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Kaiser Daily Global Health Policy Report

In The News

World Hepatitis Day Aims To Raise Awareness Of, Action On Viral Infections

“Only one-third of the world’s countries have national strategies for viral hepatitis, the [WHO said Wednesday,] urging governments to scale up measures to tackle this ‘silent epidemic,’ in particular the five types that, over time, cause chronic and debilitating illnesses,” the U.N. News Centre reports. World Hepatitis Day, recognized on July 28, “serves to promote greater understanding of hepatitis as a global public health problem and to stimulate the strengthening of preventive and control measures against infection in countries throughout the world,” the news service writes. A new WHO report (.pdf), titled “Global policy report on the prevention and control of viral hepatitis in WHO member states,” covers 126 countries and “identifies successes as well as gaps at the country level in the implementation of four priority areas: raising awareness, evidence-based data for action, prevention of transmission, and screening, care and treatment,” according to the news service (7/24).

Stefan Wiktor, team leader on the WHO’s Global Hepatitis Program, “pointed out that while hepatitis is a worldwide problem, certain regions are more affected than others,” VOA News writes, adding, “For example, Africa and Asia experience high incidence of hepatitis B and C” (Lewis, 7/25). Stephen Locarnini, an infectious diseases researcher and joint secretary of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP), “said health authorities in the Asia-Pacific region should deal with hepatitis in the same concerted manner with which they approach AIDS, tuberculosis and malaria,” Agence France-Presse/Fox News reports. According to the WHO, “viral hepatitis kills close to 1.4 million globally, and affects hundreds of millions of others,” the news agency writes (7/25).

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IRIN Examines Future Of Global Food Aid

“By the end of the next decade food security could deteriorate in some of the world’s poorest countries, according to a recent global forecast by the U.S. Department of Agriculture (USDA),” IRIN reports. “In the past decade global food aid, including the amount making its way to sub-Saharan Africa” — which will remain the most food-insecure region in the world — “has been on a downward trend,” the news service writes, adding, “The face of food aid has also begun to change. In the past decade, ‘food aid’ has begun to evolve into ‘food assistance,’ which includes help provided in the form of cash and vouchers for people in need.” According to the news service, “IRIN asked some of the world’s leading experts to speculate on the future of food aid.” The article includes comments from Christopher Barrett of Cornell University; Daniel Maxwell, a professor at Tufts University’s Feinstein International Center; Eric Munoz, senior policy adviser with Oxfam America; and José Luis Vivero Pol, an anti-hunger activist with Université Catholique de Louvain (Kindra, 7/26).

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The Lancet Examines Global Health Diplomacy In Indonesia

The Lancet examines Indonesia’s increasing role in the global health arena, noting, “In a report [.pdf] published this month by the Center for Strategic and International Studies based in Washington, D.C., senior fellow Murray Heibert argues that this year, Indonesia will hold an unprecedented position as a health leader.” The journal writes, “In a single year, the Indonesian president was appointed to co-chair a U.N. panel tasked with setting post-2015 Millennium Development Goals (MDGs); the Indonesian health minister took over as [Board] chair of the multibillion dollar Global Fund for AIDS, Tuberculosis and Malaria, becoming the first person from Asia to serve; and the nation will play host to two high-level health conferences in 2013 — an APEC health financing meeting and the 4th Islamic Conference of Health Ministers of the Organization of Islamic Conference.”

“The appointments mark a swift evolution of Indonesia’s role on the global health scene, the report argues,” according to The Lancet. “The year 2013 provides Indonesia [with] an opportunity to put itself at the center of the global health diplomacy map,” Heibert writes, adding, “To play at this level on a global multilateral platform will require that Indonesia invest heavily in the expertise and diplomatic skills necessary to drive a complex agenda at the global level,” according to the journal. The Lancet adds, “WHO Representative to Indonesia, Khanchit Limpakarnjanarat, says that there was little surprise that Indonesia had grown more focused on health diplomacy as it became an increasingly influential nation” (Seiff, 7/27).

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No Need For Hajj Pilgrims To Be Screened For MERS, WHO States

“The risk from a new Middle East respiratory virus for millions of Muslims planning to go to the annual hajj pilgrimage in Saudi Arabia is very low and there is no need for pilgrims to be screened, the [WHO] said on Thursday,” Reuters reports (Kelland, 7/25). “Saying the risk to travelers is ‘very low,’ the WHO recommended no travel restrictions or border screening during the Muslim Umrah and Hajj pilgrimages, which are expected to draw millions of people to Saudi Arabia,” CIDRAP News writes, adding, “The recommendations focus on awareness and routine precautions to prevent travel-related infections” (7/25). “Saudi Arabia is the epicenter of the disease with 70 cases and 38 deaths recorded,” the Wall Street Journal’s “India Real Time” blog notes, adding, “Transmission of the virus isn’t fully understood, but it is known to spread between humans” (Butler, 7/26). “Despite its high current death rate, the [virus] that emerged in Saudi Arabia last year is unlikely to cause a SARS-like epidemic because it is not spreading as easily, scientists said on Friday,” according to a separate article from Reuters, which notes “SARS spread far more rapidly, infecting more than 8,000 people between November 2002 and July 2003” (Kelland, 7/25).

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Editorials and Opinions

New WHO Guidelines On HIV Treatment Offer Opportunities, Challenges

Writing in a Lancet opinion piece, Kenneth Mayer of Harvard Medical School and Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program and Center for Public Health & Human Rights, discuss the opportunities and challenges presented by the WHO’s revised HIV treatment guidelines recommending “earlier initiation of highly active antiretroviral therapy (HAART),” released earlier this month at the International AIDS Society (IAS) conference. Mayer and Beyrer discuss the details of the new guidelines, writing, “The social and economic implications of the revised guidelines are substantial.” They continue, “The public health benefits of expanded treatment are predicated on expectations that if more people are virologically suppressed they will transmit fewer HIV infections, which would result in lower costs in the long run as the epidemic contracts.” Mayer and Beyrer conclude, “Thoughtful discussion is needed about the optimum ways to implement WHO’s new HIV guidelines. … [T]he challenges now are to identify, and effectively use, the new resources needed to realize our common goal of eventual control of the HIV pandemic” (7/27).

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Community Health Workers Vital Component Of Achieving MDGs

Since the Millennium Development Goals (MDGs) were implemented in 2000, community health workers (CHWs) “have … been part of an international attempt to revise primary health care delivery in low-income settings, and CHW programs have been changed accordingly,” Prabhjot Singh, co-chair of the One Million Community Health Worker campaign, and Jeffrey Sachs, director of the Millennium Villages Project, write in a Lancet opinion piece. “Instead of being regarded as unpaid, lightly trained members of the community who focus mainly on health education and provide basic treatments, CHWs are increasingly envisioned as a trained and paid corps who give advice and treatments, and implement preventive measures,” they note. The authors discuss the results of a June 2011 Technical Taskforce convened by the Earth Institute at Columbia University “to examine the best practices for scaling up and integrating CHWs into health systems.” Singh and Sachs note “[t]he Taskforce agreed that to achieve the MDGs, roughly one million CHWs should be trained and deployed in sub-Saharan Africa by 2015.”

“To support the achievable goal of one million CHWs across sub-Saharan Africa by 2015, additional financing will have to be mobilized to support well-tailored, country-specific plans,” Singh and Sachs write, adding, “We regard the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunizations (GAVI), and the World Bank as the three most relevant potential partners in such initiatives.” They continue, “The case for an expanded and dynamic CHW subsystem is very strong. CHW subsystems are proven, effective, low cost, and rapidly scalable components of rural health care systems,” and conclude, “CHW scale-up in low-income countries, particularly sub-Saharan Africa, will be a crucial stepping stone towards achievement of the MDGs and the overarching aim of health for all” (7/27).

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International Community Should Prioritize Family Planning In Refugee Settings

Writing in The Guardian’s “Poverty Matters Blog,” Lizzy Berryman, head of emergencies for Merlin, examines why “family planning [is] seldom prioritized in refugee settings,” noting, “Family planning remains a low-cost way of reducing pregnancy-related deaths, and one that women have told us they need time and again. But conflict-affected settings receive 50 percent less funding for reproductive health than stable settings.” She writes, “Some 15 percent of deliveries are likely to result in life-threatening complications and require emergency obstetric care, which only a doctor or midwife can provide. Delivery is more likely to be complicated if you have been through the trauma of fleeing a conflict or natural disaster, and medical assistance, such as antenatal care, is less likely to be available,” adding, “But even though the risks associated with pregnancy are greater, reproductive health is often put to one side in emergency relief situations.”

Berryman highlights Syria as an example, noting “the last time an extensive survey was carried out among Syrian refugees in Lebanon, only 37 percent of non-pregnant married women were using contraception.” She asks, “Syrian refugees frequently tell aid workers they are terrified of becoming pregnant, so why is family planning such a rarity?” Berryman states, “Part of the answer is rooted in the same reasons that women lack health care in general. Lebanon, whose population has grown by nearly 25 percent since the war in Syria began, is struggling to meet demand for basic health care. … Fundamentally, however, there are simply more immediate needs.” She writes, “The solution lies in adapting to the specific needs of refugees, whether they are living in camps, host communities or informal settlements,” and she concludes, “Addressing this different and often complex set of challenges means that pregnancy can be the natural and life-affirming process it should be for women who have already endured conflict and disaster” (7/25).

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Uganda Faces Challenges Of Malaria, Corruption

Writing in the GlobalPost’s “Pulse” blog, GlobalPost correspondent Sasha Chavkin examines “the heavy toll taken on Ugandan children’s health by two pernicious, but very different, sorts of parasites.” She continues, “The first is the Plasmodium parasite, the mosquito-borne microorganism that causes malaria. The second are corrupt government officials, whose theft of international aid prompted foreign donors to withdraw” a significant amount of aid to the country. Chavkin states, “Malaria is Uganda’s leading cause of illness and mortality, according to the [USAID], and young children are among the most likely to die from infections.” She discusses how “Uganda was one of the initial countries targeted in the 2005 launch of George W. Bush’s President’s Malaria Initiative (PMI),” and she notes, “PMI says it is maintaining its support: in large part because it works primarily with [non-governmental organizations (NGOs)] to deliver services, rather than government programs.” Chavkin concludes, “Over the next two weeks, I’ll be meeting with health officials and experts, and traveling to rural clinics and communities to examine the front lines of Uganda’s battle against child malaria” (7/25).

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From the Global Health Policy Community

Advocates, Humanitarian Workers Discuss South Sudan At White House Event

“In response to the political crisis in South Sudan and the deeply troubling violence in Jonglei state, the White House [on Wednesday] hosted [non-governmental organizations (NGOs)] and advocacy groups to discuss the situation and confer on how the United States — in concert with partners and allies around the world — can help end the violence and support South Sudan’s democratic development,” Special Assistant to the President and Senior Director for African Affairs Grant Harris writes in the White House Blog. “A significant portion of the conversation focused on what the United States and its partners can do to address disturbing reports of human rights abuses, attacks on civilians, and ethnically motivated violence taking place in Jonglei, including reports that elements of the Sudan People’s Liberation Army have been complicit in the abuses,” he notes, adding, “In the coming weeks, we’ll be working with partner countries, humanitarian organizations, advocacy groups, and others to shine a light on the crisis, press for an immediate end to the violence, and meet the urgent humanitarian needs of those affected by the conflict” (7/24).

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With PEPFAR Support, Initiative Works To Improve Palliative Care Delivery In Tanzania

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, published as part of a series of posts “written by one of the Frontline Health Workers Coalition’s 30+ member organizations,” Hayden Peters and Jeremy Taglieri of FHSSA, formerly the Foundation for Hospices in Sub-Saharan Africa, discuss the organization. “Through the PEPFAR-financed project known as CHAT (Continuum of Care for People living with HIV/AIDS in Tanzania), FHSSA was able to not only better support the work of hospices throughout Tanzania, but to do so in a cost-effective and long-lasting way.” They describe the project and state, “Although CHAT officially ended, its effects will be seen for the foreseeable future” (7/25).

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USAID Announces 2 New Feed The Future Innovation Labs

“[A]t the U.S. launch of the Feed the Future 2013 Progress Report [on Thursday], [USAID] Administrator Rajiv Shah announced two new Feed the Future Innovation Labs to improve climate resilience in some of Africa’s main cereal crops and increase private sector investment that can help smallholder farmers,” a USAID press release reports. “The two new labs include the Feed the Future Innovation Lab for Collaborative Research on Sorghum & Millet and the Feed the Future Innovation Lab for Food Security Policy,” the press release states, noting they “draw on the expertise of top universities around the country and represent a new model of development, using science and technology to address our greatest challenges in agriculture and food security” (7/25).

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Blog Highlights PLOS Editorial Examining NTDs In DRC

The Democratic Republic of the Congo (DRC) “is home to some of the highest levels of neglected tropical diseases (NTDs) in the world, as reported in a new editorial published [Thursday] in PLOS NTDs,” the Global Network for Neglected Tropical Diseases’ “End the Neglect” blog writes. “The paper was authored by Dr. Anne Rimoin, associate professor in the Department of Epidemiology at the UCLA School of Public Health, and Dr. Peter Hotez, president of the Sabin Vaccine Institute and founding dean of the National School of Tropical Medicine at Baylor College of Medicine,” the blog notes, adding, “They write that ‘despite the public health importance of DRC’s NTDs, there is much more that we do not know than we do know about both the high prevalence NTDs and the emerging viruses in the Congo Basin.'” The blog adds, “Rimoin and Hotez call for improved disease surveillance to understand the total reach and severity of NTDs in DRC, which they argue is a crucial first step for providing treatment to those that need it and which is currently lacking there” (Alabaster, 7/25).

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Aidspan Publishes New Issue Of 'Global Fund Observer'

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has published Issue 223 of its “Global Fund Observer.” This “special issue” of the newsletter is “devoted almost entirely to a review of the reforms that the Global Fund has undertaken, and of the major challenges facing the Fund,” according to the Editor’s Note, which adds, “In Article 1, Aidspan’s David Garmaise and Kate Macintyre provide an assessment of the reforms and discuss their impact. In Article 2, guest commentators from four organizations provide their perspectives on the major challenges.” The issue also includes an announcement that the Global Fund “has issued a formal call for applications from people interested in being part of the Technical Review Panel (TRP) for the period 2014-­2016” (7/25).

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