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Kaiser Daily Global Health Policy Report

In The News

President Obama Highlights U.S., Private Sector Funding For Food Security Efforts In Senegal

“President Barack Obama highlighted U.S. and private-sector financial commitments for food security efforts at a summit [on Friday] in Senegal as he wrapped up the first stop of a three-country tour of sub-Saharan Africa,” Bloomberg Businessweek reports. According to announcements made on Friday, “[t]he U.S. will increase by $47 million its assistance for seeds and agricultural technology, while private companies will commit to invest $134 million in Senegal’s agricultural system,” the news service adds (Talev/Goldman, 6/28). “Standing in front of the agricultural displays at an event hosted by Feed the Future, the U.S. government’s global hunger initiative, Obama said his administration was making food security a top priority of its development agenda,” Reuters writes (6/28). “The president emphasized food security while touring Dakar, Senegal’s capital, saying far too many people on the continent endure poverty and chronic hunger,” the Los Angeles Times notes, adding, “He also announced that Senegal had become the 10th country to join the New Alliance for Food Security and Nutrition, a [G8] plan that has seen $3.7 billion pledged in private investments in Africa” (Dixon/Hennessey, 6/28).

“Obama is pitching U.S. foreign aid and, by extension, an image of a new Africa — not one of malnourished children with hollow eyes and distended tummies, but one of smiles and plump babies,” the Associated Press reports (6/28). “Obama said the U.S. government’s Feed the Future initiative had made progress in its goal to lift 50 million people from poverty within a decade,” The Hill’s “Global Affairs” blog notes (Sink, 6/28). “The assistance is ‘helping people to become more self-sufficient, and it’s creating new markets for U.S. companies,'” the president said, according to GlobalPost (Stuart, 6/28). CBS News/Washington Post provides video footage of Obama in Senegal (6/28). The White House provides video footage of Obama speaking at the event (6/29). And a fact sheet about food security in sub-Saharan Africa is available on the White House website (6/28).

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Bush Administration AIDS Policies 'Overshadowing' Obama's Tour Of Sub-Saharan Africa, Washington Post Reports

The Washington Post examines how a focus on policies implemented under President George W. Bush — specifically PEPFAR — are “overshadowing” President Obama’s current three-country tour of sub-Saharan Africa, writing, “Obama has been widely applauded for distinguishing himself from Bush’s policies, especially in Iraq and Afghanistan,” but “across this continent, many Africans wish Obama was more like Bush in his social and health policies, particularly in the fight against HIV/AIDS — one of the former president’s signature foreign policy aid programs.” The newspaper writes, “Bush poured billions of dollars into the effort to combat the spread of the disease that once threatened to consume a generation of young Africans, and as Obama has spent two days touring South Africa, the shadow of his predecessor has trailed him.” The newspaper notes that some AIDS advocates have expressed concern that cuts to the PEPFAR budget “threaten to turn back years of progress in the fight against the AIDS epidemic,” but “[a]dministration officials note that the decreases in funding for PEPFAR have been made up by increases in funding to multilateral programs that tackle a variety of diseases, including AIDS.”

“‘Given the budget constraints, for us to try to get the kind of money that President Bush was able to get out of the Republican House for massively scaled new foreign aid program is very difficult,’ the president said Sunday in the discussion with reporters,” the Washington Post writes, adding, “At the Tutu Center [in Cape Town, South Africa,] on Sunday, Obama said the goal of U.S. policy under his administration is to increase capacity for South Africa and other nations to manage their own programs to fight the disease, rather than rely largely on U.S. funding” (Raghavan/Nakamura, 6/30). In a separate article, the newspaper notes Obama and Bush, who is on his own tour of the continent, “on Tuesday will both participate in a wreath-laying ceremony at the U.S. Embassy [in Tanzania], the site of a terrorist bombing in 1998” (Nakamura, 7/1).

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New WHO HIV Treatment Guidelines Could Prevent 3.5M New Infections By 2025

“Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the [WHO] said on Sunday,” Reuters reports (Kelland, 6/30). “Recent evidence indicates that earlier [antiretroviral therapy (ART)] will help people with HIV to live longer, healthier lives, and substantially reduce the risk of transmitting HIV to others,” a WHO press release notes, adding that the new guidelines, released on the opening day of the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, could “prevent 3.5 million more new HIV infections between now and 2025” (6/30). The WHO “recommended that the threshold for starting to prescribe HIV medicines should be expanded to when patients have a CD4 cell count (a measure of strength of the human immune system) below 500 cells per cubic millimeter, compared with a current much lower threshold of 350,” the Financial Times notes (Jack, 6/30). “WHO says several other groups should also get AIDS drugs as soon as they’re diagnosed with HIV: pregnant and breast-feeding women, people whose partners are uninfected …, those who also have tuberculosis or hepatitis B,” and children under age five, the Associated Press states (Cheng, 6/30).

“About 9.7 million people were on drugs at the end of last year, and 1.6 million people started treatment, the biggest increase in a single year, as funding in developing nations to fight local epidemics exceeded international donations for the first time,” Bloomberg Businessweek reports. “Commencing treatment at an earlier stage of infection would expand the number of people eligible for therapy to 26 million from 17 million,” the news service writes (Bennett, 6/30). “A single pill combining three drugs will be given to people who are HIV positive much earlier, while their immune systems are still strong,” BBC News notes, adding, “Five companies make the daily combination pill, which can cost about $127 for a year’s individual treatment in countries where price reductions have been negotiated” (Dreaper, 6/30). “The guidelines also mean the total global spending on AIDS … will rise by about 10 percent, according to Gottfried Hirnschall, director of WHO’s HIV department,” but “[i]t’s unclear how willing donors will be to pitch in for even more AIDS treatments,” the AP writes (6/30). WHO Director-General Margaret Chan “called the guidelines ‘a leap ahead in a trend of ever-higher goals and ever-greater achievements,’ while [UNAIDS Executive Director] Michel Sidibé, … who several years ago called for universal treatment, said the step-by-step rise of the guidelines ‘gets most of the people we want on treatment, but not all — so it shows that you have limits to the system,'” according to the New York Times (McNeil, 6/30).

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New Global Update On HIV/AIDS Shows 9.7M On Treatment In 2012

A new report from UNAIDS, the WHO and UNICEF, titled “Global update on HIV treatment 2013: results, impact and opportunities” and released at the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur in conjunction with new WHO treatment guidelines, shows a “record 9.7 million people living with HIV were accessing treatment in 2012 compared to just over 8.1 million in 2011 — an increase of 1.6 million in one year alone,” a UNAIDS press release reports (6/30). “By making smart choices, UNAIDS estimates that treatment can be further expanded within the existing resource needs of between $22-24 billion for 2015,” the U.N. News Centre notes, adding, “The agency estimates that cost savings could be achieved through three main areas: a reduction in costs of medicines and medical supplies, particularly as volumes increase; simplifying delivery systems; and increasing efficiencies within the overall AIDS response” (6/30). The report notes several examples of cost savings and “also highlights that the [U.S. PEPFAR program] estimates that by leveraging existing opportunities for cost efficiencies it has more than halved the average cost per person receiving treatment in PEPFAR-supported programs,” the press release states (6/30).

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U.N. MDG Report Shows Uneven Progress, Calls For More Action To Meet Goals By 2015

“Millions of lives have been saved and improved as several Millennium Development Goals (MDGs) have been met or are within reach, but bolder action is needed in many areas, a U.N. report card said on Monday, with less than three years until the 2015 deadline,” The Guardian reports. “Though targets on halving the number of people living in extreme poverty and on access to clean drinking water have been met, progress on the eight MDGs, which have a number of sub-targets, has been uneven between regions and countries, and within countries, according to this year’s annual progress report,” the newspaper writes (Tran, 7/1). “U.N. Secretary-General Ban Ki-moon said Monday at the outset of a monthlong session of the organization’s main economic arm … that many nations are still struggling to make good on pledges made in 2000, such as cutting child mortality by two-thirds and maternal mortality by three-quarters,” the Associated Press/Washington Post notes, adding, “He said other areas with lagging progress include protections for forests and fish stocks, universal access to antiretroviral therapy among people living with HIV, primary education, sanitation and foreign aid” (7/1).

“Noting that progress towards the [MDGs] had been uneven, the U.N. report urged the international community to smooth out the disparities between regions and countries, as well as between population groups within countries,” Agence France-Presse/News24 reports. “The report also warned that the world’s ability to reach its goals had been impacted by dwindling aid money, with global aid funds falling two percent from 2010 to 2011 and another four percent in 2012, to $126 billion,” the news agency writes. “The report called on the world to look beyond 2015 and begin crafting ‘an ambitious, yet realistic, agenda for the period after the MDG target date,'” AFP states (7/1). Last year, Ban “appointed a panel … to recommend a new development agenda after the goals expire in 2015,” the AP notes (7/1). Released last month, the panel’s report “proposed 12 development goals and 54 targets,” including goals aimed at “ending extreme poverty by 2030, [providing] universal access to food and water, promoting good governance, and boosting jobs and growth,” The Guardian states, adding, “The post-2015 report will be discussed at the U.N. general assembly in September,” and “[n]ext year, a separate group will report to the U.N. with its recommendations on sustainable goals” (7/1).

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Public Health Emergency Looming As Crisis In Syria Continues, Researchers Warn

Noting “[t]he death toll in Syria’s ongoing civil war may now be as high as 100,000,” NPR’s “Weekend Edition Saturday” examines how, “[a]s the violence mounts, another emergency is looming: a public health crisis across the region.” The news service highlights an article published last week by The Lancet, which concludes “Syria’s health care system is near collapse,” as “[o]utbreaks of disease are on the rise in the country, and refugees sheltered beyond the border are also at great risk.” According to NPR, “Seventy percent of Syria’s medical professionals have fled the country,” and “[p]ublic health researchers Dr. Adam Coutts and Dr. Fouad Fouad say there has been a dramatic rise in communicable disease.” The news service notes “there were 7,000 cases of measles in northern Syria in the past few months after a vaccination program was disrupted by war, and the list is growing to include TB, leishmaniasis, typhoid and cholera, which will come up during the summer months.” In addition, “[d]isease moves easily across boundaries along with the refugees,” and “[s]crambling to care for one of the world’s largest refugee populations is another burden of the Syrian war,” the news service writes (Amos, 6/29).

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Polio Outbreak In Somalia, Low Immunization Rates In Ukraine Pose Challenges For WHO

NPR’s “Shots” blog reports on an outbreak of polio in Somalia, which had not recorded a case of the disease for more than five years. “Polio has paralyzed 25 kids in Somalia and another six in a Kenyan refugee camp since early May, the Global Polio Eradication Initiative reported Wednesday,” the blog writes, adding the outbreak could threaten progress in efforts to eradicate the disease. “Despite … security problems in Somalia, emergency responses to the polio cases are underway,” but “WHO expects to see more polio cases reported from Somalia in the coming weeks,” the blog notes (Beaubien, 6/28). In related news, Inter Press Service reports that “Ukraine is facing a ‘real threat’ of a return of polio as well as outbreaks of other serious diseases such as mumps, rubella and measles because of a combination of state inefficiency and public mistrust of vaccinations, health experts have said.” The news service examines public opinion about immunization in the country and the challenges the WHO faces in improving vaccination coverage (Stracansky, 6/28).

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Humanitarian Agencies Appeal For $80M In Aid For CAR As Country Faces Heavy Rains

“Sickness and death rates in the anarchic Central African Republic (CAR), which are already triple the emergency threshold, are likely to soar with the arrival of the rains, nine humanitarian agencies said on Friday, appealing for $80 million in aid,” Thomson Reuters Foundation reports. “Despite widespread hunger and the rebels’ suspension of health services, the world has largely turned its back on the tiny nation, the agencies said,” the news service writes, adding, “CAR remains deeply unstable following a coup in March, the latest of many military interventions and mutinies.” Reuters notes, “Before the escalation of the conflict in December, CAR already had the third highest infant mortality rate in the world,” and writes, “The entire population of 4.6 million people is in need of aid because the limited services that existed before the rebel takeover have now been suspended, [a statement from Dieudonne Nzapalainga, the archbishop of CAR capital Bangui,] said.” The news service adds, “Over the last six months, some 200,000 people have been displaced and are largely without food, shelter or medical care, the nine agencies said,” noting, “There are fears that the forgotten crisis in CAR could destabilize the entire region as it borders six other fragile states, such as Chad, South Sudan and the Democratic Republic of Congo, which would struggle to manage an inflow of refugees” (Migiro, 6/28).

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Editorials and Opinions

Partnerships Critical To Achieving AIDS-Free Generation

Citing President Obama’s trip to Africa, including a visit to South Africa, Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, writes in a CNN opinion piece, “[A]s President Obama makes this historic trip to Africa, we are at a point where an AIDS-free generation is within sight,” noting, “With the world’s largest number of people living with HIV and AIDS (5.6 million), South Africa has always been on the front lines of the epidemic.” Goosby discusses the history of U.S. government HIV/AIDS efforts in South Africa, which began in 2003, as well as the successes that have been achieved in the past decade by PEPFAR and its partners, including the South African government and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Goosby states that PEPFAR’s relationship with South Africa has “evolved” and adds, “Last year, we signed an agreement to make our partnership based on co-investment, showcasing South Africa’s leadership in caring for and treating its own people.” “As U.S. funding shifts increasingly to HIV prevention, health systems strengthening and technical support — South Africa is expanding its own investments in the care and treatment of HIV and TB,” he writes, continuing, “These new partnerships with high-burden countries, forged by the Obama administration, have been a driving force in our collective push to achieve an AIDS-free generation.” “Today, I am proud to stand with President Barack Obama and Archbishop Desmond Tutu at one of the pioneering youth and HIV centers in Cape Town,” he writes and concludes, “Thanks to the dedication of President George W. Bush, President Obama and bipartisan support from the U.S. Congress — what a difference a decade has made” (6/30).

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Continued Investment In Polio Eradication Has 'Never Been More Critical'

“As I read the final communiqué from the G8 Summit in Lough Erne, Ireland, I was struck by the virtual silence on global health and development,” Paul Martin, former prime minister of Canada, writes in a Thomas Reuters Foundation opinion piece. “This absence is especially unfortunate given that one of the G8’s long-standing health priorities, polio eradication, is at a critical juncture,” he continues, adding, “As we enter the final chapter of this disease, the G8’s support is needed now more than ever.” Since its first commitment to eradicate polio was made in 2002 in Kananaskis, Canada, “To this day, the G8 has stood firm in its leadership on eradication, reaffirming its support at summits in France and the United States,” Martin writes, highlighting individual country contributions. Noting in 2012 “there were fewer polio cases in fewer countries than ever before,” he writes, “As the eradication effort comes to a turning point, the G8’s continued investment has never been more critical.”

“But the final stretch is undoubtedly the most difficult,” as “[i]nsecurity continues to prevent vaccinators from reaching children in the corners where polio persists,” Martin continues. He discusses the Global Polio Eradication Initiative’s (GPEI) Polio Eradication and Endgame Strategic Plan, and writes, “I’m impressed by the care taken in modeling the road to eradication.” However, “the plan’s success relies on full upfront funding, which will give the GPEI the certainty and flexibility to effectively respond to sudden challenges without compromising long-term priorities,” he states, noting, “In the past, partial funding has forced the GPEI to make painful choices that cut or delay vaccination campaigns, leading to outbreaks and increasing the overall cost of eradication.” He highlights a current outbreak in the Horn of Africa, stating it “demonstrates the importance of strengthening routine immunization,” and concludes, “As the G20 leaders gather in Russia this September they too must prioritize polio. Indeed its eradication requires the commitment of the entire global community” (6/28).

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Saudi Authorities Face Challenges To Preventing Spread Of MERS, Other Diseases During Pilgrimages

“Today, the Middle East is threatened with a new plague, one eponymously if not ominously named the Middle East respiratory syndrome (MERS-CoV, or MERS for short),” Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations (CFR), and Maxine Builder, a research associate at CFR, write in a Foreign Policy opinion piece. “Although the numbers — so far — are small, the disease is raising anxiety throughout the region,” they note, adding, “But officials in Saudi Arabia are particularly concerned” as “[t]his fall, millions of devout Muslims will descend upon Mecca, Medina, and Saudi Arabia’s holy sites in one of the largest annual migrations in human history.” They note, “Traditionally, the onus to protect the pilgrimage and prevent disease rests on the shoulders of the Saudi royal family,” but “[t]oday, that responsibility lies with the kingdom’s Ministry of Health, which has deployed all its disease-fighting resources to tracking down MERS.”

“The ministry also must deal with the distinct possibility that pilgrims from abroad could bring other diseases to the kingdom, especially polio,” Garrett and Builder continue, noting, “It has been eliminated in Saudi Arabia, but pilgrims from outside could carry the disease back into the region.” “Despite these risks of disease transmission, neither the [WHO] nor the Saudi government has placed explicit travel guidelines in advance of this influx,” although “Saudi authorities are urging pilgrims to postpone their hajj plans due” to construction work at the Grand Mosque, they state. However, “even if pilgrims postpone their plans for pilgrimage, they are not the only mobile population in the region who could serve as global vectors,” they write, highlighting migrant workers and Syrian refugees. Garrett and Builder highlight issues surrounding the spread of the disease in hospitals, controversy over research patents, and WHO funding for emergencies. They say identifying the virus’s origin, halting human-to-human transmission, quickly identifying new patients, and breaking down “barriers to a transparent international research and information-sharing system” are important challenges to preventing the continued spread of MERS (6/28).

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From the Global Health Policy Community

Blogs Discuss U.S. Efforts To Improve Food Security, Nutrition In Africa

The U.S. government recently published several blog posts related to food security and nutrition, highlighting President Obama’s trip to Africa. The following is a summary of those posts.

  • Linda Etim, USAID’s IMPACTblog: Etim, deputy assistant administrator for Africa, highlights Obama’s trip to Africa and USAID’s work on the continent, writing the agency supports “investments in improved agriculture, health care, and democratic institutions, and [has an] increased focus on women and a new generation of African thinkers, entrepreneurs, and innovators, each of which are delivering transformational results” (6/27).
  • Valerie Jarrett, The White House Blog: Jarrett, senior adviser and assistant to the president for intergovernmental affairs and public engagement, discusses a New Alliance for Food Security and Nutrition roundtable that took place in Senegal on Friday. “Everyone agreed that Africa has the potential for more sustainable agricultural development, and we look forward to working together to realize that potential,” she writes (6/28).
  • Tjada McKenna and Jonathan Shrier, Feed the Future Blog: McKenna, deputy coordinator for development for Feed the Future, and Shrier, acting special representative for global food security and deputy coordinator for diplomacy for Feed the Future, highlight “five brief points” of Feed the Future’s recently released second progress report (6/28).
  • Margaret Enis Spears and Beth Dunford, Feed the Future Blog: Spears and Dunford, who work with the USAID Bureau for Food Security, describe Obama’s remarks on food security during a speech at a marketplace in Senegal on Friday. They note Obama highlighted the New Alliance and Feed the Future (6/28).

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USAID Blog Examines Efforts To Control, Eliminate Cholera In Hispaniola

Writing in USAID’s “IMPACTblog,” Natalia Machuca, infectious disease adviser for Latin America and the Caribbean, examines efforts to control and eliminate cholera in Hispaniola, noting USAID on Friday “became an official member of the Coalition on Water and Sanitation for the Elimination of Cholera in Hispaniola.” She writes, “To add to the ongoing efforts of the Pan American Health Organization, the Centers for Disease Control, UNICEF and other strategic partners, USAID has pledged to support the Government of Haiti’s plan to eliminate cholera from Hispaniola.” She discusses USAID’s current work, which she states “already contributes to this goal through many different avenues that focus on cholera prevention as well as treatment and control” (6/28).

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Acknowledging Link Between Treating NTDs, Advancing Prosperity

“As [President Obama] continues his tour encouraging African nations to foster economic growth and empower youth, we urge him to acknowledge the essential link between treating [neglected tropical diseases (NTDs)] and advancing prosperity,” Deborah Elson, communications officer at the Sabin Vaccine Institute, writes in the Global Network for Neglected Tropical Diseases’ “End the Neglect” blog. She provides a “wish list” of three points for President Obama to address, including increasing U.S. commitment “to reducing the impact of NTDs in Africa by supporting integrated treatment programs and offering technical assistance”; adding “deworming programs to all childhood nutrition efforts [to help] strengthen food security and nutrition interventions”; and cultivating South Africa’s role “in elevating NTDs as a priority health issue for the African region” (6/28).

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CSIS Blog Examines GPEI Polio Eradication Plan

In a video analysis, the Center for Strategic & International Studies’ (CSIS) “Smart Global Health” blog examines the Global Polio Eradication Initiative’s (GPEI) six-year Polio Eradication and Endgame Strategic Plan released this year, noting, “The strategy outlines steps to end polio transmission, help improve childhood immunization programs, and begin a worldwide polio vaccine transition.” However, the blog adds, “[w]hile the plan is considered to be a solid approach to eradicating poliovirus, the initiative faces a variety of obstacles including deadly violence aimed at health workers in several of the remaining endemic countries, new outbreaks in previously polio-free areas, and continued difficulties reaching all children with vaccines” (6/28).

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