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Kaiser Daily Global Health Policy Report

In The News

Health Services Organizations Feeling Impact Of Expanded Mexico City Policy, Adapting To Find New Donors To Fill Funding Gaps

Inside Philanthropy: Weathering the Storm: How a Global Family Planning Outfit Is Coping With Funding Cuts
“President Trump has made a mission of cutting funding for women’s reproductive health, but funders and grantees are responding with changes of their own. … With Trump’s re-imposition of the global gag rule, and three more years left in his presidency, instability in funding for global reproductive rights isn’t going away any time soon. Looking ahead, both grantees and funders can be expected to continue adapting…” (Pattee, 2/1).

TIME: The Impact of President Trump’s ‘Global Gag Rule’ on Women’s Health is Becoming Clear
“…In just one year, health care workers say the policy has had disastrous effect; as expected, clinics are shutting down, unsafe abortions are predicted to rise sharply, and families are losing critical services across the globe. While no death count has been directly linked to the policy, providers do have estimates of how many life-saving procedures could have been offered by the funding they are now denied, and the numbers are in some cases staggering…” (Quackenbush, 2/2).

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CDC Set To Cease 80% Of Global Epidemic Prevention Activities Without New Funding

Washington Post: CDC to cut by 80 percent efforts to prevent global disease outbreak
“…[T]he Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said. … Most of the funding comes from a one-time, five-year emergency package that Congress approved to respond to the 2014 Ebola epidemic in West Africa. … That money is slated to run out by September 2019. Despite statements from President Trump and senior administration officials affirming the importance of controlling outbreaks, officials and global infectious disease experts are not anticipating that the administration will budget additional resources. … A senior government official said Thursday that the president’s budget ‘will include details on global health security funding,’ but declined to elaborate” (Sun, 2/1).

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CDC Principal Deputy Director Anne Schuchat Takes Over Agency As Acting Director; Former Director's Financial Conflicts Of Interest Confuse Ethics Experts

STAT: CDC director’s investment in tobacco, drug companies baffles ethics experts
“It was a financial investment in a tobacco company that helped lead to the downfall of Brenda Fitzgerald, who until Wednesday was the director of the Centers for Disease Control and Prevention. For many in the public health community, the notion that the head of the CDC held shares of a company in an industry that has been so anathema to the agency’s mission was shocking. But Fitzgerald also purchased shares in pharma giants Merck and Bayer after taking over the CDC — an apparent conflict of interest that also confounded government ethics experts…” (Branswell, 1/31).

Washington Post: CDC employees are delighted that their acting director is back in charge
“…When the notice finally went out on the CDC’s internal announcement board that the principal deputy director, Anne Schuchat, 58, with nearly three decades of CDC experience, would be taking over (again) as acting director, employees were very happy to hear the news. … [Schuchat] served as acting director for six months in 2017 after Tom Frieden resigned from the post and before Fitzgerald was appointed…” (Sun, 2/1).

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Devex Examines Several Aspects Of WHO General Program Of Work, Including DG Tedros's Views On Global Health Funding

Devex: ‘What worries me is not the money for WHO’ — Tedros
“The draft 13th General Program of Work cut across discussions at last week’s 142nd executive board session of the World Health Organization. But while some stakeholders perceived progress on the current draft, questions remain, including the nagging question on how WHO Director-General Tedros Adhanom Ghebreyesus would be able to finance his vision for the organization. … [W]hile some raise concerns for WHO’s budget, funding WHO’s work doesn’t appear to worry Tedros as much — at least in the immediate term — as that for the wider global health agenda. … [H]e believes unlocking enough resources for global health lies not so much in what donors can provide, but in countries’ commitment to invest and mobilize sufficient resources for the health of their own populations. … He however acknowledged that the ‘global gag rule’ imposed by the current U.S. administration will have major impacts on women, especially those who have less…” (Ravelo, 2/1).

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DFID Leadership Outlines Agency's Priorities, Including 0.7% Of GNI Commitment, Working With Private Sector

Devex: New DFID leadership team sets out priorities
“Penny Mordaunt and Matthew Rycroft outlined their priorities Wednesday in their first appearance together as secretary of state and permanent secretary of the United Kingdom Department for International Development. Speaking in an evidence session before the International Development Committee in the House of Commons, Mordaunt was pressed on issues including the national interest agenda, tied aid, and multilateral reforms…” (Anders/Edwards, 2/1).

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Open Letter To Global Fund Expresses Concern Over Partnership With Beer Maker Heineken

Reuters: Health campaigners decry global HIV fund’s deal with Heineken
“International health campaigners and alcohol concern groups called on a major global HIV and malaria fund on Thursday to end immediately a partnership it had signed with the Dutch brewer Heineken. In an open letter to the director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an alliance of more than 2,000 health organizations voiced ‘deep concern’ and said the deal would only help Heineken broaden its marketing reach…” (Kelland/Blenkinsop, 2/1).

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Drug-Resistant Malaria Continuing To Spread In Southeast Asia, Study Shows; Authors Call For More Action

The Guardian: Drug-resistant malaria will spread without urgent action, experts warn
“Urgent action must be taken to stop the spread of drug-resistant malaria in southeast Asia and potentially beyond, according to scientists. The outbreak in Cambodia, then Thailand, Laos, and most recently Vietnam, of malaria that is untreatable with the newest and best drugs we have has alarmed experts. … A study led by scientists from the Wellcome Sanger Institute and published in the Lancet Infectious Diseases journal, investigated what happened in Cambodia between 2008 and 2013, when it became obvious that some patients were not being cured…” (Boseley, 2/1).

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More News In Global Health

Devex: Liberian executive order banning FGM expected to lack enforcement (Roby, 2/2).

New York Times: India Wants to Give Half a Billion People Free Health Care (Goel/Kumar, 2/1).
Reuters: India’s ‘Modicare’ to cost about $1.7 billion a year: sources (Kalra et. al, 2/2).

Reuters: Philippines says anti-dengue vaccine may be connected to three deaths (Mogato, 2/2).

STAT: Concerns over one dengue vaccine raise alarms over others in development (Branswell, 2/2).

WIRED: Big Pharma has the Flu (McKenna, 2/1).

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Editorials and Opinions

Next CDC Director Should Base Decisions On Science, Lead Agency Effectively, Advocate For Sufficient Funding To Protect Americans

The Hill: Dr. Tom Frieden: People working in public health are stewards of the public’s trust
Tom Frieden, president and CEO of Resolve to Save Lives

“…This is a precarious time. Our nation’s leading and most critical disease fighting force — the CDC — is facing budget cliffs and cuts that would make Americans less safe by devastating initiatives that protect Americans from diseases, disasters, and epidemics. … The greatest threat to CDC — and therefore a significant threat to the health of all Americans — is that CDC will not receive the funding it needs to protect the United States. … The next CDC director must be an effective advocate for the resources necessary to fulfill its mission of protecting America from health, safety, and security threats that arise at home and around the world. Given the potential for deep cuts to the CDC budget, it is imperative that the agency’s new head convinces all branches of government to continue urgently needed funding to protect Americans. … I urge Secretary Azar to quickly appoint a leader who will fulfill CDC’s mission by basing decisions on science [and] leading the agency effectively, and protect CDC so CDC can protect all of us” (2/1).

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Diphtheria Outbreak In Refugee Camps Indicates Rohingya Children Missing Out On Basic Vaccinations

Scientific American: A Completely Preventable Public Health Crisis
Seth Berkley, CEO of Gavi, the Vaccine Alliance

“With the recent arrival of more than 655,000 Rohingya refugees living in squalid conditions in Cox’s Bazar in Bangladesh, an outbreak of an infectious disease might have seemed inevitable. But not diphtheria. … The fact that there is a diphtheria outbreak in the first place is a clear indication that these people did not have access to even the most basic vaccines and brings into question the conditions they were living in before they arrived at the camp. This outbreak is not the product of conditions within the camps, but rather a deadly legacy of the conditions in which they had been living before they fled Myanmar. … [E]nough Rohingya children have missed out [on basic immunizations] to trigger an outbreak. This clearly indicates a major public health failure, which has compromised the Rohingya’s human right to lead healthy lives through the prevention of vaccine-preventable disease. … [W]hile the focus now must be on ending the outbreak in the refugee camps, it is important to remember that whenever diphtheria is involved, the camps are not the problem” (2/1).

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'Harnessing Culture For Change' Vital To Ending FGM By 2030

The Lancet: Changing culture to end FGM
Editorial Board

“…Feb. 6 is the U.N. International Day of Zero Tolerance for [Female Genital Mutilation (FGM)], which helps promote the Sustainable Development Goal target to eliminate the practice by 2030. … [W]ithout more urgent action [the gains made toward ending FGM] may soon be lost … [W]hile national legislation should be advocated, it is not sufficient. Laws against traditional practices often go unheeded in countries where local chiefs and religious leaders wield more influence than the government … Insights generated at the local level are most important, and they can fuel the urgency this issue needs. Chief among these is recognition that FGM is deeply embedded in culture. … On Feb. 6, when the international community convenes to condemn the cruel global problem of FGM, let us look deeper for solutions that can fuel the urgent progress we need: recognizing the cultural meanings of FGM, and harnessing culture for change” (2/3).

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More Research Needed To Understand Levels Of Protection In Fractionated vs. Full-Dose Yellow Fever Vaccines

The Lancet: Yellow fever: a major threat to public health
Editorial Board

“…Due to a global shortage of the [yellow fever] vaccine, in outbreak emergencies WHO recommends fractional dosing to protect more people by using less antigen in each dose. … For routine immunization, the standard full dose, recommended by WHO since 2013, is thought to confer lifelong protection, although supporting evidence for this view is not strong. … As a zoonotic disease, with a reservoir in non-human primates, it is unlikely that yellow fever will be eradicated. However, epidemics can be prevented if populations are protected by routine immunization and if mass vaccination campaigns are implemented quickly in response to an outbreak. A coalition of partners led by WHO, UNICEF, and Gavi, the Vaccine Alliance, aims to eliminate yellow fever epidemics worldwide by 2026. To achieve this goal, there is an urgent need for research to clarify the duration of protective levels of immunity provided by fractionated and full-dose yellow fever vaccines to support development of effective vaccination programs” (2/3).

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From the Global Health Policy Community

Brookings Experts Examine Foreign, Domestic Spending To Reduce Poverty Abroad, At Home

Brookings Institution: The link between foreign aid and domestic social spending
Homi Kharas, interim vice president and director of Brookings’ Global Economy and Development program, and Lorenz Noe, research analyst in the Global Economy and Development program, examine trends in countries’ official development assistance and domestic social spending. The authors write, “Countries that spend more domestically also spend more on foreign aid. … The real constraint on both domestic social spending and aid is political will, not finance. Policymakers, as well as civil society, need to look hard at the evidence of impact and then play a part in ensuring that the political system delivers money to programs that reduce poverty at home and abroad…” (2/1).

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Report Examines U.S. Contribution To Global Pharmaceutical Profits, Impact On Drug Innovation

Brookings Institution: The global burden of medical innovation
In a report originally published at the Schaeffer Center for Health Policy & Economics at the University of Southern California, Dana Goldman, nonresident senior fellow for economic studies at the Center for Health Policy at the USC-Brookings Schaeffer Initiative for Health Policy, and Darius Lakdawalla, Quintiles chair in pharmaceutical development and regulatory innovation at the USC Schaeffer Center for Health Policy and economics professor at the USC School of Pharmacy and Price School of Public Policy, discuss the relationship between drug spending and drug discovery, highlighting the U.S. contribution to global pharmaceutical profits. The authors write, “Pressure is building in the United States for the federal government to take action to regulate drug prices. Proponents contend that consumers will benefit from lower prices, while critics contend that reducing future revenues will slow innovation. … However, if other wealthy countries shouldered more of the burden for medical innovation, both American and European patients would benefit…” (1/30).

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UNICEF's Countdown 2030 Report Synthesizes Data On Women's, Children's, Adolescents' Health, Nutrition

UNICEF: Countdown 2030: Tracking progress towards universal coverage for women’s, children’s and adolescents’ health
“The report synthesizes data on the current situation and trends in reproductive, maternal, newborn, and child health and nutrition from a wide array of sources, including the profiles of the 81 Countdown priority countries, which together account for 95 percent of maternal deaths and 90 percent of deaths among children under age five. Countdown’s primary focus is the continuum of care, with some expansion into nutrition, adolescent health (limited to adolescent girls’ reproductive health), early childhood development, quality of care and effective coverage, and conflict settings…” (1/31).

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February 2018 Issue Of WHO Bulletin Available Online

WHO: Bulletin of the World Health Organization
The February 2018 WHO Bulletin includes articles on various issues, including an editorial on health, climate, and small island states by WHO Director-General Tedros Adhanom Ghebreyesus and Patricia Espinosa, executive secretary of the United Nations Framework Convention on Climate Change; a research paper on cholera vaccination in Zambia; and policy articles on the revision of clinical case definitions for influenza-like illnesses and severe respiratory infection, as well as on projected financial losses from an influenza pandemic (February 2018).

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'Science Speaks' Highlights Study On Global Trends In CD4 Count At Start Of ART

IDSA’s “Science Speaks”: Study finds more than half of patients worldwide don’t access HIV treatment until immune systems are severely compromised
Antigone Barton, senior editor and writer of “Science Speaks,” discusses findings from a study published in Clinical Infectious Diseases on global trends in CD4 count at the start of antiretroviral therapy, writing, “Data from nearly a million patients starting treatment for HIV across the world over the last decade shows 55 percent of them accessed antiretroviral treatment only after their immune cell — or CD4 — counts had dropped below 200, leaving them extremely vulnerable to illnesses and infections” (2/1).

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