KFF Daily Global Health Policy Report

In The News

International Organization Leaders Discuss Medical Innovation At Symposium

“The leaders of three top international organizations in Geneva last week discussed synergies in public health and called for increased collaboration and creativity to [improve] medical innovation,” Intellectual Property Watch reports. “The directors general of the WHO, World Trade Organization and World Intellectual Property Organization addressed the [July 5] opening session of a joint symposium on Medical Innovation: Changing Business Models,” presenting “their comments and evaluations of the current medical innovation landscape, providing different perspectives from health, intellectual property, and trade,” the news service writes. IP Watch summarizes comments from WHO Director-General Margaret Chan, WIPO Director-General Francis Gurry, and WTO Director-General Pascal Lamy, as well as a keynote address from GAVI Alliance CEO Seth Berkley (Ngo, 7/8).

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Nature Medicine Examines Impact Of Potential Budget Cuts On TB Research

Nature Medicine examines how U.S. federal spending cuts, known as sequestration, might affect tuberculosis (TB) research, focusing on the “Tuberculosis Trials Consortium (TBTC), a research nexus based in Atlanta that conducts tuberculosis clinical trials across nine countries in collaboration with the U.S. government, non-profits and drug companies.” The news service writes, “Over the past three years, the TBTC has seen an approximate 10 percent drop in its budget, which is determined by the U.S. Centers for Disease Control and Prevention (CDC) and which peaked in 2008 at $10.4 million, according to [TBTC Steering Committee Chair Neil] Schluger. This year, the consortium learned it would be facing dramatic additional reductions as a result of the sequester.” Noting that researchers hope the cuts do not exceed 13 percent, Nature Medicine writes, “The cuts come at a time when many in the tuberculosis community feel that new treatments are within reach,” but not without clinical trials, which might “be delayed by years, if not permanently” (Quirk, 7/8).

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NPR Series Examines How Russian Prisons Treat Drug-Resistant TB Among Inmates

In its continuing series on drug-resistant tuberculosis (TB), NPR’s “Shots” blog and “Morning Edition” examine how the Russian prison system has teamed up with the non-profit Partners In Health to fight the disease among inmates. As part of the partnership, the Siberian facility called Medical and Penal Institution Number One is “making progress against drug-resistant TB,” as “[t]he rate of infection has dropped seven-fold, and the death rate has fallen to single digits, Alexander Leshchyov, the deputy warden, says,” the blog writes. The story describes inmate Igor Davydenko’s progress, after being treated for TB three times. “The key to curing TB in prisoners is getting each patient to take responsibility for his own health, Warden Leshchyov says,” the blog writes, adding, “The experience of being treated for the disease can have a positive effect on an inmate’s rehabilitation, Leshchyov says.” According to “Shots,” prison officials “say that inmate patients, who’ve received the full spectrum of treatment, have a much better chance, not only of recovering their health, but of recovering a productive place in society” (Flintoff, 7/9).

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Challenges Of Access Remain Under Kenya's Free Maternity Services

“Kenyans welcomed with excitement when President Uhuru Kenyatta ordered that maternity fees for mothers who deliver in public hospitals be abolished” on June 1, but “the celebrative mood was short lived as people started to realize that the challenges go far beyond a waived fee,” Xinhua reports. “While hailing it as a noble idea of the government, residents now say it only scrapes the top of a bigger problem that is related to maternity health, especially in the remote areas of Kenya’s northeastern region,” the news service writes. Xinhua examines existing challenges, noting statistics from the Garissa Provincial General Hospital (PGH) “show that only five percent of the population in the northeastern region have access to health facilities for delivery.” PGH’s matron Khatra Ali “said that the hospital had a shortage of about 150 nurses and out of the 74 nurses currently at the hospital, only 12 were assigned to the maternity ward, a rate well short of the one recommended by the [WHO],” the news service writes (Ingati/Mangera, 7/8). Inter Press Service examines why, “according to Teresia Wangai, a qualified midwife at a regional hospital, the fee waiver has not led to an increase in women giving birth at hospitals,” noting some women prefer to use traditional birth attendants and deliver at home due to concerns about the quality of care at government health facilities (Gathigah, 7/9).

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IRIN Examines Male Circumcision Programs In Africa

“Fourteen African countries in eastern and southern Africa plan on circumcising a total of 20 million men by 2016 in an effort to curb the transmission of HIV,” IRIN reports, adding, “A number of these countries are lagging behind on their targets, and feel the [non-surgical circumcision] PrePex device will give their programs a much-needed boost, while others are more cautious.” The news service looks at ongoing studies and pilot programs using the device in Malawi, Kenya, Rwanda, Botswana, Tanzania, South Africa and Uganda (7/3). In a separate article, IRIN examines the voluntary medical male circumcision program in Zimbabwe, where “[f]unds for the [program] are lying idle, as the Ministry of Health and Child Welfare says not enough men are coming forward to use the service, which was launched as part of an HIV prevention package.” One “barrier to the program’s success is the fact that male circumcision is a surgical procedure, and people are generally fearful of medical procedures,” the news service writes, adding, “The government hopes that the recent WHO approval, or ‘prequalification,’ of PrePex — a nonsurgical device — could help service providers address some of the fears over surgical procedures” (7/8).

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IFRC Appeals For $1.3M For Namibian Drought Relief

“Desert-hardy Namibians, overwhelmed by the worst drought to hit their country in 30 years, are surviving off wild fruits with no harvest in sight until March 2014, the International Federation of Red Cross and Red Crescent Societies (IFRC) said as it launched an appeal on Monday … for $1.3 million for Namibia to be spent over 12 months,” Thomson Reuters Foundation reports. “The government of Namibia, the driest country in sub-Saharan Africa, declared a national emergency in May,” the news service writes, adding, “Drought has resulted in crop failure and livestock deaths across the tiny country of 2.1 million people.” Reuters continues, “The crisis is set to worsen — Namibia only has one harvest a year and the next is not due until March 2014,” noting, “The crisis is also taking on a regional dimension as neighboring Angola has also appealed for help to cope with a second year of failed rains. Relief agencies estimate that between 640,000 and one million Angolans have been hit by the drought” (Migiro, 7/8).

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Essay Examines Issue Of 'Peak Water,' Implications For Global Food Supply

“Wells are drying up and underwater tables falling so fast in the Middle East and parts of India, China and the U.S. that food supplies are seriously threatened, one of the world’s leading resource analysts has warned,” The Guardian reports. “In a major new essay, Lester Brown, head of the Earth Policy Institute in Washington, claims that 18 countries, together containing half the world’s people, are now overpumping their underground water tables to the point — known as ‘peak water’ — where they are not replenishing and where harvests are getting smaller each year,” the newspaper writes, and discusses some of Brown’s findings (Vidal, 7/6). “Tapping underground water resources, which got seriously underway in the mid-20th century, helped expand world food production, but as the demand for grain continued climbing the amount of water pumped continued to grow,” Brown writes in the essay, noting, “Eventually the extraction of water began to exceed the recharge rate of aquifers from precipitation, and water tables began to fall.” Brown continues, “The bottom line is that water constraints augmented by soil erosion, the loss of cropland, a shrinking backlog of unused agricultural technology, and climate change are making it more difficult to expand world food production” (7/6).

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France 24 Video Report Examines Vaccine Industry

A video report from France 24’s “Beyond Business” examines the vaccine industry, “a $34 billion industry that’s saving millions of lives,” and asks, “[I]s the money spent on vaccines going as far as it should?” According to the summary, “The market is now dominated by the public-private partnership, the Global Alliance for Vaccination and Immunization — GAVI,” but “critics say GAVI is too close to the supplier and that its purchasing decisions are being influenced by some donor countries” (Ben Aïssa/Laïdi/Winspear, 7/8).

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Editorials and Opinions

Universal Access To HIV Therapy Essential To Reach End Of AIDS

“Antiretroviral therapy saves lives, improves quality of life, and lifts communities and economies, enabling people to once again work, go to school, care for their families, and participate in society. Every day, treatment access and other investments are helping us get closer to an end of the AIDS epidemic,” UNAIDS Executive Director Michel Sidibé writes in the Huffington Post’s “Impact” blog. Though treatment “successes are inspiring … the concluding chapters of this story have yet to be written. It’s time to raise the bar,” he states. Sidibé notes the new WHO HIV treatment guidelines, which call for earlier, simpler therapy. The guidelines “are welcome news for people living with HIV, but implementing them presents challenges,” he notes, adding, “I am optimistic that national leaders, international donors, civil society and partners will seize this opportunity and work with us to expand access to treatment,” as well as expand prevention efforts such as male circumcision and work to eliminate stigma and discrimination. Sidibé concludes, “The path to zero — zero new infections, zero discrimination, and zero AIDS-related deaths — is clearer today than ever before. Universal access to antiretroviral therapy can help pave the way” (7/8).

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Leveraging Innovative Financing Mechanisms For Global Health R&D

“Whatever the exact numbers, few would dispute that only a small fraction of health [research and development (R&D)] funding targets conditions in poor countries that account for most of the global disease burden,” Trevor Mundel, president of the Global Health Division at the Bill & Melinda Gates Foundation, writes in a SciDev.Net opinion piece. “This is hardly surprising, given that markets in these countries have historically been unable to deliver sufficient financial returns to support the commercial development of health solutions for neglected diseases,” he writes, adding, “To help meet the most urgent health needs of developing countries, the Bill & Melinda Gates Foundation is employing a range of innovative financing strategies that we believe can help markets ease the bottlenecks at various stages of the discovery, development, and delivery lifecycle of new medical products.”

“For example, equity investments can advance early-stage discovery and innovation; commercialization loans are an efficient way to scale-up manufacturing; and volume guarantees and delivery investment funds can help pharmaceutical companies and health care providers to get important vaccines and drugs to the people who need them,” Mundel continues, and provides details. “While public-private partnerships are not uncommon in global development, there is a big opportunity to leverage novel financial strategies — alongside traditional grants, partnerships, and advocacy efforts — to stimulate private-sector R&D, encourage market-driven efficiencies, and attract new capital,” he states. “But creating the right market incentives is only part of the challenge — getting affordable and effective health solutions and services to the people who need them can also be difficult,” he continues, and writes, “Over the next several years, we expect to increase our investments in these kinds of innovative financing mechanisms” (2/7).

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Improving Family Planning For Women Must Involve Human Rights Approach

Noting that one year ago governments and donors pledged $2.6 billion for family planning efforts in developing countries at the London Global Family Planning Summit, Gauri van Gulik, a researcher and advocate for Europe and Central Asia in the women’s rights division of Human Rights Watch, writes in The Guardian’s “Poverty Matters Blog,” “Human Rights Watch, together with many other organizations including Amnesty International and the Center for Reproductive Health, raised concerns that the summit did too little to address the rights of women and girls.” She continues, “Our work has shown that when health initiatives are not based on women’s human rights, they don’t deliver,” and she notes “two ways failure to address this properly undermines efforts to improve family planning.”

“First, some governments deny women the right to decide how many children they have,” and “[s]econd, governments deny women and girls the right to decide whom they marry and when,” van Gulik writes. “There are many more obstacles to family planning: women suffer discrimination in health care, violence at home, poor quality care, and abuses by health workers,” she writes, concluding, “Throwing money at family planning services is not enough. If governments ignore underlying human rights violations it will be counterproductive, leaving the most vulnerable women and girls without the choices available to women like me” (7/8).

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ColaLife Program Offers Important Lessons About Essential Medicines Distribution In Developing World

“‘We can distribute Coca-Cola all around the world, but we can’t seem to get medication to save a child from something as simple as diarrhea,’ said the singer Annie Lennox in a 2008 interview,” journalist Sarika Bansal notes in the New York Times’ “Opinionator” blog. “Indeed, Coca-Cola’s footprint in Africa is considerable,” she states, adding, “At the same time, 30 percent to 50 percent of the sub-Saharan African population lacks access to essential medicines.” She notes, “A Johns Hopkins study [.pdf] found oral rehydration salts, or ORS, a diarrhea treatment, to be unavailable during one of every five clinic visits in Tanzania,” and continues, “ORS packets are easy to transport; unlike many medicines, they do not require refrigeration or special handling, and they have a long shelf life. In theory, they could be transported and sold alongside Coca-Cola and other consumer products.” She asks, “Could this theory be tested in the real world? Is there a way to leverage Coca-Cola’s huge distribution network to get medicines to sick children?”

“Simon and Jane Berry, a British couple with extensive experience in international development, have spent the past five years trying to answer these questions,” Bansal notes, adding, “They set up a non-governmental organization called ColaLife in Zambia,” and “[w]ith the help of local partners, they created Kit Yamoyo, or ‘kit of life,'” which “contains several small packets of ORS, zinc pills (they limit duration of diarrhea), a bar of soap (handwashing can reduce risk of diarrhea by up to 50 percent), and an illustrated information packet,” and “fits snugly in the empty space in Coca-Cola crates.” Bansal writes, “ColaLife has focused on emulating what Adrian Ristow, a project manager for Coca-Cola, says is the company’s ‘secret ingredient in distribution’: the investment they put into people.” She discusses the ColaLife distribution model and the product’s design, examines existing challenges, and concludes, “[T]he public health world has tremendous hope for the lessons ColaLife can offer” (7/3).

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From the Global Health Policy Community

Addressing Malnutrition 'In India And Beyond'

Purnima Menon, a research fellow in IFPRI’s Poverty, Health and Nutrition Division, and Venkatesh Mannar, president of the Ottawa-based Micronutrient Initiative (MI), both co-authors of The Lancet 2013 Series on Maternal and Child Nutrition, write in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, “The Lancet series outlines the consequences that result from early malnutrition, yet what truly stands out are the opportunities that an investment in nutrition presents.” They focus on India, looking at the impact of malnutrition on children in the country and efforts to improve food security and nutrition. “Working together, we can do more and have a greater impact — a lasting impact. Malnutrition deserves far greater attention and investment by public, private, and civic leaders and citizens than it currently receives,” they write, adding, “There are proven solutions within our reach, and our focus on science and economic growth has paid off. Let us now focus on growing and nourishing tomorrow’s leaders, in India and beyond” (7/8).

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Twitter Chat Examines Global Newborn Health

Writing in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Jennifer James, founder of Mom Bloggers for Social Good, recaps a Twitter chat about global newborn health with Gary Darmstadt, director of family health at the Gates Foundation. “A robust online conversation between Social Good Moms, experts, researchers, bloggers, and [non-governmental organizations (NGOs)] took place within a short 30-minute window,” she notes, and provides a Storify of the conversation (7/8).

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