Lelio Marmora is stepping down as Executive Director of Unitaid in March 2020, sources told Health Policy Watch. Marmora, who has led the organization since 2014, told staff on Monday that he would be leaving to seek “new challenges.”

His departure is not likely to bring “unexpected or drastic changes” to Unitaid’s funding priorities over the next few months, Unitaid Board Member for NGOs Fifa Rahman told Health Policy Watch. The organization has already set its strategy for the next two years, and has identified an acting ED committed to the same goals.

Rahman confirmed that Philippe Duneton, current deputy executive director of Unitaid, will step in as interim Executive Director. Duneton has been with the organization since its founding in 2006, and has taken on this role at least once before.

Still, it will be important for Unitaid to find a new ED who understands the “unique role [of the organization] in funding change in how medicines are developed and made accessible for people,” Ellen ‘t Hoen, director of Medicines Law & Policy, told Health Policy Watch.

The director of Medicine Law & Policy, which provides legal and policy analysis on issues related to access to medicines and international law, further added that Unitaid is the only funder that explicitly focuses on thorny issues such as intellectual property.

Additionally, according to observers, Marmora did exert a strong influence over the organizational culture. While Marmora doubled the staff during his tenure, sources close to the organization told HPW that there was dissatisfaction among staff about the management style, and hopes that there would be some improvements.

Rahman told Health Policy Watch that the Board will be “monitoring risks” to ensure that any organizational change moves in a “positive direction.” She further added that the Board will be making a final decision on a new ED in 6-8 months.

The announcement was first made to Unitaid’s staff on Monday, and a second announcement was made by Marmora to the Board of Unitaid at the annual Board meeting on November 20-21. The announcement comes less than a month after Unitaid’s success in helping to negotiate a new deal with rifapentine drug manufacturer Sanofi to slash prices for the essential tuberculosis drug by up to 70% in 100 low- and middle-income countries. The volume-based deal between Unitaid, the Global Fund, and Sanofi was announced at the Union World Conference for Lung Health on October 31.

UNITAID’s Role in Global Health Financing

In its 13-year history, Unitaid has emerged as a major donor of upstream health product innovation and downstream access to medicines work in the “big 3” – HIV/AIDs, tuberculosis, and malaria. Among other projects, the organization funds access to medicines work around intellectual property and pharmaceutical innovation.

Notably, Unitaid does not have a United States representative on its board, which may be why the organization can fund work on controversial issues such as intellectual property and pharmaceutical development. Experts in access to medicines work further added that unlike the other, larger “big 3”-focused organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid is a much smaller and more nimble organization.

It has historically helped negotiate major deals to reduce antiretroviral drug prices and is currently the largest multilateral funder of tuberculosis research and development. Some of its major grantees include The South Centre, the Medicines for Malaria Venture (MMV), the Drugs for Neglected Diseases Initiative, the Stop TB Partnership, and the Foundation for Innovative Diagnostics (FIND). Unitaid also funds a significant portion of WHO’s Prequalification Programme, which provides international regulatory guidance on the safety and efficacy of new health products.

Initially formed by France, Brazil, Chile, the UK, and Norway at the height of the global HIV/AIDs crisis in 2006, Unitaid uses so-called “innovative financing” mechanisms to raise money for the “big three” – HIV/AIDs, tuberculosis, and malaria. As of 2019, the organization reports it has received some US$3 billion from donors, with 70% of its funding coming directly from a “solidarity levy” on airline tickets – a funding mechanism first piloted by France and since adopted by nine additional countries. Other member states earmark a portion of specific tax revenues for the organization, such as Norway, which contributes part of its carbon emissions tax revenue to Unitaid.

This article has been amended on November 23 to update Ellen ‘t Hoen’s name and title.

Image Credits: UN Photo/Rick Bajornas.