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Kaiser Daily Global Health Policy Report

In The News

Global Polio Eradication Effort Facing Setbacks In Africa, Middle East

“The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on two continents,” the New York Times reports. “The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago,” the newspaper writes (McNeil, 8/22). According to VOA News the “polio outbreak on the Horn of Africa has spread to Ethiopia,” and “[a] Somali refugee camp in Kenya has also seen 12 cases of the paralyzing disease this year” (Baragona, 8/22). In addition, “[t]he battle to eliminate polio has hit apparent setbacks in northern Pakistan, where new cases are being reported, and in Israel, where the discovery of the virus in the sewage system has led to a mass immunization campaign,” The Guardian adds, noting, “Fourteen suspected cases of polio have been discovered in Pakistan’s insurgency-racked north-west, where Taliban militants have banned vaccination workers” (Boone/Sherwood/Boseley, 8/22). Scientific American interviews Bruce Aylward, assistant director general for polio, emergencies and country collaboration at the WHO, “to find out more about the situation in Israel and how recent events there are affecting global efforts to wipe out the disease” (Maron, 8/22).

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Number Of Child Refugees Fleeing Syria Reaches 1M, U.N. Reports

“The number of children among refugees who have fled Syria’s civil war has reached one million, the United Nations said” Friday, Bloomberg Businessweek reports (Yoon, 8/23). “Roughly half of all the nearly two million registered refugees from Syria are children, and some 740,000 of those are under the age of 11, according to the U.N. refugee and children’s agencies,” the Associated Press writes (Heilprin, 8/23). “Another two million Syrian minors are uprooted within their country and are often attacked or recruited as fighters in violation of humanitarian law, the U.N. refugee agency UNHCR and U.N. Children’s Fund (UNICEF) said,” according to Reuters.

“‘The youth of Syria are losing their homes, their family members and their futures. Even after they have crossed a border to safety, they are traumatized, depressed and in need of a reason for hope,’ Antonio Guterres, U.N. high commissioner for refugees, said in a statement,” the news service notes (Nebehay, 8/23). “The physical upheaval, fear, stress and trauma experienced by so many children account for just part of the human crisis,” a joint press release from the agencies states (8/23). “Besides the physical stress and trauma of leaving home, often in perilous circumstances, refugee children must [often] confront the threats from child labor, early marriage and the potential for sexual exploitation and trafficking,” The Guardian adds (Tran, 8/22).

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DfID To Spend $214.5M Over 5 Years On Public-Private Partnerships To Fight Infectious Diseases

The U.K.’s Department for International Development (DfID) plans to invest £138 million ($214.5 million) over the next five years “with nine public-private partnerships to support development of drugs, vaccines, insecticides, diagnostic tools and microbicides, all to prevent, diagnose or treat disease,” This Is Guernsey reports (8/22). “Diseases to be targeted include HIV, tuberculosis, malaria, diarrhea and ‘neglected’ tropical diseases where there are either no treatments available, or they are difficult to use, or where infections have become resistant to existing drugs,” according to Public Finance International. The nine partnerships include the Drugs for Neglected Diseases initiative (DNDi), Medicines for Malaria Venture (MMV), Innovative Vector Control Consortium (IVCC), Foundation for Innovative New Diagnostics (FIND), TB Alliance, Aeras, New Products for Diarrhea and Malaria (PATH), International AIDS Vaccine Initiative (IAVI), and International Partnership for Microbicides (IPM), the news service notes (Smulian, 8/23). In a DfID press release, International Development Secretary Justine Greening said, “Working together in product development partnerships, the public and private sectors have a chance to bring together their expertise for the benefit of millions of the world’s poorest and most vulnerable people” (8/22).

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Devex Blog Examines GAVI's New Partnership Model

Devex’s “Impact” blog examines a new partnership model being implemented by the GAVI Alliance, noting, “Three hundred and seventy million children in the world’s poorest countries have been immunized with support from GAVI.” The existing partnership model “has enabled the delivery of millions of low-cost vaccines into developing countries — and demonstrated how multinationals can be incentivized to tackle major development challenges,” the blog writes. “But, as GAVI’s leaders have learned, ensuring a vaccine supply alone is not enough to solve the world’s immunization problems. That supply must be effectively managed,” the blog continues, adding, “According to David Ferreira, managing director for GAVI’s innovative finance department, GAVI began to consider new ways of partnering with private-sector companies,” and “[w]here previously those companies had made primarily financial commitments, now GAVI wanted to tap into their core business expertise.”

“At the end of 2012, GAVI announced its first such partnership, a collaboration with U.K.-based telecom Vodafone that seeks to increase Mozambique’s vaccine coverage rate by improving information flows along the supply chain,” according to “Impact.” The blog examines why the mHealth market in Africa “is an important business priority for Vodafone” and discusses the partnership in detail. Noting “Ferreira said the GAVI leadership worried about the risk of ‘pilotitis,’ a common scenario in which a new development model is tested as a pilot but never fully brought to scale due to a lack of planning or other issues,” the blog writes, “It’s far too early to assess whether the GAVI-Vodafone partnership will be successful — implementation hasn’t even begun. But if it is successful, it has the potential to demonstrate that a company seeking to grow into new mHealth markets can achieve business goals while helping to solve an important development challenge.” The blog notes, “It has now been about 18 months since Vodafone and GAVI started their partnership conversation, and both sides are hopeful that implementation will begin soon” (Hanson, 8/21).

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Cuba Experiencing Cholera Cases One Year After Outbreak; U.S. Issues Travel Advisory

“A year after the first cholera cases in decades were reported in Cuba, the country is still struggling with outbreaks in various provinces, health workers and residents told Reuters on Thursday,” the news agency reports. The disease first appeared on the island in July 2012, and “[l]ast week the Pan American Health Organization reported five confirmed cholera cases among travelers to the Caribbean island this summer, an Italian, two Venezuelans and two Chileans,” the first cases reported among tourists since the beginning of the outbreak, Reuters notes. “The Cuban government has yet to publicly respond to the reports and officials were not immediately available for comment,” according to the news agency (Frank, 8/22). On Tuesday, “[t]he United States … issued an advisory for travelers to Cuba,” recommending “visitors and U.S. citizens living on the island avoid untreated water, street food and under- or uncooked dishes such as ceviche,” the Associated Press reports (Orsi/Duran, 8/21).

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Insecticide-Treated Bed Nets Eliminate Filariasis Transmission In Study

“Bed nets treated with insecticide are a simple and economical way to eradicate filariasis, a mosquito-born tropical disease that threatens 1.4 billion people worldwide, according to research published Wednesday,” Agence France-Presse/Health24 reports (8/22). The study, published in the latest New England Journal of Medicine, “found that insecticide-treated bed nets reduce transmission of lymphatic filariasis to undetectable levels — even in the absence of additional medication,” a press release from Case Western Reserve University School of Medicine, published on News Medical, states (8/22). The most common symptom of filariasis infection is elephantiasis, “the massive swelling of skin and tissue,” VOA News notes. “Filariasis is only picked up by mosquitoes late in the evening, so this is the time when people are more likely to be protected by their bed nets. So we found that bed net use actually is a greater barrier against filariasis transmission whereas malaria transmission may still be occurring outside the times when the user is under the net,” lead author Lisa Reimer of the Liverpool School of Tropical Medicine said, according to the news service. “The WHO estimates that 120 million people suffer from lymphatic filariasis,” VOA notes (Herman, 8/21).

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Early Treatment Of HIV-Positive Infants Might Allow Later Therapy Interruptions, Study Shows

According to results from the long-running CHER trial published online in The Lancet, HIV-positive “[c]hildren who began an immediate course of [antiretroviral (ARV)] drugs were able to interrupt their treatment, giving them a break from the powerful, potentially toxic drugs,” Agence France-Presse/GlobalPost reports (8/21). “‘Breaks’ from HIV treatment could help reduce drug resistance in children, who have fewer ARV treatment options than adults, and reduce side effects in the long term, according to Dr. Mark Cotton, the study’s lead author and Tygerburg Hospital’s head of pediatric infectious diseases,” Health-e News notes.

Conducted in South Africa “among 377 HIV-positive infants, the randomized controlled clinical trial tested whether babies who started ARVs at about two months old could safely interrupt their treatment with careful monitoring,” the news service writes, adding, “Babies in the study were placed on ARVs and then stopped at either 10 months or two years. Babies were restarted on treatment if their CD4 counts fell to less than 1000.” Health-e continues, “At the end of the trial, about half of the babies who had interrupted treatment were still well enough to remain off ARVs” (Gonzalez, 8/22). While the findings renew “hopes … that patients could get a temporary holiday from AIDS drugs,” Robert Colebunders of the Institute of Tropical Medicine in Belgium and Victor Musiime of Makerere University College of Health Sciences in Uganda cautioned against the practice in an accompanying commentary, AFP notes, adding, “Treatment interruption is a risky option in poor countries which lack laboratory facilities to monitor levels of CD4 immune cells, they said” (8/21).

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Editorials and Opinions

Removal Of 'Safe Harbor' Provision From TPP Will Threaten Global Anti-Tobacco Efforts

“[T]he Obama administration appears to be on the verge of bowing to pressure from a powerful special-interest group, the tobacco industry, in a move that would be a colossal public health mistake and potentially contribute to the deaths of tens of millions of people around the world,” New York City Mayor Michael Bloomberg writes in a New York Times opinion piece. “Although the president’s signature domestic issue has been health-care reform, his legacy on public health will be severely tarnished — at a terrible cost to the poor in the developing world — unless his administration reverses course on this issue,” he continues, noting the Obama administration this week removed from the Trans-Pacific Partnership, a multinational trade agreement, a “safe harbor” clause “protecting nations that have adopted regulations on tobacco — like package warnings and advertising and marketing restrictions — because of ‘the unique status of tobacco products from a health and regulatory perspective.'”

“If the Obama administration’s policy reversal is allowed to stand, not only will cigarettes be cheaper for the 800 million people in the countries affected by the trade pact, but multinational tobacco corporations will be able to challenge those governments — including America’s — for implementing lifesaving public health policies,” Bloomberg writes, noting “[t]obacco use causes more deaths around the world than HIV/AIDS, malaria and tuberculosis combined.” He discusses successful anti-tobacco policies and programs implemented in New York City and in other countries through his philanthropy. “But if the trade pact proceeds without the safe harbor provision, this progress will be jeopardized, a devastating setback for the global effort to reduce tobacco use, particularly because the signatories to the trade pact include nations — like the United States, Australia and Vietnam — that have some of the world’s strongest tobacco control measures,” Bloomberg writes, concluding, “[A] deal that sells out our national commitment to public health, and forfeits our sovereign authority over our tobacco laws, does not merit the support of Mr. Obama; of the Senate, which would have to ratify it; or of the American people” (8/22).

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India's Food Law 'Expedient,' 'Chaotic'

“‘Historic’ and ‘unparalleled’ were the words Sonia Gandhi, boss of [India’s] ruling Congress party, used to describe [the country’s] new food law at a launch in Delhi on August 20th,” but “[m]ore accurate terms for the law and its introduction would be ‘expedient’ and ‘chaotic,'” an editorial in The Economist states. “The scheme aims to reach 800 million of India’s 1.2 billion people, giving each a monthly dole of five kilos of rice or wheat, at a nominal price” — “mak[ing] it the world’s biggest serving of subsidized food” — “[y]et it has been launched amid confusion, cynicism and claims of fiscal irresponsibility,” the magazine writes and provides a brief history of the law’s passage. “The new law is good in parts,” the editorial states, adding, “It makes sense to enshrine a national obligation to give children a daily hot lunch and new mothers a six-month stipend”; “promote better nutritional help and health care for under-sixes, especially girls, using the existing Integrated Child Development Services”; and help states address the poor populace.

“But much is rotten about the food scheme,” The Economist adds. “It is too costly,” the editorial states, adding that while “[s]ome argue that it is not a given that the money will always be badly spent, … [because of] the chronic abuse of procurement and food schemes elsewhere, massive theft and waste will surely continue.” The “scheme is also badly targeted,” the magazine states, noting, “Just over 20 million people, many in tribal areas or rural bits of northern states, need more help. Yet two-thirds of India’s total population will get the new food aid. That broad splurge of handouts is driven more by raw politics than by development priorities.” The editorial continues, “[H]elping children requires more than a supply of base calories. A lack of protein or vitamins in diet, dirty water, neglect of girls, lack of education on hygiene and ill-nourished mothers who get pregnant too often: all contribute to the problem” (8/24).

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From the Global Health Policy Community

USAID, UNFPA To Strengthen Collaboration On Reproductive Health

USAID and the U.N. Population Fund (UNFPA) “announced [Thursday] new efforts to strengthen their collaboration to advance reproductive health, including voluntary family planning, worldwide,” a UNFPA press release reports. “[T]he two agencies will build on their work and expertise, accumulated over 40 years, to ensure women who want contraceptives can access them through … [c]oordinating supply planning to prevent organizations distributing contraceptives on the ground from running out of these life-saving commodities”; “[a]ddressing funding and technical assistance gaps to allow the two agencies’ country teams to help smoothly implement voluntary national family planning and reproductive health plans”; and “[j]oint analyses of progress and evidence-based recommendations for future direction, leading to improved collaboration between the two agencies’ country teams as they strive to achieve the [Millennium Development Goals (MDGs)], particularly MDG 5 (Improve maternal health), and to input into the post-2015 development agenda,” the press release states (8/22).

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WHO Health Care Hand Hygiene Strategy Works In Hospital Setting, Study Shows

“WHO’s strategy for improving hand hygiene is easy for health care workers to practice, according to a new study published today in Lancet Infectious Diseases,” a WHO press release states, noting, “Practicing good hand hygiene during health care reduces the risk of [health-care associated] infections and the spread of antimicrobial resistance.” The study took place at “six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, [where] the research team implemented WHO’s strategy in 55 departments in 43 hospitals,” the press release notes and describes the WHO Clean Care is Safer Care Program (8/23).

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Reflecting On Importance Of Disease Modeling

Writing in the Center for Global Development’s “Global Health Policy” blog, research fellow Victoria Fan reflects on a TED talk by Nathan Myhrvold, former chief technology officer at Microsoft and co-founder of Intellectual Ventures, about mosquito-zapping lasers, refrigerators for vaccines, and disease modeling. She highlights an opinion piece she wrote in response to the talk in the Huffington Post’s “TED Weekends” blog, which focused on the first two technologies, and goes on to discuss “the importance of his third technology — disease modeling” (8/21).

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Gates Blog Continues Series By Nigerian-Born Polio Survivor

The Bill & Melinda Gates Foundation’s “Impatient Optimists” blog continues its four-part series in which U.K. broadcaster and ex-Paralympian Ade Adepitan, a polio survivor, reflects on his recent trip “back to his birth country of Nigeria to see why kids in his country were still getting polio.” In the second post, he talks about his experience “[g]oing back to Nigeria to learn about polio” (8/20). In the third post, Adepitan highlights his time in Northern Nigeria, where he spent time with a family in the city of Sokoto (8/21). And in the final post, he talks about taking action against the disease (8/23).

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