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Kaiser Daily Global Health Policy Report

In The News

U.S. Nearly Doubles Aid To UNHCR

At an event to mark World Refugee Day, “[t]he United States on Thursday [nearly] doubled its aid to the U.N. refugee organization to some $890 million,” Agence France-Presse reports. “Some $289.3 million of the funds going to the UNHCR are earmarked for Syrian refugees and had been previously unveiled by the U.S. administration,” the news service adds (Biddle, 6/21). “U.S. Secretary of State John Kerry made the announcement Thursday as [U.N. High Commissioner for Refugees Antonio Guterres] warned that one person every four seconds flees home somewhere in the world to escape violence and strife,” VOA News writes, noting, “Guterres spoke via satellite link from a refugee camp in Jordan that he visited with [actor Angelina Jolie], his special envoy” (Hoke, 6/21). “The sum makes the United States the largest single contributor to the UNHCR, Kerry added,” AFP writes (6/21). “A new report [.pdf] released by the UNHCR warns that there are now 45.2 million people who are refugees or internally displaced, an 18-year high,” according to Reuters/Solar News, which adds, “The report cited the crisis in Syria as the reason behind the increase” (6/21).

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Global Health Advocates React To Supreme Court Ruling Striking Down Anti-Prostitution Pledge

“Global health advocates said [the Supreme Court’s decision last week striking down a law requiring groups to take an anti-prostitution pledge as a condition for funding] lifts the stigma surrounding sex workers and their role in the world’s three-decade-long HIV epidemic, and will allow scientists to talk more openly about effective ways to combat the virus,” Agence France-Presse reports. “Population Action International president Suzanne Ehlers said that the … anti-prostitution pledge was a ‘harmful policy’ that had damaged anti-AIDS efforts around the world,” the news agency writes, adding that Ehlers said, “Evidence, not ideology, should drive policy governing public health programs.” Chris Collins, director of public policy at amfAR, The Foundation for AIDS Research, said, “I think [the ruling] will have practical impact. … Groups addressing the AIDS epidemic will feel more secure in being open about getting appropriate services to sex workers and that is an absolutely critical thing we need to do,” according to AFP (Sheridan, 6/24).

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Former President Bush Makes 3rd Trip To Africa Since Leaving Office As Part Of Program Combating Cervical Cancer

Former President George W. Bush, “who made fighting AIDS in Africa a top goal of his administration, will take a trip there — his third since leaving office — as part of a program to combat cervical cancer,” the New York Times’ “The Caucus” blog reports. “He will leave late [this] week for Zambia, where he will help refurbish a clinic, and then head to Tanzania, where his wife, Laura Bush, is organizing a forum for African first ladies,” the blog writes, noting, “Bush will overlap briefly on July 2 with [President] Obama in Tanzania, the last stop on the current president’s itinerary after Senegal and South Africa,” as he also travels across the continent this week. “Africa was a personal priority for Mr. Bush during his presidency, overshadowed by Iraq, terrorism and other issues but one of the few areas where he drew praise across party lines,” the blog continues, highlighting some of his efforts, such as the Millennium Challenge program, which “steered billions of dollars in development aid to countries that committed to reform,” and the establishment of PEPFAR, which “was called the largest humanitarian health effort ever undertaken by any country.” The blog notes, “Teaming up with PEPFAR, the United Nations, Susan G. Komen for the Cure and pharmaceutical companies, Mr. Bush [also] helped form Pink Ribbon Red Ribbon, which is devoted to curbing cervical cancer and breast cancer” (Baker, 6/22).

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WFP Head Says Funding Short For Food Emergencies In Pakistan, North Korea

“Hunger in Pakistan is at emergency levels after years of conflict and floods, but funding has dwindled as new crises such as Syria grab donors’ attention, the United Nations food aid chief said on Sunday,” Reuters reports. “[A]bout half of Pakistan’s population still does not have secure access to enough food, up from a little over a third a decade ago, the U.N. World Food Programme (WFP) said,” the news agency writes, adding, “Fifteen percent of children are severely malnourished, and some 40 percent suffer from stunted growth.” According to Reuters, “[t]here is growing concern that international donors will lose interest in the unstable border areas after the withdrawal next year of U.S.-led foreign forces from Afghanistan.” In addition, WFP Executive Director Ertharin Cousin “said the rising cost of the refugee crisis in Syria meant it was harder to attract funds to Pakistan,” as well as North Korea, which “is even worse hit by funding shortages,” the news agency notes (Daniel, 6/24).

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UNICEF Warns High Temperatures In Syria, Middle East Increase Children's Disease Risks

“The U.N. Children’s Fund (UNICEF) warns soaring summer temperatures in conflict-ridden Syria and neighboring countries of refuge are putting millions of children at risk of disease,” VOA News reports. “According to UNICEF, overcrowding and worsening hygiene are threatening the health and well-being of some four million children affected by the ongoing conflict in Syria,” the news agency adds (Schlein, 6/21). “There are some 6.8 million people in need of humanitarian assistance as a result of the fighting between the Syrian army and opposition forces seeking to oust President Bashar Al-Assad,” and “[t]he crisis, which began in March 2011, has claimed more than 93,000 lives and sent some 1.5 million people fleeing to neighboring countries for safety,” the U.N. News Centre notes. “UNICEF needs more than $200 million for its water, sanitation and hygiene programs in Syria, Lebanon, Jordan and Iraq until the end of the year,” according to the news service, but “[n]early half way through the year, it remains $124 million short of this target” (6/21).

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Saudi Arabia Reports More Cases Of MERS; Health Experts Ask Countries To Standardize Disease's Treatment

“Saudi Arabia said another person had died of the SARS-like coronavirus MERS and six new cases were registered, as international experts said on Saturday countries should standardize their approach to treating the disease,” Reuters reports. “The latest cases bring the total number infected worldwide to 70, with 39 having died since MERS was identified last year,” the news agency writes. Experts gathered at the WHO offices in Cairo “said in a statement after the meeting on Saturday that countries hosting mass gatherings where MERS was a risk should develop specific plans, without giving details,” according to Reuters, which notes “many Muslim pilgrims from around the world are expected to head for Mecca next month during the fast of Ramadan” (McDowall, 6/22). “What’s alarming about MERS is that it spreads within hospitals, even when patients are not in close proximity to one another, and its mortality rate is much higher — 65 percent,” The Atlantic reports, adding, “[I]n another confusing development, more than twice as many men as women have contracted MERS — making for interesting case study how cultural practices impact responses to disease.” The news service examines possible reasons for the gender disparity (Khazan, 6/21).

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H7N9 Flu Virus Less Deadly Than Originally Theorized, Researchers Say

“The H7N9 strain of bird flu that has killed 38 people in China since March is less deadly than had been supposed, according to the most detailed analysis of the outbreak so far,” conducted by researchers at the Chinese Center for Disease Control and Prevention and the University of Hong Kong and published in The Lancet on Sunday, Bloomberg reports. The study “found only one human case of the H7N9 bird flu strain has been identified since early May,” according to Reuters, which adds the “deadly strain of bird flu that emerged in China in February but seems to have petered out in recent months could reappear later this year when the warm season comes to an end — and could spread internationally, scientists said” (Kelland, 6/24). The researchers “found that H7N9 proved fatal in 36 percent of patients admitted to hospital in mainland China,” Agence France-Presse writes, adding, “This was a lower fatality rate than H5N1-type bird flu which emerged in 2003 and killed about 60 percent of hospitalized patients” (6/24). “Still, H7N9 is more lethal than the swine flu that caused a 2009 global epidemic,” which “had a death rate of less than one percent,” according to the Associated Press (6/23). “In contrast to H1N1 swine flu, which is now part of the seasonal flu vaccine, H7N9 and H5N1 flu viruses most commonly occur after exposure to infected poultry, and do not appear to spread easily from person-to-person,” CNN’s “The Chart” blog notes (6/23).

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Editorials and Opinions

Editorials, Opinion Pieces Address Supreme Court's Ruling Striking Down Anti-Prostitution Pledge

The U.S. Supreme Court on Thursday struck down as unconstitutional the federal government’s requirement that groups accepting U.S. aid declare their opposition to prostitution. Chief Justice John Roberts wrote the majority opinion (.pdf), with Justices Antonin Scalia and Clarence Thomas dissenting, and Justice Elena Kagan was recused. The following editorials and opinion pieces address the ruling.

  • Denver Post: The ruling “sets important limits on government power,” the editorial states, continuing, “Had the ruling in this case gone the other way, it’s conceivable all manner of requirements might be imposed on those seeking support in the future. We’re glad the court saw the importance of drawing this line in the sand.” The editorial adds, “In the opinion, supported by six justices, the court said the government may attach conditions to the way money is spent, but cannot require groups to ‘pledge allegiance’ to the federal government’s view that prostitution ought to be eradicated.” The Denver Post concludes, “These groups shouldn’t have to give up their constitutional rights in order to get support to help people who desperately need it” (6/23).
  • New York Times: “By requiring recipients to advocate the government’s position, without the option of staying silent, the court said this policy could hurt outreach programs by undermining trust with sex workers, who may avoid seeking help from groups with a declared anti-prostitution agenda,” the editorial writes, adding, “This ruling does not limit the government’s power to specify the kind of activities it wants to subsidize.” The editorial concludes, “Chief Justice Roberts, quoting from a 1943 opinion barring the government from requiring public schoolchildren to salute the flag, noted: ‘If there is any fixed star in our constitutional constellation, it is that no official, high or petty, can prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion.’ That principle guided the court to the right result in this case” (6/20).
  • Leo Beletsky, Huffington Post’s “Politics” blog: “Non-U.S. organizations are not covered by the First Amendment protections, so unless there is an executive decision or legislative reform to lift the pledge requirement in the international context, the anti-prostitution pledge still stands in that context,” Beletsky, assistant professor of law and health sciences at Northeastern University, writes. In addition, “the … litigation never challenged the closely related Leadership Act clause mandating that no funds ‘may be used to promote or advocate the legalization or practice of prostitution,'” he writes, adding, “Although likely constitutional, this clause may be as counterproductive in public health terms as the now defunct ‘pledge’ requirement.” He concludes, “Now is the time to galvanize the momentum from the Supreme Court ruling to force a re-examination of these outdated and misguided provisions in light of public health science rather than political expediency” (6/21).
  • Lenora Lapidus, Huffington Post’s “Politics” blog: The ACLU filed an amicus brief in which “we argued [the pledge] unconstitutionally imposed the government’s opinion on private organizations,” Lapidus, director of the ACLU Women’s Rights Project, writes. “The government argued that it could place conditions on funding without violating First Amendment rights because non-governmental organizations were free to reject federal funding and adopt any stance on prostitution that they wished, or work through an affiliate,” she notes, adding, “[T]he Supreme Court rejected the government’s arguments, recognizing a critical distinction between restricting the use of federal funds to define the scope of a program, which is constitutional, and using federal funds to coerce grant recipients into adopting a particular ideological viewpoint that is separate from its use of those funds, which is not.” She concludes, “Today, we celebrate the Court’s reaffirmation of the First Amendment and its rejection of Congress’s attempt to dictate the content of free speech” (6/21).

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Examining Debate Surrounding Jeffrey Sachs's Millennium Villages Project

In an analysis piece in Foreign Policy’s “Failed States” annual special report in conjunction with the Fund for Peace, journalist Paul Starobin examines the debate surrounding American economist Jeffrey Sachs’s Millennium Villages Project (MVP), “a series of model villages across Africa that would demonstrate the efficacy of targeted measures to address the corrosive lack of health care, education, and employment that keep so many people around the world in a pernicious ‘poverty trap.'” He notes, “Sachs dubbed his experimental communities ‘Millennium Villages’ in a nod to the Millennium Development Goals, the ambitious set of targets for the eradication of extreme poverty and hunger agreed on by world leaders to much fanfare at a United Nations summit in September 2000. His villages, Sachs argued, would show how those goals could be met.” Starobin writes, “These days, though, Sachs is increasingly on the defensive, assailed by a growing number of critics for what they say are fundamental methodological errors that have arguably rendered his [MVP] — now consisting of 14 village clusters scattered across Africa and covering half a million people — worthless as a showcase for what can lift the poorest of the poor out of their misery.”

Starobin discusses Sachs’s background and motivation for the project and writes, “As critics see it, Sachs botched his project by not putting in place a system by which progress (or lack thereof) at the Millennium Villages could be objectively measured, evaluated, and compared with trends in surrounding rural communities.” Starobin provides a detailed account of arguments both for and against the project, writing, “While Sachs can be faulted for flaunting his mighty self-regard, the criticism he is encountering on MPV also reflects an important evolution within the development community and its more insistent demands for tough, transparent assessments of aid programs.” He continues, “Meanwhile, state-of-the-art thinking in the development field is in flux. There is no consensus on what works best to get rid of extreme poverty” (July/August 2013).

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For India's Hungry To Benefit From Food Security Bill, Government Must Approach Issue With 'Genuine Seriousness'

Writing in The Guardian’s “Poverty Matters Blog,” economist Jayati Ghosh, the executive secretary of International Development Economics Associates (Ideas), examines the issue of food security in India, highlighting a national food bill currently up for debate in the country’s parliament. In its current form, the “final bill (.pdf) is a pale shadow — some would say a mockery — of the original intention,” she states, noting, “It does not provide universal access, but instead restricts the responsibility of the government to provide subsidized food grain to households on the basis of defined eligibility criteria, estimated to account for two-thirds of the population.” She continues, “The Congress party has been toying with the idea of an ordinance that would force the bill into law while parliament is in recess, but its allies have apparently been persuaded to call a special session of parliament to discuss this,” adding, “But if India’s hungry millions are really to benefit from such legislation, the government needs to approach this matter with genuine seriousness, not as a cynical ploy to gain electoral mileage” (6/24).

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From the Global Health Policy Community

Polio Eradication Activities Can Help Improve Routine Immunization Efforts

Naveen Thacker, president-elect of the Asia Pacific Pediatric Association (APPA), writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, “Beyond the value of face-to-face advocacy, the polio eradication effort [in India and elsewhere] opens the door for the delivery of all essential vaccines and health services in a number of other ways.” He continues, “For instance, the infrastructure and expertise that India established to keep polio vaccines cold as health workers transport them around the country have enabled the introduction of other vaccines that require a cold chain, including Hepatitis B and Japanese Encephalitis vaccines,” and “new mapping technology is helping health workers reach children with a wide variety of health services.” Thacker adds, “Seizing the unprecedented opportunity to complete polio eradication isn’t just about polio – it’s about building a system and cadre of health workers that will reach all children, including the most vulnerable, with the vaccines they deserve” (6/21).

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PLOS Announces New Venue For Research On Disease Outbreaks

In the PLOS “Speaking of Medicine” blog, Liz Flavall, publications manager for PLOS Currents, on Friday announced “a new venue for the rapid publication of research in all aspects of infectious disease outbreaks, PLOS Currents: Outbreaks.” She adds, “The emergence of a disease outbreak creates the need for up-to-date, reliable information that is readily available,” and “PLOS Currents: Outbreaks will aim for a swift peer review turnaround in order to provide a channel for the publication of breaking research when it is most needed” (6/21).

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