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Kaiser Daily Global Health Policy Report

In The News

Experts Discuss Future Of PEPFAR, Potential For Reauthorization

While “experts agree” the “chances of [PEPFAR] being reauthorized is slim,” they also “say that Congress does not need to reauthorize the program,” CQ Online News reports. Chris Collins, vice president and director of public policy at amfAR, the Foundation for AIDS Research, “said reauthorization is not imperative as long as the State Department continues to implement PEPFAR, which celebrated its 10-year anniversary two months ago, and Congress maintains the sort of funding levels for the program that it has received over the last decade,” according to the news service. “Collins added that besides funding, Congress does have the responsibility to ‘keep asking how are we doing in pursuing the goal of an AIDS-free generation,'” as outlined in the PEPFAR Blueprint released in November 2012, CQ writes. Speaking at a June 21 teleconference before President Obama’s trip to Africa, Gayle Smith, senior director at the National Security Council, called PEPFAR — first implemented in 2003 and reauthorized for five years in 2008 — a “terrific foundation” that the U.S. government has built on “substantially by shifting it a lot more in the direction of capacity-building, of strengthening systems in partner countries, in building on things like maternal, child health so that we could help to radically reduce the rate of the spread of the infection from mother to child,” CQ notes. Robert Black, a professor and director of the Institute of International Programs at the Johns Hopkins Bloomberg School of Public Health, said, “Reauthorization isn’t necessary, but additional funding is,” the news service states (Khatami/Cadei, 8/7).

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U.S. To Send Additional $195M In Humanitarian Aid To Syria

“President Obama on Wednesday announced the U.S. would give an additional $195 million in humanitarian aid to displaced Syrians as a gesture to celebrate Eid al-Fitr, the holiday marking the end of the Muslim holy month,” The Hill’s “Blog Briefing Room” reports (Easley, 8/7). “A statement from Obama marking Eid al-Fitr … said the $195 million in additional aid would bring the U.S. humanitarian contribution to more than $1 billion since the Syrian crisis began,” Reuters writes (Holland, 8/7). “The aid will include food, medical assistance and hygiene kits, clothing and household supplies,” VOA News notes, adding, “Aid agencies say Syria is facing a food crisis due to a poor harvest combined with critical shortages of staple goods caused by the country’s civil war” (8/7).

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World Bank President Kim Aims To Have Broad Development Impact

Bloomberg profiles World Bank President Jim Yong Kim and his “fantasy” of replicating the small-scale success of treating tuberculosis patients in Peru he experienced when he was with Partners In Health on a larger scale with the World Bank. “Leaning on the field work of his past, he’s trying to refocus 15,000 employees on a poverty-ending mission that’s under threat from an institutional aversion to change built up over almost seven decades and from outside forces such as the global tide of private capital searching for higher returns,” the news agency writes. “Kim has concluded that the bank has grown too fragmented, cautious and self-absorbed to accomplish its mission,” Bloomberg states, adding he aims “to reshape the organization and cut red tape.” The news service describes Kim’s upbringing and how he is shuffling staff at the World Bank. “If we can show that even in these poor communities we can deliver, we could have a much, much broader impact,” Kim said, adding, “There’s no question that’s still what I am here to do,” according to Bloomberg, which also provides an audio interview with Kim (Rostello, 8/8).

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Researchers Plan To Genetically Modify H7N9 Virus To Better Understand Mutations

“Scientists have unveiled plans to genetically engineer a lethal strain of bird flu to understand how it could mutate in nature and trigger a catastrophic pandemic,” The Guardian reports (Sample, 8/7). “Some of the world’s leading flu researchers argue that genetically altering [the H7N9] virus in high-security labs is key to studying how it might mutate in the wild to become a bigger threat to people, maybe even the next pandemic,” Fox News writes (8/7). “In letters published Wednesday in the journals Science and Nature, [Ron Fouchier of Erasmus University in the Netherlands] and colleagues from a dozen research centers in the U.S., Hong Kong and Britain outlined plans for what’s called gain-of-function research — creating potentially stronger strains, including ones that might spread easily through the air between lab animals,” the Associated Press notes (Neergaard, 8/7). The research proposal “comes a day after Chinese scientists reported the first probable case of person-to-person transmission of the H7N9 virus,” VOA News notes (8/7).

“By finding the mutations needed, researchers and health authorities can better assess how likely it is that a new virus could become dangerous and if so, how soon they should begin developing drugs, vaccines and other scientific defenses,” according to Reuters (8/7). “The proposal still is controversial, with some researchers calling for the very highest level of security for labs pursuing the research,” USA Today writes, adding, “Responding to past concerns about such research, the U.S. government said it will require extra safety measures” (Vergano, 8/7). “The U.S. government has put together new guidelines for conducting H5N1 research, and in a separate letter also published in Nature and Science, authors from the [CDC], the [NIH] and [HHS] affirmed that any H7N9 work funded by the federal government would receive extra oversight,” according to the Los Angeles Times (Brown, 8/7). Science also includes a roundup of researchers’ reactions to the proposed studies (Malakoff, 8/7).

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Bloomberg Businessweek Interviews Bill Gates About His Foundation's Health, Education Efforts

In Bloomberg Businessweek’s “Interview Issue,” the news service talks with philanthropist Bill Gates, co-chair of the Bill & Melinda Gates Foundation, about the organization’s health and education campaigns. According to the interview transcript, Gates discusses the foundation’s polio and malaria efforts, reflects on the experiences that have led him to work on global health issues, and examines the connections between public health, political stability and economic growth, among other topics (Stone, 8/8).

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Former Prisoner Aims To Reform TB Prevention Efforts In South African Prisons

The Wall Street Journal examines how a former prisoner in South Africa “is forcing [the country] this year to intensify its fight against [tuberculosis (TB),] a disease that has breached jail cells, defied international borders, and grown increasingly drug resistant.” Arrested “on accusations of money laundering and trafficking counterfeit passports and dollars” in 1999, Dudley Lee was infected with TB while awaiting trial for over four years in Pollsmoor Prison, according to the newspaper. “In 2004, after his acquittal, he sued the prison system for giving him TB,” and “he won his case in December,” the Wall Street Journal notes, adding, “Following Mr. Lee’s legal victory, ‘We sat down to see what we needed to do to address the situation,’ says Delekile Klaas, who oversees Pollsmoor and other prisons for the Department of Correctional Services.”

“Lee’s account of survival offers a stark lesson in how prisons can become deadly incubators,” the Wall Street Journal writes, noting that “in its latest annual report, South Africa’s prison watchdog, the Judicial Inspectorate for Correctional Services, attributed 110 out of 804 natural deaths to tuberculosis in the year starting April 2011. While the rate has subsided from a decade-earlier peak, the report warned that dense populations still undermine the fight against prison TB.” The newspaper writes, “The WHO estimates that globally one quarter of a country’s tuberculosis burden may come from inside prisons,” and “[p]oor monitoring abets these epidemics.” Lee said, “Hopefully, in some small way I’ve managed to goad, or bully, this country into doing something about” TB in the South African prison system, according to the newspaper (Wonacott, 8/7).

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Chinese Health Commission Spokesperson Lowers Expectations For Change To Family Planning Policy

China’s “health commission has attempted to tamp down expectations for a relaxation of the one-child policy, after a policy paper and media reports excited hopes for change,” the South China Morning Post reports. “National Health and Family Planning Commission spokesman Mao Qunan told the Beijing Morning Post that the commission was not necessarily referring to the number of children a couple can have when it alluded to policy changes in an action plan released on Tuesday,” the newspaper writes. Mao said, “It is incorrect to interpret ‘improving the family-planning policy’ as a renewed sign of relaxing the policy to allow for a second child. … Whether to allow couples to have two children … is a different matter from the family-planning policy revision,” according to the newspaper, which added, “Mao said Beijing needed to make long-term family planning a fundamental national policy, which he conceded would be a major task of the newly formed health commission.” According to the Morning Post, “Some mainland population experts expressed surprise at the spokesman’s remarks,” and the article includes comments from two population experts (He, 8/8).

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Former Pharmaceutical Executive Speaks About Vaccine Development, Distribution

In partnership with the Skoll World Forum, Forbes features an interview with Kevin Reilly, former president of the vaccines and nutrition division of Wyeth Pharmaceuticals, who discusses the challenges of vaccine development and distribution. “Increasingly, I see pharmaceutical and vaccine manufacturers engaging in the dialogue about strengthening immunization and distribution systems to ensure vaccines get to where they are needed,” he said, according to the interview transcript. “Similarly, I see growing awareness among global health organizations about the difficult, multiyear process required to develop vaccines and how that process influences the price,” he added. Reilly also discusses the relationship among businesses, governments, civil society, and educational institutions in the development and delivery of medical products (Kanani, 8/6).

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PATH Working With Private Sector To Develop Public Health Innovations

The Atlantic speaks with Anurag Mairal, director of technology solutions at PATH Health Technologies, about PATH’s “wor[k] with the commercial sector to scale, distribute, and market its innovations.” Mairal’s “approach includes disruptive innovation (disrupt the global health system by changing the cost equation, moving away from a grants-based approach to a commercial-approach) and developing a market for said innovations,” according to the news service, which profiles several of PATH’s innovations, including a test for river blindness, vaccine vial monitors and freezers, and female condoms, among others (Chhabra, 8/7).

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Nature Examines Research Efforts To Find Optimal Dose Of HIV Treatment

Noting UNAIDS has set a goal of increasing the number of people infected with HIV who are receiving antiretroviral treatment worldwide “to 15 million by 2015 and to add an additional million each subsequent year, a task that will be challenging under current financial conditions,” Nature examines research efforts to find the optimal dose of the antiretroviral drug efavirenz. “At last month’s International AIDS Society (IAS) conference in Kuala Lumpur, Malaysia, researchers presented preliminary results from a clinical trial that showed a lower dose of the commonly used antiretroviral drug efavirenz was just as effective as the approved higher dose and seemed to cause fewer side effects in study participants,” the magazine writes. “The fact that this very useful drug can be used in a reduced dose is a big deal. This is a money saver that will allow us to treat more patients,” Keith Crawford, assistant chief of public health research at the U.S. Military HIV Research Program in Bethesda, Maryland, said, according to Nature. The magazine details the study, “one of several dose optimization trials being pursued in an effort to increase access to drugs in a cost-effective manner while also reducing toxicity from the drugs,” and writes, “With the verdict of the ENCORE1 trial now in, the study investigators plan to start working with the FDA on regulatory approval as well as with the drug manufacturers to create lower-dose pills, says [Sean Emery, principal investigator of the ENCORE1 study]” (Heger, 8/6).

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Editorials and Opinions

From the Global Health Policy Community

Examining Global Need For Trained Midwives To Meet Infant Mortality MDG

Highlighting discussions from the Africa regional conference of the International Confederation of Midwives (ICM) held last month in Nairobi, Kenya, Rene Kiamba, manager of the Johnson & Johnson Family of Companies corporate contributions community support programs and initiatives in sub-Saharan Africa, writes in USAID’s “IMPACTblog,” “In order to meet the United Nations Millennium Development Goal (MDG) of reducing infant mortality by two thirds before 2015, birth attendants in large numbers must acquire the basic skills and equipment to help newborns breathe.” She examines the Helping Babies Breathe (HBB) program, “a global public-private partnership working towards achieving a significant reduction in newborn mortality by increasing the availability of skilled birth attendants at every birth,” writing, “The ICM meeting dedicated a core session to HBB, including providing attendees hands-on HBB introductory training and a related symposium that debated why little progress has been made in combating infant mortality in Africa” (8/7).

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Policy Engagement Essential To Eliminating NTDs By 2020

“Recently, we have been thrilled to see [neglected tropical diseases (NTDs)] take the spotlight at three prominent international policy forums — the African Union (A.U.), the World Health Assembly (WHA), and the Organization of American States (OAS),” Richard Hatzfeld, communications director at the Sabin Vaccine Institute who also works with the Global Network for Neglected Tropical Diseases and its END7 Campaign, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. “These new demonstrations of political will are catapulting the global movement against NTDs to new heights, and they are indicative of transforming attitudes among policymakers toward the importance of seeing the end of these diseases,” he writes and describes actions from each forum. “We are confident that eliminating the most common NTDs as a public health threat by 2020 is possible, but not without broad support by the world community,” he states, adding, “Policy engagement is … an important part of the solution” (8/7).

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Study Examines Treatment Retention Among HIV Patients In Uganda

The Center for Global Health Policy’s “Science Speaks” blog reports on a study, released this week by Clinical Infectious Diseases, that “follow[ed] patients in two Ugandan HIV care centers (one rural, one urban), [and] found not only were retention rates high for patients still considered too healthy to be eligible for medicine under guidelines of the last few years, but concluded those retention rates may be ‘systematically underestimated in many other settings.'” According to the blog, “The findings carry weight against a long unchallenged perception that people who feel well drop out of treatment, the resulting conclusion that patients receiving medicine before they have begun to feel ill can’t be counted on to continue to take it, and the specter that is then raised — that early treatment could lead to widespread drug resistance” (Barton, 8/7).

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