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Kaiser Daily Global Health Policy Report

In The News

WHO Emergency Committee Meeting To Determine Whether To Declare Ebola Epidemic International Threat; CDC Opens Emergency Operations Center To Assist In DRC Outbreak

Agence France-Presse: WHO emergency panel meets on Ebola after Uganda deaths
“The World Health Organization emergency committee will decide Friday whether to declare a raging Ebola epidemic an international threat, after an outbreak that began in Democratic Republic of Congo crossed into Uganda. The WHO panel, which was formed in 2005, has used the label ‘public health emergency of international concern’ for only four previous epidemics…” (6/14).

Financial Times: Ebola escalation keeps World Bank’s ‘pandemic bonds’ in spotlight
“The World Bank’s ‘pandemic bonds’ are under scrutiny again following an escalation in the Ebola outbreak in central Africa. … Despite [the outbreak’s recent spread into Uganda], the World Bank’s pandemic bonds would not pay out until at least 20 people were confirmed to have died in Uganda and a positive rate of growth of the outbreak was confirmed, according to a person familiar with the bonds. Only then would the Washington-headquartered institution pay $90m to help both governments and international aid responders tackle the crisis…” (Asgari, 6/13).

HealthDay News: CDC Opens Emergency Operations Center for Congo Ebola Outbreak
“The United States is stepping up its response to a historic outbreak of Ebola in two African nations. The U.S. Centers for Disease Control and Prevention activated its Emergency Operations Center Thursday to assist in the government’s response to the second-largest outbreak of Ebola on record. The announcement came as the deadly virus crossed the border from the eastern Democratic Republic of the Congo (DRC) to Uganda, where two have died…” (Reinberg, 6/13).

New York Times: Uganda Discloses Greater Ebola Threat Than Previously Known
“Uganda’s exposure to Ebola infection from the neighboring Democratic Republic of Congo appeared to have increased on Thursday, as the death toll rose to two and three suspected cases were reported in a Ugandan border hospital. The number of people in Uganda who may have been exposed to carriers of the Ebola virus expanded significantly, from eight to at least 27. The disclosures, in a Ministry of Health update on its website, suggested an accelerating threat to Uganda from the Ebola virus…” (Gladstone, 6/13).

Reuters: INTERVIEW — Ebola not known to be spreading in Uganda — WHO
“There has been no known person-to-person spread of Ebola in Uganda despite the deaths of two people there who arrived with the disease from Congo, the top World Health Organization (WHO) expert told Reuters on Thursday. Dr. Mike Ryan, head of WHO’s emergencies program, said that he expected Uganda to approve the use of experimental therapeutic drug treatments, to be shipped ‘in coming days.’ Monitoring and vaccination had been stepped up, but there had been ‘no panic reaction’ so far to the cases there…” (Nebehay, 6/13).

Additional coverage of the Ebola outbreak is available from Agence France-Presse, Associated Press, Axios, CIDRAP News, CNN, Reuters (2), U.N. News, and UPI.

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Half Of Ebola Outbreaks Go Undetected, Researchers Estimate, Call For Better Control, Diagnostic Resources

Agence France-Presse: Half of Ebola outbreaks go ‘undetected’: study
“…Researchers at the University of Cambridge used several independent datasets from the last major outbreak, in West Africa in 2013-2016, to simulate thousands of outbreaks. They calculated how often on average a spillover event could be expected to fizzle out before gripping the population, versus how often a true outbreak was likely. The results consistently showed that only one in two Ebola outbreaks were likely to be detected. … ‘Knowing that Ebola is rarely detected within the first few cases emphasizes the importance of having widely available infection control and diagnostic resources,’ she said. The research was published in the journal PLOS Neglected Tropical Diseases” (6/13).

The researchers published a related opinion piece in The Conversation.

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House Democrats Vote To Block Part Of Trump Administration's New Fetal Tissue Research Policy

The Hill: House Democrats vote to overturn Trump ban on fetal tissue research
“House Democrats on Thursday voted to block [some of] the Trump administration’s recent ban on using federal funds to conduct medical research that relies on material collected from elective abortions. An amendment from Reps. Mark Pocan (D-Wis.) and Ted Deutch (D-Fla.) to a broader health care spending package passed 225-193, largely along party lines…” (Weixel, 6/13).

Science: House Democrats move to block part of Trump’s fetal tissue policy
“…[The] amendment to a 2020 spending bill … would bar the Trump administration from convening ethics advisory boards to review grant applications at the National Institutes of Health (NIH) for studies that use fetal tissue. Three Democrats and all Republicans voted against the amendment. … [The] amendment, to a spending bill that covers HHS and NIH for the 2020 fiscal year that begins on 1 October, would bar HHS from expending money to convene the panels…” (Malakoff, 6/13).

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Gateses Launch Gates Policy Initiative To Lobby For Global Health, Development, Other Issues

The Hill: Bill and Melinda Gates launch lobbying shop
“Bill and Melinda Gates have launched the Gates Policy Initiative to lobby for issues the billionaire couple has been working on through the Bill & Melinda Gates Foundation, The Hill first reported. The initiative will be focused on global health, global development, U.S. education and outcomes for black, Latino and rural students specifically, and efforts to move people from poverty to employment…” (Gangitano, 6/13).

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Injectable Contraceptive Does Not Increase Risk Of HIV, Study Shows

The Guardian: Contraceptive injections do not increase risk of contracting HIV, study finds
“A landmark study has ended 30 years of anxiety that hormonal contraceptive injections may increase women’s chances of infection from HIV. But the study found a dramatically higher rate of HIV infection among women in southern Africa than was expected, which one leading campaigning organization said signified a public health crisis. … The new study, called ECHO (Evidence for Contraceptive Options and HIV Outcomes), published in The Lancet, … compared the HIV infection rates among women using hormonal injections with those using an IUD (intrauterine device or coil) or an implant. It involved more than 7,800 women in Eswatini, Kenya, South Africa, and Zambia…” (Boseley, 6/13).

Healio: ECHO trial: HIV risk does not differ by contraceptive method
“…The researchers found no substantial difference in HIV risk among the different contraceptive methods, and reported that all three methods were safe and highly effective. However, they noted that HIV incidence was high, underscoring the need for integration of HIV prevention within contraceptive services. … In a related editorial, Lisa Miyako Noguchi, PhD, MSN, an associate in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and Princess Nothemba Simelela, MD, assistant director general for family, women, children and adolescents at WHO, called the results ‘largely reassuring’ but noted ‘substantial’ gaps in meeting the needs of women at risk for unplanned pregnancy and HIV infection…” (Ghizzone, 6/13).

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Long-Term, Grant-Based Development Work Needed To Ensure Success Of Military, Humanitarian Efforts In Sahel, UNOCHA Head Says

Devex: U.N. humanitarian chief decries short-term focus in Sahel
“Military and humanitarian efforts in the Sahel will fail unless they are accompanied by long-term, grant-based development work, head of United Nations Office for the Coordination of Humanitarian Affairs, Mark Lowcock, said Wednesday. … Lowcock said the underlying problems to be addressed include: poverty, demographic growth, education, governance failures, and environmental stresses, made worse by climate change. ‘A lot of what needs to be done can only be done through (grants) or very, very concessional resources,’ he said… ” (Chadwick, 6/14).

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WHO, U.N. Officials Urge Sudan To Cease Violence Against Health Workers, Patients, Civilians

The Lancet: Health targeted in Sudan’s political transition
“WHO has urged Sudan to end violence against health workers, patients, and peaceful campaigners after security forces raided a protest camp and made incursions into hospitals in Khartoum, leading to the injuries or deaths of hundreds of people. Sudanese opposition groups say that 113 people were killed after the storming of the civilian sit-in camp in front of the military’s headquarters on June 3, whereas the government says that 61 people were killed, including three security personnel…” (Devi, 6/15).

U.N. News: Sudan: top U.N. official demands cessation of violence and rape against civilians by security forces
“… ‘I demand the immediate and complete cessation of all violence against civilians including sexual violence,’ stated Special Representative Patten, noting that the [the ‘Rapid Support Forces’ or RSF — a paramilitary group run by the Sudanese Government –] have consistently been listed in the U.N. Secretary-General’s annual report on conflict-related sexual violence. ‘[They] should take effective measures to prevent and punish sexual violence in accordance with relevant Security Council resolutions, including resolution 2467,’ she added…” (6/13).

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Unsafe Medical Practices, Including Syringe, Drip Reuse, Likely Caused HIV Infections Among Pakistani Children, WHO Finds

Wall Street Journal: Reusing Syringes, Drips Infected Hundreds of Pakistani Children With HIV
“Unsafe, but common, practices such as reusing drips and syringes caused hundreds of Pakistani children to be infected with HIV, according to a World Health Organization team investigating an outbreak in a poor southeastern town. The WHO’s preliminary findings, reviewed by the Wall Street Journal and presented to Pakistani health officials Friday, offer a window into how more than 650 children tested positive for HIV in one town over six weeks of government tests, while nearly all their parents tested negative…” (Rana, 6/14).

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More News In Global Health

BBC News: Ecuador’s top court approves same-sex marriage (6/13).

Christian Science Monitor: For Afghan midwife, saving women’s lives is a lifelong passion (Peterson, 6/13).

The Economist: Drone deliveries are advancing in health care (6/15).

The Guardian: Uganda jails hundreds of men for sex offenses against women and girls (Okiror, 6/13).

Inter Press Service: Asia-Pacific Region Falters on U.N. Development Goals (Deen, 6/14).

The Lancet Respiratory Medicine: Finding the missing millions affected by tuberculosis is one thing; treating them is another (Cooper, 6/6).

U.N. News: Sexual abuse of elderly likely to ‘grow dramatically,’ U.N. expert says (6/13).

U.N. News: Recognize, celebrate and ‘stand in solidarity’ with persons with albinism (6/13).

VOA News: Zimbabwe Prisons Face Shortage of Drugs for HIV (6/13).

Wall Street Journal: Brazil’s Supreme Court Criminalizes Homophobic Acts (Lewis/Trevisani, 6/13).

Xinhua News: Cameroon begins distribution of 15 million mosquito nets to fight malaria (6/14).

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Editorials and Opinions

Lancet Editorial Discusses Potential Impact Of Mexico City Policy On Global Health

The Lancet: The devastating impact of Trump’s global gag rule
Editorial Board

“…The effects of the Trump global gag rule [also known as the Mexico City policy] on a broad range of sexual and reproductive health services is particularly concerning in light of recent global data from WHO on the persistently high prevalence and incidence of sexually transmitted infections. That the global gag rule might ultimately prove to increase the number of abortions by reducing access to modern contraception is not just an unfortunate irony. Rather, it reveals the way in which the policy has little to do with fostering health and everything to do with politics. … Two years on from its reinstatement, evidence shows that for care to be effective it must be holistic, comprehensive, and patient-centered. There can be no right to health without the right to access safe abortion” (6/15).

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Response To ECHO Study On Contraception, HIV Infection 'Must Be Centered On, Informed By Women, Girls'

The Lancet: How should we listen to ECHO?
Lisa Miyako Noguchi, associate in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health, and Princess Nothemba Simelela, assistant director general for Family, Women’s and Children’s Health at the WHO

“For many years before the long-awaited results of the study by the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium, observational and laboratory studies suggested that some hormonal contraceptive methods … might increase women’s susceptibility to HIV acquisition. … Notably, ECHO successfully answered some but not all questions about potential interactions between contraception and HIV infection. … In July, 2019, ECHO results will be reviewed in the context of the WHO medical eligibility criteria for contraceptive use … Regardless of the outcome of those deliberations, family planning should remain prioritized as one of public health’s most powerful tools against a range of adverse outcomes, including maternal mortality. … Ultimately, the response to ECHO results must be centered on and informed by women and girls in Africa, where the trial occurred and where substantial burden persists in unmet need for family planning and HIV prevention … Decision makers need to listen to the voices of women and girls — who continue to suffer and die not solely as a result of their unconscionable lack of access to high-quality contraceptive and HIV-related care but also to primary care, cancer prevention, mental health, safe abortion, violence prevention, and maternal health services. Therein lies the message we need to hear and amplify as we listen to results of ECHO” (6/13).

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Venezuelan Government Should Allow NGOs To Restore Access To Food, Medicines In Country

The Lancet: Venezuela: food and medicines used as weapons
Editorial Board

“…Those living without access to food and medicine display the reality of an unprecedented humanitarian emergency in [Venezuela]. On June 7, the U.N. stated that more than 4 million people have already left Venezuela, while a further 7 million need humanitarian assistance. [Venezuelan President Nicolás] Maduro’s strategy in the face of such a catastrophe includes the control of food production and distribution, and subsidizing food handouts as a political weapon. He also controls international humanitarian help, which he considers a threat to his personal authority. … The safest way to ensure that international assistance can reach Venezuelans is by using national non-governmental organizations (NGOs) as operators in the field, which, despite their small capacity, can be more transparent about how aid is being distributed and managed. The sovereignty of a country should be respected but can never be used to justify the use of humanitarian aid as a weapon. We call on the Venezuelan government to let NGOs restore access to food and medicines” (6/15).

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From the Global Health Policy Community

MFAN Offers Recommendations To Ensure USAID's Policy Framework Is 'Effective, Efficient, Accountable'

Modernizing Foreign Assistance Network: How does USAID’s recent Policy Framework perform on aid effectiveness?
Madeline Hartlieb, program associate at MFAN, discusses USAID’s recently released policy framework, which “pulls from goals outlined in the United States’ National Security Strategy (NSS) and the Department of State and USAID Joint Strategic Plan (JSP), and weaves these goals into U.S. development policy.” Hartlieb continues, “The policy framework will serve as the guiding light for U.S. development and humanitarian assistance, translating the agency’s policy and operational approaches and priorities into actions that impact the agency’s staff and communities on the ground. … While this policy framework improves on the previous two iterations, USAID should focus on the … recommendations [outlined by MFAN] to make sure U.S. foreign assistance is that much more effective, efficient, and accountable in the future” (6/12).

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Global Fund Supports Global Health Security As Shared Responsibility, Board Vice Chair Says

Global Fund to Fight AIDS, Tuberculosis and Malaria’s “VOICES”: Our Global Health Security is Only as Strong as our Weakest Link
Roslyn Morauta, vice chair of the Board of the Global Fund, discusses the importance of addressing regional and global health challenges to ensure global health security, using Papua New Guinea as an example. Morauta writes, “With Papua New Guinea only four kilometers from Australia at its nearest point, failure to address TB or an outbreak of any infectious disease is a threat to the health and economic security of my native Australia. TB is airborne and highly contagious, so a raging TB epidemic could easily destabilize the Asia Pacific region. One weak link can affect everyone. … The Global Fund model increases accountability and shared responsibility and helps countries on their road to self-reliance by fostering domestic investments in health. … Our global health security is only as strong as our weakest link.” This article first appeared in The Mandarin (6/12).

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Council On Foreign Relations Provides Overview Of DRC Ebola Outbreak

Council on Foreign Relations: The Escalating Ebola Crisis in the DRC
Claire Felter, copy editor/writer at CFR, discusses the escalating Ebola crisis in the Democratic Republic of the Congo (DRC), which has recently spread to Uganda, and provides an overview of the current situation, response, challenges, and needs (6/13).

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From the U.S. Government

CDC Activates Emergency Operations Center To Provide Increased Support To Ebola Response Efforts In Eastern DRC

CDC: CDC Activates Emergency Operations Center for Ebola Outbreak in Eastern DRC
“[On Wednesday,] the U.S. Centers for Disease Control and Prevention (CDC) [announced the] activation of its Emergency Operations Center (EOC) on Thursday, June 13, 2019, to support the inter-agency response to the current Ebola outbreak in eastern Democratic Republic of the Congo (DRC). … As part of the administration’s whole-of-government effort, CDC subject matter experts are working with the USAID Disaster Assistance Response Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to support the Congolese and international response. The CDC’s EOC staff will further enhance this effort. CDC’s activation of the EOC at Level 3, the lowest level of activation, allows the agency to provide increased operational support for the response to meet the outbreak’s evolving challenges…” (6/12).

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