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Kaiser Daily Global Health Policy Report

In The News

WHO Committee Declines To Label DRC Ebola Outbreak As International Emergency

Associated Press: U.N. says Congo’s Ebola outbreak not yet a global emergency
“The ongoing Ebola outbreak in Congo does not yet warrant being declared a global emergency but is of ‘deep concern,’ the World Health Organization said Friday. Following a meeting of its expert committee, the U.N. health agency called for efforts to be redoubled to stop the deadly virus, noting that the recent spike in Ebola cases raises the risk of spread to other countries…” (Cheng/Keaten, 4/12).

CIDRAP News: WHO experts: Ebola in DRC still not global emergency
“… ‘Although we have great concern about rising numbers in some regions, the outbreak has not spread internationally over many months,’ said Robert Steffen, PhD, the head of the committee, during press conference. ‘There is no added benefit to [a Public Health Emergency of International Concern (PHEIC) declaration], as excellent work is being done on the ground by WHO and its partner organizations’…” (Soucheray, 4/12).

The Hill: WHO declines to designate Ebola outbreak as international emergency
“…WHO Director-General Tedros Adhanom Ghebreyesus said Friday that he had accepted the conclusions of an advisory emergency committee, meeting here at WHO’s world headquarters, which decided the outbreak had not yet reached the level of international concern…” (Wilson, 4/12).

New York Times: As Ebola Cases Rise in Congo, the WHO Declines to Issue Emergency Declaration
“…This is the second time since the outbreak began last year that the WHO has declined to issue such a declaration. The first was in October. Some researchers have urged the organization to do so for months; such pronouncements are reserved for epidemics that pose a serious threat to public health and could spread internationally. A global health emergency, they argue, would bring more money and international help to stamp out the disease…” (Grady, 4/12).

Science: Ebola outbreak in Congo still not an international crisis, WHO decides
“…Some public health experts believe WHO needed to take the dramatic step in order to draw greater attention — and funding — to fighting the DRC Ebola outbreak, which is centered in two conflict-ridden provinces the country’s northeast. Cases began to surface in August 2018, and the outbreak is now second in size only to the massive Ebola epidemic that devastated three West African countries between 2014 and 2016…” (Cohen, 4/12).

U.N. News: Ebola not an international ‘health emergency’ but risks spreading across DR Congo border, warns U.N. health agency
“…Because there is a very high risk of regional spread, the committee said that neighboring countries should continue to accelerate preparedness and surveillance, including vaccinating health care and front-line workers in surrounding countries. The Emergency Committee recommended that cross-border collaboration be strengthened, including through the timely sharing of Ebola data and alerts; community engagement; and awareness raising. Moreover, work should be done to better map population movements and understand the community networks which bridge national boundaries. The committee maintained its previous advice that no international travel or trade restrictions should be applied…” (4/12).

Additional coverage of the WHO’s decision is available from Agence France-Presse, Al Jazeera, Associated Press, Axios, BBC News, CNN, Healio, Nature, Reuters, Science Speaks, STAT, The Telegraph, VOA News, Vox, Washington Post, and Washington Times.

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Health Care Workers In DRC Ebola Outbreak Continue To Face Attacks; Experimental Vaccine Shows Success

STAT: The data are clear: Ebola vaccine shows ‘very impressive’ performance in outbreak
“The experimental Ebola vaccine being used to try to contain the outbreak in the Democratic Republic of the Congo is protective 97.5% of the time, according to new data released by the World Health Organization on Friday. The data — the first to be released on how the vaccine is working in the outbreak — suggest a ‘very impressive’ performance by the vaccine, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, who reviewed the report for STAT…” (Branswell, 4/12).

Wall Street Journal: In New Ebola Outbreak, Health Care Workers Come Under Attack
“…Ebola is on the rise in Congo’s mineral-rich borderlands, killing 803 people and infecting 1,251 over the past nine months. Stopping the spread of the disease has become a formidable challenge. Health care workers have found themselves deliberately targeted — both by militias that have ravaged the area for nearly 25 years and by locals who think they’re part of a Western plot. … Many locals don’t understand why Ebola is attracting so much attention and resources when hundreds die each year of more common illnesses such as malaria or diarrhea…” (Steers et al., 4/14).

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Ivanka Trump Visits Ethiopia To Promote Women's Global Development And Prosperity Initiative

Associated Press: Ivanka Trump promotes women’s empowerment in Ethiopia
“Far from the din of Washington, Ivanka Trump toured businesses run by women in Ethiopia on Sunday while promoting a White House global economic program for women. President Donald Trump’s daughter and senior adviser visited a coffee shop and textile company in Addis Ababa. It was her first stop in Africa on a four-day trip to Ethiopia and Ivory Coast on behalf of a White House project intended to boost 50 million women in developing countries by 2025. … This is Ivanka Trump’s first visit to Africa since the president launched the Women’s Global Development and Prosperity Initiative. It’s a program she hopes will outlast an administration better known for ‘America First’ isolationism…” (Lucey, 4/14).

Additional coverage of Ivanka Trump’s four-day visit to Africa is available from BBC News, CNN, Fox News, The Hill, Reuters, and VOA News.

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Devex Examines David Malpass's First Week As World Bank President

Devex: From critic to cheerleader — David Malpass’ first week at the World Bank
“The World Bank Spring Meetings, which concluded on Sunday, might have lacked the policy significance that accompanied last year’s negotiations over the terms of the institution’s capital increase, but they did offer something else: a first glimpse of David Malpass as the bank’s president…” (Edwards/Igoe, 4/15).

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Food Security, Disease Prevention Remain Concerns In Southeastern African Nations 1 Month After Cyclone Idai

New Humanitarian: Stolen by the storm: farms and food for Mozambique
“…Government figures estimate that some 715,000 hectares of crops were flooded or destroyed in all of Mozambique. More than 75,000 people in the Sofala province and Manica will soon receive agricultural kits containing mature seeds and equipment. Farmers in these two provinces alone produce approximately 25 percent of the national cereal output. While more than 4,000 cases of cholera and seven deaths have been reported from the disease, health officials are also concerned about a rise in malaria due to the standing water…” (De Vleeschauwer, 4/12).

Reuters: Cyclone Idai’s death toll over 1,000, hundreds of thousands displaced
“…More than 1,000 people have been reported killed by the storm, the flooding it caused, and heavy rains before it hit. The World Bank estimates the affected countries will need over $2 billion to recover. Following is an outline of the disaster, according to government and U.N. officials…” (Rumney, 4/15).

U.N. News: Cholera surges, children in urgent need one month after Cyclone Idai slammed southern Africa — UNICEF
“One month after Cyclone Idai devastated parts of Mozambique, Malawi, and Zimbabwe, the United Nations Children’s Fund (UNICEF) appealed to the international community to help some 1.6 million children still reeling from its impact. … Since the cyclone hit Mozambique, cholera has surged to 4,600 cases and malaria to 7,500 cases. UNICEF said that any prolonged interruption to essential services could lead to disease outbreaks and spikes in malnutrition — where children are especially vulnerable…” (4/13).

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Governments, Civil Society Push For Improved Transparency, Affordable Prices For Medicines At WHO Fair Pricing Forum

Health Policy Watch: WHO-led Fair Pricing Forum Gathers Diverse Groups To Improve Drug Access
“A diverse group of civil society, industry, and government representatives convened [Thursday] at the WHO-led 2nd Fair Pricing Forum in Johannesburg, South Africa, in the quest for new solutions that can unlock people’s access to desperately needed drugs at more affordable prices. The two-day meeting, co-sponsored with South Africa and involving some 30 countries and 40 industry and nonprofit groups, comes at a time when the debate over drug access has become increasingly polarized…” (Fletcher, 4/11).

U.N. News: Greater transparency, fairer prices for medicines ‘a global human rights issue,’ says U.N. health agency
“… ‘This is a global human rights issue,’ said WHO Assistant Director-General for Medicines and Health Products Mariângela Simão on Saturday at the WHO Forum on Medicines in Johannesburg. ‘Everyone has a right to access quality health care.’ … Industry bodies at the forum supported access to medicines for all, and recommitted to the 2030 Agenda for Sustainable Development, which calls for private partnerships to address global challenges, such as access to medicines. WHO announced that over the coming weeks, it will launch a public consultation online to collect views from relevant participants on what actually constitutes a fair price” (4/14).

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Climate Change Could Influence Spread Of Diseases, Antimicrobial Resistance In Europe, Scientists At Clinical Microbiology Meeting Say

The Guardian: Europe at risk from spread of tropical insect-borne diseases
“Insect-borne diseases such as dengue fever, leishmaniasis, and encephalitis are on the rise and are now threatening to spread into many areas of Europe, scientists have warned. Outbreaks of these illnesses are increasing because of climate change and the expansion of international travel and trade, the European Congress of Clinical Microbiology and Infectious Diseases was told in Amsterdam on Saturday…” (McKie, 4/14).

Newsweek: Climate Change Could Worsen Antimicrobial Resistance Threat, Scientists Predict
“…Antibiotic resistance, a subset of antimicrobial resistance, is one of the ‘biggest threats to global health, food security, and development today,’ the World Health Organization has said. The authors of a study presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) say global warming could also play an important role. The study has not yet been published in a peer-reviewed journal…” (Gander, 4/13).

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Website, Photo Gallery Document Global Menstrual Health Research, Products

The Guardian: Cloth, cow dung, cups: how the world’s women manage their periods
“…Basic necessities for dealing properly with menstruation, such as access to clean water or a decent toilet, are simply unavailable to millions of women and girls. Without these services, menstruation can negatively affect women’s health as well as their involvement in social and economic activities, says Louisa Gosling of WaterAid, which has published a photo gallery detailing the various ways women around the world manage their periods…” (Hodal, 4/13).

Washington Post: Tracking a sensitive topic: Menstrual health in women
“…According to UNICEF, at least 500 million women and girls worldwide lack adequate facilities for managing menstruation. And comfortable, effective menstrual supplies aren’t available to everyone with a period. People who care about ­menstrual health management want to change that. And the International Menstrual Health Entrepreneurship Roundup ­(IMHER) is tracking their efforts. The new website, developed by Dartmouth College’s Global Girls Forward Lab, is an information hub created by a research team with no financial stake in menstrual health…” (Blakemore, 4/13).

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More News In Global Health

Associated Press: In South Sudan, midwives bring down deaths despite the odds (Mednick, 4/13).

Borgen Magazine: The World’s Largest Refugee Camp: Life in Cox’s Bazar (Dunphey, 4/15).

Forbes: Here Is A Major Soil Problem That Will Affect Health (Lee, 4/14).

Fox News: Madagascar measles epidemic kills over 1,200 people (Aaro, 4/14).

Homeland Preparedness News: International research team creates Middle East Respiratory Syndrome vaccine (Galford, 4/12).

New York Times: Melinda Gates on tech innovation, global health and her own privilege (Marchese, 4/14).

The Telegraph: One in ten suffer chronic illness as air pollution in Nepal soars (Wallen, 4/14).

Wall Street Journal: WhatsApp Users Spread Antivaccine Rumors in India (Purnell, 4/13).

Xinhua News: Tanzania making progress in fight against HIV/AIDS (4/15).

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Editorials and Opinions

U.S. Should Reform Approach To Humanitarian Assistance, Recognize Links Between Refugee Response, Development, Security, Opinion Piece Says

The Hill: Now is the time to reform U.S. humanitarian assistance, refugee response
Daniel Runde, senior vice president and William A. Schreyer chair in global analysis at the Center for Strategic and International Studies

“…U.S. policy for refugee response has historically been a benchmark globally; however, our policies, divisions of responsibility, and strategies do not reflect the evolving forced displacement landscape. Now is the time to reform the system to connect humanitarian response with development and security, delineate lines of responsibility, and to recognize the modern realities. Congress has a chance to both improve humanitarian aid delivery and to maintain focus on the linkages between refugee issues and larger foreign policy. A new Bureau of International Humanitarian Assistance (IHA) within USAID could better coordinate overall refugee response and assistance, making it more effectual and efficient, while empowering the State Department to better focus on higher level foreign policy and diplomatic strategy related to refugees. … [The Bureau of Population, Refugees, and Migration (PRM)] should remain at State, focused on policy, diplomacy functions. The humanitarian response programming for refugees should move to USAID. … PRM as a bureau should be protected. But consolidating humanitarian assistance delivery within USAID and scaling its budget to reflect modern elevated need will better serve the millions of people in need globally” (4/14).

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Opinion Piece Explores Potential Reasons For Prevalence Of Vaccine Hesitancy

The Guardian: As Ebola kills in Africa, in the west lies over vaccines beguile the complacent
Mark Honigsbaum, medical historian and author

“…[F]rom New York’s Brooklyn to Camden in north London to Kivu in the Democratic Republic of the Congo, vaccines are in retreat, shunned by populations who seemingly have little sense of the risks they are running with their own or other people’s lives. Why this should be so is one of the conundrums of our age. Is it all the fault of social media and anti-vax propaganda that has taken root on Facebook, Twitter, and YouTube? Or has society grown complacent about the risks that infectious diseases posed to previous generations, when it was common for children to be paralyzed by polio or rendered deaf or brain-damaged by measles? … Although it is difficult to gauge the impact of Facebook and Google on all this, the suspicion is that social media has skewed the game in favor of anti-vaxxers. But surely that is only part of the story. … What is surprising and demands more explanation is the persistence of these fears in the face of overwhelming scientific evidence that vaccination is a boon to health and, for the most part, safe. Perhaps the phenomenon is best explained by our own hubris. With no experience of the childhood diseases that shortened or blighted our grandparents’ lives, much less tropical diseases such as Ebola and malaria, we have forgotten that it is only because of vaccines and other medical advances that we no longer need fear infectious disease…” (4/14).

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Gene Editing, Experiments Involving Human Subjects Must Undergo Thorough Review Process

STAT: He Jiankui, embryo editing, CCR5, the London patient, and jumping to conclusions
Henry T. Greely, professor at Stanford University

“When He Jiankui announced the birth of twin girls whose DNA he had modified when they were embryos using the CRISPR gene-editing tool, he justified his actions on the ground that he had given the two girls lifetime immunity from HIV infection. The Chinese scientist claimed that he had altered a gene called CCR5, which allows the AIDS-causing virus to infect an important class of cells in the human immune system. Not only was He ethically wrong in doing this work, but its scientific basis was even weaker than generally recognized. … Many scientific commentators, as well as He himself, quickly jumped at the idea that people without functioning CCR5 proteins cannot become HIV infected. That’s not correct. … There is good evidence that the absence of functional CCR5 proteins is not completely protective against HIV. … Would a serious advance review of He’s experiment have caught this issue? I can only hope so. It certainly should have if the reviewing group included expertise in HIV infection and not just in CRISPR editing. This is a crucial lesson in the importance of a probing prior review before any experiment involving human subjects and especially before any first-in-human experiment. It is also a sobering lesson … about retrospective review of such experiments. Nature is complicated, viruses are tricky, assumptions are dangerous…” (4/15).

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From the Global Health Policy Community

Global Health Organizations Urge Congress To Maintain 33% Global Fund Match In Letter To Senate, House Appropriations Subcommittees

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria: Global Health Community Sends Letter to Congress on Global Fund Match
“[On Friday], Friends led a coalition of 40 organizations in sending a letter to the Chair and Ranking Members of the Senate and House Appropriations Subcommittees for State and Foreign Operations. The letter thanks Senator Graham (R-S.C.), Senator Leahy (D-Vt.), Representative Lowey (D-N.Y.), and Representative Rogers (R-Ky.) for their leadership in support of the Global Fund. The letter also expresses concern regarding a proposal in the President’s FY20 budget that seeks to reduce the U.S. contribution to the Global Fund from 33 percent to 25 percent and asks the congressional leaders to ensure the match remains at 33 percent…” (4/12).

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MSF, Georgetown University Experts React To WHO Decision To Not Declare DRC Ebola Outbreak Global Emergency

Médecins Sans Frontières: MSF: Ebola epidemic not under control, urgent change of strategy needed
“The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) made the following statement after the World Health Organization decided [on Friday] to not declare a Public Health Emergency of International Concern for the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC). … ‘Whatever the official status of this outbreak is, it is clear that the outbreak is not under control and therefore we need a better collective effort. The virus has not spread to neighboring countries so far, but the possibility exists. What is most important now if we want to gain control of this epidemic is to change the way we are dealing with it,’ [said Gwenola Serouz, emergency manager at MSF]…” (4/12).

Georgetown University Medical Center: Georgetown Global Health Experts in Infectious Disease Available to Comment on WHO PHEIC Meeting
“[On Friday], World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus, on the recommendation of the Emergency Committee, declined to declare the Ebola outbreak in the Democratic Republic of Congo a Public Health Emergency of International Concern (PHEIC). Global health security expert Rebecca Katz, [director of the Center for Global Health Science and Security at Georgetown University and an associate professor of microbiology and immunology,] and global health legal and policy expert Alexandra Phelan, [faculty instructor in Georgetown’s Center for Global Health Science and Security and adjunct professor at Georgetown Law,] both express disappointment about the decision…” (4/12).

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FT Health Discusses UNFPA's Latest Annual Report, Features Interview With UNICEF Executive Director

FT Health: The struggle for women’s rights
The latest issue of the Financial Times’ weekly global health newsletter discusses results from UNFPA’s latest annual report, which provides an overview of global progress on women’s access to contraception and sexual and reproductive health and rights, as well as features an interview with Henrietta Fore, executive director at UNICEF, who discusses a recently published report on the state of water supplies and sanitation in health care centers. The newsletter also provides a round-up of global health-related news stories (Jack/Dodd, 4/12).

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Johns Hopkins Bloomberg School Of Public Health's Center For Health Security Releases 2018 Annual Report

Johns Hopkins Bloomberg School of Public Health’s Center for Health Security: Twentieth Anniversary Annual Report 2018
Johns Hopkins Bloomberg School of Public Health’s Center for Health Security released its 2018 annual report. The report details the center’s efforts to enhance research and analysis on major domestic and international health security issues, including emerging infectious diseases and pandemic flu; biosafety and biosecurity; medical and public health preparedness and response; global catastrophic biological risks; community resilience; disease surveillance; risk communication; advanced science research; policies on medicines, vaccines, and diagnostics; and science diplomacy (April 2019).

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