days. Different tensions now, and I can talk about that, and I know you can't, but different, but tensions then about who was really calling the shots. And I think the early days of that Ebola outbreak in northern Uganda demonstrated and gave a really good opportunity, frankly, but really demonstrated that who, when it came to emergency responses, could move quickly, could move effectively with funding and help countries control and then eliminate the pandemics. And that was in the case of Ebola, what you were very much involved in.
- [25:17]
B
Absolutely. And this was with Mike Ryan, who then ended up leading our health emergencies work for a long time. I, I learned so much from, I was only there for three weeks. I learned so much from Mike during that time. And again, you know, it was really WHO at its best. We were fast, I think we had news from, from Uganda on the Friday and we were on the ground on Sunday evening, six of us. And again that was David Nabarro calling me up saying, I'd like you to consider doing this. And I just said yes. And so there we were. What was this?
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A
What did you do?
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B
So we were the first responders really to arrive from the international community and we had to set up the various structures. And the first role really was coordination. So we needed to understand what was happening in terms of surveillance and numbers, but also set up who have we got on the ground, who is here working on which elements. It was very, very basic when we got there. So we recognized that there were the two parallel systems, if you will, the well funded, faith based, kind of like health infrastructure, and then the public health infrastructure which was less well funded. And there's been so many deaths, including amongst healthcare workers, and there were many bodies sadly piled up in a mortuary. And part of my job was to support health promotion and prevention messaging, but also to work with the international media which had suddenly gathered mass and they'd worked out in previous outbreaks that unless you had a dedicated person coordinating the media, they could really interfere with and disrupt, you know, the response. And so our, our role really was to make sure that they were assisting in the response. And, and, and they really did, you know, so they were, it was a really interesting kind of like time in terms of and again, it was all hands on deck. So my role was. Was multifaceted. So I didn't just do health promotion coordination. We had to look at. Yeah, sorry, please. No, no, just, just very quickly, you know, in order to communicate that it was a good idea to bury the people respectfully who had died. Of course, people were very frightened, and so we literally were digging graves and burying people in front of the community so they could see that this could be done safely with no risk of infection. So it was modeling and monitoring how. How to do something that then the community could take on for themselves.
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A
Did you bury anybody? Were you?
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B
Yes, we were part of that team doing that again because we felt that if we weren't able to show that the international people coming in were prepared to do this, why on earth would they believe us that this was a safe thing for us to do? So. So we were such a small group of people. I think we were six, you know, the initial team to get there. So. So we. It was all hands on deck. Yeah.
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A
What was going through your mind when
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B
you do, you know, Ben, doing this?
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A
I mean, burying someone with a rapidly fatal.
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B
When, when we were there, we just did it. And it was, it was. You really felt like you were contributing and it was, I hate to use the word, but it was kind of exhilarating and exciting that you really felt that you were, you were making a difference. When I got back to Geneva three weeks later, it all hit me just how, you know, what, what a huge thing this had been. And I did have a wobble for a couple of days on, on return to Geneva. Yeah.
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A
Did the WHO provide any, I don't know, PTSD support or counseling support to you at that time?
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B
No. I think I did go and see, you know, the, the, the health workforce people, and they said, well, this is quite normal, which was helpful in itself, let's be honest. But I know that since then, a mutual friend of ours, Sally Smith, has set up some services for people who come out of humanitarian and complex emergencies, who've seen stuff that. That's difficult to help them decompress. Really, it's. It's a little bit like deep sea diving. I think you need that. You need to take your time to come back to reality.
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A
And, you know, you really saw it with the folks working on the World Food Program later on in Sudan.
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B
Right.
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A
And now Southern Sudan, where there is a rush and people don't want to come out living in that moment. And you've got to make sure that you provide adequate psychosocial Support. Yeah, I mean, Sally Smith's an absolute star. I mean, but I, I was interested in this, particularly the journalism side of it, because I think that deeply influenced the work that UNAIDS began to do. And I was hired into UNAIDS by this extraordinary character. I mean, so I'm going to say up front, she to this day, I think, is one of the most powerful communications leaders I have ever met.
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B
Yes.
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A
Her name is Anne Winter. She's English. She's known in other parts of the UN as Nuclear Winter, because you say something stupid and boy, oh boy. But she created a network of communications experts, folks like you, I think, but from countries who built their networks and who had a program of stories literally every month that were designed not just willy, whoosh, washy, to raise awareness, but to target specific prevention messages or specific treatment and anti discrimination and anti stigma messaging that were appropriate for their, for their countries and their regions. And Ann would bring in the evidence and bring in the expertise from, from other countries or from the co sponsors, including who, and I saw that. And I mean, it made mincemeat of the communication strategies that I had seen in the pharmaceutical industry and hiv, for example. So it was a real pull for me to work for our nuclear.
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B
In fact, she was the one that also enticed me over from WHO to UNAIDS when I joined you there. So Anne was also my boss and I did work on a stigma campaign with her. That was my first job. So no very fond memories of Anne and absolutely agree. A formidable character.
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A
Everyone was terrified.
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B
Huge respect for Anne.
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A
Yeah. And I remember that one of her lead consultants in New York said to me, I told Anne not to hire you because if you got hired, Peter would move you and she'd lose the staff head, she'd lose the position. And lo and behold, that happened. And I think within six months, I got assigned to the upcoming UN General assembly special session on aids. And this is, I think, for me, the start of this next phase of the era. I cover it in the audio podcast I did called Business Fights aids. Because that was the starting point for me meeting Richard Holbrooke and then ending up as the first executive director of the Global Business Coalition on aids. And it's a series that we're going to ramp up again now and complete. So watch out for that, everybody. But you make a very big early appearance in business fights AIDS. Because I moved there literally the day before September 11th.
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B
Right.
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A
And I arrived. Well, take it away, Ben.
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B
I must try and get the chronology right here. But I had moved back Actually temporarily. So I fell in love with the wrong guy and followed him back to London after spending a year or so in Geneva. And there I was working for Barts in the London and I ended up getting my own HIV diagnosis the same week as September 11th. I think you were one of the first person that I called to say, ben, this is what's happening. And then I think maybe the same day or one or two days later,
- [33:48]
A
the day after, I had to call
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B
you again to say, ben, what on earth is happening? Are you okay? And I think you answered the phone, you had an early mobile phone and I was able to speak to you while you were in the street.
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A
And you were one of the first people to get through to me. But I remember it that well. I was in Bed Bath and Beyond by the Queensborough Bridge and I see that I've missed a message from Andy Seale and it's. Oh, hi, Ben, Hi, yeah, Andy here. Yeah, just ringing to let you know I got my test. Yes, it's positive. Yeah, all good. Don't worry, no need to call me back. Yeah, talk to you later.
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B
That sounds exactly right. And if you remember, after the attacks on the Twin Towers, there were really cheap flights to New York because nobody wanted to travel. So I came out to see you.
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A
That's right.
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B
I think your mum was there at the same time.
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A
I think she was. Indeed she was. God bless Lady Janet. Yes. I think you were there for slightly different purposes.
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B
We were. Yes. Nonetheless. Yes, exactly. So, yeah, I was coming to terms with my new situation and looking for like minded friends. And Janet was coming to look after you, I guess.
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A
No, she was coming to express Ringwood's support to the American firefighters. And she, she.
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B
Did she bring a wreath?
- [35:08]
A
She brought this huge. I mean, you know what we're like on Armistice Day. We have these huge poppies. Well, she bought this huge rhinestone poppy that she then delivered to the firemen on 10th street between 22nd and 23rd Avenue. I think I may have got the cross street cross avenues wrong or whatever. And I just remember sort of, you know, praying that the earth would open and I would disappear and the earth would swallow me up. And she says, yes. And I bring this on behalf of the citizens of Ringwood to thank you and to say that ever you need anything from us. Retirement community on the verge, corner of the New Forest in southwest England. We are there for you. And I mean, they were blown away. I mean they loved it. But then what bloody buggery bollocks is this in American of Course. Oh, oh, Lady J. But we, we were also involved in a project together.
- [36:18]
B
We were. I think I know what you're going to talk about.
- [36:20]
A
Yes, you know what I'm going to talk about. And, and it was another example of WHO and UNAIDS not, not quite agreeing. And it was before the establishment of the Global Fund to Fights aids, TB and Malaria. And well, so here's my recollection and it's tempered by a mutual friend of ours who, an American who then moved back to the United States, worked for Department of State, I think Health and Human Services and I think most latterly the World Bank. But John Paul. John Paul, yes. I wasn't going to mention his name. Please John Paul, don't sue us. So the initiative was called the Massive
- [37:07]
B
Effort against Diseases of Poverty.
- [37:10]
A
That's right. And Peter Pierre rightly got very angry because HIV is not just a disease of poverty, neither by the way is malaria nor tb. But anyway. But we of course were focused more on the massive effort side of it. And I remember taking a bus with John Paul from the WHO and UNAIDS offices down to the center of town and we passed a residential park and out there was a lovely sweet upper middle class Swiss lady with her dog and the dog was straining to do his number twos and John Paul just turned to me, well, there's a massive effort if ever you saw one. But it had a serious fund. It had a serious massive effort.
- [38:00]
B
It did. I mean when you think about it Ben, it was the precursor to the Global Fund. I mean really this was all about recognizing that we needed a financial mechanism, we needed a financial mechanism of solidarity to raise money for. And I know there was initially quite a scramble. I think Malaria was looking for its own funding mechanism, TB was looking for its own funding mechanism and HIV was as well. So I think it was an attempt to bring those three ambitions together in, in, in one, you know, kind of like coordinated, which is I think where they came up with the umbrella of diseases of poverty because it wasn't all communicable diseases. They really were quite keen just to focus on the three. And it was definitely the precursor to the Global Fund. And many people, many people involved in the massive effort as you and I were, and there was that fantastic conference in Winterthur near Zurich which was quite bizarre.
- [38:55]
A
Do you remember we went out to try and find a gay bar one evening. There was nothing. It was a post industrial, totally was post apocalyptic wasteland.
- [39:07]
B
I think we did find something that was recommended in one newspaper, but there was nobody there. If I recall. But, yeah, I mean, there were amazing people at that conference. And many of the people who were involved on the technical side ended up being part of the initial secretariat of the Global Fund.
- [39:28]
A
Yeah. And you may be surprised, but I was a very early supporter of the idea of this being the three diseases, aids, TB and malaria. I mean, I had completely drunk the koolaid aid like every other HIV activist. That HIV needs an exceptional response. It's an exceptional crisis. You know, in my mind, early 2000s, we had missed the deadline of ending AIDS by the millennium in my own mind. So we really had to get together and pull on whatever resources we needed. And of course, TB co traveler with HIV joined at the hip, unfortunately. And it made sense that suddenly donor governments, and particularly the United States with a new young Republican president, should want to embrace this. And if this is what we had to do, we had to go. Hell for leather. But I remember a meeting of the co sponsors well after the concept of the Global Fund had been announced and agreed by countries. And I was there with the deputy executive director of UNAIDS at the time, Kathleen Cravero, who is another superstar, another major leader in the AIDS response and doesn't get half enough credit for what she did. And head in hands, she was, as co sponsor after co sponsor, said, well, no, I don't agree that a global fund should be established. A fund for aids, TB and malaria should rest with this UN agency or that UN agency. And she goes, look, guys, it's done. We gotta get with the program. We're either in it or we're out of it. And I know we're talking serious things. And I think it speaks to the way that throughout the seriousness of the issues that have marked our careers, we cope with humor. But I came very close to trying to write a book, A murder mystery. A murder mystery taking place inside the UN with a former US diplomat, not Richard Holbrooke at all whatsoever, but that the Secretary General had invited him to lead a new UN institution called the UN Commission for the Rationalization of Administrative Processes. Uncrap. And so the idea was that in one of the Commission's meetings, an American or a Russian diplomat gets murdered and we don't notice for weeks on end. Even though he's not moving, he doesn't say anything anyway. Didn't get very far with that.
- [42:23]
B
I think we should collaborate on that, but I think that sounds like a very good project.
- [42:30]
A
But so in. In that the golden era of epidemic responses,
- [42:40]
B
what were.
- [42:40]
A
What were your roles? What did you do during that time. Because you had a fascinating career at that juncture. To my mind, you moved between WHO, UNAIDS, the Global Fund.
- [42:51]
B
Yep.
- [42:52]
A
International NGOs and all around again.
- [42:56]
B
Yeah, I mean, I think the first, the first big move for me was inside UNAIDS when I was asked to take on the partnership lead function, which was just so. Again, it was such a golden era. We were hiring, so I helped hire 20 plus partnership advisors for country offices. I had. I had a. Quite a big team there as well. And the work we were doing was phenomenal. We were able to, I don't know, doors open for us at that time. It was so easy in some ways and it was such a privilege to be there and to be able to. I mean, we worked hard, we worked long hours, but the access that we had. I remember accompanying Peter Peel to meet with Jack Rog at the International Olympic Committee, for example. We would meet with. I mean, through the Global Business Coalition. I mean the access that we had there to world. World business leaders was phenomenal. Again, thanks to your work as well, Ben.
- [43:52]
A
No, really thanks to Peter because this was Peter was.
- [43:54]
B
No, he was. This was Peter at his peak. I 100% agree. And then for me, I moved down to. And did some work at the regional support team in Eastern and Southern Africa for UN aids. And then I moved to the Global Fund with Michelle Kazatskin and I was working on sexual orientation and gender identities. So really working on a key populations agenda that was in been. That was fantastic. I loved every minute of that. But I was only there for three years because then the Global Fund, every organization has its various eras of upheaval and change and downsizing. And so I was there at one of the moments for the Global Fund where they faced a big change.
- [44:34]
A
And you worked with Michelle Kazachkin, who was the director.
- [44:38]
B
Yeah, yeah, yeah.
- [44:40]
A
I mean, he again is one. One of our crucible leaders.
- [44:44]
B
Totally.
- [44:45]
A
Special Envoy, UN Special Envoy on HIV to Eastern Europe, expert in tb. You. And he got on very, very well, I recall.
- [44:53]
B
We did. And in fact. And also his work on drug policy and drug reform. I mean, amazing. I mean, he has been such a champion for issues that are not politically popular and he stayed consistently engaged. No, he's fantastic. And again, through. Through Michelle, you know, I worked at the Fund with Anarita Baines who is now at unicef. And yeah, so some of those links have really stayed quite, quite strong. Michelle has recently popped back into my, into my life in the last few days, actually. So again, I think he's keen to find out what's happening with the changes currently happening at who. So I'm looking forward to connecting with him.
- [45:32]
A
And don't worry, we're coming back to that in this podcast as well. But you mentioned sogi, sexual orientation and gender identity strategy, and I think that's one example where the rubber hits the road. Because the Global Fund had really established itself as in that moment in time that made sense given the historical moment of supporting countries, empowering, if countries needed empowering, the establishment of high quality, high standard clinical laboratory procurement mechanisms to tackle these three diseases. But what they understood, what you all understood, was that it makes no difference if you don't reach the people most in need. And the people most in need in many of the countries that were partners of the Global Fund are countries where, for example, it is illegal for men to have sex with men. You can be persecuted, prosecuted, executed, sex work as well, girls and women even. Yeah, and the. And trans, of course, trans community, 100%. And I, I am in awe of the work that you all did then to raise the flag on this, particularly given the political pushback that we see today.
- [47:03]
B
Thanks, Ben. And I think one of the things I was particularly proud of from the Global Fund's approach was that they really tried hard to be long term and thoughtful and they really tried hard not to be a donor. That would necessarily take the place of really important conversations around marginalized communities becoming more visible, becoming more acceptable, building relationships with government rather than just being funded independently by a donor. So we put a lot of effort into really trying to make sure the services were funded, but trying to build in a sustainability approach as well, which would see some of those critical relationships mature. And sometimes those relationships matured in spite of harmful laws and policies. Yeah, and that was also really important. Sometimes they involve policy change as well, which was very exciting to see. But the really important thing was it wasn't just about getting the services of the people in need. It was really about having that longer term view of how can we help. Some of these communities really support the maturing of approaches to sexual orientation and gender identities where they were. So a lot of that really involved quite a bit of, you know, what we call now the decolonization agenda is really exposing where a lot of the harmful kind of like cultural references came from us, the Brits. Totally, Ben. So 100%. And so I think, you know, once and again we saw big differences in Francophone Africa compared to Anglophone Africa, for example. So much freer social acceptance. I think in Francophone Africa, not everywhere I mean, I'm generalizing to a certain degree, you know, but certainly they weren't boxed in with the same kind of like harmful laws and policies that had been inherited from the Brits.
- [48:54]
A
Yeah, and I liked the way you brought in other countries, other partners. So I remember Brazil being 100% a really helpful guide to certain African countries, both about drug manufacture and procurement, but also some of these strategies to reach. And the same is true for Southeast Asian countries, Thailand and others that were also part of the Global Fund family. But there's a dark underside during this part of our era. Andy and I was struggling with the word earlier and you reminded me it is complacency. We were beginning to get very comfortable and I felt in 2016, 2017, when of course by then I was outside of the un, I was with the Pangea Global AIDS foundation. And we were just realizing that we didn't really have a role to play, that who needs expensive northern infrastructure to tell Africans what to do when Africans tell us what to do. And I remember being deeply, deeply affected by the deputy head civil servant of the Zimbabwean Department for Health and Child Welfare who described to me models of community health workers that they had established. And I was just becoming familiar with what was happening in San Francisco, which despite all the glitz and glamour around the so called San Francisco model, was really very exclusionary to trans populations, Asian populations, all people of color, to be honest. And it struck me that the lessons being learnt, the standards being developed in Zimbabwe were as relevant to San Francisco as they were to Harare. And so it just made no sense for this model that flourished at the start of the 2000s to be driving the agenda. And I don't know when you first started getting a sense that this sort of, this needed updating, if not radically altering.
- [51:19]
B
You know, Ben, a couple of insights for me again around that time. So I'd left the Global Fund and I'd taken a break from HIV to work on vaccines for path. And I had a couple of really. And it was a really interesting time for me. You know, I was, I was managing teams in drc Ethiopia, but I was based out of Geneva. So already the model was, you know, a little bit uncomfortable in the way that you're describing, you know. You know, was it assuming that an international NGO would have the capacities and the strategic vision required to manage at a distance what was needed in country? But my job was really to build up some of that in country capacity, which I did in DRC in Ethiopia. And then at the end of the grant, basically, I'd done what I was being paid to do, which was build up some of this country capacity, but I'd not spent time investing in getting some global investment back into, you know, the Geneva Fernie Voltaire operation. So sadly, my role came to an end there quite naturally, I would say quite abruptly.
- [52:23]
A
But I could say that.
- [52:23]
B
Exactly, you can say that. But you know, I have to say path, I love path. And you know, shout out to Kim Green, who is one of my favorite collaborators at the moment. She's now working in Geneva for PATH and brilliant work on integration. And perhaps we'll come to the integration piece a bit, a bit later on. But at that time I then moved to who. So I've been there for 10 years now. And my, my 10 years, Ben. It's the longest I've ever been anywhere. Very crazy. Yep. But my initial role was to develop 2016-21 strat, 2021 strategies for HIV, hepatitis and STIs. And the idea was that we would establish these in a way that would really promote country ownership and sustainability and really look thoughtfully at the integration piece. So what were the commonalities between these three disease areas that could be managed simultaneously? So whether there were systems approaches, prevention approaches, community engagement and governance approaches. So we really looked at the whole kind of like shebang, if you will. And so at that point, you know, we did a lot of. We did a roadshow of different regions. This was pre Covid, so we were able to go and do, you know, again, complacency, well funded. So we could do these road shows, we could go out to each of the five WHO regions and have these meetings. And it became really clear that we really needed to readjust how we thought about the various relationships within global health and put much more emphasis on the regions, number one, but certainly on the countries. You know, this is where the knowledge was, this is where the innovation was happening. This is really where all of the thoughtful, you know, so our strategies ended up. You've already mentioned Brazil. We borrowed heavily from the strategies from Brazil to build our global strategies. We really did, and they were very happy for us to do that. So they also have always been very generous about seeing their health products, if you will. So their strategies that their technical work as global public health goods in the same way that WHO does. So we. This was the first time really I got to feel for myself. There was a shift happening.
- [54:25]
A
Do you know, I could.
- [54:26]
B
Yeah.
- [54:27]
A
It strikes me there's something, perhaps there is something not surprising that you and I are having these similar thoughts at the same time, because although we come from a sloppy, lazy British de developing country as it is now after Brexit, which of course was happening during these times, we were really questioning the authority and the wisdom of donors. Know best. And I wonder if it is our roots through the HIV field that get us to this point. We're not development professionals who went to soas, the School of Oriental and African Studies. What an appalling name, if ever there is one or two. Love the institution. But the name, the London School of Tropical Hygiene. Hygiene and Medicine. I mean, come on, come on. It's really interesting that we're coming at this and perhaps only people with journeys like ours from the United Kingdom could be there. I see it a little bit in Robin Gorner as well.
- [55:39]
B
Oh, 100%.
- [55:40]
A
You know, there are folks who are. This is bullshit. We've got to end it. Yeah.
- [55:44]
B
Robin, Kate Thompson. I think there's quite a few of us, actually, when you think about it, who've again shared similar journeys professionally and we've often ended up working in the same institutions at different points. Yeah.
- [55:56]
A
So let's go now to the next phase in the ERAS tour. And. And I suppose we have to express a token of gratitude to the very lovely Taylor Swift, because as you said, and we're recording this on Wednesday, she announced she's having a new album. What's it called? The Diary of a Showgirl. Day of a Showgirl.
- [56:17]
B
I think it's the life of a showgirl.
- [56:18]
A
The life of a showgirl.
- [56:19]
B
I think five young. Yes.
- [56:23]
A
So she's been very helpful in promoting this episode and this conversation about the next.
- [56:28]
B
We're not wearing the right colours, Bo.
- [56:30]
A
I'm wearing the right colors.
- [56:31]
B
Oh, you are wearing the right colors.
- [56:32]
A
Yes. I mean, she was a country and western singer. Yee haw. For a while, wasn't she? Anyway, so we're entering the next era and it really kicked off for us, whether we like it or not, in January this year, it did. And I mean, we've. The field and this podcast has spent plenty, plenty of episodes discussing what happened, how that felt for folks. But I'm really interested in what you see happening next. And you're still at the who. You, as an individual, are still employed by who. Right. For the moment.
- [57:10]
B
But now.
- [57:12]
A
And you're in the new tb, hiv,
- [57:17]
B
hepatitis and STI department.
- [57:19]
A
That's right. So. So to the extent that you can. Yeah. And. And feel free to push back and say, no, you. You bugger. Ben, you answer this. How do you see this new era? Are you optimistic, excited, or are you afraid?
- [57:36]
B
Ben I think we have to be optimistic. I don't think there's it, but we don't have a choice. We have to be optimistic, but we have to build some of that optimism around a reality check. And part of that is being afraid of what is actually happening. Keeping a track of all of the data and the modeling that we're seeing, but also having a few anchor points who are based in some of the countries that have been heavily donor reliant. So one of my purse anchor points is Florence and, and from the global network of people living with hiv. And I really appreciate Florence in the fact that I feel that she's got a strategic, thoughtful brain and she doesn't care what, what others think necessarily. So she doesn't fall into line with the common ways of thinking.
- [58:21]
A
Florence and of course, who is Florence's best friend in all of this, but a shot in the arm podcast's very own Yvette Raphael.
- [58:28]
B
Yvette Raphael, exactly.
- [58:30]
A
Tells us exactly what she thinks.
- [58:32]
B
You know, exactly right. And I think this is, you know, I think both Florence, Yvette Spongile, also from GMP plus others will say, look, you know, this is time for Africa to stand on its own two feet. We do not need to be defined by a third party. You know, we have to really, you know, take these challenges on. So I think it's a moment of opportunity for rebuilding relationships without third party facilitation, shall we say. And when I'm, when I'm talking about relationships, I'm talking about communities with government and with, with other donors with other sectors. I think the private sector is going to have an increasing role as, as we look to the future. And I think, you know, we have to really do our very best to give space to countries to really work out what's happening and define their own paths on, on the way forward.
- [59:24]
A
This is what, why you are such a good WHO spokesperson, because you haven't really answered the question and you haven't really addressed the big elephant in the room, which is of course who's role. And I really recommend this to everyone if they haven't subscribed, do subscribe to the global health files that Priti sets up. And she has had a number of really interesting opinion pieces, most recently today. I don't know if you followed them or if you want me to speak to them.
- [59:59]
B
I'd love for you to summarize, Ben, because I've only read some of the I've read a couple of articles you've recommended, but I've not read the initial article that triggered quite some debate.
- [60:10]
A
So three opinion leaders, Kite, Bush, Kazachkin and Piot, two people we've already spoken about, and another important global health leader penned an opinion piece that pretty published in the last edition of the files, setting out an agenda for WHO reform. And I thought it was pretty sensible, it was pretty direct. It was saying, look guys, you've got much reduced funding, you've got much reduced staffing, you've got much reduced capacity across both of those things, but also in terms of what member states are going to allow you to do. And yet the demands in front of you are exponential. You need to make decisions and they offer some views on the kind of things that need to be thought through again. And I think they're very sensible. So for example, who of course is the keeper of normative guidelines. That's its genius. It tells the world what the data is, how we interpret it and how we can implement it. Nobody else does that. And that is its sacrosanct. I would use that word, sacrosanct role. What WHO is not therefore is a producer or convener or funder of clinical trials because that is a direct conflict of interest. So it has to pull back from that. I also think that applies to the role it has played understandably during the golden era in helping countries fast track national approval processes for new medicines and for new diagnostics. It's been a little bit like the English phrase the curate's egg. Good in parts. The good part is that at least someone was looking at it. The rest of it is that frankly, who had neither the expertise, capacity or the intellectual curios to fast track these kind of pre qualifications work. And I know that's extremely controversial things to say. I don't expect you to comment on it, but I feel that very, very strongly. I think WHO has delayed and delayed and delayed new product approvals because of pre qualification. And I think right now we have the opportunity to move that to regional approvals. I see that emerging with the Africa CDC and the Africa Union. We obviously see that in Southeast Asia with ASEAN and others. So I think it's right for them to raise that. But then today this. It was. There was a retort article from an academic from St. Mary's I think in London. I can't. My apologies if I get the. I'll include it in the show notes so we get his correct affiliation. Andrew Hammer. It's hammer time. It's a Spectacular opening to paragraphs saying that, well, these are leaders. You would have thought they would have applied some intellect, experience, evidence to what are essentially autocratic recommendations that bear no, bear no fruit in reality. And you know, his idea basically is we've got to keep going with WHO as it is and just fund it properly. And if 150 countries committed, they'd only have to pay an additional, I think it was $4.5 million per year each. Well, who's got 4.5 million across, you know, the 150 member states. I mean they can't spend that on their own national health systems in many settings and that's not including the uk. And so I think there is a really important conversation to be had about who. But Andy, my big fear, my big fear. And this again speaks to the differences between you and me. Maybe you're glass half open and I'm glass half empty. I'm actually really scared because I think the era that we are entering now, it's the end of the Pax Americana, it's the end of the post second World War social compact, transactional relations all round, which means that we have no values to guide us. And what bothers me about the global health community is that we are so insular and so, so narrow minded, we refuse, in fact, we deliberately do not pollute our thinking about connecting what happens in our field to other priorities. And yet those other priorities are precisely why our challenges are taking place. We talk about it a bit with climate change and we talk about it a bit with pandemics, preparations, but only in the context that we should be running things. The climate folks should just shut up and listen to, listen to us. But I'm really worried about global security and not to be a Debbie Downer, but it's interesting the conversations about the use of militaries in both the Ukraine war and what's been going on in the occupied territories, particularly the Gaza Strip, as it relates to militaries deliberately targeting healthcare facilities. And I don't think we've appreciate, appreciated the half of how that is going to come back and bite us.
- [66:05]
B
So Ben, a couple of things and I think I should, I will speak for who in the sense that on two points. First of all, you know, big chapeau to Ted Ross. I mean if anybody has championed, oh yes, the, you know, the horrors of like targeting medical facilities in Gaza or Ukraine, Tedros has been there, he's been out there outspoken and he's been absolutely appropriate and we've got a fantastic representative on the Ground. He used to work at unaids, in fact, Rick Peppercorn. So he's the WHO representative there. The work that my colleagues do in the Gaza. In Gaza Strip. Yeah. So the work that's happening there from. From who? I think you're right. We deliberately prioritize this and it is correct. This is this, this is the future, sadly. And I. And I was privy to a conversation with Ted Ross and another UN leader this year after the US had withdrawn from who. And this other UN leader was asking Tedros, so are you really concerned about what's happening here? And Tedros said, you know what, what concerns me and keeps me awake up at night, it's the security context in Europe and elsewhere. And that was a real surprise to me to hear him really thinking about this. So Tedros has already connected the dots. It is about security, looking into the future. And if I may just quickly jump
- [67:23]
A
back to your previous comment is something about pre qualification.
- [67:26]
B
Exactly.
- [67:27]
A
Go for it.
- [67:28]
B
I mean, I think there is a role for WHO to have a comprehensive access strategy approach. If there isn't an institution globally who really looks at the whole picture and understands where the gaps are, where the market failures are and what can be done to fix it with partners, including the private sector, who has to be there. So I think you look at the work that we've done on Lena Caprevir, so we got guidance out and as you're right, the norms and standards are probably the most important. So we got the guidance out very quickly and we're working with partners around different access strategies. I can't say too much about. Ben, you're looking at me, you're telling me.
- [68:05]
A
Well, no, I mean the role of market evaluation and looking at what is missing and what should be there. I think there is a role, but it's a secondary role. It should be driven by groups like UNIT Aid. Yes, even the Global Fund. But I think the problem comes in when we expect WHO to play a sort of a chapeau, a parastatal responsibility driving approvals.
- [68:35]
B
Sure, I think. No, I hear you on that one. But I do think the partnership role that we have with UNIT Aid, with Medicines Patent Pool and with industry, we talk to industry all the time. Ben,
- [68:47]
A
the one thing I would like to do to end up and finish this podcast on is, okay, we've learned one thing about you, that you are a swiftie.
- [68:59]
B
I am.
- [69:00]
A
I'm not sure that I know a single Taylor Swift song. Probably if I heard it, I would say on the radio, but no one listens to the radio anymore. Oh, if I listened to it on a Spotify playlist, I might have heard a song. To the uninitiated, what Taylor Swift song would you recommend?
- [69:20]
B
One all too well, 10 minute version. No question.
- [69:30]
A
All too well, 10 minute version. Modern equivalent of New Order's Black Friday. Blue Monday. Black Friday Plumly, what's wrong with you? Blue Monday.
- [69:42]
B
Yes.
- [69:42]
A
I can't help myself, can I?
- [69:44]
B
You can't.
- [69:46]
A
Anyway, Andy, thank you so much. What a pleasure, Ben, for coming to Sacramento, putting yourself in the hot seat. It's been so lovely to catch up on things we haven't spoken about in years. We haven't if we've spoken about them at all.
- [70:00]
B
Yeah, it's been fantastic, Ben. Thank you.
- [70:03]
A
Well, that's it for this episode. Thank you. Thank you to Andy Seale. Thanks also to Taylor Swift for agreeing to launch her new album as we're recording this podcast. Thanks also to Eric Aspera, our director and producer from A shot in the ARM media. And finally, a big thanks to you. Of course you can subscribe wherever you get your audio podcasts, please do so. And if you haven't already, check out our YouTube YouTube channel, www.youtubearmpodcast. and there you will hit the notification button, I hope, and then be advised about all the fantastic new episodes like this one as soon as they hit. So with that, hope you're having a great summer. Have a safe week and a great week, everyone.