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Kaiser Daily Global Health Policy Report

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VOA Examines HIV Drug Shortages In Zambia, Uganda

In two separate articles, VOA News reports on drug shortages in Zambia and Uganda. “The Zambian government is putting in place stringent measures aimed at ensuring a sufficient supply of antiretroviral drugs [ARVs] …, the second time this year that the more than 500,000 people living with HIV in Zambia have had to cope with what the Ministry of Health calls rationing of the drugs — a system that some patients here have been contending with for more than a decade,” the news service writes in the first article, noting, “Zambia’s Ministry of Health admits there is a challenge regarding the stocks of ARVs in the country, which it refers to not as a shortage, but as ‘rationing.'” The news service examines the reasons behind the shortages, discusses the “rationing” strategy, and highlights other potential “long-term interventions that Zambia’s Ministry of Health wants to achieve” (Chimba, 8/17).

In the second article, the news service examines drug shortages in Uganda, writing, “Clinics outside the capital have been complaining of drug shortages, especially of HIV test kits and ARVs.” The news service notes, “Elvis Basudde, head of the Positive Men’s Union, says he has been receiving complaints of drug shortages from clinics across the country,” adding, “For HIV-positive Ugandans, he says, lack of access to ARVs could be disastrous.” However, the news service continues, “Ugandan health advocates such as Margaret Happy, who works with the National Forum of People Living with HIV, say that there is no shortage of drugs in the country,” and, “[a]ccording to the Ministry of Health, Uganda has plenty of ARVs, enough to last until December.” VOA adds, “Ministry spokesperson Rukia Nakamatte says the problem lies with the clinics themselves, and with health workers who do not know how to use the government’s new Internet-based system for ordering medicine” (Heuler, 8/16).

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Indian Government To Launch Food Security Program Before Parliament's Approval

The Indian government plans to launch a food security program that would provide subsidized food to two-thirds of its population, “even though the controversial Food Security Bill which maps out this welfare scheme is yet to be approved by parliament,” BBC News reports. “Critics say the scheme is a political move to win votes and will drain India’s finances … [b]ut India accounts for a third of the world’s poor and supporters say such assistance will help reduce poverty and hunger,” the news agency writes. Sonia Ghandi, head of the governing Congress, will launch the program in the capital, Delhi, and “[f]our other states, ruled by the Congress, will also launch the scheme on Tuesday,” BBC writes, noting that the lower house of Parliament plans to take up the bill on Tuesday (8/20).

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CDC Launches New Disease Detection Center In Bangladesh

The CDC on Tuesday “launched its eighth global disease detection center in Bangladesh,” Bangladesh News 24 reports. “A two-year ‘extensive’ disease detection course also started off at the government’s disease monitoring arm, the Institute of Epidemiology, Disease Control and Research (IEDCR),” the news service writes, adding, “With this, the institute would now help as a regional center ‘to protect the world by rapidly detecting emerging health threats.'” The news service details the launch event and notes Bangladesh Health Minister AFM Ruhal Haque and senior administrators attended the event, as did Thomas Kenyon, CDC director for the Center for Global Health, and other CDC officials (8/20).

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Israel Expands Polio Vaccination Campaign Nationwide

“Israel took its polio vaccination campaign nationwide on Sunday, saying a two-week vaccination effort in the south was not enough to curb the threat of an outbreak of the virus,” Agence France-Presse/Fox News reports (8/18). The country kicked off the “extensive anti-polio drive by vaccinating over 30,000 children under nine years of age on Sunday,” Pentagon Post writes, adding, “The anti-polio operation is expected to last 60 days” (Bender, 8/19). “Israel already immunizes its children against the disease,” but the “new campaign gives a second boost of protection,” according to the Associated Press/ABC News (8/18). “A decision to launch the nationwide campaign came just weeks after Israel ordered all children in the south to be vaccinated after the virus was found in the sewage system,” UPI notes (8/18). “The ministry said that since the launch of the campaign in the south of the country two weeks ago, 60,000 children — or 60 percent of the children in that region — had already been vaccinated,” AFP writes (8/18).

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Women's eNews Examines Campaign Against FGM In Sudan

Women’s eNews reports on a campaign to end the practice of female genital mutilation (FGM) in Sudan. Called “Saleema,” which “translates to complete, to signify that a girl should remain the way she was born,” the campaign “has been ramping up recently in its fight against FGM, … with extensive media outreach, opening a new dialogue about this once-taboo issue in Sudan,” the news service writes. “Still, activists here criticized the campaign as being presented in such a way as to appease conservatives and to avoid clashes,” the news service adds, noting “[t]he billboards covering the streets of Khartoum, for example, show celebrities and respected individuals and have the slogan ‘She is born Saleema, let her grow Saleema,’ but they do not mention FGM.” The news service continues, “Talking to women in different communities made the [Babiker Badri Scientific Association for Women’s Studies, based at Ahfad University for Women in Omdurman,] which is involved in the Saleema campaign, begin to realize they needed a new approach and that they had to make the campaign inclusive,” adding, “This approach has helped shape the Saleema campaign, which has only recently made its presence more known, though it was launched in 2008” (Abbas, 8/19).

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Daily Isoniazid Can Prevent TB In HIV Patients, Study Shows

“An inexpensive daily pill can often fend off a lethal bout of tuberculosis [TB] in people with HIV, according to a large new study,” the New York Times reports. “The study, published last week by Lancet Infectious Diseases, found that a daily isoniazid pill reduced deaths and active TB cases by 31 percent among 12,816 patients at 29 Brazilian clinics,” the newspaper writes, adding that among patients who took their pills, determined through urine testing, “the effect was far greater.” Side effects of the drug were minor and no patients who developed TB showed signs of drug resistance, the newspaper notes. “An editorial accompanying the study looked at several isoniazid trials and said the antibiotic worked, but only when public clinics could test patients correctly, provide pills steadily and make sure they were taken,” the New York Times writes (McNeil, 8/19).

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Editorials and Opinions

Engaging LGBT Communities, Ending Discriminatory Policies Necessary To End AIDS

Highlighting the “debate about gay rights in the West,” Bertrand Audoin, executive director of the International AIDS Society, writes in a New York Times opinion piece, “Three decades of experience in responding to the HIV/AIDS epidemic has provided indisputable evidence that depriving those groups most at risk of HIV infection of their human rights drives them underground.” He states, “[T]his deprivation of human rights goes beyond mere civil liberties: It is bad public health.” “In the early days of the HIV/AIDS epidemic, it was soon evident that the virus did not discriminate but that governments and people sometimes did,” he writes, adding, “Today stigma and discrimination still fuel the epidemic — and we need look no further than Russia to see how repression and inaction have worsened one of the fastest-growing HIV epidemics in the world.”

Audoin provides “estimates of the number of people in Russia living with HIV,” highlighting various policies and widespread discrimination affecting HIV rates among high-risk groups in the country. “The potential for HIV transmission among gay men in Russia as well as sub-Saharan Africa is very clear. At the same time, we know what steps can be taken that work to stem this tide,” he states. “Engaging the homosexual community in this battle brings broad public health benefits, and Australia is a case in point,” he writes, noting, “Containment of the HIV/AIDS epidemic in Australia was a public health milestone — achieved through legislation that implicitly recognized the human rights of homosexuals.” He states, “Unfortunately political leaders in many parts of the world are the true drivers of the stigma against gays. But it is those very leaders who have a historic opportunity not only to end such discrimination but to make a major dent in one of the world’s most lethal pandemics in their own backyards” (8/20).

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U.N. 'Disregards Haitians' Humanity' By Refusing Responsibility For Cholera Outbreak

Despite multiple reports confirming the U.N. is responsible for the cholera outbreak in Haiti — including a report (.pdf) published last week by the Transnational Development Clinic at Yale Law School and the Global Health Justice Partnership between the law school and the Yale School of Public Health that concluded “not only that the U.N. brought cholera to Haiti, but that by failing to take responsibility for its role in the outbreak, the United Nations violates both its contractual commitments to Haiti as well as its obligations under international law” — “the U.N. continues to deny its role,” Charanya Krishnaswami, a co-author of the Yale report, writes in a Slate opinion piece. “Previously, the organization rejected claims for relief from more than 5,000 cholera victims, simply declaring that the claims were ‘not receivable,'” she writes, adding, “This week, U.N. spokesman Martin Nesirky responded to renewed calls for accountability by asking the international community to donate money to help Haiti recover from the ‘double tragedy of earthquake and cholera’ while saying nothing about the part the U.N. played in visiting this tragedy upon the country in the first place.”

Though the recovery “plan will, critically, prevent future harm … it will not address the harm that has already befallen so many victims — the men, women, and children who died or lost loved ones in a profoundly senseless tragedy,” Krishnaswami writes. “The U.N. should accept responsibility, and it can, in a variety of ways,” including issuing a formal apology, establishing a claims commission, “and ensuring internal change so that such preventable tragedy will not happen again,” she says. She concludes, “It is now abundantly clear that the U.N. brought cholera to Haiti. By failing to accept responsibility for this wrong, the U.N. continues to disregard Haitians’ humanity” (8/19).

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Post-2015 Development Responsibilities Should Be Clearly Defined

If the post-2015 development goals “are to be as effective as realistically possible, the debate must push well beyond the report of the U.N.’s High-Level Panel on the subject,” as “[t]he 12 goals proposed suffer from the same key defects as the [Millennium Development Goals (MDGs)]: they are general wishes that do not assign concrete tasks and responsibilities to specific actors, and they do not meet civil society aspirations for systemic reforms of global institutions,” Thomas Pogge, Leitner professor of philosophy and international affairs at Yale University and international president of Academics Stand Against Poverty (Asap), and Mitu Sengupta, associate professor of politics at Ryerson University and director of Asap Canada, write in The Guardian’s “Poverty Matters Blog.”

“If stated commitments to solidarity and shared responsibility are to amount to more than lip service, future work on hammering out new development goals should specify plausible institutional reforms that could be implemented by the more affluent countries, and which would reduce the headwinds existing institutional arrangements are blowing against the poor,” they write. “The most powerful and influential agents must be given clear tasks and responsibilities — not merely in the arena of development assistance, but also in terms of tasks that must be taken into account in all their policy and institutional design decisions, at both the domestic and — especially — the supranational level,” the authors write, concluding, “A good start would be to commission experts to provide written assessments of the impact specific decisions can be expected to have on the world’s poor” (8/20).

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From the Global Health Policy Community

State Department, USAID Commemorate World Humanitarian Day

In a statement, Secretary of State John Kerry commemorated World Humanitarian Day, recognized on August 19, saying, “This is an important day for all of us to pause and join with our colleagues in honoring the committed staff who work to save the lives of others, often at great risk to their own. World Humanitarian Day is a commemoration of their sacrifice and a sober reminder that our work is far from done.” He highlighted the specific efforts of humanitarian workers worldwide, concluding, “In a world growing more — not less — interconnected, when our common humanity is threatened, aid workers will be there — this day and every day the world over” (8/19). In a post on USAID’s “IMPACTblog,” Carol Chan, acting director of the Office of U.S. Foreign Disaster Assistance, writes, “On World Humanitarian Day, we pause to remember those who died, as well as celebrate the commitment and passion of those, who, at this very moment, are saving lives in some of the most dangerous regions around the world” (8/16). And in the State Department’s “DipNote” blog, “Heather Fabrikant, a program officer with the State Department’s Bureau of Population, Refugees, and Migration, discusses what the day means to her” (8/19).

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'Amazing Progress' On Vaccine Development, Delivery, But More Can Be Accomplished

“I recently returned from a trip to Vellore, in southern India, where I had a chance to observe first-hand the clinical trials for a new vaccine that could prevent nearly 100,000 child deaths a year in India from rotavirus,” Trevor Mundel, president of global health at the Bill & Melinda Gates Foundation, writes in the foundation’s “Impatient Optimists” blog. “I also had the opportunity to meet with scientists at Bharat Biotech Ltd., an Indian biotech company in Hyderabad that developed and is manufacturing the vaccine in partnership with the Indian government and other partners, including the Gates Foundation,” he notes, adding, “Bharat’s rotavirus vaccine represents an important step forward in the maturation of India’s scientific research and vaccine manufacturing capabilities. And it’s a reminder of the amazing progress we have made over the last 50 years developing and delivering vaccines — the most powerful and cost-effective health solutions of all time.” Mundel continues, “[W]e must continue to work together — industry, governments, and non-profits — to accelerate the development of vaccines for diseases that continue to impose such a huge burden on people in developing countries” (8/19).

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MSF Reports On Malaria Prevention Campaign In Niger

“In the weeks before the rainy season begins, teams from Médecins Sans Frontières (MSF) in Niger have been working hard to distribute medicine that will prevent malaria, while preparing themselves to deal with possible food crises in some areas of the country,” the humanitarian organization reports in an article on its webpage. “MSF teams have just completed an initial round of seasonal malaria chemoprevention (SMC), a new preventive method recommended by the World Health Organization (WHO) since last year,” according to the article. “The campaign to protect young children from malaria has seen more than 1,850 local community agents together with international teams visiting villages across the area, raising awareness about the campaign among local people, distributing the medicine and encouraging parents to make sure their children receive the full 12 doses,” the article states (8/19).

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New Issue Of 'Global Health: Science And Practice' Journal Available Online

The August 2013 issue of the “Global Health: Science and Practice” journal is now available online. The issue includes an editorial about “[m]aking the most of food aid to help prevent child and maternal deaths,” a commentary on “[m]ultiplicity in public health supply systems,” and a technical paper on “mHealth innovations as health system strengthening tools,” among other articles (8/12).

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