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Kaiser Daily Global Health Policy Report

In The News

House Foreign Affairs Committee Chair Schedules Food Aid Reform Hearing

Rep. Ed Royce (R-Calif.), chair of the House Committee on Foreign Affairs, “has scheduled a hearing on reforming food aid next week, setting up a bitter fight with farm state lawmakers,” The Hill’s “Global Affairs” blog reports. Last month, Royce and Rep. Karen Bass (D-Calif.) introduced legislation (.pdf) that would “eliminate the requirement that food assistance to starving nations be produced in the United States and shipped on U.S.-flagged vessels” and that “closely tracks” food aid reform described in President Obama’s FY 2014 budget proposal, according to the blog. “Opponents say the reforms would gut a Cold War-era program that provides crucial support for U.S. farmers,” the blog writes (Pecquet, 6/6).

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Major Rally To Be Held In London's Hyde Park Ahead Of Nutrition Summit

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, “the former Archbishop of Canterbury Rowan Williams and Nelson Mandela’s wife, Graça Machel, will speak at a major rally in [London’s] Hyde Park this weekend as part of a campaign to end child malnutrition,” The Guardian reports. “The Hyde Park event coincides with David Cameron’s hosting of a Nutrition for Growth summit on Saturday and attended by the Malawian president, Joyce Banda,” the newspaper adds (Wintour, 6/6). The event will “bring together business leaders, scientists, governments and civil society to make the political and financial commitments needed to prevent undernutrition, enabling people and nations to prosper,” according to a press release from the U.K.’s Department for International Development (6/5). “Some 165 million children worldwide are stunted by malnutrition as babies and face a future of ill health, poor education, low earnings and poverty, the head of the United Nations Children’s Fund [UNICEF] said on Friday,” Reuters notes (Kelland, 6/7).

“Meanwhile, [The Lancet] has reported [in a series published Thursday] that malnutrition is responsible for the deaths of 3.1 million children each year or 45 percent of all deaths of children under five years of age,” the U.N. News Centre writes, noting, “The figure is higher than the journal’s last estimates in 2008” (6/6). “The findings suggest that addressing the problem means addressing the underlying causes of malnutrition, such as, ‘poverty, food insecurity, poor education, and gender inequity,'” Inter Press Service adds (6/6). “Malnutrition — which includes being overweight or obese as well as under-nourished — also has an economic impact,” BBC News notes, highlighting a recent United Nations report that found “malnutrition is estimated to cost the world $3.5 trillion (£2.3 trillion) — or $500 for every person — in health care and lost productivity” (Briggs, 6/5). PRI’s “The World” examines a study in the Lancet series that “outlines 10 key nutrition interventions that could save the lives of almost a million children a year” (Thomson, 6/6).

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WHO Issues Guidance On Obesity, Undernutrition In Developing Countries

“The United Nations health agency has issued new guidance to help low- and middle-income countries tackle the emerging double threat of childhood obesity and undernutrition, and halt the growing burden of associated diseases such as diabetes, heart disease and stroke,” the U.N. News Centre reports. “According to the [WHO], more than 75 percent of overweight children live in developing countries, with the prevalence in Africa almost doubling in the last 20 years,” the news service writes, adding, “Globally, over 100 million children under five years of age are underweight, the agency noted in a news release, while 165 million are stunted – a better indicator of chronic undernutrition” (6/6). “The WHO says being overweight or obese can lead to serious long-term health problems like diabetes, heart disease and stroke,” VOA News notes.

Francesco Branca, director of the WHO’s Department of Nutrition for Health and Development, “says successful policy initiatives, such as urging exclusive breastfeeding during the first six months of life and the distribution of vitamin and nutrient supplements, have helped to reduce rates of child malnutrition and stunting in recent years,” the news service writes, adding, “Now, he said, countries need to get proactive on childhood obesity” (Lazuta, 6/6). “To assist countries, WHO presented a package of 24 essential nutrition actions,” the U.N. News Centre writes, noting, “These include improving nutrition of pregnant and breastfeeding women; encouraging early initiation of breastfeeding, exclusive breastfeeding for the first six months, then continued breastfeeding up to two years; and promoting appropriate solid foods for young children” (6/6).

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Reports Examine Cost Of Global Malnutrition, Agricultural Forecasts; World Bank Predicts More Nutrition Program Spending

According to a new report from the U.N. Food and Agriculture Organization (FAO), “[g]lobal hunger, poor nutrition and obesity are costing the world trillions of dollars in health costs and lost productivity,” VOA News reports. According to the report, “the combined effects of all … forms of malnutrition cut the world’s income by an estimated five percent per year, or about $3.5 trillion,” the news service states. “While about 40 countries have reached the goal of reducing hunger by half, there is a long way to go to improve nutrition,” VOA writes, noting the focus on nutrition is new for FAO. “The effort needs to involve players throughout the entire food system, from farmers and food processors to consumers and government agencies, according to FAO Deputy Director-General Daniel Gustafson,” the news service writes (Baragona, 6/4).

A separate report from the FAO and the Organization for Economic Cooperation and Development (OECD) found that “[a]gricultural production is expected to slow down over the next decade, due largely to limited expansion of arable land, rising production costs, environmental pressures and resource constraints,” the U.N. News Centre writes (6/6). “Rising global food demand will push up prices 10 to 40 percent over the coming decade and governments need to boost investment to increase farm production,” according to the forecast, released on Thursday, the Associated Press adds (McDonald, 6/6). However, the World Bank announced on Thursday that “its direct funds for nutrition programs should rise to $600 million for 2013-14 from $230 million in 2011-12,” Reuters reports. “The World Bank’s nutrition programs focus especially on children two years old or younger, when nutrition interventions can have the biggest impact,” the news agency notes (Yukhananov, 6/6).

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Wall Street Journal Examines Global Shortage Of TB Drugs

“The U.S., India and other nations are facing shortages of tuberculosis [TB] drugs — threatening to reverse decades of progress against a deadly disease that is becoming increasingly untreatable,” the Wall Street Journal reports. “Worldwide, TB is becoming increasingly drug-resistant, and drug shortages are ‘one of the main reasons,’ said Lucica Ditiu, executive secretary of the Stop TB Partnership, which oversees a global drug-procurement facility used by more than 123 countries,” the newspaper writes. “In India, some clinics are turning away sick children due to short supplies of pediatric doses, and in a risky move, adult pills are sometimes being split to approximate children’s dosages,” according to the Wall Street Journal. “Doctors in at least four other countries in Africa, South Asia and South America have reported drug shortages recently, according to Erica Lessem, assistant director of the TB/HIV Project at Treatment Action Group, a research and policy think tank,” the newspaper notes.

“The shortages reflect fundamental problems including poor government-procurement systems, weak supply chains, poor profitability for some drugs and inadequate methods of gauging demand,” the Wall Street Journal reports and further details the situation in India. “Mario Raviglione, the WHO’s TB chief, said India’s problem is surprising because Indian drug makers supply the vast majority of the world’s TB patients,” the newspaper writes. “The extent of global shortages is difficult to assess for some of the very reasons shortages occur: poor tracking of drug supply and a lack of good global reporting systems,” the newspaper states, adding, “At present, drug makers say governments order so erratically and estimate demand so poorly that it is hard to manufacture the right amount” (Anand/Shah/McKay, 6/6).

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WHO Credits New Vaccine For Lowest Meningitis Case Numbers In 10 Years

“Case numbers in Africa’s meningitis season this year were the lowest in 10 years thanks to a cheap new vaccine designed to treat a type of the disease common in the so-called meningitis belt, the [WHO] said on Thursday,” Reuters reports. The vaccine, called MenAfriVac and developed with support from the Bill & Melinda Gates Foundation and the Meningitis Vaccine Project (MVP), is designed to prevent meningitis A, which commonly causes outbreaks across “Africa’s ‘meningitis belt,’ a band of 26 countries stretching from Senegal to Ethiopia,” the news agency notes. “The introduction of this first meningococcal vaccine available for preventive purposes in Africa has enabled the immunization of over 100 million people from 10 countries in the meningitis belt in the past three years,” the WHO said, adding, “The reduced case load and epidemic activity observed this year adds to the evidence on the impact … of this vaccine,” according to Reuters (Kelland, 6/6).

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Bird Flu Mutations Remain A Threat, Researchers Say

Writing in a New England Journal of Medicine perspective piece published on Wednesday, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and colleagues “look at the genetic sequences of past flu pandemics to learn how a virus goes from infecting only chickens or pigeons to sickening millions of people globally,” NPR’s “Shots” blog reports. Although the newly identified H7N9, which has infected 132 people and killed 37, “doesn’t transmit easily between people, some scientists have worried that it could gain that ability,” the blog writes. Though the virus has some mutations that help it infect human cells, and “[t]hese mutations are also found in flus that have caused pandemics, … Fauci and his colleagues say that’s not the way other flu pandemics came about,” according to “Shots.” Instead, in the three flu pandemics since 1957, the virus, related closely to the Spanish flu, “underwent large, sweeping genetic changes to create the contagion that swept across continents,” the blog writes, adding, “Fauci and his colleagues say these historical precedents are ‘only slightly reassuring’ for H7N9” (Doucleff, 6/6). In related news, two reports published on Thursday in the journal Cell describe how H7N9 and H5N1 flu strains could mutate to become better adapted for human-to-human transmission, HealthDay reports (Reinberg, 6/6).

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DNDi R&D Making Progress, But More Leadership, Coordination, Funding Needed

“For the past 10 years, the Drugs for Neglected Diseases Initiative (DNDi) has been involved in research and development (R&D) for neglected diseases around the world, developing six new treatments for malaria, sleeping sickness, kala azar and Chagas,” IRIN reports. The news service provides statements from several people who attended a recent two-day event in Nairobi, Kenya, where “more than 400 scientists, government health officials and members of the organizations that make up DNDi agreed that while significant progress has been made in the fight against several neglected diseases, better leadership, coordination and funding will be necessary to eliminate them from the continent.” According to IRIN, “[I]t is not just health systems that need improvement; poor road networks, inadequate local research capacity, corruption, conflict and the remoteness of many of the areas where these illnesses are found all hinder efforts to control neglected tropical diseases.” In addition, “[b]uilding the capacity of African governments and research facilities will … be important for the fight against neglected tropical diseases,” the news service writes (6/6).

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China Experiencing Increases In Rates Of 'First-World Health Problems'

While “China has managed to beat back the plagues of poverty, such as diarrhea, pneumonia, measles and malaria,” the nation’s “economic boom” has caused rates of “so-called First World health problems,” such as stroke and heart disease, to become more common among the Chinese, according to a study published this week in The Lancet, NPR’s “Shots” blog reports. “Life expectancy in China jumped significantly over just one generation,” but “[t]he downside of this success is that the Chinese public health system must now adapt to fight a whole new set of health problems,” according to the study, the blog notes (Beaubien, 6/6). The June 8 issue of The Lancet features several papers “provid[ing] a picture of the complex health issues facing China,” according to a Lancet editorial (6/8).

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Group Therapy Technique Successful For Women Victims Of Sexual Violence In DRC, Study Shows

“A type of group therapy designed for trauma victims has proved extraordinarily helpful for survivors of sexual violence in Democratic Republic of Congo [DRC], enabling women to overcome the shame, nightmares and terrifying flashbacks that had left them unable to work or take care of their families or themselves,” researchers from Johns Hopkins University, the University of Washington in Seattle and the International Rescue Committee reported Wednesday in the New England Journal of Medicine, the New York Times reports. The researchers “brought a type of treatment called cognitive processing therapy to Congo …, adapted the method to treat women who could not read or write, and taught it to local health workers who had a high school education or less,” the newspaper writes. “The workers then conducted group therapy sessions in five languages with survivors of sexual attacks who had severe anxiety, depression and post-traumatic stress disorder,” according to the New York Times. “Researchers estimate that about 40 percent of the women in the region have been victims of sexual violence,” the newspaper notes (Grady, 6/5).

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Editorials and Opinions

More Flexibility Needed In U.S. Food Aid System

“While far more aid is still needed in Syria and [for] the refugees in neighboring countries, the U.S. government has been able to pursue a flexible approach in the country that better responds to needs on the ground,” Helene Gayle, president and CEO of CARE USA, and Raymond Offenheiser, president of Oxfam America, write in a Christian Science Monitor opinion piece. “Yet such flexibility is the exception, not the rule, when it comes to U.S. food aid programs,” they continue, adding, “Instead, the vast majority of American food aid comes from another program altogether, one that is ensnared by red tape and regulations from another era.” They highlight a food aid reform proposal included in the Obama administration’s FY 2014 budget request and write, “With hunger bound to arise as a topic of discussion at the G8 Summit later this month, quicker and more flexible food aid can be a practical solution.”

“A more prudent approach, as allowed by Mr. Obama’s proposed reforms, would allow aid agencies to buy food from local farmers, or the closest supplier who offers the best price,” Gayle and Offenheiser continue. “While the president’s budget does not completely eliminate every outdated restriction that slows the delivery of U.S. food aid and inflates its cost, the reforms represent an important step in the right direction,” they state. The U.S. “needs a flexible response when addressing emergencies and chronic hunger,” they write, concluding, “Let’s take a stand and make sure U.S. citizens encourage their members of Congress to support modernizing America’s food aid system to provide maximum value for taxpayers while feeding as many hungry people as possible” (6/6).

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Opinion Pieces Address Malnutrition Ahead Of Nutrition For Growth Summit

The following is a summary of opinion pieces addressing the issue of malnutrition ahead of the Nutrition for Growth summit to take place in London on Saturday.

  • Lucy Martinez Sullivan, Huffington Post’s “Impact” blog: “In just a few days, on June 8th, the governments of the U.K. and Brazil together with the Children’s Investment Fund Foundation will do something that I hope will turn the tide on malnutrition,” Sullivan, executive director of 1,000 Days, writes, referring to the summit. “It is expected that a few leaders and philanthropists will make game-changing financial commitments to dramatically improve nutrition for millions of women and children around the world and save lives,” she notes, adding, “It is time we all double-down on ending the unimaginable tragedy of losing a single child — let alone three million children — to malnutrition” (6/6).
  • Jomo Kwame Sundaram, Inter Press Service: Sundaram, assistant director-general for economic and social development at the U.N. Food and Agriculture Organization (FAO), “writes that while the Millennium Development Goal of halving hunger by 2015 is within reach, much more needs to be done to eradicate malnutrition.” He highlights the upcoming London summit and notes, “On Nov. 19-21, 2014, the FAO, the [WHO] and others in the U.N. system will co-organize the inter-governmental International Conference on Nutrition (ICN2), 22 years after the first one in 1992, to establish the bases for sustained international cooperation and policy coordination to overcome malnutrition” (6/6).

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Patent Application On MERS Creates Questions For Cooperative Medical Research

At the closing session of the World Health Assembly (WHA) on May 27, WHO Director-General Margaret Chan said an outbreak of a newly identified virus, Middle East Respiratory Syndrome coronavirus (MERS-CoV), is “a threat to the entire world.” At the meeting, controversy emerged because researchers at Erasmus Medical Centre in the Netherlands, who first identified the virus, had applied for a patent on the virus’s genetic sequence and were sharing virus samples under a Material Transfer Agreement (MTA). The Saudi Arabian government and some researchers claimed the patent application and Erasmus were hindering research on MERS, but Erasmus defended its actions. The following editorial and opinion piece discuss issues surrounding the patent application for MERS.

  • The Lancet: “Many unanswered questions remain about MERS-CoV, including the source of, and main risk factors for, infection. A collaborative global research effort will help close the gaps in knowledge,” the editorial states. The news of the patent application “has caused consternation,” according to the editorial, which writes, “The researchers have publicly responded to say that they have sent the virus free of charge to many public research and health institutions and they will continue to do so. They have told media that they applied for a patent to ensure companies invest in making diagnostics, vaccines, and antiviral medication. Let us hope their expectations prove correct.” The Lancet concludes, “Free information sharing, trust, and research cooperation will be crucial to aid prevention, diagnosis, and treatment of this evolving global health threat” (6/8).
  • David Fidler, Foreign Policy: “This dispute raises three broad legal issues,” Fidler, a professor at Indiana University’s Maurer School of Law, writes. “The first involves information sharing: MERS triggers obligations under the International Health Regulations (2005), a treaty binding on all WHO members, to notify WHO of disease events that might constitute a public health emergency of international concern (MERS qualifies) and to share with WHO information about such events”; “[s]econd, the controversy involves disputes about ownership of the MERS virus, and the implications of ownership on the international response to the outbreak”; and the third “involves the claims that the Erasmus MTA and patent application are hindering research on, and responses to, the MERS virus and outbreak,” he states, expanding on each point. If Chan “investigate[s] the legal implications of the MERS outbreak as she promised … the undertaking will be fraught with problems and could worsen the global legal imbroglio that has already flared up. Right now, with MERS a threat to the entire world, it is not a problem we are going to lawyer away,” he concludes (6/7).

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End To Polio 'Now In Sight'

“The massive effort to eradicate polio through worldwide vaccination hit some new speed bumps over the past several days, with fresh reports of outbreaks of the disease in the Horn of Africa, and continued deadly attacks on polio workers in rebel-controlled areas of Pakistan and Nigeria,” Jay Winsten, an associate dean and the Frank Stanton director of the Center for Health Communication at the Harvard School of Public Health, and Sameer Anaokar, a principal at the Boston Consulting Group, write in the Huffington Post’s “Global Motherhood” blog. “Nevertheless, the overall outlook for eradication of polio remains highly promising,” but “the final stage of the effort presents complex, difficult challenges,” they continue. They discuss some of these challenges, including accessing “extremely hard-to-reach and underserved populations” and overcoming “political instability and violence in rebel-controlled areas of the three [remaining] endemic countries.” They highlight India’s success in eradicating the disease and write, “It is India’s dramatic achievement that has catapulted polio eradication to the top of the near-term global health agenda. The ‘last mile’ to eradication may be hazardous to transverse — but the end-point is now in sight” (6/6).

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Moving Forward On Gender Equality, Poverty Eradication Will Involve Breaking Down Barriers

The Women Deliver 2013 conference “has created a vision of what we want for girls and women around the world, and of what is required to achieve it — in family planning, maternal health, and the battle against HIV and other sexually transmitted infections, including HPV,” Serra Sippel, president of the Center for Health and Gender Equity, writes in the Huffington Post’s “World” blog. “We must … recognize that just as our targets are interlinked — HIV/AIDS, family planning, maternal mortality, violence against women, child marriage — so must our work — and our spending — be comprehensive as well,” she continues. Noting the U.N. High-Level Panel on Post-2015 Development released its final report the same day the Women Deliver conference ended, Sippel writes, “To end poverty worldwide we must become a serious, broad-based coalition of social movements and global health advocates committed to human rights and systemic change. We must work together for gender equality in a pact of mutual accountability among global and national decision-makers, [non-governmental organizations (NGOs)], and international donors and agencies” (6/6).

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From the Global Health Policy Community

Health Professionals Ask Congress Members To Continue U.S. Leadership On HIV/AIDS

On Thursday, 629 health professionals from across the United States sent a letter [.pdf] to Congressional leaders that outlines the success of PEPFAR and “warns that failure to fund PEPFAR adequately now will reverse the gains” achieved under the 10-year-old program, the Center for Global Health Policy’s “Science Speaks” blog reports. The blog notes, “The letter is addressed to Senate Appropriations Committee Chair Barbara Mikulski [D-Md.], Ranking Member Richard Shelby [R-Ala.], Subcommittee on State and Foreign Operations Chair Patrick Leahy [D-Vt.] and Ranking Member Lindsey Graham [R-S.C.], House Appropriations Committee Chair Hal Rogers [R-Ky.], Subcommittee on State and Foreign Operations Chair Kay Granger [R-Texas], and Appropriations Committee and State and Foreign Operations Subcommittee Ranking Member Nita Lowey [D-N.Y.],” the blog notes (Barton, 6/6). The letter states, “[W]e fear that the global AIDS response embodied in PEPFAR is threatened by a retreat in spending just as science has confirmed a set of potent interventions that, if effectively and rapidly deployed, could stop the AIDS epidemic in its tracks. … We implore you to continue the U.S. leadership that has made an AIDS-free generation an achievable goal in our lifetimes” (6/6).

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Governance, Security Are 'Essential' To Eradicate Polio

In his “Africa in Transition” blog, John Campbell, Ralph Bunche senior fellow for Africa policy studies at the Council on Foreign Relations, examines the reemergence of polio in the Horn of Africa, noting the WHO in April “reported the new presence of wild polio virus type 1 (WPV1) in the Banadir region of Somalia” and another “confirmed case of polio at Kenya’s Dadaab refugee camp” in May. “This most recent polio episode highlights the importance of thorough and ongoing vaccination campaigns,” he states, adding, “The governments of Somalia and Kenya and the relevant U.N. agencies are moving quickly to respond.” However, he notes, “As in so many other areas, governance and security are proving to be essential to the elimination of a disease” (6/5).

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'Seize The Opportunity' Of Nutrition Summit

“Over the last 50 years, the global community has made amazing progress reducing poverty, extreme hunger, and disease,” Gary Darmstadt, head of the Bill & Melinda Gates Foundation’s Family Health Division, writes in the foundation’s “Impatient Optimists” blog. “Yet, new research published this week in the respected medical journal, The Lancet, underscores one area — undernutrition in young children — where there is a lot more work to do,” he continues. He writes, “Building on the latest scientific research about undernutrition — and the momentum around the Nutrition for Growth summit — we must seize the opportunity and work toward a day when every child has the opportunity for a healthy start at life” (6/6).

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