Chief Executive, Royal Society of Tropical Medicine and Hygiene
Tamar Ghosh is the Chief Executive of Royal Society of Tropical Medicine and Hygiene. Before then she was at Nesta running the Longitude Prize, a 10m science prize looking for a rapid diagnostic test to fight antibiotic resistance. She was Director of the social action campaign Give More’ on behalf of one of the Pears Foundation, promoting increased giving of money and time amongst the UK public. Prior to that, she spent 15 years developing and delivering funding strategies for international NGOs, including Action Aid and VSO. She has an MBA from Imperial College, London and Masters in Development Studies, following an undergraduate degree in Mathematics at Bristol University. Tamar is also a trustee of Article 19, a consultant on fundraising and strategy development, and a guest speaker at Imperial College Business School on innovation and entrepreneurship as part of their MBA and masters in health programmes.
Q. How does your professional experience help in doing justice to your task in your present role? What is the present focus of Royal Society towards achieving its goal and what is your plan for India?
A. I was delighted to interview by CSR VISION, most respected CSR magazine of India as I have a long history of setting up and working on CSR partnerships, and a real love for India, being half of my heritage. My first job after graduating was at Coopers and Lybrand, training to be an accountant. I then worked for 15 years in charities and NGOs, crafting partnerships with companies to fund health or education programmes around the world. When I lived in India more than 15 years ago, my role as a volunteer was to establish CSR partnerships. CSR partnerships were much rare then, but still companies were open to discussions and exploring options. For example, TCS donated staff time and expertise to help the small health NGO with HR and project management. Since then, working on global partnerships with all sizes and shapes of business, I have seen firsthand the benefits of close collaborations towards shared goals between charities, communities and companies. I have also seen some difficult situations develop, and understand the importance of planning and building strong relations and foundations before partnerships are activated. After working in the charity sector I then did my MBA and set up a social enterprise to improve eye care in India between London and Madurai. For me the balance of a business operating in response to real demand, and through those transactions delivering direct or indirect social value is a perfect win-win.
My current role is Chief Executive of the Royal Society of Tropical Medicine and Hygiene. We were formed in 1907 and are now based in London. We’re a membership organization for people all over the world, who work in or are interested in tropical medicine and global health. We have a number of activities to fund, promote and showcase research, including the provision of small grants, the publication of two scientific journals and running a number of meetings and events. We convene groups and establish networks across countries, disciplines and sectors and try and stimulate important conversations in tropical medicine and global health.
Since our formation the scope of our work has changed remarkably. The practical difficulties of attributing diseases to specific populations and geographies have proven more and more difficulty, as has the growth in non-communicable diseases affecting all of us. As communities travel, climate change occurs and diseases and infections adapt, so our areas of work need to be reframed. In our new strategy we talk explicitly of the importance of considering animal health, and factors including the environment, social, political and economic changes, when we talk about our goals around disease elimination and improving health equity.
Membership of the organization is on a subscription basis, having changed from being a vote-based system some years ago. We have around 1,000 members from over 40 countries and a further 20,000 people involved in our work in specific ways. Despite the need to encourage global voices into the society, so we can maximise the impact of our work, and affect more improvements to health, we have only a very small proportion, just 3%, of total members from India. On my recent visit to India, I started to explore some of the reasons for this and will be trying to make improvements in the coming months with plans for some meetings in India in 2018. There is such an abundance of expertise and experience of tropical medicine and health in India, and I feel it’s important we ensure more of that knowledge and experience is captured in our global research and work.
We have just launched a new 5-year strategy which is focused on providing better value to our members. This includes ensuring members outside of the UK are able to better engage and contribute to our work, through meetings and events in their regions, improved awareness of our available grants, and opportunities to be spokespeople on key areas. It also focuses on aligning our activities better, so we can achieve better impact. That involves gathering and analyzing data, so we can identify patterns and highlight gaps in research, issues with implementation or suggestions for policy. Another part of our strategy is about the importance of us strengthening our partnerships across many countries, sectors and disciplines. These partnerships are diverse and we’re in a good position to bring together groups that may not otherwise meet, for debate, discussion and planning. There is much more we could do in partnership with companies in the UK and globally, and this is an area we’ll be exploring alongside other types of organization. As a charity independent of other sectors we have an important role to play in convening people across these and establishing ways they can discuss and debate key areas.
The strategy has real importance to India and I was recently in Delhi and Bangalore for launch events for our new strategy, and meetings to discuss our priorities. It was felt that more needed to be done to ensure that Indian researchers and professionals, particularly early career, are fully aware of opportunities such as small grants, and can benefit from mentorships, career development advice and training. There was a desire for us to help bring start-ups and established companies together with academic groups and NGOs on specific tropical medicine projects.
Before I joined the Royal Society of Tropical Medicine and Hygiene I worked at Nesta in London running the Longitude Prize. This is a five-year global science prize, with a 10m million fund. It will award a team who can develop an affordable, point of care, accurate, and easy to use diagnostic test that will tell us more about the infections , and whether antibiotics would help us or not. It may even tell us the specific antibiotics we should take, based on where we live. The Prize is still open for another couple of years and there are many Indian teams working on it from universities, hospitals, and company start-ups. Most excitingly, there are also many cross-sector groups forming all over India. The Government of India helped ensure Indian teams are fully involved in this, through providing seed funding, to give new teams a chance to scope and develop their ideas.
There is no doubt that a test like this would save lives, but it has much in common with pathways for tropical diseases. The diagnostic test alone can’t achieve its maximum potential, as so many other factors affect antibiotic resistance. Surveillance is needed to understand more about the infections and about the ways in which people access antibiotics, to make sure the test is available in the right places. In India, this is a complex area due to the large range of pathways to accessing treatment, through GP’s, pharmacies, clinics and others. The test itself needs to be affordable compared to the cost of antibiotics, preferably made available for free. If antibiotics are needed then the right ones need to be available in all corners of the world.
One of the most important things needed, in common with many tropical diseases, is a change in established behaviors and practice. In many countries we have become accustomed to taking antibiotics and relied on their success to get us better. However taking them routinely, when we may not need them, not completing our doses, sharing them with friends and family, all help the infections to develop more resistance to the antibiotics. We need a concerted effort to change our behaviours to maximise our chances of getting better. In India, steps have been made in this area through government campaigns but we need to work faster and harder to spread the word before the bugs get even more resistant. When I was in India recently I was reading about the problem of Dengue Fever in some areas, a disease made worse if we don’t restrict the number of sites where water is standing for some time, and where the disease can flourish. Similarly, the problem of malaria could be helped with some aspect of behaviour shift, such as the use of bed nets and other prevention techniques. Changes to our patterns of behaviour as consumers, patients, pharmacists, doctors and others are tough we all have our own reasons for the behaviours we display, and there are often good reasons for these to not change. For example we cannot ask someone to not take antibiotics and remain ill for longer, giving up their daily pay, without clear evidence, and without some way of helping them to continue to provide their family with the support they need. These conversations need governments, the private sector, health workers of all kinds, communities and patients to work together, and that is a challenge. But I like to think this is not an impossible one, and I was privileged to observe how things started to change in the world of antibiotic resistance as more and more groups became involved in the discussions.
Q. What are your expectations from India?
A. There is no single and quick fix to these urgent health problems, including antibiotic resistance and tropical disease. All types of knowledge are needed those working in universities, hospitals, companies, governments and charities all have an important part to play. We need people working in tropical medicine research, implementing health programmes, innovating for new techniques, drugs and tools, understanding health economics, social science and data modelling, involved in policy development and behavioural change. This wide range of voices and knowledge from across India would provide us with a greater chance of meeting some of our ambitious goals, shared with so many of our Indian partners.
Q. What are the key areas of concern in controlling tropical disease? What unique features did you find in tropical diseases in India as per your assessment?
A. One of the key areas of concern in fighting tropical diseases is the difficulty of viewing them in isolation. Tropical diseases are not diseases that only occur in the tropical areas. Diseases, like us, are travelling more and more across countries and continents. Also, so many other factors have an impact on these diseases. If we consider the Sustainable Development Goals as a context, there have been strong links made between levels of poverty, access to security, access to food, water and nutrition Poverty and lack of access to financial support in times of bad health can mean the difference between recovery and not.
In a country as large and diverse as India, even recording the data about tropical diseases, their causes and treatment pathways is difficult. One example of this is the recent incidence of Dengue Fever and Chikungunya in India, which was severe when I happened to be visiting. Tackling these diseases is tough due to urbanization, large population sizes, and changes in temperature and weather patterns have made the practical issues of reducing their breeding grounds, in stagnant water, a real challenge. A combination of preventative and reactive steps need to be taken, and this needs wide coverage, awareness raising and many actions taken in parallel. What we can’t account for is the natural evolution of the vector and the host in this equation. The Government of India had published adverts in the media to raise awareness of this problem, and this is an important part of the jigsaw.
Having accurate prevalence figures for diseases such as these, are very important so we can look at global patterns, and what that may mean for specific countries and regions. It would also help us in establishing partnerships with institutions, governments, charities and communities, to bring about the right research and analysis to deliver the right results. As one example many funders will rely on accurate data in order to justify their funding, which help to move things forward. I understand this is a challenging field and I look forward to working with the governments, institutions and other organizations in this area of work.
Q. What has been your experience of engaging with CSR oriented companies in fighting against tropical disease?
A. I’ve been working in global health now for around 15 years, at charities and social enterprises mostly. I’ve been lucky to work with some incredible organizations, who have helped tackle disease through donating funds, enabling access to distribution networks, sharing niche skills and expertise and providing gifts in kind to help reduce costs. In the field of tropical medicine there is a vast array of support being provided, through the donation of essential medicines by pharmaceutical companies, through the given table
|Company||Medicine||Neglected Tropical Disease||Donation||Commitment timescale|
|Bayer||Nifurtimax||human African trypanosomiasis||Up to 320,000 tablets annually||2014 – 2019|
|Nifurtimax||Second line Chagas disease||7,750,000 tablets over 5 years||2012 – 2021|
|Suramin||human African trypanosomiasis||Up to 10,000 vials annually||Until 2020|
|Eisai||Diethylcarbamazine combined with albendazole||Lymphatic filariasis||Up to 2.2 billion tablets||2014 – 2020|
|Gilead Sciences. Inc||Liposomal amphotericin B||Visceral leishmaniasis||Up to 380,000 vials||2017-2020|
|GlaxoSmithKline||albendazole||Lymphatic filariasis and soil transmitted helminthiases||Up to 1 thousand million tablets||Since 1997|
|Johnson & Johnson||mebendazole||soil transmitted helminthiases||Up to 200 million tablets annually||2012 – 2016|
|Merck||praziquantel||Since 2007||Schistosomiasis||250,000 tablets annually|
|Merck Sharp & Dohme||ivermectin||Onchocerciasis|
|Lymphatic filariasis||Unlimited supply||Since 1987|
|Novartis||clofazimine||Leprosy||Unlimited supply||Since 2000|
|Triclabendazole||Fascioliasis and paragonimiasis||Up to 600,000 tablets||2016-2018|
|Pfizer||Azithromycin||Trachoma||Unlimited supply||1998 2020|
|Sanofi||Eflornithine||human African trypanosomiasis||Unlimited supply||Until 2020|
|Melarsopral||human African trypanosomiasis||Unlimited supply||Until 2020|
|pentamidine||human African trypanosomiasis||Unlimited supply||Until 2020|
One of areas I would like us to do more of is to champion these programmes, and to share learnings about the best parts of them. Highlighting the gains made by these partnerships and quantifying the impact, as well as capturing the learnings, helps to stimulate other companies to consider their positions and develop their own programmes. Something we are interested in around this area is how the donated medicines reach patients, and whether other partners could be added in to achieve even more. One of the important areas in this discussion is Snakebite. In a recent Lancet article it was predicted that snake bite accounts for at least 49,000 deaths a day. The Ministry of Health and Family Welfare has been calling for better data gathering for this issue, which causes death, disability and threatens poor communities harder through reducing opportunities to work. There is more to do to understand how best the Society can help snake bite in India but it may include funding research into new drugs, encouraging existing manufacturers to donate antivenom, helping gather data around bite patterns, sharing best practice of awareness raising and behavioural change. As India accounts for a large proportion of snake bites across the world its important we are working with the best minds in this topic.
As with many other diseases and health issues in India there are many ways the private sector can be involved, through innovating, helping with distribution, specialist skills etc.
I believe the best way to deal with these challenges is to pull together collective skills and experience from all areas of life and collectively find solutions that will work. As I move into the second year of my role I hope to be able to include many more voices from India in our work and to establish many new partnerships with companies, institutions, charities and communities.
Q. Anything you would love to share with CSR VISION readers.
A. As you might have guessed from my name I have strong links to India, indeed my father is Indian, from Kolkata. I’ve been lucky enough to be able to visit India many times and lived in Kolkata for a year whilst I was working as a volunteer for a health charity. In fact it was in India that I decided that the focus of my career should be in tackling disease, and improving access to health.
Around twenty years ago I was working in London, doing accountancy training, and I came to Kolkata for a short holiday, on a volunteering placement. I was helping a small charity to raise funds, for its services a leprosy clinic, informal schools and informal health clinics. While I was there I often visited the health clinics, to understand more about the work of the charity, so I could help them to find organizations and people to support them. In fact partnerships with companies in and around Kolkata may have been some of the earlier examples of CSR in practice. Companies donated their staff time and skills, funded outreach events, and funded specific areas of work.
On one of the days I went to the Leprosy clinic and met an elderly man. He had leprosy for many years and was living far from his family, friends and community, as the stigma associated with leprosy was so high. Despite the physical pain and loneliness he mentioned he was still happy to be part of a new community of other leprosy patients. This was many years ago, and now leprosy is better understood, stigma has lessened. However at the time I remember feeling angry and sad at the same time. Sad about the distance he had to put between his family and friends, and that he would most probably have his final years and months there also.
During the same visit I met a family a mother, young boy and baby girl. They had travelled a long way to receive treatment for the baby. They didn’t have treatment close to where they live, and had only set off when she was very ill. Shortly after reaching the clinic the baby died despite the very best efforts of the incredible health workers. This lack of local access to health, forcing families to travel great distances also helped to fuel my sense of injustice and on returning from that trip I decided to pursue a career that would help improve access to health and make it more equitable. Though these examples are from a couple of decades ago we need not look too far to find injustice of some kind in health provision and access, in India and in most countries.