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Kaiser Daily Global Health Policy Report

In The News

President Trump Releases FY 2019 Budget Request, Includes Proposed Cuts To State Department, USAID

CNN: Trump admin wants to slash funding for diplomacy
“The Trump administration is proposing sharp cuts to the budget for international diplomacy and aid in 2019, in line with a determination to boost spending on the military and cut it elsewhere. … Anticipating the cuts, 151 retired three- and four-star generals wrote congressional leaders from both parties on Friday urging them to ‘ensure a responsible commitment of resources’ that keeps pace with the growing threats the U.S. faces. ‘We must not undercut our nation’s ability to lead around the world in such turbulent times,’ the generals wrote. … Last year, Congress largely ignored the administration’s request for cuts, with many lawmakers voicing concerns similar to the generals’…” (Gaouette, 2/12).

Politico: Lawmakers promise bipartisan ‘no’ to Trump plan for cutting diplomacy and aid money
“…The White House on Monday proposed allocating $41.7 billion for the International Affairs Budget in fiscal 2019, a category that includes the State Department and the U.S. Agency for International Development. That’s a 30 percent cut from the fiscal 2017 enacted level of $59.6 billion, according to an analysis of the proposal by the U.S. Global Leadership Coalition. Trump sought similar cuts in his budget proposal last year, shortly after taking office, saying he’d prefer to direct the money to the Pentagon. But he faced stiff bipartisan resistance in Congress then, as he is now…” (Toosi, 2/12).

Vox: Trump wants to gut the State Department by 25 percent. You read that right.
“…Combined with the administration’s proposed increase in military spending, the budget vividly illustrates that Trump sees military force — and not diplomacy — as the most effective way of preventing conflicts and advancing America’s national security interests. … The Trump budget proposal takes aim at many different programs at the State Department that many defense and diplomacy experts from across the political spectrum consider essential to promoting American interests…” (Aleem, 2/12).

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Foreign Policy Examines Implications Of Recent Budget Deal For State Department, USAID

Foreign Policy: State Department, USAID Face Drastic Budget Cut
“The State Department and the U.S. Agency for International Development face deep funding cuts under a budget deal worked out last week that ended a government shutdown, and lawmakers are struggling to find additional funds to plug the gap. … The funding shortfall for the State Department and USAID affects operations for the current fiscal year, and for 2019. The sweeping budget deal hammered out last week among congressional leaders and the White House averted a prolonged government shutdown by setting spending levels for fiscal year 2018 and fiscal year 2019. But while the deal boosted funding for the U.S. military, it reduced nondefense funding in the Overseas Contingency Operations budget, which has previously provided one-third of the budget for the State Department and USAID. As a result, lawmakers have only weeks to find additional funds for the State Department in the FY 2018 budget, and they will face a similar gap for the proposed FY 2019 budget. In the meantime, the Trump administration will present its federal budget request for 2019 on Monday…” (De Luce/Gramer, 2/12).

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Bill, Melinda Gates Issue Annual Letter, Address Questions About Foundation's Efforts, Trump Administration's Policies, Foreign Aid Spending

Fast Company: Bill And Melinda Answer 10 Tough Questions About The Gates Foundation
“At the Gates Foundation, Melinda and Bill Gates command a $40 billion endowment aimed at improving health, and eradicating hunger and poverty in developing counties. To a lesser degree, the foundation also works to improve the U.S. educational system. On average, the organization doles out more than $4 billion in grants each year. Over the years, that sort of spending has raised questions from people both inside the sector and beyond. For the foundation’s annual letter this month, which is posted on GatesNotes, Bill’s personal blog, the power couple decided to answer 10 of the tougher ones they’ve encountered in recent years…” (Paynter, 2/13).

New York Times: Bill and Melinda Gates Tackle ‘Tough Questions’ and Trump
“For the past year, Bill and Melinda Gates have received the same question repeatedly while jetting around the world: How is President Trump affecting their work as two of the world’s top philanthropists? The president has rattled it in several ways, they answer. His policies have shaken up the field of family planning, they say, and his derogatory comments about African countries and Haiti have caused disbelief among people they work with outside the United States. … Mr. and Ms. Gates are badgered about Mr. Trump so often that they made the topic part of the annual letter they published early Tuesday, a digest the couple releases about the philanthropic activities of the Bill and Melinda Gates Foundation. … This is the 10th annual letter the Gateses have published, which they’re marking by answering 10 ‘tough questions’ they frequently get. In addition to Mr. Trump, they address topics like why they team up with corporations and whether they’re imposing their values on other cultures…” (Wingfield, 2/13).

Washington Post: Bill and Melinda Gates take on tough questions about their giving
“…In the letter, and in a brief recent interview with The Washington Post, the duo discussed their effort to respond to some of the more frequent — and not always flattering — questions they get from people scrutinizing their work. … One of the challenges the Gateses face is not only addressing questions or concerns about the wide diversity of intractable global problems they do work on — from eradicating polio in Nigeria and the Middle East to reducing homelessness in the Pacific Northwest — but demands about the problems they don’t fund…” (McGregor, 2/13).

The Atlantic: ‘America First’ Is Straining Bill Gates’s Optimism
“Bill Gates isn’t a big fan of ‘America First.’ In a recent episode of The Atlantic Interview, he told Jeffrey Goldberg, the editor in chief of The Atlantic, ‘the long-term benefit of [nations] trusting each other, even beyond one or two terms of office, is a pretty gigantic thing.’ That’s not to say Gates is pessimistic about the future. His and Melinda Gates’s tenth annual letter, released Tuesday, is otherwise sunny in its global outlook. … But as Gates stressed to Goldberg, the modern world still faces serious threats, especially those that transcend geopolitical borders. ‘We have more connectivity working against us,’ he said. And because of this connectivity, Gates fears a new global pandemic. More spending on global health could avert such a crisis, but a dip in public-health spending could hasten catastrophe…” (Gutman, 2/13).

TIME: Melinda Gates: President Trump’s ‘Misguided’ Budget Shows U.S. Doesn’t Care About Women and Children
“President Trump on Monday released his latest budget request for the next fiscal year. The plan drew reactions from all over, including criticism from philanthropist Melinda Gates, who took issue with a ‘misguided’ approach to global health and poverty funding. Gates, whose work at the Bill and Melinda Gates Foundation aims to reduce health inequities around the developing world, said that Trump’s proposed cuts to international health programs leaves the U.S. vulnerable to health crises like rapidly-spreading pandemics. … Gates also argued that Trump’s budget, if passed in its current state, will harm women and children in need of family planning services…” (Jenkins, 2/12).

USA TODAY: Bill Gates’ dire warning: U.S. could lose its global leadership role under Trump
“Tech pioneer Bill Gates thinks the U.S. can keep its historically influential role as a global leader. But for a second year in a row, he cautioned that the nation risks losing its geopolitical clout if the Trump administration succeeds in slashing foreign aid, as proposed Monday in a new federal budget that prioritizes a jump in military spending. Last year, the White House tried to reduce foreign aid by one-third, but Congress did not approve the cuts. … Gates points out even his sizeable philanthropic spend is dwarfed by the tens of billions of dollars that countries, including the U.S. and United Kingdom, typically funnel to international programs…” (della Cava, 2/13).

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Wired Examines Potential Of, Challenges To Eradicating Measles

Wired: The Shadow Crusade to End Measles
“…Defeating measles has long been a cherished dream in global health. … Opposing camps within public health argue either that the time is now, to piggyback on top of current campaigns, or after polio is gone, because we can only fund and focus on one global disease at a time. In other words: Is the best way to end measles in the future by not ending measles now? Could the failures — and near-successes — of other eradication campaigns ultimately teach us how to conquer measles?…” (McKenna, 2/12).

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Devex Interviews Seed Global Health CEO About Health Worker Capacity Building

Devex: Q&A: Kerry says community health worker model “cannot be done in isolation”
“Community health workers are seen by many, including donors, as a cost-effective solution to the problem of the global shortage of health care professionals. But depending so heavily on community health workers, without prioritizing investments toward training doctors, nurses, and midwives, will ultimately result in substandard care for patients, Dr. Vanessa Kerry, chief executive officer of Seed Global Health, told Devex during a recent trip to Malawi. … Seed Global Health, a United States-based nonprofit, is one of the organizations aiming to address this shortage. … Its Global Health Service Partnership, a public-private collaboration with the Peace Corps and the U.S. President’s Emergency Plan for AIDS Relief, places health professionals ‘alongside local medical and nursing faculty counterparts to meet the teaching needs identified at each partner institution’…” (Jerving, 2/12).

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Botswana's Lack Of Data Systems To Track Malnutrition Hampering Efforts To Address Problem

Malnutrition Deeply: Experts Warn Data Gaps Are Undermining Botswana’s Nutrition Programs
“…In a country where nearly one-third of all children under 5 years of age suffer from stunting, according to statistics from the World Health Organization, Botswana is scrambling to address undernutrition among the country’s children. But it lacks the systems to accurately and consistently track data on how the situation is changing. … Information about malnutrition in Botswana is coming from administrative records that are collected by health institutions in the course of their day-to-day work, but that information is gathered infrequently and plagued by gaps, officials said…” (Tshipa, 2/12).

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More News In Global Health

Newsweek: People Are Beating Monkeys To Death In Brazil Amid Panic Over Yellow Fever (Dovey, 2/12).

Xinhua: Charity warns malnutrition threatens 4.7 mln children in East Africa (2/12).

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Editorials and Opinions

U.S. Foreign Policy Needs 'Thoughtful' Reforms, Fully Empowered, Coordinated Diplomacy, Development Functions

Reuters: Commentary: The best way to fix U.S. diplomacy
Richard G. Lugar, former U.S. Senator from Indiana and former chair of the Senate Foreign Relations Committee, and Thomas Pickering, former under secretary of state and former ambassador

“American foreign policy currently stands at a crossroads. There are two possible paths forward: withdrawal from the world as a result of the Trump administration’s proposed cuts to the international affairs budget, or a reassertion of America’s indispensable global role led by a capable, modern State Department and an empowered, adequately-funded U.S. Agency for International Development (USAID). … International engagement is in America’s economic and security interests, and we must support our civilian agencies in their unique and mutually-reinforcing missions. The national security of the United States will suffer greatly if the true purpose of the Trump administration’s reorganization of the State Department and USAID is to shrink the role of or force a merger of our civilian foreign policy agencies. What is needed are thoughtful reforms that enhance our foreign policy capacity and strength through fully empowered and coordinated diplomacy and development functions. … We know from experience that changes will only be sustained through an inclusive and cooperative interagency process, consultations with outside experts, and bipartisan engagement. At this critical crossroads, we urge administration officials, members of Congress, and the broader foreign policy community to work together and ensure that our nation’s diplomacy and development institutions are equipped to meet today’s global challenges to achieve a safer, more stable and prosperous world” (2/12).

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Opinion Piece Examines Food Security In Africa

The Star: Why is Africa still hungry?
Alex O. Awiti, director of the East Africa Institute at Aga Khan University

“…Why is Africa still hungry when the continent recorded the highest GDP growth and is on the upswing? Why does agriculture, which employs more than 70 percent of Africa’s workforce, contribute the least to the continent’s GDP? … Why is Africa still hungry when it is jam-packed with NGOs, civil society, research and academic institutions focused on agriculture? Why is Africa hungry when the World Bank, AfDB, and foundations such [as] the Bill and Melinda Gates and Rockefeller Foundations and MasterCard have made available hundreds of millions of dollars to fund agriculture. Why is Africa still hungry when thousands of African researchers have received higher training in agronomy, economics, soil science, crop and animal breeding, agroforestry, finance, and insurance? Why is Africa hungry when each country has an agriculture department and a plethora of policies and strategies? Is the reason Africa is hungry really about inadequate human capacity and institutions? For nearly a century, different experts have sworn that the problem is markets or inputs or genetics or roads or policies or finance or post-harvest losses or property rights for women or subsidies or value addition. Experts have debated loud and long. While each expert has been partially right, all were wrong about Africa’s agriculture…” (2/13).

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Ethical Implications Of Strategies Addressing Drug Resistance Require 'Careful Consideration'

Project Syndicate: The Ethics of Fighting Drug Resistance
Christian Munthe, bioethicist and professor of philosophy at the University of Gothenburg

“…[T]he ethical roadmap for addressing [drug resistance] remains dangerously ill-defined. Health care policies that pursue long-term goals often have short-term costs for human, animal, and environmental well-being. … [E]thicists, health care researchers, and social scientists have begun to examine how best to ensure that strategies for tackling drug resistance are ethically responsible. … These scholarly gatherings have helped to foster academic interest in the ethical considerations of drug resistance, but represent only a tiny fraction of what is needed to help the world safely navigate the looming moral minefield. Any effort to restrict antibiotic consumption, regulate the food and pharmaceutical industries, or change human behaviors — all strategies that are currently being discussed — will require complex ethical reflection and analysis. … As drug resistance-related challenges become more urgent, one might think that ethical debates are an unaffordable luxury. But, given the risks implied by deploying ill-considered solutions, careful consideration of the ethical implications of drug resistance strategies is essential” (2/12).

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From the Global Health Policy Community

'Science Speaks' Examines Global Health Aspects Of President's FY 2019 Budget Request

IDSA’s “Science Speaks”: White House budget recognizes global health threats with words, but not dollars with massive cuts to HHS, State Department, USAID
Antigone Barton, senior editor and writer of “Science Speaks,” discusses global health aspects of President Trump’s FY 2019 budget request (2/12).

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Friends Of The Global Fight Urges Congress To Fully Fund Global Fund, Provides Infographic On Impact Of Proposed Global Health Cuts

Friends of the Global Fight: Friends Urges Congress to Reject Proposed Cuts to the Global Fund and U.S. Foreign Assistance
“Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends) expresses deep concern with the Trump Administration’s proposal [on Monday] of a $425 million cut to the Global Fund, which could set back global progress in the fight against the AIDS, tuberculosis (TB), and malaria epidemics. Friends calls on Congress to fully fund the Global Fund with an appropriation of $1.35 billion in fiscal year 2019, consistent with the U.S. pledge…” (2/12).

Friends of the Global Fight: Infographic: The Significant Impact of Budget Cuts on Global Health
“…The following Friends of the Global Fight infographic demonstrates the human impact of the proposed $425 million budget cut. If enacted, the Global Fund calculates that a budget cut would translate to fewer lives saved, fewer infections averted and lost economic opportunities” (2/12).

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In Annual Letter, Bill, Melinda Gates Answer 10 'Tough' Questions About Their Work

GatesNotes: The 10 Toughest Questions We Get
In their 10th annual letter, Bill and Melinda Gates, co-chairs of the Bill & Melinda Gates Foundation, answer “10 tough questions that people ask us,” including questions on the Foundation’s giving in the U.S., investments in climate change, imposing values on other cultures, overpopulation, the impact of President Trump’s policies on the Foundation’s efforts, and the Foundation’s work with corporations (2/13).

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Post Examines Role Of OECD's DAC In Advancing Development, Achieving SDGs

Brookings Institution’s “Future Development”: In defense of traditional aid
Anthony F. Pipa, senior fellow for global economy and development at Brookings, discusses highlights from a roundtable discussion on the role of the Organization for Economic Cooperation and Development’s (OECD) Development Assistance Committee (DAC) and writes, “The DAC, the arbiter and guardian of official development assistance (ODA), is increasingly at risk of obsolescence. … Our roundtable discussion … highlighted that an uncertain environment and even lack of consensus provides the DAC a basis for renewal. … The DAC is … well-positioned to provide leadership in shepherding the shift from development aid to development finance, the much broader array of tools and capital that includes both public and private resources that will be necessary to achieve the scale of the [Sustainable Development Goals (SDGs)]. … Such a central focus on sustained and sustainable development impact, and the values that undergird it, should continue to set the DAC apart…” (2/12).

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UNDP Working On Risk-Informed Urban Infrastructure Development In Face Of Climate Change

UNDP: Our cities are on the frontline of changing climate
In this blog post, Jan Kellett, adviser on climate change and disaster risk reduction at the UNDP’s Bureau for Policy and Programme Support, discusses the risks that climate change poses to the world’s largest cities, as many are located in coastal areas. He notes, “[W]ith population growth comes massive needs in terms of infrastructure, with estimates that governments will have to spend more than U.S.$70 trillion on critical areas like road and rail transport telecommunications, water, and energy before 2030. … The critical message is that urban infrastructure will only be sustainable if it is risk-informed. Without this, many, not just a few, will be ‘left behind’ come 2030” (2/12).

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From the U.S. Government

U.S. Department Of State, USAID Fact Sheets, USAID Administrator Statement Address FY 2019 Budget Request

U.S. Department of State: State Department and U.S. Agency for International Development FY 2019 Budget Request
This fact sheet provides an overview of the State Department’s priorities, including global health priorities, in the FY 2019 budget request (2/12).

USAID: Statement by USAID Administrator Mark Green on the Fiscal Year 2019 Budget Request
“[Monday] the President released his Fiscal Year (FY) 2019 Budget request of $39.3 billion for the State Department and the United States Agency for International Development (USAID). … For USAID, the FY 2019 Budget request includes $16.8 billion [that] the Agency fully or partially manages…” (2/12).

USAID: Fiscal Year (FY) 2019 Development and Humanitarian Assistance Budget
This fact sheet provides an overview of USAID’s priorities, including global health priorities, in the FY 2019 budget request (2/12).

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From the Kaiser Family Foundation

Kaiser Family Foundation Budget Summary Analyzes Global Health Aspects Of President’s FY 2019 Budget Request

Kaiser Family Foundation: White House Releases FY 2019 Budget Request
This budget summary highlights global health-related funding proposals contained in President Trump’s FY 2019 budget request released on Monday. The request includes significant cuts to global health, including a decline in funding provided to the State Department and USAID. Funding provided to the State Department and USAID (through the Global Health Programs account) would decline by more than $2 billion (-23 percent), from $8,725 million in FY 2017 to $6,703 million, which would be the lowest level of funding since FY 2007 (2/13).

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