KFF Daily Global Health Policy Report

In The News

Following Appointment Of Presidential Ebola Task Force, Communications On DRC Outbreak In Flux; Islamists Attack Two Towns In Ebola Zone, Killing 12

Associated Press: Ebola vaccine’s promise undermined by deep distrust in Congo
“…Deep distrust — along with political instability and deadly violence — has severely undermined efforts by public health authorities in Congo to curb the outbreak by tracing and vaccinating those who may have come into contact with infected people…” (Larson et al., 7/24).

CIDRAP News: DRC Ebola total grows by 5, with outbreak info in flux
“Amid uncertainty in notifications of new Ebola cases in the Democratic Republic of the Congo (DRC) related to changes in the government’s outbreak management, World Health Organization (WHO) online tracking shows 5 more infections [Tuesday], lifting the outbreak total to 2,597. … Late in the day, the health ministry released a daily report, which it said would be the last to come from the health ministry’s press team. The daily detailed reports — which have covered cases, deaths, vaccination progress, security incidents, health worker infections, and other developments — have been widely praised for their detail and timeliness. The health ministry said all future response communications will be managed directly by the office of DRC President Felix Tshisekedi…” (Schnirring, 7/23).

OZY: Can the ‘Ebola Hunter’ Keep This Outbreak From Going Worldwide?
“…On Saturday, the 77-year-old [Jean-Jacques Muyembe] was named head of a technical committee to combat the virus by Congolese President Félix Tshisekedi, who took over the post in January. … The creation of the committee and his leadership of it was controversial: in response, the health commissioner Oly Ilunga Kalenga resigned…” (Fouriezos, 7/24).

Washington Post: Attack by Islamists in Congo kills 12 in ‘Triangle of Death’ Ebola zone
“Fighters from an Islamist insurgency attacked two towns at the center of an ongoing Ebola outbreak zone in eastern Congo on Wednesday, killing 12 according to local officials. The towns, Oicha and Eringite, are in an area sometimes referred to by health workers as ‘le triangle de la mort’ or triangle of death as a vicious cycle of attacks have aided the spread of Ebola…” (Bearak, 7/24).

Additional coverage of the DRC Ebola outbreak and response is available from the Associated Press, BBC News, CNBC Africa, The Guardian, Reuters, Scientific American, and Washington Times.

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U.S. Research Agencies Would Receive Funding Increases Under New Budget Deal

Science: Budget deal raises hopes for U.S. research agencies
“A new budget deal between the White House and congressional leaders means U.S. research agencies could receive increases on the order of the 4% to 5% that Democrats have already proposed for next year. [Monday’s] agreement, which must be approved by both chambers of Congress, governs spending for fiscal years 2020 and 2021. … The House is expected to vote on the budget agreement this week before it goes on a 6-week summer recess, meaning Democratic leaders will need to rally support quickly. The Senate is scheduled to be in session next week, giving Republican leaders a bit more time if they need it” (Mervis, 7/23).

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Development Community Awaits New British PM Johnson's Treatment Of DFID; Stewart Steps Down As International Development Secretary

Devex: Boris in, Rory out amid fears for future of U.K. aid
“Boris Johnson was announced as the United Kingdom’s new prime minister Tuesday afternoon as aid leaders urged him to protect the country’s development commitments. The first immediate impact for the development community was the resignation of International Development Secretary Rory Stewart following the announcement. He had maintained for weeks that he would not serve under Johnson due to their disagreements over Brexit, though he said it would be ‘heartbreaking’ to leave the role. … But insiders say it is what happens next that really counts. With Johnson having taken a turn against aid in recent times, there are fears the office will go to an aid skeptic, and that steps could be taken to limit DFID’s control over the aid budget or merge it with another department…” (Abrahams, 7/23).

The Guardian: Trade and foreign aid: will Boris Johnson bring an end to DFID?
“…How will [Johnson] ensure the U.K., which has the third largest aid budget in the world, retains its reputation as a ‘development superpower,’ in the words of former international development secretary Penny Mordaunt, with the competing trade, diplomacy, and defense requirements of post-Brexit Britain? … After leaving his job as foreign secretary, Johnson spelled out his thinking over foreign aid, telling the Financial Times that if ‘Global Britain’ is going to achieve its ‘full and massive potential’ then we must bring back the Department for International Development (DFID) to the Foreign Office. … Following Johnson’s appointment as prime minister on Tuesday, development organizations, already concerned at the existing pot of aid money being spent outside DFID, warned against any ‘messy and costly’ merger between DFID, the Department for International Trade (DIT), and the Foreign Office…” (McVeigh, 7/24).

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Progress Against AIDS Under Threat In Some Regions, UNAIDS Executive Director Says

Inter Press Service: Global AIDS Fight Running out of Steam, U.N. says
“The global fight against AIDS is floundering amid cash shortfalls and spikes in new HIV infections among marginalized groups in developing regions, Gunilla Carlsson, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said Tuesday. Speaking with reporters in New York, Carlsson, head of U.N.-led efforts against the pandemic, warned that gains over recent years were under threat, particularly in parts of Eastern Europe, Central Asia, the Middle East, and Africa. … Global funding for the fight against AIDS dropped off markedly in 2018 — by nearly one billion dollars…” (Reinl, 7/24).

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Merck Releases Early Clinical Trial Data On Experimental HIV Drug Administered As Arm Implant For Prevention

The Guardian: Trial of HIV prevention implant hailed as boost in fight against disease
“An implant containing an HIV prevention drug has been trialed in humans, in a step experts have hailed as an exciting development in curtailing infections…” (Davis, 7/23).

New York Times: Someday, an Arm Implant May Prevent HIV Infection for a Year
“…The new implant, by the drug company Merck, was tested in just a dozen subjects for 12 weeks. But experts were quite excited at its potential to revolutionize the long battle against HIV. The research was described on Tuesday at an international AIDS conference in Mexico City…” (McNeil, 7/23).

STAT: Merck unveils early data on HIV drug it says could be ‘a game changer’
“…One of the benefits of [Merck’s experimental drug MK-8591, also called islatravir,] is that it builds up in the body, and it could be given as an implant that might only need to be replaced once a year. By contrast, Gilead’s HIV pill Truvada, given to patients at high risk of HIV, is a once-a-day pill…” (Herper, 7/23).

The Telegraph: Game-changing implant could prevent HIV transmission for up to a year
“… A review of 18 studies looking at adherence to PrEP found widely differing rates — with one reporting that just 24 percent of participants stuck to the regime. An implant that only needs to be replaced every 12 months could be a powerful prevention tool, particularly in sub-Saharan Africa where the rate of new HIV infections is still high and PrEP take-up has been low…” (Gulland, 7/23).

Washington Post: Implanted drug could someday prevent HIV infection
“…[The experimental drug] was tested on just 12 people, at two different concentrations. Another four test subjects received a placebo, in an early study designed to assess the safety of the drug and implant. They are years away from being publicly available. … Merck is also looking into the possibility of using the same drug as an oral medication to treat HIV infections, [George Hanna, a vice president with Merck Research Laboratories,] said” (Bernstein, 7/23).

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News Outlets Continue Coverage Of Lancet Studies Showing Rapid Spread Of Drug-Resistant Malaria In Southeast Asia

CIDRAP News: Highly resistant malaria spreading rapidly in Southeast Asia
“An aggressive strain of drug-resistant malaria that originated in Cambodia has rapidly spread into neighboring countries, causing high rates of treatment failure to first-line treatment and complicating efforts to eliminate the disease, according to two studies published [Monday] in The Lancet Infectious Diseases…” (Dall, 7/23).

Additional coverage of the studies is available from SciDev.Net and VICE.

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More News In Global Health

CIDRAP News: Reports profile MCR gene in South America, first detection in Uruguay (Schnirring, 7/23).

Devex: Candidate HIV vaccine to be tested for efficacy in MSM, transgender individuals (Ravelo, 7/24).

Health-e News: #IAS2019: WHO gives blockbuster HIV drug the green light (Pilane, 7/23).

Health-e News: #IAS2019: High HIV & STI rates in ECHO analyses (Pilane, 7/23).

Quartz Africa: Malawi is testing using wearables to measure kids’ well-being (Timsit, 7/23).

Reuters: Letterbox campaign helps Afghans cope with silent war of mental health (Hakimi/Jain, 7/23).

Science: Mexico’s new president shocks scientists with budget cuts and disparaging remarks (Wade, 7/23).

The Telegraph: Patients cured of deadly tropical disease can infect others for years, researchers warn (Newey, 7/23).

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Editorials and Opinions

U.S. Should Increase Global Health Funding For Fragile States To Prevent Spread Of Disease, Shore Up Regional Stability, Prevent Humanitarian Disasters, Opinion Piece Says

Foreign Policy: In Fragile States, Disease Outbreaks Don’t Stay Local for Long
Shannon Kellman, deputy policy director at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, and Mark P. Lagon, chief policy officer at the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, and a distinguished senior scholar at Georgetown University’s Walsh School of Foreign Service

“…U.S. policymakers should ask themselves what they can do to best mitigate the challenge of global health crises in fragile states. Local threats often don’t stay that way for long, but with the right measures, the United States can help prevent them and in so doing keep itself safe, too. Policymakers concerned with stability, for their part, would be wise to back increased funding for multilateral and bilateral global health programs, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR). Investment in health aid is not just a way to prevent the spread of disease but to shore up regional stability, which is in the broader interest of the United States. It also enhances the United States’ humanitarian credentials. … Channeling global health aid to fragile states can help mitigate the humanitarian disasters caused by poor governance and conflict. But it can also lead to more capable, accountable, and inclusive governance. In areas where the Global Fund works to end epidemics, there have been tangible improvements in political freedom, control of corruption, governmental accountability, and the rule of law. … The United States has vital interests in promoting stability, mitigating extremism, and avoiding costly longer-term military interventions. All of these efforts are well served by investing in robust global health aid. Washington also wins good will from addressing those most in need, as a much-needed complement to its use of hard power. As the United States reconsiders its strategic priorities in the world, increased global health aid must be among them” (7/22).

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Confidence, Trust In Science, Government Vital To Health Care

Project Syndicate: The Most Important Health-Care Tool Is Trust
Jeremy Farrar, director of the Wellcome Trust

“…According to the Wellcome Global Monitor, the largest-ever survey of public attitudes toward science and health, … more than 70% of survey participants reported that they trust scientists, doctors, and nurses. But their responses also indicate that there is no room for complacency. Half of the … respondents … reported that they know little or nothing about science, and almost one in five don’t think that it benefits them personally. This lack of engagement with science raises serious — even life-threatening — risks. … Education undoubtedly plays a role in shaping attitudes toward vaccines, but so do myriad personal, social, religious, and cultural factors — and, most fundamentally, trust. In fact, trust in science and health care is linked to trust in government and other national institutions. When confidence in one is lost, confidence in the rest tends to suffer as well. And when faith in all of these spheres is depleted, the consequences are typically disastrous. … No matter how exciting the treatment, how clever the delivery method, or how robust the science, there will be no impact unless the local community is open to it. … [A]s the world faces profound science-related challenges — from climate change to antimicrobial resistance — policymakers, practitioners, and civic leaders would do well to learn as much as possible from the Wellcome Global Monitor’s unprecedented, unique, and invaluable data” (7/23).

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Vaccination Mandates Must Be Implemented With Care, Regard To Context

Nature: Mandate vaccination with care
Saad B. Omer, director of the Yale Institute for Global Health and professor at Yale School of Medicine and Yale School of Public Health; Cornelia Betsch, professor at the University of Erfurt, Psychology and Infectious Diseases Lab; and Julie Leask, professor in the Susan Wakil School of Nursing and Midwifery at the University of Sydney, Faculty of Medicine and Health

“…[S]ome governments are now considering making vaccination for measles and other diseases a legal requirement. … However, mandatory vaccination can worsen inequities in access to resources, because penalties for not complying can disproportionately affect disadvantaged groups. What’s more, the evidence suggests that there is no simple linear relationship between the forcefulness of a policy and its impact on the rate of vaccination. It is crucial that policies don’t inadvertently entrench inequity or fuel anti-vaccine activism. … If governments … decide that mandates are appropriate, they should take the following five steps. Use multiple interventions. … Ensure just procedures. … Make penalties proportionate. … Monitor safety and compensate for side effects. … Avoid selective mandates. … [M]aking vaccination a legal requirement can be a powerful and effective tool if implemented with care and with regard to the context. … Overly strict mandates can result in parents finding ways to avoid the vaccine requirements, and selective mandates might damage the broader vaccination program. Most importantly, vaccine policy — like other types of effective public policy — must be based on evidence, and not driven by political and ideological considerations” (7/22).

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From the Global Health Policy Community

CFR Expert Advocates Increased Foreign Assistance To Improve Governance, Strengthen Health Systems In Poor Nations

Council on Foreign Relations: Absent More International Support, Ebola Will Continue to Spread Beyond Congo
John Campbell, Ralph Bunche senior fellow for Africa Policy Studies, discusses a recent article published in Foreign Policy that makes “the point that disease outbreaks in states with weak governance and high rates of poverty often spread to other countries,” using the Ebola outbreak in the Democratic Republic of the Congo (DRC) as an example. Campbell notes, “The authors advocate increased international health assistance to fragile states such as Congo, especially by the United States. … They suggest that increased assistance has the potential to improve governance and stability in affected areas, both of which are in the interest of the United States. … However distant the outbreak may seem at present, its far-reaching effects are yet more reason why aggressive and substantial support for disease-fighting efforts must be advanced” (7/23).

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'Science Speaks' Continues Coverage Of IAS 2019

IDSA’s “Science Speaks”: IAS 2019: While dispelling concerns of [Depo-Provera] HIV risk, ECHO study yields data on STIs, PrEP interest, pregnancy rates (Aziz, 7/23).

IDSA’s “Science Speaks”: IAS 2019: Data shows indigenous, nonbinary populations among those missed by HIV epidemic ending efforts (Aziz, 7/23).

IDSA’s “Science Speaks”: IAS 2019: While plans for HIV control innovations accelerate, community input remains an afterthought (Barton, 7/23).

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JIAS Special Issue Discusses Maximizing Impact Of HIV Prevention Technologies In Sub-Saharan Africa

Journal of the International AIDS Society: Special Issue: Maximizing the impact of HIV prevention technologies in sub‐Saharan Africa, Guest Editors: Helen Ward, Geoffrey P. Garnett, Kenneth H. Mayer, Gina A. Dallabetta
This special issue of JIAS features commentaries, viewpoints, and research articles on the importance of well-designed and managed HIV prevention campaigns (7/22).

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MSF Expanding Medical Activities In Venezuela

Médecins Sans Frontières: Addressing mounting health needs in Venezuela
“Médecins Sans Frontières is expanding its medical activities in Venezuela, where years of economic and political crisis are taking a heavy toll on households and health facilities alike. … Last month, MSF started assessing health needs in different parts of the country and began rehabilitating sections of the 302-bed Vargas Hospital, one of the reference hospitals in the capital, Caracas. These works are part of a collaboration with the Venezuelan health authorities that is set to expand over the next two years, including the training of personnel and the provision of materials…” (7/24).

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From the U.S. Government

3 CDC Ebola Responders Discuss Experiences Addressing Disease In Uganda

CDC’s “Our Global Voices”: Three Responders talk about their experiences in Uganda
This post highlights the experiences of three Ebola responders in Uganda: Vance Brown, Ebola coordinator and deputy director at the CDC’s Division of Global Health Protection Program in Uganda; Joseph “OJ” Ojwang, global health security disease detective at the CDC’s Division of Global Health Protection Program in Uganda; and Rosalind Carter, epidemiologist at the CDC’s Global Immunization Division who worked on an Ebola vaccination campaign in Uganda (7/23).

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NIH-Supported Research Examines HIV Prevention Tools For Women In Africa

NIH: Most women use vaginal ring for HIV prevention in open-label study
“In an open-label study of women in southern and eastern Africa, a vaginal ring that is inserted once a month and slowly releases an antiviral drug was estimated to reduce the risk of HIV by 39%, according to statistical modeling. In addition, the study found that participants appeared to use the ring more in the open-label study than in a previous clinical trial. These and other results of the HIV Open Label Extension (HOPE) study were presented [Tuesday] at the 10th IAS Conference on HIV Science (IAS 2019) in Mexico City…” (7/23).

NIH: PrEP use high but wanes after three months among young African women
“In a study of open-label Truvada as daily pre-exposure prophylaxis (PrEP) to prevent HIV among 427 young African women and adolescent girls, 95% initiated the HIV prevention strategy, and most used PrEP for the first three months. However, PrEP use fell among participants in this critical population during a year of follow-up clinic visits, although HIV incidence at 12 months was low. The preliminary results suggest that tailored, evidence-based adherence support strategies may be needed to durably engage young African women in consistent PrEP use…” (7/23).

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