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By Jennifer Rigby LONDON (Reuters) -The Gates Foundation and the Pan American Health Organization are both working on ways to make weight-loss drugs like Novo Nordisk's Wegovy and Eli Lilly's Mounjaro more accessible in lower-income countries, the global health groups told Reuters. In separate interviews, Microsoft founder Bill Gates and PAHO director Dr Jarbas Barbosa said for the first time that their organizations were each seeking strategies to remedy the unequal availability of the highly effective but expensive treatments. About 70% of the roughly one billion people with obesity live in low and middle-income countries which may struggle to meet the costs of tackling the epidemic and associated health problems like diabetes and heart disease. In response to a question about the treatments, Gates said his Foundation would take any drug that was effective in high-income countries "and figure out how to make it super, super cheap so that it can get to everyone in the world". For example, it is currently working with Indian drug manufacturer Hetero to help bring cheaper copies of a new HIV prevention drug to the market in lower-income countries for $40 a year. LOW-COST COPIES     From next year, the active ingredient in Novo Nordisk's blockbuster Wegovy drug, semaglutide, comes off patent in countries including China and India. Generic manufacturers are already working on low-cost copies. The brand-name weight-loss drugs are primarily sold in wealthier countries, where prescriptions cost hundreds of dollars per month. The Gates Foundation could also potentially support clinical trials to test how these medicines affect different populations and provide the data needed to broaden access, Gates said.     Any entry into obesity would represent a new arena for the Gates Foundation, which remains focused on fighting the deadliest diseases in low-income countries, like malaria. Obesity's role in chronic illness has created a new urgency around addressing rising global rates, although it is still not the biggest problem facing most of the countries where the Foundation operates, Gates said.     The World Health Organization estimates that the economic costs of overweight and obesity will reach $3 trillion by 2030 if nothing is done to contain it. WHO recommended in draft guidelines this year using weight-loss drugs as an obesity treatment for adults, but criticized their manufacturers over cost and lack of availability.     Its Americas arm, PAHO, manages a fund that helps push down medicine prices by guaranteeing bulk orders on behalf of its 35 member states. Using the fund, which is financed by the member states, is an option for weight-loss drugs, Barbosa told Reuters. He said it could also help manufacturers clear regulatory requirements rather than applying in each country for approval.     "We are starting the conversation," he said, adding that PAHO is developing recommendations for how best to use the drugs and plans to speak to Novo, Lilly and generic drugmakers within the next couple of weeks.     Eli Lilly declined to comment. Novo Nordisk said in a statement that it recognised the "unmet need" for its treatments.     "We are deeply committed to serving patients around the world," the Danish company said. (Editing by Michele Gershberg and Catherine Evans)

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By Nell Mackenzie LONDON (Reuters) -Eisler Capital's decision to close its flagship multi-strategy hedge fund as soaring staff costs eroded trading profit exposes the difficulty London-based funds face when trying to grow rapidly and replicate bigger, entrenched U.S. players, investors and industry insiders say. They warn that flows in the $4 trillion hedge fund sector will increasingly be absorbed by incumbents – likely leaving an industry that runs on public pension and retirement money concentrated in the hands of a few big firms with an outsized impact on financial markets. Eisler said last week that it would shut just four years after it pivoted to try and emulate the kind of business model used by the most renowned U.S. headquartered multi-strategy hedge funds such as Citadel, Balyasny and Millennium Management that trade different strategies under one roof. Crucially, Eisler also changed how it charged investors, adopting a pass-through fee structure, where costs take a bite out of trading returns. At Eisler, this meant that on top of a 15-20% performance fee, investors paid the hedge fund's expenses and compensation costs, an investor document seen by Reuters showed.   Eisler's turnover climbed by over 40% between 2023 and 2024, a Reuters analysis of the hedge fund's publicly reported accounts showed. But its staff costs grew much faster, over 900% in five years, outpacing its ability to retain profit and leaving investors with smaller and smaller net returns.  "Multi-strats strike me as the final frontier…what percentage take of gross profits can we squeeze investors on without losing them?" asked hedge fund investor Harald Berlinicke, CIO of Berlin-based Max-Berlinicke-Erben Family Office. "It's not an easy balancing act to get right for a new kid on the block as the sky-high fees the established players can charge gives them an edge in terms of attracting the right talent."  A representative for Eisler Capital declined to comment. Citadel, Balyasny and Millennium also declined to comment. In its last investor letter in October, Eisler highlighted the burden of compensation costs.  Portfolio managers are the most expensive they have ever been, three recruitment professionals, who wished to remain anonymous, told Reuters. They mentioned direct knowledge of star fund managers hired in New York and London this year on salaries of over $100 million, which can prove costly for investors if not offset by stellar trading returns.  BLAME THE MODEL? Investors in pass-through funds receive less than half of the trading spoils, according to Barclays research. While they may have been content with that when multi-manager funds were outperforming the wider industry, net returns have now fallen just short of peers with fixed charges, Barclays said in a July client note. Pass-through fees have, however, traditionally been too rich for some European pension funds. "In Europe, some of the world’s largest and most prestigious pension funds have stated they prefer to invest in lower net returning managers with lower fees than higher net returning managers with higher fees," said Michael Oliver Weinberg, deputy CIO of a family office and previously at Dutch pension fund manager APG.  London is home to large and well-performing hedge funds, not necessarily all multi-strats but still successful, including Rokos Capital Management and Marshall Wace.   The partial pass-through model, seen with Man Group's 1783 Strategies fund, operates as a product included in a wider group of funds, some with lower fees.  Man Group, Rokos Capital Management and Marshall Wace declined to comment.  Berlinicke said that while some investors may give established pass-through funds the benefit of the doubt, that might not be true for newer entrants given the level of the fees.  Meanwhile, one effect of the growing sway of multi-strategy funds was that stock price swings on earnings days in 2024 were the largest since at least 2016, a Reuters analysis showed.  NEW YORK, NEW YORK  New York has been the centre of the multi-manager model with pass-through fees and that won't change, investors said.  London, the second largest hedge fund centre, has 171 hedge fund managers, compared to 911 in New York, a city which has accounted for roughly 85% of hedge funds consistently for the last five years, data from hedge fund research firm PivotalPath shows.  Other centres such as Dubai and Abu Dhabi are also emerging as rivals.  "Crowding in markets has always been something to watch out for," said Berlinicke. "The question is whether large players grow and will that be a problem for markets? Possibly, if they dominate strategies or certain parts of the market."  (Reporting by Nell Mackenzie; Editing by Dhara Ranasinghe and Kirsten Donovan)

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