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Kaiser Daily Global Health Policy Report

In The News

The Lancet Profiles PEPFAR's Successes, Challenges At 15 Years

The Lancet: PEPFAR at 15 years
“15 years after then-U.S. President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), … U.S. officials and HIV/AIDS analysts alike still commend its vastly important contributions. Its strategy for the future, they say, offers substantial hope that the global pandemic can be brought under control. Marking PEPFAR’s 15th anniversary in May, U.S. Secretary of State Mike Pompeo described it as ‘money well spent.’ … Ambassador Deborah Birx, U.S. global AIDS coordinator and U.S. special representative for global health diplomacy, told The Lancet that PEPFAR has flourished through three presidential administrations and eight U.S. Congresses, and has made the U.S. government the world’s largest bilateral donor to the global HIV/AIDS response…” (Webster, 7/21).

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Global HIV Epidemic Risks Resurgence Due To 'Dangerous Complacency,' Experts Warn In IAS-Lancet Commission Report

BBC News: ‘Dangerous complacency’ to global HIV epidemic risks resurgence
“Experts said a stalling of HIV funding in recent years was endangering efforts to control the illness. As things stand, the world is no longer on course to end the pandemic by 2030 — a target agreed by U.N. member states, say experts in The Lancet. They call for urgent changes in how the disease is treated and controlled…” (Therrien, 7/20).

Devex: The ‘end of AIDS’ is not even nearly in sight, experts warn
“…[T]he International AIDS Society-Lancet Commission … worked with more than 40 experts to make recommendations on how HIV and global health efforts can be better integrated to improve outcomes in both. The report warns of a possible resurgence of the epidemic and highlights the risks for adolescents and young people, especially girls, in sub-Saharan Africa for whom AIDS is the fourth leading cause of death. The continent’s looming demographic bulge will exacerbate the issue unless action is taken, it adds…” (Edwards, 7/20).

NPR: Report Warns Of ‘Dangerous Complacency’ In The Fight Against HIV
“…The report finds that efforts to prevent the spread of HIV have stalled, in part, because international funding for AIDS has begun to decline. What’s more, a key finding of the report is that ‘the HIV pandemic is not on track to end, and the prevailing discourse on ending AIDS has bred a dangerous complacency and may have hastened the weakening of global resolve to combat HIV’…” (Brink, 7/19).

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Experts Express Concern Polio Eradication Efforts Face Challenges In Final Push

The Lancet: Setbacks in the fight to eradicate polio
“Concern is rising among global health experts that the success of a concerted campaign to eradicate polio worldwide — which has prevented 1,000 children from becoming paralyzed each day — might have stalled as it faces the final hurdles in hard-to-reach and persistent pockets of the world…” (Devi, 7/21).

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MSF Beginning To Close Some Hospitals In Haiti Opened After Earthquake

Miami Herald: Haiti’s maternal mortality rates among the highest. So why is this hospital closing?
“In a country where more women die before, during and after childbirth than anywhere else in the Western Hemisphere, poor women in Haiti with high-risk pregnancies now have one less option for life-saving care. The Geneva-based medical charity, Doctors Without Borders/Médecins Sans Frontières (MSF), has closed down its free, round-the-clock maternity hospital in Haiti’s capital at Delmas 33. … Michelle Chouinard, MSF’s head of mission, said … ‘It’s not MSF’s role to remain indefinitely.’ … The charity’s 122-bed trauma hospital in Tabarre, which receives a large number of head trauma cases and broken bones related to the country’s motorcycle culture, is scheduled to close permanently in June 2019. But other medical facilities run by the charity will remain open…” (Charles, 7/19).

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More News In Global Health

Bloomberg: Ebola Eludes Drug Testing Once More as Outbreak Tapers Off (Fourcade/Kresge, 7/19).

Devex: In South Africa, ATM pharmacies help fill a massive shortfall (Fallon, 7/20).

The Lancet: Changes to dolutegravir policy in several African countries (Nakkazi, 7/21).

SciDev.Net: Brazil suspects leprosy spreads through armadillos (de Oliveira Andrade, 7/19).

Science: On a remote Pacific island, this doctor has revived a 60-year quest to eradicate a disfiguring disease (Enserink, 7/19).

Xinhua News: South Sudan calls on aid agencies to open more humanitarian aid corridors (7/19).

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Editorials and Opinions

IAS-Lancet Commission Explores Key Domains In HIV Response, Advancement Of Global Health In SDG Era

The Lancet: Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission
Linda-Gail Bekker, president of the International AIDS Society (IAS) and deputy director of the Desmond Tutu HIV Foundation, and colleagues on the International AIDS Society-Lancet Commission

“The Sustainable Development Goals (SDGs) have marked a new era in global development … But even in the short time since their endorsement, there are immense and growing challenges to achieving them. The global HIV/AIDS response is not immune to this changing landscape and there are signs that the response is faltering. The International AIDS Society-Lancet Commission will interrogate the following questions: First, what is the future of the HIV response in a more integrated global health and development agenda? How can we bring AIDS to an end in an era in which health and development priorities are proliferating? Second, what have we learned in four decades of battling HIV/AIDS that could inform and strengthen global health more broadly? Third, what are the real threats to global health and to universal health coverage? And finally, what are the ways forward for a more unified movement to ensure sustainable health and development for all? The Commission explores key domains in global health with relevance to HIV, and proposes ways forward for an invigorated and sustainable global health effort” (7/19).

The Lancet: Beyond the silos: integrating HIV and global health
Pamela Das, senior executive editor, and Richard Horton, editor-in-chief, both at The Lancet

“This week, we publish a new International AIDS Society (IAS)-Lancet Commission report: Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals. … [T]his Commission engaged an international group of experts in HIV and across other global health domains to examine the future of the AIDS response in the context of a more integrated global health and sustainable development agenda. The Commission has several key findings. First, the HIV/AIDS community made a serious error by pursuing ‘the end of AIDS’ message. … Second, as the global community revitalizes efforts on HIV, more of the same is not enough. … Third, and perhaps most importantly, it is now time to end the siloed and vertical response to AIDS, and, in the words of the Commission, to ‘make common cause with the global health field.’ … Integration of the AIDS response with broader aspects of global health will be challenging and difficult. But there needs to be leadership. We invite these institutions to reflect on the message of the Commission and consider how to broaden their mandates” (7/19).

The Lancet: HIV: from exceptionalism to endgame
Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

“…The need to revitalize the battle against HIV is one reason HIV programs must be better integrated with initiatives to strengthen the health system as a whole. … The report of the International AIDS Society-Lancet Commission provides powerful insights into how HIV programs can be more effectively integrated into the SDG3 agenda. … I welcome the Commission’s support for continued robust funding of the Global Fund and PEPFAR. Yet the most urgent priority is to increase national funding. While some countries have taken important steps to increase domestic resources, … overall fiscal mobilization for health in many low-income and middle-income countries is dismally short of what will be required to turn SDG3 into a reality. … Ending the HIV epidemic will take more money. Achieving the SDG3 goal of universal health coverage will require even more. We must rediscover the energy and global solidarity that inspired the exceptionalism of the HIV response, expanding its reach to encompass SDG3. We must build people-centered health systems while maintaining laser-like focus on achieving results” (7/19).

The Lancet: Tackling global health inequities in the HIV response
Keletso Makofane and Bruno Spire, both members of the IAS-Lancet Commission, and Phumi Mtetwa of the Masithandane End Hate Crimes Collective and Social Change Initiative

“…Although patterns of HIV risk and burden trace the contours of deeper social inequities within and across countries, the HIV response has yet to develop a common language to use in addressing the unequal distributions of power and the unfair economic arrangements that drive these inequities. … In heralding a new era of global solidarity, the International AIDS Society-Lancet Commission’s report sees in the global health field the potential to re-engineer the development project ‘from one based on charity from the high-income countries to one that tackles the central determinants of global health inequities.’ … The call for a new global solidarity is an opportunity to reflect on these silences and construct something new. If global health is to re-engineer the development project and tackle inequality, can it do so without using the words capitalism and oppression?” (7/19).

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Lancet Editorial, Opinion Pieces Examine Gender Disparities, Access To UHC, Investing In Reproductive Health

The Lancet: Gender and health are also about boys and men
Editorial Board

“…Needed insight into gender is revealed in a new report from the American Psychological Association, which highlights the particular vulnerabilities of racial and sexual minority males who do not experience the same power and privilege typically afforded men in the USA. … Above all, [the report] reminds us that being gender blind benefits neither men nor women” (7/21).

The Lancet: Three global health-care quality reports in 2018
Donald M. Berwick of the Institute for Healthcare Improvement and colleagues

“…Universal health coverage (UHC) is the central thread of Sustainable Development Goal (SDG) 3. However, without improvements in the quality of the health system, UHC will prove an empty vessel and billions of people will not gain from benefits that could arrive from UHC…” (7/21).

The Lancet Global Health: Investing in sexual and reproductive health and rights of women and girls to reach HIV and UHC goals
Manjulaa Narasimhan of the WHO Department of Reproductive Health and Research and colleagues on behalf of participants at the Wilton Park Consultation

“…Supporting countries to implement strategies that enable UHC, including sustainable approaches to advance universal access to integrated sexual and reproductive health and HIV services, must be a priority for the global health community…” (7/18).

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Ahead Of U.N. HLM On NCDs, Lancet Pieces Discuss Recommendations To Accelerate Global Progress On NCDs

The Lancet: Reducing NCDs globally: the under-recognized role of environmental risk factors
Rajiv Chowdhury, principal researcher and associate professor in the School of Clinical Medicine’s Department of Public Health and Primary Care at the University of Cambridge, and colleagues, on behalf of the Research Councils U.K.-CAPABLE Programme on Environmental Hazards and Non-Communicable Diseases

“This month, the WHO Independent High-Level Commission on Non-Communicable Diseases (NCDs) published a set of recommendations to accelerate progress towards achieving the Sustainable Development Goals Target 3.4 for reducing NCDs by 2030. Unfortunately, this globally important report had a major omission: recognizing the detrimental role of environmental risk factors, beyond the conventional behavioral factors (tobacco and alcohol use, physical inactivity, and unhealthy diet), in enhancing global NCD burden and health inequality. … The current WHO report … would benefit greatly by explicitly recognizing the importance of major environmental risk factors — such as toxic chemicals and indoor and outdoor air pollution — in reducing NCD burden, beyond the roles of conventional behavioral risk factors. Such considerations are essential to gain wider sociopolitical support for promoting appropriate legislation to regulate water, food, and air quality; national and regional standards for environmental health protection; and adequate investments towards reducing NCDs attributed to these major global determinants” (7/21).

The Lancet: The how: a message for the U.N. high-level meeting on NCDs
Members of Friends of the U.N. HLM on NCDs

“…The WHO Independent High-Level Commission on NCDs made a number of solid proposals to inform [the U.N. General Assembly High-Level Meeting (HLM) on NCDs] negotiations. … We propose an agenda for member state HLM negotiators. … First, accountability must be assigned at the highest political levels. … Second, improving fiscal policies should be prioritized. … Third, additional financial resources must be mobilized. … Fourth, the commercial determinants of health should be more rigorously regulated. … Fifth, the growing impact of pollution and urbanization on NCDs, injuries, and mental health must be addressed. … Sixth, support should be provided for meaningful civil society engagement. … Seventh, principles of equity, human rights, and gender equality must be upheld. … Finally, independent accountability should be fostered…” (7/21).

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U.N. HLM On TB Provides Opportunity To Address Prison Conditions Fueling TB Epidemic

Inter Press Service: How Prison Conditions Fuel the Tuberculosis Epidemic
David Bryden, TB advocacy officer at RESULTS and co-chair of the TB Roundtable

“…The state of the world’s prisons ensures they are ‘factories’ for TB transmission, including drug-resistant TB — now the single biggest infectious disease killer in the world. Tackling prison conditions, therefore, is essential to ending the disease. … Reducing prison populations and improved nutrition [is] important to this success. … Experts on TB also point to the need for screening and treatment, not only for active TB, but also for latent TB infection, which is very widely prevalent among prisoners, to support better TB prevention. TB preventive therapy, a course of antibiotics, has been proven highly effective but is still not widely used in high-burden countries. … With a strong commitment to finding TB cases, including those hiding in plain sight in prison populations, and support from member states for an independent and regular progress assessment, the [upcoming United Nations High-Level Meeting (UNHLM) on Tuberculosis (TB)] can be a turning point in the drive to end this disease” (7/19).

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From the Global Health Policy Community

MFAN Delivers Statement On U.S. House Passage Of BUILD Act

MFAN: MFAN Co-Chairs Applaud the U.S. House of Representatives for Passage of BUILD Act
In a statement delivered on behalf of MFAN, Co-chairs George Ingram, Tessie San Martin, and Connie Veillette discuss the House passage of the Better Utilization of Investments Leading to Development Act of 2018 (BUILD Act). The co-chairs write, “The legislation would expand U.S. development finance capabilities by establishing a new International Development Finance Corporation (IDFC). Private investment is a key element in unlocking development progress, and joining assistance resources with private finance can expand the universe that advances inclusive economic development. … The MFAN co-chairs urge swift consideration of the BUILD Act in the Senate” (7/18).

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Brookings Blog Posts Address Private Finance, Accountability For SDGs

Brookings Institution: Multilateral Development Banks must mobilize private finance to achieve the SDGs
Mahmoud Mohieldin, senior vice president for the 2030 Development Agenda, United Nations Relations, and Partnerships at the World Bank; Nritya Subramaniam, independent consultant; and Jos Verbeek, manager and special representative to the U.N. and the WTO at the World Bank, discuss how Multilateral Development Banks (MDBs) “will need to form partnerships with the private sector to catalyze private finance for development well into the 21st century.” The blog post is adapted from the authors’ chapter in the news Brookings Press book, “From Summits to Solutions: Innovations in Implementing the Sustainable Development Goals” (7/19).

Brookings Institution: Should not meeting the Sustainable Development Goals get you fired?
Dhananjayan Sriskandarajah, secretary general of CIVICUS, writes, “Successfully implementing the 17 SDGs requires a new way of working with more meaningful multi-stakeholder partnerships. Members of civil society need to play their rightful and multifaceted roles in sustainable development — as campaigners, as generators of data, as implementers, and as innovators. Part of their role is to convince key power-holders — from government officials to business leaders — that they are ultimately answerable to citizens for the delivery of Agenda 2030.” The blog post is adapted from the author’s chapter in the news Brookings Press book, “From Summits to Solutions: Innovations in Implementing the Sustainable Development Goals” (7/17).

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Lancet Global Health Article Proposes New Metric To Measure Population Health, Economic Wellbeing In SDG Era

The Lancet Global Health: Measuring health and economic wellbeing in the Sustainable Development Goals era: development of a poverty-free life expectancy metric and estimates for 90 countries
Carlos Riumallo-Herl, postdoctoral researcher at the Erasmus School of Economics; David Canning, professor in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health; and Joshua A. Salomon, professor at the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University, discuss the link between health and economic development policies in the Sustainable Development Goal era and lack of monitoring tools that measure both health and economic status. The authors “propose poverty-free life expectancy (PFLE) as a new metric that uses widely available data to provide a composite measure of population health and economic wellbeing” (August 2018).

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Lancet HIV Article, Commentary Discuss Harm Reduction Programs For HIV Prevention In Russia

The Lancet HIV: Potential impact of implementing and scaling up harm reduction and antiretroviral therapy on HIV prevalence and mortality and overdose deaths among people who inject drugs in two Russian cities: a modelling study
Javier A. Cepeda of the Division of Infectious Diseases and Global Public Health at the University of California San Diego, and colleagues examined “the effects that scaling up harm reduction (i.e., use of [opioid agonist therapy (OAT)] and coverage of [needle and syringe programs (NSPs)]) and use of [antiretroviral therapy (ART)] might have on HIV incidence and the frequency of fatal overdoses among [people who inject drugs (PWID)] in two cities in the Ural Federal District and Siberian Federal District, where the prevalence of HIV is high or increasing in PWID.” The authors conclude, “Legalization of OAT and increased use of ART and NSPs for PWID are urgently needed to prevent HIV and fatal overdose among PWID in Russia” (7/19).

The Lancet HIV: Access to opioid agonist therapy in Russia: time for reform
In an accompanying editorial, Alexei Zelenev of the Yale School of Medicine AIDS Program, discusses the report from Javier Cepeda and colleagues, writing, “Although compartmental models, such as the one by Cepeda and colleagues, provide a useful insight into the scaling up of interventions to treat HIV, further studies are needed to guide HIV prevention efforts in Russia and globally. … A commitment to support and expand harm reduction programs, including OAT, is a crucial step in the right direction. Without policy reform and commitment, Russia’s current prospects for stopping the HIV epidemic appear bleak” (7/19).

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Paper Examines Intersections Of Global Health Policy, International Relations Theory

Global Public Health: Engagement or dismissiveness? Intersecting international theory and global health
Independent scholar Nathan Paxton and Jeremy Youde of the Department of International Relations at the Australian National University “argue that drawing on insights from classic and contemporary international theory more explicitly will positively augment the study of global health politics. This paper highlights four major theoretical orientations in the international relations literature (realism, neoliberal institutionalism, constructivism, and feminism) and discusses how an understanding of these perspectives can strengthen our understanding of global health policy” (7/19).

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From the U.S. Government

White House Press Secretary Delivers Statement On BUILD Act

White House: Statement from the Press Secretary on H.R. 5105/S. 2463, the Better Utilization of Investments Leading to Development (BUILD) Act of 2018
“The Administration supports H.R. 5105/S. 2463, the ‘Better Utilization of Investments Leading to Development (BUILD) Act of 2018,’ which would consolidate the Overseas Private Investment Corporation (OPIC) and other development-finance programs into a reformed United States International Development Finance Corporation (USDFC). This action will catalyze market-based, private-sector development and economic growth in less-developed countries and advance the foreign policy interests of the United States…” (7/17).

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CDC's MMWR Recognizes World Hepatitis Day, Highlights Report On Access To Hepatitis B Treatment Worldwide

CDC’s “Morbidity and Mortality Weekly Report”: World Hepatitis Day — July 28, 2018
“World Hepatitis Day is commemorated each year on July 28 with the goal of promoting awareness and inspiring action to prevent and treat viral hepatitis. … This issue of MMWR features a report on progress toward access to hepatitis B treatment worldwide. Overall, hepatitis B treatment coverage is low among countries in all income strata. Increased awareness of, access to, and availability of affordable diagnostics, and training of health care providers might increase access to treatment” (7/20).

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