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Kaiser Daily Global Health Policy Report

In The News

White House Executive Order Calls For Working Group On National HIV/AIDS Strategy As Part Of AIDS-Free Generation Goal

In line with the Obama administration’s goal of creating a global AIDS-free generation, President Barack Obama on Monday “ordered a stepped up effort to deal with the HIV/AIDS epidemic in the United States” through an executive order from the White House, Reuters reports. “The order said a working group chaired by Grant Colfax, director of the Office of National AIDS Policy, and Health and Human Services Secretary Kathleen Sebelius would have 180 days to deliver recommendations to the president,” the news agency writes, adding, “The HIV Care Continuum Working Group will gather information from federal agencies on HIV testing and care, review HIV research, and recommend ways to accelerate and improve HIV treatment and care, it said” (Abutaleb, 7/15). “The order directs Colfax and Sebelius to convene representatives from major federal departments and agencies to review new literature on HIV/AIDS treatment and prevention,” as well as meet with stakeholders, The Hill’s “Healthwatch” blog states (Baker/Vieback, 7/15). Sebelius and Valerie Jarrett, senior adviser to the president, write about the HIV Care Continuum Initiative in the AIDS.gov blog (7/15).

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A.U. Special Summit On HIV/AIDS, TB, Malaria Kicks Off In Abuja

Robert Newman, director of the WHO’s Global Malaria Program, “said on the sidelines of the ongoing preparatory meetings to this week’s African Union (A.U.) Special Summit on HIV/ AIDS, Tuberculosis and Malaria in Abuja [‘Abuja +12’ ] … on Sunday that a vaccine for malaria may just be three years away,” PANA/AfriqueJet reports. He “said … that malaria vaccine trials were going on in eleven sites across seven countries in Africa,” the news service notes. “Experts said a malaria vaccine might offer the greatest hope of achieving significantly improved malaria control, particularly in Africa, where the ecological habitat is such that effective mosquito control has proved difficult or impossible to maintain,” the news service writes (7/15). A.U. Commissioner for Social Affairs Mustapha Kaloko “said [at the summit] on Sunday it requires $3.6 billion yearly for the prevention and control of malaria in the continent, which accounts for most of the malaria cases and deaths worldwide,” PANA notes in a separate article. “Kaloko called for more creative local funding to close the gap, and said the A.U. was ready to work with all stakeholders to ensure that the ever-increasing funding gap is narrowed,” the news service adds (7/15).

“Among objectives of the Special Summit is leveraging on the opportunity to review and identify factors that underpin the persistent burden of HIV, TB and malaria on the continent, as well as the status of health financing on the continent while committing the African leaders to the implementation of innovative and sustainable health financing initiatives,” Nigeria’s Vanguard reports (Ogundipe, 7/15). Nigerian President Goodluck Jonathan, who is hosting the Special Summit, on Monday “launched a new, special purpose program targeted at achieving universal access to the prevention, treatment, care and support for Nigerians living with HIV/AIDS,” the newspaper writes in a separate article (Ogundipe, 7/15). A report (.pdf) launched Monday at the summit — “Abuja +12: Shaping the future of health in Africa,” published by the A.U. and UNAIDS — “highlights increased, targeted health spending as an essential foundation to greater economic growth and development in Africa,” according to a UNAIDS press release, which notes the report “reviews progress made since the A.U.’s 2001 Abuja Declaration — in which leaders pledged to mobilize domestic and international resources for health and remove barriers to the AIDS response — highlights remaining gaps, and prioritizes next steps” (7/15).

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NPR Examines Implications Of WHO's New HIV Treatment Guidelines On South Africa

Noting the WHO this month “issued revised guidelines saying that people with HIV should be put on antiviral drugs far earlier than was previously recommended …, a move that could have huge implications for African nations where millions of people are infected with HIV,” NPR’s “Shots” blog and “Morning Edition” program examine the implications for South Africa. “If the country ends up adopting the latest WHO recommendations, more than one million additional South Africans could be put on antiretroviral therapy at public expense,” the blog states. According to the news service, “[t]he new WHO treatment guidelines are widely praised in the country by physicians and activists as a step forward,” although some in the country have “been opposed to the new global guidelines.” NPR quotes a number of public health experts and policymakers on both sides of the argument, highlighting the issues of drug toxicity and stock outs in the country. Joe Maila, a health ministry spokesperson, “says there’s no set timeline for deciding whether South Africa will move to put hundreds of thousands of additional HIV patients on drug therapy, but he says the ministry is seriously considering it,” the blog states (Beaubien, 7/16).

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PRI Examines Efforts Against Malaria In Malawi

Reporting on PRI’s “The World,” Amy Costello, host of Tiny Spark, “a podcast that investigates the business of doing good,” examines efforts against malaria in Malawi, writing, “Malaria is incredibly common here, despite a multibillion-dollar effort that has drastically reduced the incidence in other parts of Africa.” She continues, “There have been campaigns to kill baby mosquitoes with larvicide,” while “[o]ther campaigns have focused on killing adult mosquitoes by spraying insecticides on the walls of homes,” but “[p]erhaps the best-known campaign has focused on bed nets.” She discusses the distribution of bed nets in the country, highlighting early concerns, and examines how mosquitoes in the region have developed resistance to the chemicals used on the nets. Costello notes that Janet Hemingway, a malaria researcher and director of the Liverpool School of Tropical Medicine in the U.K., “agrees with other health experts that bed nets remain a crucial part of malaria control in Africa. But Hemingway does argue that those behind the bed net campaign should have made a bigger push — early on — to develop new insecticides” for the nets. “She [also] contends that those who organized the bed net campaign should have put a greater focus on developing stronger nets — ones that would withstand wear and tear,” Costello adds, noting the WHO “predicts that if the insecticides on bed nets continue to fail, an additional 120,000 African children will die from malaria each year.” An audio version of the report is available online (7/15).

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WHO Names Drugs For 'Neglected' Diseases To Essential Medicines List

“A 10-year-old program to develop drugs for ‘neglected’ diseases scored an important victory this month when three of its medicines were named essential drugs by the [WHO],” the New York Times reports. “The medicines that made the list are for three lethal insect-borne diseases: malaria, Chagas and sleeping sickness,” the newspaper notes, adding, “They exemplify how complicated it can be to develop a new drug with a low profit margin.” According to the newspaper, Nathalie Strub Wourgaft, medical director of the Drugs for Neglected Diseases Initiative, said a drug’s acceptance on the list “indicates that it’s a priority treatment for a priority disease.” She added, “This validates the credibility of what we and our partners have been doing,” the New York Times notes (McNeil, 7/15).

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GlobalPost Blog Examines How Civil War In CAR Affecting Child Health

GlobalPost’s “Pulse” blog reports on how civil war in the Central African Republic (CAR) is affecting the public health system, leading to higher rates of child malnutrition and malaria. Citing a report (.pdf) from Médecins Sans Frontières (MSF), the blog writes, “During the first quarter of 2013, MSF treated 33 percent more malaria cases in the Central African Republic than during the same period last year.” In addition, “[f]amilies have lost not only the food they harvested to feed their families, but also the grain stores they set aside for next year’s planting season,” the blog notes. “Pulse” includes comments from Ellen van der Velden, MSF’s head of mission in CAR; Philip Verwimp, an associate professor of development economics at the Université Libre de Bruxelles; and Richard Akresh, an economics professor at the University of Illinois at Urbana-Champaign (Stuart, 7/15).

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Outbreak Of H5N1 Avian Flu In Cambodia Continues To Spread

“Cambodia’s outbreak of H5N1 avian influenza continues apace as the summer wears on, with a three-year-old boy becoming the 14th victim this year and the 35th case confirmed in the Southeast Asian nation since records began to be kept,” GlobalPost reports. “Avian influenza has been an issue in Cambodia for years, but 2013 has seen the highest number of deaths in a single year and the largest number of cases ever recorded, according to [WHO spokesperson Sonny] Krishnan,” the news service states, noting, “Although neighboring Thailand and Vietnam are subject to H5N1 as well, these two nations carefully control the cross-border movement of both eggs and live poultry, which keeps the communicable disease under better control than in poorer Cambodia.” GlobalPost notes the Cambodian Ministry of Health is working with the WHO to conduct contact tracing and other surveillance (Greenwood, 7/16).

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Editorials and Opinions

'Power Africa' Initiative Holds Promise, But Obama Must Follow Through

“President Obama’s ‘Power Africa‘ initiative, unveiled during his recent trip there, has the potential to make a major impact on a continent where millions of people — including more than two-thirds of those in the sub-Saharan region — live every day without reliable access to affordable electricity,” a New York Times editorial states. “But the outcome depends heavily on how the plan is designed and carried out and whether it is sustained,” the newspaper writes. “Obama’s pledge to invest $7 billion over the next five years in eight countries is modest,” the editorial notes, adding, “Still, the initiative holds promise because it provides a vehicle for leveraging private sector investment and, significantly, anchors the United States firmly in the kind of trade and investment relationship that increasingly will help determine Africa’s future.”

“For too long, the international response to poverty, war, famine and dictatorial leaders in Africa has consisted largely of humanitarian aid,” the editorial continues, adding, “Before his trip, Mr. Obama was faulted for not showing enough interest in the continent where his father, a Kenyan, was born.” However, the newspaper states, “his administration was central to the independence of South Sudan and has invested heavily in improving Africa’s agriculture production through the [Feed the Future] program.” The editorial writes, “Still, he has been overshadowed by two predecessors who left a lasting imprint with signature programs, George W. Bush on HIV and Bill Clinton on health care and reduced trade barriers.” The newspaper concludes, “Having now raised expectations that he intends to make a difference with ‘Power Africa,’ it is vital for Mr. Obama to follow through” (7/15).

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Science, Engineering Education Important For Public Health Capacity

“The path to development in all geographies goes through higher education. In particular, sustainable development in meeting the public health challenges relies heavily on reliable local capacity of doctors, nurses and public health professionals,” Muhammad Zaman, director of the Laboratory of Engineering Education and Development at Boston University, writes in the Huffington Post’s “Impact” blog. “While capacity in public health is undoubtedly needed, so is the capacity to innovate and sustain the medical and engineering innovations that come through various public, private or philanthropic ventures,” such as the Medical Education Partnership Initiative (MEPI) and USAID’s Higher Education Solutions Network (HESN), he states. “What we need is therefore a program that mirrors MEPI, something that I would call ‘Science and Engineering Education for Development,’ or SEED,” Zaman writes, describing his “three-pronged vision” for such a program. “With a large portion of society falling in the college-going age group in many countries across the globe, the demand for higher education is immense,” he writes, concluding, “There is opportunity not only in using education for innovation but the moment is ripe to harness innovation in education to make the world a better place beyond the Millennium Development Goals” (7/15).

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Canada Should Continue To 'Lead By Example' On TB Funding

“Over the course of our history as a donor country, Canada has always shown that the best way to attack a disease is from all sides, recognizing that there are a number of mechanisms that need to contribute to the overall process to achieve success,” Meaghan Derynck, a project officer with RESULTS Canada, writes in an Ottawa Citizen opinion piece, providing details about some of the country’s pledges to fight tuberculosis (TB). “Canada continues to be a principal donor and global leader” for the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership, she states, noting the Global Fund is in a replenishment period and the initial funding period of Stop TB’s TB REACH program is set to expire in 2014. “Both the Global Fund and the Stop TB Partnership have proven themselves over time to be cost-effective, transparent, and truly country-driven mechanisms in the ongoing fight against tuberculosis, and one cannot work without the other,” Derynck writes.

“This week Ottawa has had the honor of hosting ministers, dignitaries and passionate TB advocates from around the world for the Stop TB Partnership’s Coordinating Board Meeting, held in Canada for the very first time,” Derynck notes. She concludes, “Now is a perfect opportunity to appeal to other donor countries to follow in Canada’s footsteps, and also for Canada to lead by example. If we can combine our efforts and maintain these variable channels of support, we can work together to eradicate this devastating disease once and for all” (7/12).

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From the Global Health Policy Community

USAID Blog Highlights 'SafeTStop' Program In East Africa

In a post in USAID’s “IMPACTblog,” Carole Douglis, development outreach coordinator for East Africa, profiles a small trucking community in Djibouti “called PK-12 for ‘Point Kilometre 12’ in French.” Noting “[a]bout 25 percent are thought to be HIV-positive” in the community, Douglis writes, “As late as 2004, HIV was a taboo subject, along with condoms. Voluntary testing did not exist.” She highlights “a center for recreation and HIV education in the community,” which serves as a “SafeTStop.” The SafeTStops comprise “a network of 52 [centers] in communities along the main highways of East Africa …, part of the ROADS II program funded by [PEPFAR] through USAID and implemented by FHI 360,” she writes, noting the program has helped increase visibility of HIV prevention programs and decreased stigma surrounding the disease (7/15).

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Program In Côte d'Ivoire Provides Affordable Cervical Cancer Treatment

Writing in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Nina Kouassi, a member of the Key Correspondents program who lives in Côte d’Ivoire, discusses cervical cancer care and treatment in the country, provided through a program started in 2009 by Johns Hopkins University and Côte d’Ivoire’s national HIV/AIDS program. “In March 2012, two referral sites in Abidjan and Bouaké were upgraded and began offering loop electrical excision procedure (LEEP) for treatment of large lesions. By September 2012, more than 7,300 HIV-positive women had been screened, among whom 365 with small lesions were treated with cryotherapy while 64 women with larger, pre-cancerous lesions benefited from an outpatient treatment for cervical lesions that were too large for cryotherapy,” she writes. “LEEP has many advantages including a high success rate, ease of use and a low cost,” Kouassi states, relaying the story of one woman who underwent the procedure (7/15).

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'Science Speaks' Blog Highlights UNAIDS 'Treatment 2015' Document

The Center for Global Health Policy’s “Science Speaks” blog highlights a document (.pdf) released by UNAIDS on Saturday, titled “Treatment 2015,” which “gathers strategies based on clinical research, mathematical modeling and on-the-ground outcomes to lay out a framework for expanded [HIV/AIDS] treatment coverage, a critical step, authors say, on a path to the end of the epidemic.” Reaching the goal of 15 million HIV-positive people on antiretroviral therapy by 2015 “will mean both accelerated and adapted approaches to testing and treating people worldwide for HIV,” according to the document, the blog notes (Barton, 7/15).

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Gates Blog Examines Implications Of Global Enteric Multicenter Study

“[A] lack of any local epidemiological evidence about what actually causes diarrheal diseases and the impact they have on young children limit[s] the ability of public health officials, researchers, caretakers and parents to protect children from this devastating scourge,” Thomas Brewer, a deputy director on the Bill & Melinda Gates Foundation’s global health team who oversees the foundation’s work in enteric and diarrheal diseases, writes in the foundation’s “Impatient Optimists” blog. “Fortunately, we now have a better understanding thanks to the Global Enteric Multicenter Study (GEMS), which published data on the impact and leading causes of moderate-to-severe diarrhea in The Lancet last month,” he notes. He discusses some of the report’s findings, writing “just four pathogens — rotavirus, Cryptosporidium, Shigella and ST-ETEC — were responsible for the majority of diarrheal disease cases across all sites” in the study, and he examines “the impact [the data] can have in individual study countries.” He continues, “Regardless of context — whether in a country where the causes of diarrhea are a relative mystery or one in the final stages of developing its own rotavirus vaccine — fully understanding the problem is what enables us to act in the most effective way possible” (7/15).

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