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Kaiser Daily Global Health Policy Report

In The News

CDC Sends 12 Employees To DRC's Goma After City Records Additional Ebola Cases; Security Issues Hamper More Robust U.S., WHO Response; Questions Raised Over World Bank's Pandemic Bonds

Associated Press: 1-year-old daughter, wife of Congo’s Goma victim have Ebola
“The wife and 1-year-old daughter of the man who died of Ebola in Goma this week have tested positive for the disease, health officials confirmed Thursday, the first transmission of the virus inside the densely populated crossroads city on the border with Rwanda, a scenario that health experts have long feared…” (Mwanamilongo/Ssuuna, 8/1).

Devex: WHO calls for return to basics to fight DRC Ebola crisis
“The ongoing Ebola response in the Democratic Republic of the Congo requires a review of the basics to prevent the crisis from escalating, World Health Organization experts said on Thursday at a press briefing in New York. … [I]mproved core response techniques, such as proper surveillance and monitoring systems, are still needed to boost vaccination rates and treat all infected people, [David Gressly, WHO’s Ebola emergency response coordinator,] explained. Timely delivery of funding and a coordinated effort, beyond the work of WHO, are also key, Gressly said, noting that ‘this is no longer a WHO-led effort. All of the agencies that have something to contribute have come together’…” (Lieberman, 8/2).

The Hill: Ebola outbreak highlights global rise in epidemics
“…[The DRC Ebola] outbreak — which as of Wednesday had infected more than 2,700 people and killed two-thirds of them — is just one of a troubling spread of viral epidemics happening around the world. Some say the spread of preventable diseases is a worrying trend in a turbulent world, in which public health is among the first victims of both crumbling institutions and popular mistrust of expert opinion…” (Wilson, 8/1).

NBC News: Fear, violence and distrust hamper U.S. involvement in Ebola outbreak
“Ongoing violence, community resistance, and mistrust of health care workers are hampering efforts by the U.S. government to send a robust team of experts to the Democratic Republic of Congo to assist in the Ebola outbreak that has now been raging for a year. … ‘We’re anxious to get on the ground in the outbreak areas, but there are security concerns,’ Dr. Henry Walke, director of the CDC’s division of preparedness and emerging infections, told reporters on a conference call Thursday. … Walke said the CDC plans to double the number of staff in Congo over the next month, but is watching the security situation closely…” (Edwards, 8/1).

Reuters: Pandemic bonds face scrutiny after Ebola outbreak yet to trigger payout
“World Bank funding instruments issued to help emerging countries swiftly tackle pandemics have come under the spotlight after the latest deadly Ebola outbreak has yet to trigger a payout. … Payouts are triggered once a virus outbreak crosses an international border and claims at least 20 lives in each of at least two countries. The virus has killed more than 1,800 people in Democratic Republic of Congo and two in neighboring Uganda — meaning the threshold for payouts have not been reached. … [Michael Bennett, head of derivatives and structured finance at the World Bank’s capital markets division,] said the pandemic facility had been very specifically designed to insure against cross-border events rather than single-country outbreaks. But with the instruments due to mature next summer, the bank is examining possible changes to the structure, for instance, seeking out a cost-efficient way of insuring single-country events, he said…” (Strohecker, 8/1).

VOA News: CDC Sends More Ebola Staffers to Congo Border
“…Twelve CDC employees will go to Goma, a major transit city near the Congolese border with Rwanda. … CDC Director Dr. Robert R. Redfield said Thursday on Twitter that armed conflict was hampering health officials’ attempts to manage the outbreak, ‘increas[ing] the risk of disease spread.’ … The CDC said it is working with the U.S. State Department to determine if it is safe to send more U.S. health workers to areas outside Goma…” (Kasereka/Muhero, 8/1).

Additional coverage of the DRC Ebola outbreak and response is available from Associated Press, Axios, Bloomberg, The BMJ, CIDRAP News, CNN, Deutsche Welle, The Economist (2), The Hill, New Humanitarian, Newsweek, New York Times, PRI, Reuters (2), The Telegraph, VOA News, Washington Times, and Xinhua News.

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Devex Examines Increase In Number Of DFID's Joint Ministers

Devex: What does the increase in joint ministers mean for DFID? Experts weigh in
“As the dust settles in Westminster after last week’s leadership change, the U.K. Department for International Development is still standing but has undergone a major ministerial overhaul — including the appointment of its first-ever joint minister with the Department for Environment, Food & Rural Affairs, meaning that three out of DFID’s five ministers now work jointly with another department. … While the number of joint ministers has been increasing across government in recent years, it is unusual for a department to have more joint than sole ministers, according to Gavin Freeguard from the Institute for Government…” (Edwards, 8/2).

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Syrian Government Agrees To Conditional Ceasefire In Rebel-Controlled Area After U.N. Authorizes Investigation Into Attacks On Health Facilities

Associated Press: Syria says it agrees to cease-fire in rebel stronghold
“Syria’s government said it has agreed to a conditional cease-fire starting late Thursday in northwestern Syria, according to state media. Government troops and allied Russia warplanes have been carrying out a three-month offensive against the rebel’s last stronghold, which has displaced hundreds of thousands and has targeted health facilities and other infrastructure. The decision came hours after U.N. Secretary-General António Guterres authorized an investigation into attacks on health facilities and schools in the rebel-held enclave, following a petition from 10 members of the U.N. Security Council…” (Aji/Lederer, 8/1).

Washington Post: U.N. to investigate accusations that Russia, Syria are deliberately targeting hospitals
“The United Nations has ordered an investigation into a surge of Russian and Syrian airstrikes against hospitals and clinics in northwestern Syria amid growing concerns that Russia is using U.N.-supplied data to deliberately target medical facilities. U.N. Secretary General António Guterres authorized the inquiry Thursday after pressure from U.N. Security Council members and human rights groups to do more to establish why health facilities and other civilian infrastructure such as schools and rescue services are being hit so frequently in the recent fighting…” (Sly, 8/1).

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Humanitarian Crisis In Northeast Nigeria Continues 10 Years After Start Of Violent Insurgency; U.N., Aid Partners Urge Increased Efforts

U.N. News: Ten years on, crisis in Nigeria ‘far from over’; U.N. and humanitarian partners urge support for millions still affected
“Ten years after the start of a violent insurgency in north-east Nigeria plunged the country into a humanitarian crisis that is ‘still far from over,’ the United Nations and its aid partners have underscored the need to ‘collectively redouble efforts’ to help the most vulnerable…” (8/1).

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Science Publishes 'CRISPER In China' Series Of Articles With Support From Pulitzer Center

Science: Did CRISPR help — or harm — the first-ever gene-edited babies? (Cohen, 8/1).

Science: The untold story of the ‘circle of trust’ behind the world’s first gene-edited babies (Cohen, 8/1).

Science: China’s CRISPR push in animals promises better meat, novel therapies, and pig organs for people (Cohen, 7/31).

Science: To feed its 1.4 billion, China bets big on genome editing of crops (Cohen, 7/29).

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More News In Global Health

BBC News: Kenyan survivors: Cancer is ‘national disaster’ (8/1).

The Economist: A history of humankind’s enemy number one (8/1).

The Guardian: Running dry: the water crisis driving migration to the U.S. (Lakhani, 8/1).

The Lancet: Honduras’s worst dengue outbreak in 50 years (Alves, 8/3).

The Lancet: North Korea ‘on the verge of a food crisis’ (Devi, 8/3).

MedPage Today: WHO Report Casts Shadow on Global Anti-HIV Fight (Walker, 7/31).

New York Times: Vas Narasimhan of Novartis: ‘We Are Not at All Prepared for a Pandemic’ (Gelles, 8/1).

New York Times: In Zimbabwe, the Water Taps Run Dry and Worsen ‘a Nightmare’ (Kingsley et al., 7/31).

Reuters: Philippines weighs re-use of controversial dengue vaccine (Lema, 8/2).

SciDev.Net: Childhood cancer claims 7 million years of life in poorer nations (Vesper, 8/2).

The Telegraph: Could an army of female ‘tele-medics’ solve Pakistan’s chronic doctor shortage? (Farmer, 8/31).

Thomson Reuters Foundation: New taskforces to tackle ‘missing wombs’ scandal in rural India (Srivastava, 8/2).

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Editorials and Opinions

Editorial, Opinion Pieces Discuss DRC's Ebola Outbreak, International, Local Responses

Bloomberg: Congo’s Ebola Outbreak Isn’t Just Congo’s Problem
Editorial Board

“…President Donald Trump has failed to respond [to the Ebola outbreak] with urgency. … If [the] possibility [of Ebola spreading throughout Africa] is unpersuasive, there’s also a risk to the U.S.: Regional turmoil is enlarging the trickle of refugees from Congo showing up at the southern border. The U.S. should lift restrictions on aid … and help CDC deploy its skills. It should spur a new global effort — partnering for this purpose with China, Congo’s biggest foreign investor. To be sure, this emergency presents severe difficulties. … This underlines the need to combine an effective emergency response with stronger pressure for political reform and better government. Greater support for the U.N.’s peacekeeping mission would help; the administration’s reflexive effort to wind it down will not. … The U.S. can’t solve Congo’s problems, but it can’t afford to ignore them, either” (8/1).

New Humanitarian: We can’t stop Congo’s Ebola outbreak until communities lead the response
Amy Daffe, deputy country director for Mercy Corps in the Democratic Republic of Congo

“…We are only going to succeed in stopping the expansion of this epidemic by treating the communities as partners … We need to engage local leadership, including local chiefs, and bring community groups on board with community conversations targeting caretakers and groups vulnerable to the virus, and train them on the use of education materials, early warning mechanisms, and conflict rumor resolution. We know that Ebola is endemic in Congo. The systems and awareness we establish now will not only saves lives currently but also in the years to come. Only when communities are at the forefront of the response — with preparation, training, tools, support, and funding — will we be able to end this epidemic” (8/1).

The BMJ: Ebola in the Democratic Republic of the Congo: time for visionary political leadership
Giuseppe Ippolito, scientific director at the National Institute for Infectious Diseases Lazzaro Spallanzani, and colleagues

“… [L]ocal communities’ distrust of national authorities, aid groups, and U.N. peacekeepers is a continuing challenge. … In Africa, it seems that responsive public health systems are difficult to sustain unless long-term political commitment and planning, combined with adequate financial resources, are taken on board by countries with the help of global public health bodies. Right now, the situation in the DRC needs WHO, Africa CDC, WHO AFRO, USAID, DFID, the European Commission, and other donor agencies, together with national and regional decision makers, to engage effectively with community leaders to ensure that the trust of the population is gained” (8/2).

Deutsche Welle: Opinion: Ebola in Congo — incompetence, mistrust and greed
Dirke Köpp, head of DW’s French service for Africa

“This Thursday mark[ed] a sad anniversary. One year ago, on August 1, 2018, the Ebola epidemic broke out in the Democratic Republic of Congo (DRC). … Although there is considerable aid from abroad, the Congolese government has shown little interest in helping those of its citizens affected by the virus. … However, the people living in the regions affected by Ebola are also contributing to the failure to bring the outbreak to an end. Many are poorly educated, and distrust modern medicine and the foreigners who have come to help. … Many of the country’s decision-makers are also poorly educated and not sufficiently informed in order to do their role justice. … It’s regrettable that the World Health Organization took such a long time to declare an international emergency, waiting until mid-July, almost a year after the outbreak began…” (8/1).

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Commitment To UHC Vital To Preventing Childhood Pneumonia, Ensuring No Child Left Behind

The Telegraph: Fighting for breath: how we can win the battle against childhood pneumonia
Tedros Adhanom Ghebreyesus, Director General of the WHO, and Kevin Watkins, chief executive of Save the Children U.K.

“…[T]he most potent antidote to the ongoing crisis in child pneumonia can be summarized in three words: universal health coverage (UHC). Too many cases of pneumonia go untreated or are misdiagnosed because health systems do not provide access to effective and affordable care. … Later this year, the United Nations will convene a meeting of world leaders aimed at galvanizing action to drive progress on UHC. Increased public spending on health, and more efficient use of resources, are critical. … No country is too poor to embrace a commitment to universal health coverage, but the poorest countries will need support from aid donors to achieve it. The bad news is that development assistance for health is stagnating. When governments adopted the Sustainable Development Goals three years ago they pledged that by 2030, no child would die from a preventable disease, and that none would be left behind in pursuit of that goal because they were born poor. The battle against childhood pneumonia is a test of our collective intent to honor that pledge. This is a battle that we are losing. But with universal health coverage it is a battle we can — and must — win. The world’s most deprived children have a right to nothing less” (8/1).

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Opinion Piece Outlines 4 Actions New UNAIDS Leader Should Take To Address HIV/AIDS

The Lancet: Leading UNAIDS: a once-in-a-generation challenge?
Jamila Headley, managing director of the Health Global Access Project (Health GAP), and colleagues

“…The U.N. secretary general must embolden the AIDS response with a new UNAIDS leader who will reinvigorate the organization and position the AIDS crisis against the backdrop of other pressing priorities captured in the Sustainable Development Goals. First, the new leader must close the gap in political will and funding. … Second, he or she must partner with people living with and affected by HIV, key populations, and young people to deliver tailor-made technical, social, and political strategies for these communities. Third, he or she must lead transformations in legal and policy environments despite opposition — removing harmful laws, including those that criminalize some of the most affected populations, and accelerating uptake of evidence-based policy. Fourth, the new leader must lead the cultural and institutional changes needed at UNAIDS to address abuse of power and establish accountable leadership. We know the shortlist. Now the secretary general must ask who has the skills and experience to reform UNAIDS, to work with multiple governments, U.N. agencies, civil society, and communities, and to get the AIDS response back on track” (8/3).

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Canada Must Step Up Efforts, Increase Investments In Global Fund

Globe and Mail: Is Justin Trudeau serious about ending the AIDS crisis?
Loyce Maturu, advocacy officer at Africaid Zvandiri and Global Fund Advocacy Network speaker

“…Over the years [Canadian Prime Minister Justin] Trudeau has shown true leadership in the response to HIV, TB, and malaria and has kept his promise of saving lives. However, he is about to break that promise. I am afraid he will stop the acceleration and stall Canada’s efforts in the fight against AIDS, TB and malaria. The Global Fund asked Canada to commit $925 million to help support the fight against these diseases for the next three years. If Canada meets that request, they will be able to help save 16 million lives. But now, we hear that Mr. Trudeau and Maryam Monsef, [Canada’s] minister for women and gender equality and minister of international development, are considering giving $804 million, a so-called ‘flat pledge.’ The same investment as in 2016 is not enough. Canada should not let its efforts stall now. … Stepping up the fight against AIDS, TB, and malaria should not be seen as a choice, but as the fulfillment of a promise. … We are at a critical moment when the minimum will not be enough to prevent us from sliding back deeper into crisis. We need Canada to increase its investment, like other countries have already done…” (8/1).

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Development Community Should Be Both Optimistic, Pessimistic About Global Development Progress, Opinion Piece Says

The Hill: Optimists and pessimists on global development
Homi Kharas, interim vice president and director of the Global Economy and Development program at the Brookings Institution

“…Progress is not [a] sufficient reason to be satisfied. It has to be both sustainable and rapid enough to meet the targets. … Against this backdrop, the United Nations recently hosted a high-level political forum on progress towards the [Sustainable Development Goals (SDGs)], with an emphasis on the financing needed to accelerate change. There, … the mood was serious. There is a growing realization that accelerating change will require more funding in the neediest places, and that this additional funding is not yet forthcoming. … Should we be optimists or pessimists? Probably both. Celebrate success for the very real gains that have been achieved. Worry about the sustainability of those gains, the slowness of progress in the poorest parts of the world, and the seeming inability of donors to respond to the challenges of global poverty in a responsible fashion” (8/1).

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From the Global Health Policy Community

Chicago Council Post Discusses USAID's Restructuring, Implications For USAID's Work On Food Security, Development, Conflict Prevention, Stabilization

Chicago Council on Global Affairs’s “Global Food for Thought”: USAID’s Reorganization: Focusing on Self-Reliance and Stability
Kat Sisler, intern for government relations at the Chicago Council, discusses USAID’s Journey to Self-Reliance approach to development and provides an overview of the agency’s new structure. Sisler writes, “The three new Bureaus [– the Bureau for Resilience and Food Security, Bureau for Humanitarian Assistance, and Bureau for Conflict Prevention and Stabilization –] exemplify understanding for the complexity of development, moving on the spectrum from conflict and unrest towards food security and stability. … Ultimately, as with all changes, there are still questions to be answered. For example, how will the Center for Nutrition interact with other Bureaus in the agency, such as the Bureau for Global Health? How will the three Bureaus under the Administrator for Relief, Response, and Resilience work together? These and many other questions will be examined as USAID roles out the new structure, which is expected to begin sometime between the end of this year and early next year” (8/1).

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CSIS Post Discusses Public-Private Engagement In Global Nutrition

Center for Strategic & International Studies: Navigating the Labyrinth of Public-Private Engagements for Global Nutrition
Amy R. Beaudreault, research fellow at CSIS’s Global Food Security Project and Global Health Policy Center, highlights her experience attending Together for Nutrition, an executive short course held last month by the Global Alliance for Improved Nutrition (GAIN). She recounts discussions of public-private engagement in global nutrition, including the challenges of engaging the private sector in the nutrition field, the contribution of small- and medium-sized enterprises to profitable nutrition, the importance of evaluating funding sources for nutrition, and the lack of evidence-based recommendations for public-private engagement in global nutrition (8/1).

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E.U. Provides Funding To Philippine Red Cross To Address Dengue Outbreak

Delegation of the European Union to the Philippines: European Union brings relief to the victims of dengue outbreak in the Philippines
“In response to the ongoing dengue outbreak in the Philippines, the European Union is providing €100,000 EUR (PHP 5.670 million) in humanitarian aid funding to assist the most affected communities. … This E.U. funding supports the Philippine Red Cross (PRC) in delivering crucial assistance through the strengthening of public health services, such as the establishment of dengue emergency medical units or hospital extension wards at local government hospitals, and the provision of nursing staff to respond to overwhelming dengue cases. … The funding is part of the E.U.’s overall contribution to the Disaster Relief Emergency Fund (DREF) of the International Federation of Red Cross and Red Crescent Societies (IFRC)…” (8/2).

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From the U.S. Government

U.S. GAO Publishes Reports On State Department Reform Efforts, Foreign Assistance Monitoring, Evaluation

U.S. Government Accountability Office: State Department: Leadership Focus Needed to Guide Agency Reform Efforts
“In response to an Executive Order, the State Department launched an initiative to streamline its programs and processes in 2017 and reported specific reform projects to Congress in 2018. We found that State is implementing most of these projects. However, some projects have been stalled or discontinued due to top leadership transitions, shifting priorities, and a lack of confirmed officials in key positions. State also lacks a dedicated team to manage these projects, which could slow its overall reform efforts. We recommended that State establish a team to manage the implementation of all reform projects that the Secretary decides to pursue…” (8/1).

U.S. Government Accountability Office: Foreign Assistance: Federal Monitoring and Evaluation Guidelines Incorporate Most but Not All Leading Practices
“…We looked at how agencies monitor and evaluate [foreign assistance] programs. Specifically, we looked at the guidelines the Office of Management and Budget established for federal agencies with foreign assistance programs. We reviewed whether the guidelines incorporated leading practices for monitoring and evaluation, and whether agencies adopted the guidelines. We found the OMB guidelines included 23 of 28 leading practices, and most agencies adopted most of them. We made 7 recommendations to increase the use of OMB’s guidelines…” (7/31).

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HIV Testing, Treatment Retention Interventions Successfully Improve Viral Load Suppression Among HIV-Positive Persons In Tanzania

CDC’s “Morbidity and Mortality Weekly Report”: Threefold Increases in Population HIV Viral Load Suppression Among Men and Young Adults — Bukoba Municipal Council, Tanzania, 2014-2017
Duncan MacKellar of the CDC’s Division of Global HIV and TB at the Center for Global Health, and colleagues discuss the significance of “[a]chieving and sustaining viral load suppression (VLS)” among people living with HIV to reduce illness and the risk of disease transmission and describe the success of several interventions in Tanzania. The researchers write, “In Bukoba, Tanzania, scale-up of new testing, linkage to care, and retention on antiretroviral therapy interventions over 2.5 years helped increase VLS among HIV-positive persons approximately twofold overall (from 28.6% to 64.8%) and threefold among men (20.5% to 59.1%) and adults aged 18-29 years (15.6% to 56.7%). … During 2019, these interventions are being scaled up across Tanzania with support from the U.S. President’s Emergency Plan for AIDS Relief to help increase VLS among all persons with HIV infection” (8/2).

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