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Kaiser Daily Global Health Policy Report

In The News

Millionth Baby Born HIV-Free Celebrated On PEPFAR's 10th Anniversary

This month in sub-Saharan Africa, the one-millionth infant will be born without HIV to a mother living with the virus, “thanks in large part” to PEPFAR, which is marking its 10th anniversary, Agence France-Presse reports. In an interview with AFP, Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, noted the largest drop in mother-to-child HIV transmission has happened since 2009, according to the news agency. PEPFAR, in partnership with UNAIDS and UNICEF, aims to “‘virtually eliminate pediatric HIV by 2015 and keep their mothers alive,’ he said, with aim of reducing the number of babies born with the infection to around 30,000 annually,” AFP writes. “Absent a medical breakthrough leading to a cure, experts are working towards a so-called ‘tipping point’ when fewer people contract HIV every year than the number of people going onto treatments,” the news agency continues (6/18). U.S. Secretary of State John Kerry on Tuesday at a ceremony recognized PEPFAR’s 10th anniversary, according to a State Department media note (6/18).

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Devex Examines Issue Of Security For Polio Workers In Pakistan After 2 More Volunteers Shot Dead

“[S]ome leading figures in Pakistan’s anti-polio drive believe more could have been done by the government to prevent” the murders of two polio vaccine workers killed on Sunday in Swabi district, “the latest in a spate of violence that has a total of 16 aid workers slain so far this year,” Devex writes. “‘We have always been demanding that polio vaccine campaigns should get full security coverage from the government, and it is not enough that they offer a few police officers,’ Aziz Memon, chair of the Pakistan PolioPlus Committee for the Global Polio Eradication Initiative [GPEI], told Devex on Monday,” the news service writes. “Asked if the Pakistani government should do more to boost aid worker security in the South Asian country, [Memon] explained that it is the duty of the government, and not of donors, to protect vaccine workers at risk,” Devex writes. “Donors pledged in April $3.75 billion to eradicate polio globally by 2015, with a special focus on Pakistan,” the news service notes, continuing, “Support With Working Solution CEO Javed Akhter, who saw seven of his 56 aid workers shot dead in January, told Devex on Monday that security support is not available for those working in rural areas like the Swabi district.” The news service adds, “Meanwhile, Memon said that GPEI’s ‘mission to eradicate polio will continue and will not be bogged down by these killings'” (Morden, 6/17).

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Saudi Arabia Reports 4 More Deaths, 3 More Illnesses From MERS

“Four more people have died and three more have fallen ill in Saudi Arabia from the new SARS-like coronavirus MERS-CoV, the Saudi Health Ministry said on Monday,” Reuters reports, noting, “The ministry said the four deaths were among previously registered cases.” As the most affected country, Saudi Arabia has recorded “49 confirmed cases, of whom 32 have died, according to data from the ministry,” the news service writes (Habboush/Kelland, 6/17). According to a WHO update, “Globally, from September 2012 to date, WHO has been informed of a total of 64 laboratory-confirmed cases of infection with MERS-CoV, including 38 deaths” (6/17).

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Guardian Roundtable Discussion Examines Issues Surrounding Global Nutrition

As part of The Guardian’s “In Focus: Nutrition Matters” series, the newspaper published a sponsored feature summarizing a recent roundtable discussion “held by The Guardian, in association with global science company DSM.” According to the newspaper, “The roundtable involved participants from the private and [non-governmental organization (NGO)] sectors, as well as from academia” and “generated passionate discussion about what all the participants considered to be a really important issue; however, they held different opinions as to how this should best be tackled.” The Guardian summarizes the panelists’ points on the issues surrounding improving global nutrition as well as some challenges and proposals for solutions (George, 6/17).

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Mobile Phone-Based Program Designed To Improve Safer Sex Practices Has Opposite Effect In Uganda, Study Shows

“A mobile phone-based health program designed to improve access to sexual health information and boost safe sex in rural central Uganda had the opposite effect, according to the findings of a … study published in May,” IRIN reports, noting the study was “a partnership between Yale University, NGO Innovations for Poverty Action, Google, the Grameen Foundation and the Uganda National Council of Science and Technology.” The service, “provided free of charge by mobile phone firm MTN, allowed users in 60 central Ugandan villages to text questions on sexual and reproductive health to a server and receive pre-prepared responses from a database,” the news service notes (6/17). “Similar projects in wealthier countries have used text messages to help people quit smoking and manage their asthma and diabetes. The researchers hypothesized that with better information, Ugandans too could take charge of their health and avoid risky sexual behavior,” the Yale Alumni Magazine writes (Bass, 6/7).

However, the researchers write, “We find no increase in health knowledge regarding HIV transmission or contraception methods and no change in attitudes. Rather than seeing reductions in risky sexual behavior, we actually find higher incidence of risky sexual behavior and more infidelity, although more abstinence as well,” according to IRIN (6/17). Bloomberg examines the study’s results, as well as other mobile health technology programs, writing, “Results from various programs show phone technology is better suited for some initiatives than others,” such as maternal health (Kitamura, 6/5).

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Financial Times Examines Novartis's Health Express Project In China

“As global pharmaceutical companies increasingly look to China and other emerging markets to make up for lackluster sales in the developed world, they are working to build an image as corporate good guys,” the Financial Times writes. The newspaper examines “Novartis’s Health Express project in Xinjiang — which has extended basic health education to 50,000 schoolchildren and trained 260 infectious disease physicians” as “part of [an] attempt to use corporate social responsibility to build a brand in a region that has gone from zero to almost universal health insurance coverage in recent years.” According to the newspaper, “Joe Jimenez, Novartis’s chief executive, says simply donating medicines to those in need is no longer enough. He wants a form of corporate social responsibility that is ‘sustainable’ — sustainable enough to survive his tenure in the top job.” The newspaper continues, “To that end, the Health Express project includes a field sales force selling basic drugs in rural areas on a zero-profit basis: that is, profits get ploughed back into hiring more sales staff, so that foreign medicines can be made available in areas where they otherwise would not be.”

“‘We are leveraging [the project] for sales, and we are proud of that,’ said Mr. Jimenez on a recent trip to Urumqi, the capital of Xinjiang,” the Financial Times writes. “Novartis does not break out figures for its sales in China, although Mr. Jimenez said sales grew 20 percent last year, and China was in Novartis’s top 10 markets,” the newspaper notes, adding, “The company will also not disclose its investment in the Health Express project, which is a public-private partnership with the Xinjiang government (Esquel, a Hong Kong textile group, is also involved).” The newspaper continues, “Jimenez makes clear that Novartis’s financial commitment is not large: it is more about transferring knowledge than transferring cash, for example training infectious disease physicians how to diagnose hepatitis B, a significant problem in China” (Waldmeir/Yan, 6/17).

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Editorials and Opinions

PEPFAR's Commitment To Orphans, Vulnerable Children Must Continue

“Despite the daunting numbers of children affected by AIDS, global resources for such programs are declining,” Rachel Yates, a senior adviser for UNICEF’s Children Affected by AIDS, writes in the Huffington Post’s “Impact” blog. “Thankfully, the recent PEPFAR Blueprint and PEPFAR Guidance on Orphans and Vulnerable Children [OVC] which is closely aligned with the broader USG Children in Adversity Strategy shows continued commitment to tackle the most pressing needs of children affected by AIDS,” she continues, adding, “It is imperative that [PEPFAR’s] commitment to OVC remains to address the unfinished agenda of children affected by HIV.” She continues, “The considerable funding provided for the protection, care and support of children affected by HIV, along with the policy shifts we have seen from PEPFAR over the last few years should be loudly applauded.” Yates concludes, “I very much hope that both the U.S. public, whose tax dollars have funded these efforts, and budget holders within the U.S. government, also recognize this impressive contribution in the challenging, fiscally constrained, years ahead” (6/16).

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Debate About Food Aid Reform Missing Long-Term Focus

“There’s been a lot of debate recently in the U.S. about food aid reform, especially since [the Obama administration] proposed a shift toward more cash programs and increased local and regional purchase of food aid,” Paul Guenette, senior vice president at ACDI/VOCA, writes in The Guardian’s “Global Development Professionals Network” blog. “But what’s lost in the lively discussion on the hows and whys of food aid is a sense of long-term focus,” he states, adding, “While emergency intervention is all too often necessary, focusing on building capacity at the farm level offers long-term sustainability in addressing the root causes of food insecurity.” He continues, “[B]uilding the capacity of smallholders and strengthening markets to sustain them is pivotal and sustainable, and can render food aid unnecessary in many, if not most, cases.”

Guenette discusses a drought in the Horn of Africa in 2011, noting “the drought didn’t create famine in Ethiopia that year, nor in Kenya.” He examines what it took to build such resilience in these two countries and writes, “Necessary food aid and deliberate long-term agricultural development aren’t an either-or proposition.” He concludes, “We’ll always have another food crisis, and responding effectively will save lives. But the much more serious job, the most important and too often out-of-the-headlines job, is building the ability of those small African farmers to produce nutritious food in a sustained manner — so that when the next drought hits, and we know it will, they don’t become the next food aid emergency” (6/17).

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TPP Trade Agreement Could Damage Global Health

Writing in an Al Jazeera opinion piece, Margaret Flowers, a board member of Healthcare-Now, co-director of It’s Our Economy and co-host of Clearing the FOG Radio Show, says that the Trans-Pacific Partnership (TPP) trade agreement, currently being “secretly negotiated” among the U.S. and Pacific Rim nations “is a major power grab by large corporations.” She continues, “From the information available, one thing is clear about the impacts of the TPP on health care: the intention of the TPP is to enhance and protect the profits of medical and pharmaceutical corporations without considering the harmful effects their policies will have on human health.” Flowers outlines in detail how several provisions in the TPP might do this, including through increased patent protections, and she concludes, “The TPP takes global health in the wrong direction. The losers in this negotiation will be the patients if the profits of corporations are permitted to come before the health of people” (6/17).

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Nutrition Summit Pledges Are Improvement, But More Must Be Committed To Improve Food Security

Noting “an additional $4.15 billion was pledged directly in support of nutrition through 2020” at the recent Nutrition for Growth summit in London, Benoît Miribel, president of Action Contra La Faim-France (ACF), writes in the Huffington Post’s “Impact” blog, “So while the new pledge of $4.15 billion over the next seven years is a significant improvement, it represents less than half of [the $9.6 billion The Lancet estimates] is required annually to provide essential nutritional support for 90 percent of the populations affected by undernutrition.” In addition, “ACF has three major concerns with the New Alliance for Food Security and Nutrition,” Miribel states and outlines the three issues, including nutrition, land rights, and transparency and accountability. He concludes, “Finally, because private investments alone will never succeed in eradicating hunger, ACF calls on the G8 leaders and other donor governments to renew their commitments to public investments in agriculture that delivers food and nutritional security in ways that are accountable to their citizens” (6/17).

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Place Women At Center Of Global Development Agenda

“It’s time for women to move from the sidelines to the center” of the global development agenda, and “we must build on the achievements of the [Millennium Development Goals (MDGs)] while avoiding their shortcomings,” Lakshmi Puri, U.N. assistant-secretary general and acting head of U.N. Women, writes in the Huffington Post’s “Global Motherhood” blog. “To make greater progress, U.N. Women proposes a stand-alone goal to achieve gender equality, women’s rights and women’s empowerment that is grounded in human rights and tackles unequal power relations,” she writes, adding, “We envision three areas that require urgent action.” She continues, “First, ending violence against women and girls must be a priority”; “Second, women and men need equal opportunities, resources and responsibilities to realize equality”; “And third, women’s voices must be heard … in the household, the private sector and institutions of governance.” In addition, “[a]ny new development agenda must be grounded in human rights agreements that governments have already signed onto,” Puri states, adding, “The discussions to shape the post-2015 global development agenda offer a real opportunity to drive lasting change for women’s rights and equality” (6/17).

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New Alliance Offers 'Tremendous Opportunity' For Malawi To Generate Investment In Agriculture

“At the Nutrition for Growth Summit, held in London this month, Malawi became a member of the G8’s New Alliance for Food Security and Nutrition,” the country’s president, Joyce Banda, writes in The Guardian’s “Poverty Matters Blog,” adding, “This is a tremendous opportunity to accelerate my government’s efforts to generate greater investment in agricultural development.” She states, “The focus of my first year [in office] has been very much on repairing the damage of the past — restoring the economy, as well as democracy and good governance.” According to Banda, the New Alliance “is important as my government doesn’t just view agriculture as an essential means to attaining household and national food security; we see it as a business through which our farmers can generate wealth, improve their livelihoods and transform Malawi’s economy.” She notes, “Under our New Alliance co-operation framework, more than 20 companies — most of them domestic — announced their intention to invest more than $100 million (£63 million) in the agricultural sector. These investments will occur across the supply chain, including seed production, crop diversification and expansion of agro-processing facilities.” She continues, “I have a clear vision for my country — one that sees us move beyond poverty to a future rich with hope and opportunities, where Malawians enjoy freedom and dignity, and where they are able to maximize their potential, socially, economically and politically” (6/18).

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From the Global Health Policy Community

Blog Examines 'Advanced Market Commitment' Funding Mechanism

Writing in the Center for Global Development’s (CGD) “Global Health Policy” blog, Amanda Glassman, director of global health policy and a senior fellow at the CGD, and Kate McQueston, a program coordinator to the global health policy team, examine the Advanced Market Commitment (AMC), an “innovative financing mechanism [that] aims to increase investment in vaccines for use in lower-middle income countries (LMIC) by guaranteeing a market for appropriate health products and services, reducing unpredictability or volatility that can discourage private investment, and increasing competition and innovation between companies and organizations.” They provide a timeline of the history of the initiative from conception of the program to its launch and the delivery of its first vaccines in 2010, and highlight the “pilot AMC — launched in 2009 — [which] incentivized the development of pneumococcal vaccines (PNV).” They discuss a recent evaluation of the initiative from Dalberg, contracted by the GAVI Alliance, noting, “In particular, the report explores the processes for determining prices for vaccines funded by the AMC, which is one of the most difficult steps in the design process,” and they conclude, “Getting the price right on AMCs is a delicate balance, but the lessons learned from the PNV AMC will be instrumental in informing the design of future efforts” (6/14).

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NGOs Face Challenges When Moving From Implementation To Advocacy

Writing in the Center for Strategic & International Studies’ (CSIS) “Smart Global Health” blog, David Olson, a global development communications consultant, provides examples of how several “smaller implementation-focused” non-governmental organizations (NGOs) are using advocacy to achieve their goals. “NGOs, especially when they work together, can influence government policy when clear and positive health impact can be demonstrated. However, there are limits to what NGOs can do,” he writes. “Leo Bryant, senior policy manager at MSI, said that advocacy initiatives are unlikely to succeed when they are calling for things far removed from governments’ policy frameworks,” but Bryant added long-term initiatives can succeed, Olson states. Margot Fahnestock, a program officer with the Hewlett Foundation, said if NGOs work in partnerships with governments, it “can put them in direct conflict with also playing a watchdog or activist role with the same government, and can render these groups less effective as advocates,” according to Olson (6/17).

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Public Health Experts, Policymakers Convene To Discuss Global Burden Of Disease Study

“More than 500 public health experts, policymakers and academics from 50 different countries have gathered in Seattle this week to dig deeper into what one of the leaders in the field characterized as having done for global health what the Human Genome Project has done for biomedical science and medicine” — the new Global Burden of Disease Study, “a massive worldwide assessment of what’s killing, injuring and disabling people around the planet,” development blogger Tom Paulson reports in the Humanosphere blog. “It’s the global health community equivalent of sequencing all human DNA, [Julio Frenk, dean of the Harvard School of Public Health, said on the opening day of the conference], and a sign that this field has entered its ‘Big Data’ stage,” Paulson writes. “But data alone is not enough, Frenk said, adding that what’s needed is to use this data to create a truly global and ‘pluralistic’ community aimed at improving health,” he states (6/17).

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