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Kaiser Daily Global Health Policy Report

In The News

Drop In AIDS-Related Deaths In Eastern, Southern Africa Due To Improved Treatment Access, UNAIDS Report Says

“A 10-fold increase in access to life-prolonging drugs contributed to a 38 percent drop in the number of people dying from AIDS-related causes in eastern and southern Africa between 2005 and 2011, the United Nations said on Tuesday,” Thomson Reuters Foundation reports. In a new UNAIDS report (.pdf), titled “Getting to Zero: the HIV epidemic in the eastern and southern Africa,” the agency said “[t]he number of [AIDS-related] deaths fell from 1.3 million to 800,000 per year” and “[t]he number of people taking antiretroviral therapy soared from 625,000 to 6.3 million between 2005 and 2012,” according to the news service (Migiro, 7/30). “The report … highlights that the number of new HIV infections among children were reduced by half from 2001 to 2011 and new infections among adults aged 15-49 reduced by around a third,” a UNAIDS press release states. The rate of new HIV infections among adults declined “by more than 50 percent in seven countries — Botswana, Ethiopia, Malawi, Namibia, Rwanda, Zambia and Zimbabwe,” according to the press release (7/30).

However, “challenges remain,” VOA News writes. “HIV prevalence among young women was 4.5 percent in 2011 — more than twice the rate among young men,” the news service notes, adding, “[O]fficials acknowledged that convincing young people to take precautions against HIV [also] remains a major challenge.” Noting successes in areas such as preventing mother-to-child transmission, South African Health Minister Aaron Motsoaledi said “his nation’s health system is struggling to accommodate its various burdens, and needs to come up with a novel solution,” the news service notes. “When you add the number of people who need treatment from HIV/AIDS, those who need treatment from [tuberculosis (TB)] and the non-communicable diseases, our health facilities are going to be extremely overstretched,” he said, adding, “So that tells us that together with all the development partners, we need to start planning and innovate new methods,” VOA writes (Powell, 7/30). “Finally, there was an estimated shortfall of $7 billion if all countries were to scale up to meet the HIV challenge,” Health-e News reports (Cullinan, 7/31).

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Only 1 In 5 Countries Implement Guidelines On Marketing Of Breast-Milk Substitutes, WHO Report Says

The WHO on Tuesday “called for ensuring that women have accurate information and support regarding the importance of breastfeeding, after a new report found that only one in five countries fully implement international guidelines about the marketing of breast-milk substitutes,” the U.N. News Centre reports (7/30). “Only 37 countries, or 19 percent of those reporting, have passed laws reflecting all the recommendations of the International Code of Marketing of Breast-milk Substitutes, according to a new WHO report published during World Breastfeeding Week,” which is “celebrated in more than 170 countries from August 1-7,” according to a WHO press release (7/30). In addition, the report “says that mothers are often inundated with incorrect or biased information directly through advertising, health claims, information packs and sales representatives and indirectly through the public health system,” the Jakarta Post writes. “It further said the distribution of samples of infant formula also had an adverse impact on breastfeeding,” according to the newspaper (7/31). “Exclusive breastfeeding is recommended by WHO and its partners up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond,” Xinhua notes, adding, “But globally only an estimated 38 percent of infants are exclusively breastfed for six months,” according to the WHO (7/30). A related article on the WHO website examines breastfeeding in Peru (July 2013).

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U.N., E.U. Officials Call For More Humanitarian Action In Syria

Paulo Pinheiro, chair of the Independent International Commission of Inquiry on Syria, on Monday spoke to the U.N. General Assembly and “urged the international community to demand a diplomatic solution to the 2 1/2-year conflict that has killed more than 100,000 people,” the Associated Press reports. “He said 4.5 million people are displaced inside Syria, 18 million remain in their homes and have become the first providers of humanitarian aid to their fellow citizens, and more than 2.5 million are unemployed and struggling to survive,” the news agency writes (Lederer, 7/29). Elisabeth Byrs, spokesperson for the World Food Programme (WFP), “said Tuesday that 600,000 Syrians could not receive aid this month as spiraling violence prevented convoys from reaching them,” Agence France-Presse/GlobalPost notes (7/30). “As of [Tuesday], WFP had dispatched food for 2.4 million people, short of the July goal” of three million, the U.N. News Centre writes (7/30). “Byrs said it costs the [WFP] $29.3 million to $30 million each week to finance aid operations,” the New York Times notes, adding, “The organization is seeking $763 million in contributions through the end of the year to help up to seven million Syrians, including four million people in Syria and almost three million refugees in neighboring countries” (Banco, 7/30).

“The lawless conflict in Syria is rekindling dangers — from disease to forms of political violence — that have been dormant for decades, Kristalina Georgieva, the European Union’s commissioner for international cooperation, humanitarian aid, and crisis response, told Foreign Policy on Monday,” the news service’s “Passport” blog reports. “According to the [WHO], polio was eradicated in Syria in 1995 … [b]ut the disease has returned during the country’s civil war,” the blog writes, adding, “Other diseases — including measles, typhoid, cholera, tuberculosis, and leishmaniasis, informally called the ‘Aleppo boil’ — have also proliferated in the absence of professional medical care.” According to the blog, “Georgieva is pressing for protected humanitarian corridors to funnel aid and assistance to the countries taking in refugees,” and she said the E.U. is “prepared to do our part” (Stuster, 7/30).

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FAO Urges Developing Countries To Stop Distribution, Use Of Toxic Pesticides

“The tragic incident in India in which nearly two dozen children died after eating a contaminated school meal is a stark reminder that highly hazardous pesticides should be phased out in developing countries, the United Nations Food and Agriculture Organization (FAO) said” Tuesday, the U.N. News Centre reports. “In a news release, FAO stressed that the distribution and use of highly toxic pesticides in many developing countries poses a serious risk to human health and the environment, and measures to put safeguards in place to protect the population must be implemented,” the news service notes (7/30). “The FAO said many countries lacked the resources to properly manage the storage, distribution, handling and disposal of pesticides and to reduce their risks,” according to Reuters. “Although India’s government argues the benefits of strong pesticides outweigh the hazards if properly managed, the food poisoning tragedy underlined criticism such controls are virtually ignored on the ground,” the news service writes (Flak, 7/30).

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Honduran Government Declares State Of Emergency Over Dengue Fever Outbreak

“The Honduran government declared a state of emergency Tuesday due to the spread of dengue fever, which has killed 16 people this year and infected more than 12,000, local media reported,” Xinhua writes (7/31). “Health Minister Salvador Pineda said Tuesday’s decree means the government is making it a priority to prevent and control the disease and fight the mosquitoes that spread it,” the Associated Press/Washington Post reports, adding, “Pineda says more than half of Honduras’ municipalities have registered dengue fever cases” (7/30). “The authorities have been criticized for not doing enough to eliminate the breeding sites of the mosquitoes that transmit dengue,” Al Jazeera states. “The disease is present in all of Central America, and until last week had caused 26 deaths and infected nearly 40,000 more so far this year,” the news service writes (7/31).

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Expert Panel Offers Tips For Global Health Care Service Delivery

In a post in The Guardian’s “Global Development Professionals Network,” a number of expert panelists “offer tips for global health care service delivery.” The panel includes David Jamieson, deputy project director of health supply chains for Crown Agents in Washington, D.C.; Tamsin Chislett, partnerships manager for Living Goods in Kampala, Uganda; Andreas Seiter, senior health specialist at the World Bank; Simon Berry, founder and chief executive of ColaLife in Lusaka, Zambia; Rose Reis, communications officer for Centre for Health Market Innovations in Washington, D.C.; Mandy Sugrue, community manager for mHealth Alliance in Washington, D.C.; and George Jagoe, head of access for Medicines for Malaria Venture in Geneva, Switzerland (Scott, 7/29).

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Editorials and Opinions

International Community Must Draw Attention To 'Forgotten Crisis' In CAR

In a Guardian opinion piece, Kristalina Georgieva, European commissioner for humanitarian aid and crisis response, examines the ongoing conflict in the Central African Republic (CAR) and reflects on the lack of attention being paid to the situation in the international media. “The ferocity of the fighting and the fall of the capital Bangui has briefly forced the Central African Republic into the international news — but in truth its plight is to be a small and for the most part invisible country surrounded by a sea of troubles and conflict,” she states. “While the international community has all but handed the Syrian crisis to humanitarians to manage as best they can, seemingly abandoning efforts to seek a political solution there, the suffering of millions of others around the world is getting worse as the pressures on precious resources become ever greater.” She asks, “How is it possible for an entire country to become forgotten?” and writes, “This is the question I heard time and again from people living in mortal fear, working without pay in hospitals without electricity or medicines, without food for their malnourished children, many of them without hope.”

“It’s hard to be positive about the future of the Central African Republic when its past and present are so tragic,” Georgieva continues. “What is certain is that the Central African Republic is incapable of doing it alone,” she states, adding, “In my work as the European Union’s commissioner for humanitarian aid, I am determined to ensure that, in spite of all the dramatic needs from conflicts seen nightly on television, we continue to spend 15 percent of our annual budget on ‘forgotten crises’ — those that fail to draw the attention of the global community.” She concludes, “It is our moral duty, but also it is in our own interest, to bring the resources and the political attention needed to restore security and a functioning state for Central Africans. It is possible and it is long overdue” (7/30).

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Global Health Agencies Must Do More To Combat Drug-Resistant TB In North Korea

“Tuberculosis has long been recognized as one of the biggest public health problems in North Korea, but there is a disturbing new development: much of the TB in North Korea is resistant to regular antibiotics,” K.J. Seung, deputy director for the Partners In Health project in Lesotho and a physician in the division of global health equity at Brigham and Women’s Hospital in Boston, writes in an Atlantic opinion piece. Noting “[t]he most serious strains of drug-resistant TB, called ‘multidrug-resistant,’ or MDR-TB, don’t respond to treatment with first-line TB drugs,” he states, “For North Korean patients, MDR-TB is basically a death sentence.” Seung continues, “Until now, there has never been any clear scientific evidence that drug-resistant TB is a serious problem in North Korea, mainly because North Korea does not yet have a laboratory with the capacity to do this sort of research.” However, the doctors that work “in the TB sanatoria that dot the North Korean countryside … have been quite open about the fact that they have patients who are not being cured with regular TB drugs,” he notes.

“My research, published [Tuesday] in PLOS Medicine, analyzed sputum samples from more than 200 of these patients and found that the North Korean doctors were indeed correct — 87 percent were proven to have MDR-TB,” Seung writes. He examines why MDR-TB is spreading in North Korea, highlighting a program funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and run by UNICEF and the WHO, through which “all North Korean TB patients are treated blindly with first-line drugs without first being tested to see if they’re infected with resistant strains.” However, “[t]reating drug-resistant TB with ineffective regimens provokes the TB to become even more resistant,” he writes, adding, “From a public health point of view, bad treatment is worse than no treatment at all, because it can quickly make the problem of drug-resistant TB worse.” He concludes, “In this difficult political climate, the Global Fund, UNICEF and WHO should be applauded for their intention to improve TB control in North Korea. But with TB, good intentions are not enough, and can be dangerous. Only the correct public health strategy can defeat it” (7/30).

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Women Play Key Role In Defeating Polio, Other Vaccine-Preventable Diseases

In an opinion piece in The Atlantic, Haider Javed Warraich, a resident in internal medicine at the Beth Israel Deaconess Medical Center in Boston and an author, discusses the challenges posed by people who do not believe in vaccination, from the views of actor Jenny McCarthy in the U.S. to the negative impact of the Taliban’s and other Islamic fundamentalist’s opposition to polio vaccinations. “The global battle against polio lends itself well to the grisly metaphors of war. In many ways, the worldwide campaign to eradicate the disease has mirrored the fight against terrorism.” He notes challenges to vaccination in Afghanistan, Pakistan and Nigeria, the three remaining polio-endemic countries.

Warraich describes the violent attacks on and killing of women vaccinators working in Pakistan, writing, “The women of Pakistan are far from collateral damage in this war. … [T]he women of Pakistan have shown up where many of their men never dare trespass.” He continues, “The challenge to vaccination in the United States is an entirely different one, and much of it has the effectiveness of vaccination itself to blame,” as people forget the devastating impact of disease once it is eliminated. “Similar to Pakistan though, women, in their role as mothers and advocates, are the key to battling anti-vaccination propaganda, such as the link to autism that has been fully debunked,” Warraich writes, concluding, “In many ways, the war on polio and other vaccine-preventable diseases is likely to be just as consequential as the fight against global terror” (7/30).

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From the Global Health Policy Community

Blogs Highlight Global Health Budget Requests In Senate, House Appropriations Bills

In the Center for Global Development’s (CGD) “Global Health Policy” blog, Jenny Ottenhoff, policy outreach associate at CGD, examines the FY 2014 requests for global health in the proposed Senate and House State and Foreign Operations appropriations bills. “Both bills won approval by their respective committees,” she notes, adding, “But the $10 billion chasm between the House and the Senate, paired with a minefield of divisive policy issues, suggest that the bills likely won’t be reconciled. Instead, they will probably be rolled into a continuing resolution (CR).” Ottenhoff notes the Kaiser Family Foundation’s “Policy Tracker” contains additional information on the budget proposals (7/30). In the Global Health Technologies Coalition’s (GHTC) “Breakthroughs” blog, GHTC Policy Officer Ashley Bennett “provide[s] highlights from recent congressional budget activity that will determine funding levels for State and Foreign Operations, including global health and R&D programs at the State Department and [USAID]” (7/30).

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USAID, U.S. Treasury Release New Aid Data Sets

“For the first time ever, you can visit the Foreign Assistance Dashboard and check out how our partners have spent our dollars,” USAID Administrator Rajiv Shah writes in the agency’s “IMPACTblog,” noting the “unprecedented release of new financial data includes over 30 database fields and nearly 53,000 records — all from the first three quarters of fiscal year 2013.” He states, “This release is just the latest in a series of important changes we have made to advance President Obama’s unparalleled commitment to transparency and our own USAID Forward reform agenda” (7/30). In similar news, “[t]he Treasury Department has new data on its website on where and how it spent $23 million in FY 2012 technical assistance, and it’s available in the International Aid Transparency Initiative (IATI) format,” Sarah Jane Staats, director of the Center for Global Development’s (CGD) Rethinking U.S. Foreign Assistance Program, writes in the “Rethinking U.S. Foreign Assistance Blog.” She adds, “Both sets of new data — from Treasury and USAID — are important steps towards the Obama administration’s ‘open aid’ efforts and staff at the agencies and the Dashboard deserve credit” (7/29).

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Examining Need To Stop New Outbreaks In Polio-Free Countries

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Hamid Jafari, director of global polio eradication and research at the WHO, reflects on global polio eradication efforts, noting “[a]n editorial in the Washington Post on Monday and a recent NPR piece both draw attention to one of the major challenges we anticipate during this final push: outbreaks in polio-free countries.” He writes, “The best way to stop such outbreaks is by interrupting polio transmission in the remaining endemic countries. Meanwhile, investing in strong immunization programs in known high-risk areas can and does prevent outbreaks in the first place.” He concludes, “We know that challenges will arise on the road to polio eradication. So long as the world stays fully committed to traveling down that road, I know we’ll be successful” (7/30).

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Blog Cites Documents Helping To Outline Path To AIDS-Free Generation

The Center for Global Health Policy’s “Science Speaks” blog examines several documents it says are helping guide the way toward an AIDS-free generation. The blog highlights the PEPFAR Blueprint (.pdf); the new WHO HIV treatment guidelines; an issue brief (.pdf) from amfAR, The Foundation for AIDS Research, titled “Tackling HIV/AIDS Among Key Populations: Essential to Achieving an AIDS-free Generation”; a declaration (.pdf) from the African Union Special Summit on HIV, Tuberculosis and Malaria; and a joint statement (.pdf) by the Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and Stop AIDS Now (Barton, 7/30).

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