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Kaiser Daily Global Health Policy Report

In The News

Trump Administration Reportedly Prohibiting Several Words From Use In CDC Budget Documents, By Other Agencies; HHS, CDC Officials Offer Statements; PEPFAR Guidance Document Contains Language Shift

Washington Post: CDC gets list of forbidden words: Fetus, transgender, diversity
“The Trump administration is prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases — including ‘fetus’ and ‘transgender’ — in official documents being prepared for next year’s budget. Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden terms at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden terms are ‘vulnerable,’ ‘entitlement,’ ‘diversity,’ ‘transgender,’ ‘fetus,’ ‘evidence-based,’ and ‘science-based’…” (Sun/Eilperin, 12/15).

Washington Post: Words banned at multiple HHS agencies include ‘diversity’ and ‘vulnerable’
“… A second HHS agency received similar guidance to avoid using ‘entitlement,’ ‘diversity,’ and ‘vulnerable,’ according to an official who took part in a briefing earlier in the week. … While HHS staffers were directly notified about how they must change the language they use when preparing budget documents, a shift is happening in other departments as well. At the State Department, for example, employees received a guidance document on Wednesday that outlined how they should develop country operating plans under the President’s Plan for Emergency AIDS Relief (PEPFAR) for 2018. This document repeatedly uses the phrase ‘sexual risk avoidance,’ which has been defined in recent congressional funding bills as abstinence-only practices until marriage, as the primary form of sex education. Jen Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation, said in an interview Saturday that while the document does not specifically change how much money should be spent on abstinence-only programs under PEPFAR, the heavy emphasis on it could shift priorities on how money is spent overseas. ‘It’s a change, and the language in these documents does matter, because that’s what’s communicated to the teams in the field,’ Kates said, adding that it’s ‘too early to tell’ how this might translate into funding changes…” (Sun/Eilperin, 12/16).

New York Times: Uproar Over Purported Ban at CDC of Words Like ‘Fetus’
“The Department of Health and Human Services tried to play down on Saturday a report that officials at the Centers for Disease Control and Prevention had been barred from using seven words or phrases, including ‘science-based,’ ‘fetus,’ ‘transgender,’ and ‘vulnerable,’ in agency budget documents. ‘The assertion that HHS has “banned words” is a complete mischaracterization of discussions regarding the budget formulation process,’ an agency spokesman, Matt Lloyd, said in an email. ‘HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions’…” (Kaplan/McNeil, 12/16).

STAT: CDC director tells staff ‘there are no banned words,’ while not refuting report
“…Dr. Brenda Fitzgerald, who has led the agency since July, sent an all-hands email to the agency’s staff assuring them that the CDC is committed to its mission as a science- and evidence-based institution. She later posted it on Twitter. ‘As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work,’ Fitzgerald wrote. … Fitzgerald’s email to staff did not refute the Washington Post’s article reporting that CDC staff had been given a list of seven banned words by CDC budget analysts. … A Health and Human Services official who asked not to be named told STAT it was not accurate to say that CDC had been ordered not to use the seven words. Instead, he said, agency budget analysts were told that some words and phrasing might be more likely to win support for the CDC’s budget in the current Congress…” (Branswell, 12/17).

Additional reporting on this developing story is available from Al Jazeera, Associated Press, CNN, The Hill, PBS NewsHour, and TIME.

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New York Times Profiles UNFPA Executive Director Natalia Kanem, Agency's Work To Support Women's Health

New York Times: A Woman’s Voice for Women at the U.N. Agency for Reproductive Rights
“…With operations in 155 countries and territories, most notably the poorest, the [United Nations Population Fund (UNFPA)] is the world’s leading provider of family planning services, including contraception. … The fund has helped prevent millions of unwanted pregnancies and has sharply reduced maternal deaths in childbirth. It is a major advocate for women’s reproductive health. But the fund’s work also can extend in positive ways into other aspects of a woman’s life, [UNFPA Executive Director Natalia] Kanem said. Its mobile maternal health clinics, for example, are partly meant to give women safe spaces where they can relax and ask questions about anything, she said, including ‘things that are happening to their husbands and families’…” (Gladstone, 12/15).

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Sanctions Against North Korea Hampering Humanitarian Aid Efforts, Organizations Say

Washington Post: Sanctions are hurting aid efforts — and ordinary people — in North Korea
“Sanctions aimed at punishing the North Korean regime are hampering the ability of aid groups to operate inside the country, triggering warnings that the international campaign is harming ordinary North Koreans. Difficulties in obtaining supplies, including medical equipment, and in transferring money to fund aid programs could have a direct impact on health and nutrition levels throughout North Korea, aid groups say…” (Fifield, 12/16).

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USAID Invests Nearly $42M To Support WASH Activities In Haiti

Haiti Libre: Haiti — USA : $42M to support access to drinking water and sanitation
“The United States took another step to support access to clean water for Haiti’s citizens and continuing the fight against cholera. The U.S. Agency for International Development (USAID) Water and Sanitation project supports the goal the United States shares with the government of Haiti to expand safe water and sanitation access to vulnerable communities, the most important battlefront in the eradication of cholera and other waterborne diseases…” (12/16).

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Kenyan Nonprofit's Video Series Aims To Assist Other Nations In Rolling Out PrEP Among Women For HIV Prevention

New York Times: Six Lessons in Helping African Women Avoid HIV
“Six short videos were released last week describing how a Kenyan nonprofit organization tackles one of Africa’s toughest missions: helping young women protect themselves against HIV. The videos, by LVCT Health and posted on the PrEPWatch website, are funded by American foreign aid and the Bill & Melinda Gates Foundation, part of an effort to get PrEP — pre-exposure prophylaxis — to African women…” (McNeil, 12/15).

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Kenya, Global Fund Sign New Grants Worth $380M To Accelerate Efforts Against AIDS, TB, Malaria

Xinhua News: Kenya secures 380 mln USD from the Global Fund to fight HIV/AIDS, Malaria and TB
“The Global Fund to Fight AIDS, Malaria and Tuberculosis on Friday [signed grants worth] 380 million U.S. dollars [for] Kenya’s ministry of health and partners to support the war against the three infectious diseases that are leading cause of deaths in the East African nation. Henry Rotich, cabinet secretary for National Treasury, lauded the new funding that covers a three-year period, terming it a giant step towards elimination of HIV/AIDS, malaria, and tuberculosis in Kenya…” (12/15).

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Ebola Survivors In Sierra Leone, Liberia Demand Government, Red Cross Be Held Responsible For Allegations Of Funds Mismanagement During Outbreak

Reuters: Ebola victims sue Sierra Leone government over mismanaged funds
“Two Ebola survivors in Sierra Leone filed a lawsuit in a regional court on Friday, accusing the government of mismanaging funds during an epidemic that killed more than 3,000 people in the West African nation…” (Fofana/Bavier, 12/15).

VOA News: Sierra Leone Health Workers Sue Government Over Ebola Response
“…The Ebola survivors blame a lack of resources provided by the government for their infection and for the deaths of many of their co-workers. Their suit claims the government’s mismanagement of funds violated the plaintiffs’ ‘right to life and health’…” (12/15).

Washington Times: Ebola survivors in Liberia demand prosecutions for fraud and corruption that cost lives
“Faith Sayeh blamed the Red Cross for the death of her husband and two children during the 2014 Ebola outbreak that claimed thousands of lives [in Liberia]. … Ms. Sayeh was referring to the shocking report by International Red Cross auditors in November that $6 million was lost to fraud and corruption during the Ebola epidemic in West Africa from March 2014 to January 2016. The auditors discovered overpriced supplies, salaries for nonexistent aid workers, and fake customs bills. In Liberia, $2.7 million disappeared, according to the Red Cross. … The Red Cross said it also is trying to recover the money…” (Onyulo/Passewe, 12/17).

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Philippines Government Investigating Dengue Immunization Program Amid Concerns Sanofi's Vaccine Could Increase Disease Risk

New York Times: Drug Company Under Fire After Revealing Dengue Vaccine May Harm Some
“The first promising vaccine for dengue — a disease that afflicts hundreds of millions of people around the world — is in jeopardy after the Philippines suspended it, amid widespread fears about its safety and growing public anger over its use in 830,000 schoolchildren. The Philippines government has begun investigations into the rollout of the immunization program by the French drugmaker Sanofi, which has come under fire for discounting early warnings that its vaccine could put some people at heightened risk of a severe form of the disease…” (Grady et al., 12/17).

Wall Street Journal: Philippines Probes Dengue Vaccination Drive That Went Ahead Despite Warnings
“…Lawmakers last week began questioning former and current officials, doctors, public health experts, and Sanofi executives in an effort to determine, among other things, why Manila didn’t suspend the program until this month. Sanofi said the vaccine is still effective for people who have previously contracted dengue. … [Former President Benigno Aquino III] told lawmakers on Thursday that he acted in good faith when deciding to use the vaccine in a mass drive, and that no concerns had been raised directly with him. [President Rodrigo] Duterte said he welcomed the investigation by Congress. ‘If there is a failure, let them sort it out,’ he said Wednesday…” (Rana et al., 12/17).

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New York Times Investigation Highlights Severity Of Malnutrition Crisis Among Venezuela's Children

New York Times: Multimedia Feature: As Venezuela Collapses, Children Are Dying of Hunger
“…Hunger has stalked Venezuela for years. Now, it is killing the nation’s children at an alarming rate, doctors in the country’s public hospitals say. Venezuela has been shuddering since its economy began to collapse in 2014. … But deaths from malnutrition have remained a closely guarded secret by the Venezuelan government. In a five-month investigation by the New York Times, doctors at 21 public hospitals in 17 states across the country said that their emergency rooms were being overwhelmed by children with severe malnutrition — a condition they had rarely encountered before the economic crisis began…” (Kohut et al., 12/17).

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Gates Foundation CEO Discusses Year In Review In GeekWire Podcast

GeekWire: An ‘awesome year’? Gates Foundation CEO Sue Desmond-Hellmann has a radical view on 2017
“…Desmond-Hellmann reflected on the past year in a podcast with GeekWire this week in her office at Gates Foundation HQ in Seattle. She makes the case for 2017 in her annual Year in Review, published [Thursday]. She points to developments including the near-elimination of polio; the record number of women with access to contraception; milestones in the fight against neglected tropical diseases; new progress against pandemics; unprecedented numbers of students succeeding in college; and the groundswell of women speaking out against sexual assault…” (Bishop/McGrane, 12/14).

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More News In Global Health

Miami Herald: This Cuban industry began with 6 scientists, a tiny lab — and Fidel Castro’s obsession (Whitefield, 12/15).

Reuters: Four dead in ambush of World Food Programme convoy in Nigeria (Hazzad et al., 12/18).

STAT: Are free physicals a ‘ruse’? Questions swirl about public health program in China (Robbins, 12/18).
Xinhua News: China’s major diseases medical insurance covers 1 billion people (12/17).

U.N. News Centre: Protection, well-being of uprooted children must be central to new global migration compact — UNICEF (12/15).

VOA News: U.N. Urges Afghan Warring Sides to Facilitate Crucial Anti-Polio Drive (Gul, 12/17).

VOA News: Critics Accuse New Foundation of Acting as Smoke-Screen for Big Tobacco (Schlein, 12/17).
The Wire: Exclusive: Philip Morris Funded Anti-Smoking Foundation Targeting Public Health Leaders With Grants (Bhuyan, 12/13).
The Wire: Public Health Leaders Ask to Be Removed From Mailing List of Foundation Offering Them Tobacco-Funded Grants (Bhuyan, 12/15).

Xinhua News: Cholera kills more than 400 people in South Sudan since mid 2016: WHO (12/15).

Xinhua News: Cholera claims 20 lives in Zambian capital as infected cases reach 760 (12/17).

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Editorials and Opinions

Public-Private Partnerships Vital To Making Progress Against NTDs

Devex: Opinion: How public-private partnerships are combating NTDs
Matshidiso Rebecca Moeti, WHO regional director for Africa

“…Thanks to an innovative public-private partnership, we’ve seen remarkable progress against [neglected tropical diseases (NTDs)]. In an unprecedented move, 13 of the largest pharmaceutical companies have pulled together under the auspices of the CEO Roundtable and are executing the largest drug donation in history. … In a critical move to maximize the impact of this historic drug donation, last year the World Health Organization launched the Expanded Special Project for Elimination of Neglected Tropical Diseases, or ESPEN, a five-year project designed to help all countries on the continent reach their elimination goals by 2030. … In the fight against NTDs, we are reaping the fruits of unusual public-private partnerships: Big Pharma has joined with endemic country leadership, who are supported by technical leadership from ESPEN — and together they are making massive impact for the most vulnerable among us. We have united and are well on our way to tying up this NTD lion once and for all, bringing us closer to the goal of an NTD-free world” (12/15).

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International Community Must Take Action Against Mistreatment Of Rohingya, Work To Stop Wartime Sexual Violence, Support Victims

New York Times: When Victims of Wartime Rape Are Scorned
Riada Asimovic Akyol, writer on gender, nationalism, and religion and Ph.D. candidate at Galatasaray University in Istanbul

“Last month, Human Rights Watch published a report confirming that Myanmar’s army is engaged in the mass rape of Rohingya Muslim women and girls as a tool of ethnic cleansing. That report was followed, last week, by an article from the Associated Press that established the same set of facts: the use of ‘sweeping and methodical’ rape as a weapon of war. … The reports … all called to mind similar stories from my country, Bosnia and Herzegovina. During the 1992-95 war in Bosnia, an estimated 20,000 to 50,000 women experienced brutal sexual violence, both inside and outside numerous ‘rape camps.’ … Today, there is no more war in Bosnia. But more than two decades after the fighting ended, it is the lingering effects of this wartime sexual violence that remain among our most open wounds. … In the case of the Rohingya I worry especially for the future of the women who have suffered these mass rapes: They might be in the news for now, but as in Bosnia, could later end up marginalized, silenced, and abandoned to their traumas, even by some members of their own community. … The same tragedy that took place in Bosnia should not recur with the Rohingya. The genocide must be stopped, and the victims of sexual violence should be given the support, the rights, and the respect that they deserve” (12/18).

New York Times: Is This Genocide?
Nicholas Kristof, New York Times columnist

“…[I]ncreasingly there are indications that the carnage [against the Rohingya] may amount to genocide. … There is no easy solution to possible genocide; there never is. But accountability helps, so there should be a major push to prosecute Myanmar military officials in the International Criminal Court. Judges can resolve whether these crimes against humanity also amount to genocide. An open letter from 58 human rights and aid groups has rightly called for targeted sanctions on Myanmar officials. The House of Representatives this month passed a resolution denouncing the ethnic cleansing, and both the Senate and the House have bipartisan legislation pending that would impose sanctions on Myanmar officials, yet it seems unlikely to become law any time soon. Secretary of State Rex Tillerson has commendably described the situation as ethnic cleansing and has said that ‘the world can’t just stand idly by and be witness to the atrocities.’ But I fear that’s exactly what is happening. … We do know that international sanctions and pressure matter to Myanmar’s generals, because those were what led them to step back and hold elections. But so far there hasn’t been enough pressure exerted to stop the barbaric treatment of the Rohingya…” (12/15).

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Brazil Must Reboot National AIDS Strategy

Bloomberg: Brazil’s AIDS Fight Falls Victim to Success
Mac Margolis, author

“…Data from the public health ministry released early this month shows that AIDS — a scourge Brazil appeared on track to beat — is on the rise among some demographics (young men) and regions (the north and northeast). … Independent research conducted in Rio de Janeiro also indicated alarming rates of HIV infections among vulnerable and neglected groups … Brazil sorely needs to reboot its strategy. Fortunately, health bureaucrats are quickly, if belatedly, overhauling their prevention protocols. … Now the health ministry is preparing to blitz social media with slick safe-sex messages, and reintroduce campaigns for reproductive health in the classroom that had been suspended … ‘We’ve never had so many tools to combat HIV and AIDS as we do today,’ said [Mario Scheffer, a public health expert at the University of Sao Paulo]. All that’s needed now is to put these tools to use … and keep the country inoculated against the deadly scourge of complacency” (12/15).

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Investing In Local Peacebuilders Key To Ending War, Humanitarian Crisis In Yemen

Devex: Opinion: We cannot wait another 1,000 days to help Yemen
Shoqi A. Maktary, country director of Search for Common Ground — Yemen

“[Friday marked] the 1,000-day anniversary of the beginning of the war in Yemen. … For 1,000 days — day in, day out — we [Yemenis] have woken up and gone to bed with the terrifying reality of airstrikes, ground-fighting, and hunger. But this is not the worst of our pain. Our real source of pain is knowing that all of this could have been prevented, with one simple, life-saving decision — to support peacebuilders. In fact, a concerted effort by the international community to invest in local peacebuilders would not only help stop the violence and bloodshed, but would also stabilize our country and alleviate horrific human suffering in the long term. … It’s time to go beyond addressing only the humanitarian crisis and other symptoms of the conflict. It’s time to help local mediators and peacebuilders succeed…” (12/15).

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From the Global Health Policy Community

New Report Examines Role Of Evaluation, Learning In U.S. Foreign Assistance Programs

Lugar Center Blog: Are We Really Learning from Evaluations?
Lori Rowley, director of Global Food Security and Aid Effectiveness at the Lugar Center, discusses a recently released report from the Lugar Center and the Modernizing Foreign Assistance Network (MFAN) on the role of evaluation and learning in U.S. foreign assistance programs. Rowley highlights the importance of aid effectiveness, the status of evaluation and learning in U.S. foreign assistance programs, and recommendations on how U.S. agencies can improve data quality and the utilization of evaluations (12/14).

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UNAIDS' Progress Cited As Example Of 'U.N. Reform In Action,' Agency's Board Says

UNAIDS: Board recognizes progress made by UNAIDS as an example of United Nations reform in action
“The 41st UNAIDS Programme Coordinating Board meeting concluded in Geneva, Switzerland, on 14 December. The Board took note of the report on progress in implementing the UNAIDS Joint Programme Action Plan and the Strategic Resource Mobilization Plan 2018-2021 and called for additional contributions towards fully funding UNAIDS’ core Budget, Results, and Accountability Framework. The Board recognized the significant progress achieved by UNAIDS over the past months as an example of United Nations reform in action…” (12/15).

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FT Health Discusses Efforts To Track Universal Health Coverage, Features Interview With World Bank President

FT Health: Universal health cover, Jim Kim, expanding wineglasses
The latest issue of the Financial Times’ weekly global health newsletter highlights efforts to track universal health coverage globally and features an interview with World Bank President Jim Yong Kim on “efforts to encourage investment in health and education.” The newsletter also features a roundup of other global health-related news stories (Jack, 12/15).

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