Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria
Mark Dybul discusses his career in HIV research and the future of global health
Mark Dybul is executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He trained in Georgetown and had his residency in Chicago. In the 1980s he witnessed the emergence of the AIDS epidemic in San Francisco, which inspired his academic career in HIV research. In 2006, President George W Bush appointed him leader of the President’s Emergency Plan for AIDS Relief (PEPFAR), the world’s largest scale global health intervention by any one country. In 2012, he joined the Global Fund, which allocates $4bn (£2.8bn; €3.5bn) of public and private funding a year to programmes run by local experts to fight these diseases. By the end of 2016 it is predicted that the Global Fund will have helped save 22 million lives.
How did the emergence of HIV/AIDS shape your early career?
It was the reason I went into medicine. In 1985 I was trying to decide between English and theology, but I was grabbed by the front page of Time, which had a feature about the global AIDS epidemic. After that, my interest wouldn’t let go. My first job after medical school was based in San Francisco. Three people were dying a day from AIDS. The life of the city revolved around funerals and death. The stigma was incredible. I cared for dying teenagers, whose families had disowned them not just because they had HIV, but also because this is how they found out they were gay. But in the midst of this horror there was something beautiful, a growing solidarity with and acceptance of the gay community.
Did you plan to move into a leadership role?
Absolutely not, it was all accidental. I loved my time in research and I became involved in working on the US guidelines for HIV/AIDS. One day George W Bush called us in and said, “I want to do something really big, don’t worry about budget, tell me how you are going to change this epidemic.”
In 2006, you led the President’s Emergency Plan for AIDS Relief, the world’s largest global health intervention by any one country. What did this teach you?
That naivety can be a good thing. If I had known the US government better, I would never have thought that PEPFAR was possible. It was a brilliant piece of instinct from George W Bush in keeping it secret from Congress. If it had been public, we would still be in interagency talks about it now.
It also made me realise how paternalistic our development approaches were. People were dismissing human beings and entire continents believing that they knew best. This may be one of the greatest legacies of our response to AIDS: flipping paternalistic pilot projects run by westerners to supporting projects initiated by local researchers. We realised that once countries get the technical know how, they will figure out the solutions on their own.
In your role as executive director of the Global Fund, what skills do you need to work with presidents and politicians effectively?
Humour and humility. Most politicians want to serve and do something big, but they have a lot of people coming at them. To be effective with them you need to understand where they are coming from, where they want to get to, and where the middle ground is. As Ted Kennedy put it, “Compromise, but never compromise your principles.”
2015 was the deadline for the millennium development goals. How successful have we been in achieving them, and what should be the focus of global health in the future?
They have been hugely successful because they focused the world on development by setting very specific targets. These have driven action and resource commitments.
Going forward, we need to respond to the changing world. People are connected in new ways, where top-down approaches will no longer work. We need to integrate approaches and look at people not single diseases. We also need to ask: how do we create equal opportunities for humans to develop? Creating opportunities can have a direct influence on health outcomes. For example, recent data indicate that if we keep girls in school their HIV rates drop, they don’t get married early, they have fewer pregnancies, and they go on to be able to care better for their families.
What advice would you give medical students interested in a career in global health?
The most important thing is not to plan too much. The world changes too fast. If you’re doing what you planned to do in 10 years, then you probably messed up. You will have missed huge opportunities that came flying your way. My career is an example of failing to plan. Focus on your passions and you’ll be successful professionally and personally.
Do you miss your days as a clinician?
Every day. A mentor once told me, “Beware the administrator that always wanted to be an administrator.” What you learn from your patients is one of the greatest gifts in the world. There is nothing more wonderful than engaging on that level with another human being. I miss it a lot.Charles Dearman, final year medical student
University of Oxford, UK
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.