Ten days before today’s (Tuesday, 13 September) opening of the seventh South African Tuberculosis (TB) Conference  — on the morning of Saturday, September 3 — the event was set to be the best-attended iteration of the gathering to date.  

More than 1,000 delegates had signed up and the interest from civil society was unparalleled. Public health experts’ enthusiasm came at a crucial time, after the Covid-19 pandemic had undone years of progress in reducing TB deaths (which are preventable).  

But by the end of that Saturday, high-profile delegates’ interest in attending the meeting had plummeted. 

The World Health Organization (WHO) informed the conference chair, Professor Willem Hanekom, that they were withdrawing their delegates’ attendance. Shortly thereafter, 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 baffled — but not for long.  

It soon emerged that the conference’s main sponsor, the Foundation for Professional Development (FPD), had committed the fraternity’s deadliest sin: it had accepted money from the tobacco industry (in 2021). 

Smoking makes people more likely to get infected with TB, and it 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 those people died. A 2011 study found that 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 South Africa’s oldest nonprofits (FPD) get into this mess?

It 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 FSFW is funded entirely by tobacco giant Philip Morris International (PMI). It’s 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 and reframe them as being part of the solution to smoking (enter vapes and e-cigarettes) rather than the problem.  

The Foundation for a Smoke-Free World granted the FPD R2-million 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 FPD’s chief operations 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.”  

That’s surprising.  

A Google search for “Foundation for a Smoke-Free World” brings up — on the first page — a WHO warning about FSFW, disparaging editorials in authoritative scientific journals and investigations by the University of Bath’s watchdog, Tobacco Tactics. Plus, the FSFW’s Wikipedia page mentions its links to PMI in the very first paragraph.  

Public health experts also warned the FPD about the foundation’s links to Philip Morris International, according to emails Bhekisisa has seen. 

Leslie London, a public health researcher at the University of Cape Town, says the FPD stood firm in their belief that the Foundation for A Smoke-Free World could be trusted because they knew its president Derek Yach (who used to work for the South African Medical Research Council). “I’ve known Derek Yach for most of my career. I really don’t see him punting a pro-tobacco agenda,” reads the FPD’s response

London says: “This illustrates the power of the ‘old boys’ club’. This ‘old boys’ club network’ is the only way that the foundation for a Smoke-Free World can make progress in South Africa.”

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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 decadeslong 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 2½ 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 of Philip Morris. An analysis of the foundation’s 2021 tax returns shows that the pool of organisations that are willing to accept its grants is also shrinking fast. 

South Africa’s political context makes FPD’s blunder that much worse, since big tobacco’s spies and dirty tricks have weakened the defences of offices such as the country’s spy agency and the revenue service, setting the scene for organised capture of state institutions, according to whistle-blower Johann van Loggerenberg. 

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 (which is not true).   

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, write researchers in the South African Medical Journal. 

Last year, food and beverage company Nestlé hosted a free event for mothers and guardians, where the company’s brand ambassadors talked about the benefits of using infant formula. The event was cancelled, but not before being advertised prominently on websites such as News24, Daily Maverick reported.  

When immediately isn’t soon enough 

In the aftermath of the course 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.  

But it may have been too late. For one, a day before the big meeting, the WHO hadn’t indicated whether it accepted the new set-up.  

The FSFW 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 FSFW claims it abides by this, because its bylaws, for example, set out that all funding relationships must be disclosed. But the foundation does not specify which type of links would be unacceptable.  

Other critics, from the McCabe Centre for Law and Cancer, point out that the FSFW’s agreement with Philip Morris includes loopholes that would allow the tobacco giant to pull funding if the FSFW 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 FSFW updated its agreement with Philip Morris so that it allows it to share information with its funder. The document now also says the foundation will be “free from improper influence” instead of just “free from influence”.  

How to dodge insidious industries 

None of this should be surprising. The devil has always been in the detail when it comes to the tobacco industry’s tactics for pushing its agenda.  

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 FSFW 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. DM/MC 

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

The Bill & Melinda Gates Foundation is one of Bhekisisa’s donors. Read how we ensure editorial independence.