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Kaiser Daily Global Health Policy Report

In The News

Advocacy Groups Urge Obama To Prioritize Development During Trip To Africa This Week

“Starting Wednesday, [President] Obama will visit Senegal, South Africa and Tanzania on what will be his second trip to the [African] continent as president,” Inter Press Service reports, noting “[h]is advisers say he hopes to focus on increasing trade, investments and other economic opportunities.” However, “[a]dvocacy groups [in Washington] are urging [Obama] to focus on more than just economic development,” the news service writes, adding, “They are also hoping that the state visits will be able to turn the tide on years of U.S. engagement with Africa only through the lens of security and counter-terrorism.” IPS continues, “According to aides, Obama will also put significant emphasis on supporting growing democracies in each of the three countries, as well as on the African youth population,” noting, “In addition to bilateral meetings with political leaders in the three countries, Obama will participate in events with private sector leaders. Development issues will play a role, particularly regarding food security” (Hargis, 6/24).

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U.N. Security Council Adopts Resolution Demanding Cessation Of Sexual Violence In Conflict

“The U.N. Security Council [on Monday] unanimously adopted a resolution strengthening ways to fight the use of sexual violence as a weapon of war,” VOA News reports (Besheer, 6/24). “[T]he council adopted a legally binding resolution demanding the complete and immediate cessation of all acts of sexual violence by all parties to armed conflict,” the Associated Press/Huffington Post reports, adding the resolution also “noted that sexual violence can constitute a crime against humanity and a contributing act to genocide, called for improved monitoring of sexual violence in conflict, and urged the U.N. and donors to assist survivors.” According to the AP, “It was the broadest resolution adopted by the council on the sexual violence in conflict” (Lederer, 6/24).

U.N. Secretary-General Ban Ki-moon “said the Security Council resolution sent a strong signal to perpetrators that their acts will no longer be tolerated and they will be held accountable,” Reuters reports (Nichols, 6/24). Actor Angelina Jolie, a goodwill ambassador for the U.N. high commissioner for refugees, “criticized U.N. Security Council powers for their lack of action over wartime rapes, invoking Syria and other conflicts in a surprise speech to the body,” Agence France-Presse notes. “I understand that there are many difficult things for the Security Council to agree on, but sexual violence in conflict should not be one of them,” she said, adding, “If the U.N. Security Council sets rape and sexual violence in conflict as a priority, it will become one and progress will be made. If you do not this horror will continue,” according to AFP. Britain’s Foreign Secretary William Hague, who chaired the Security Council meeting, “said he would organize a new meeting on the topic at the U.N. General Assembly in September,” the news agency notes (6/25).

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Health Groups Urge U.S. Trade Representative To Ensure TPP Upholds Tobacco Control Efforts

“Health advocates are urging President Obama’s new trade representative to make sure a pending trade deal with Pacific rim nations can’t be used to gut U.S. tobacco control efforts,” The Hill’s “Global Affairs” blog reports. In a letter to U.S. Trade Representative Michael Froman, the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association and the American Academy of Pediatrics urged the Office of the U.S. Trade Representative to include language in the Trans-Pacific Partnership (TPP) trade agreement “that ensures no provision can be used as a legal basis to prevent participating nations from enacting ‘the strongest possible, nondiscriminatory tobacco control measures that it considers appropriate for the protection of public health,'” according to the blog. “From a public health perspective, international trade and investment rules should not result in increased tobacco consumption,” the letter said, adding, “They should also not inhibit any nation from exercising its sovereign authority to protect the health of its citizens by enacting legitimate public health measures aimed at reducing tobacco use,” according to the blog (Pecquet, 6/25).

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Gates Foundation, Rotary International Renew Partnership To Eradicate Polio

“Rotary International and the Bill & Melinda Gates Foundation have renewed a fundraising partnership they hope will inject millions of new dollars into the final push to eradicate polio, a goal both say is closer than ever,” the Wall Street Journal reports. “Under the agreement, the Gates Foundation said it will match two to one every new dollar that Rotary commits to polio eradication up to $35 million a year over five years,” the newspaper writes, noting, “That could total $525 million, including $175 million from the Rotary Foundation and $350 million from the Gates Foundation for polio immunization programs, the organizations said” (McKay, 6/25). “The joint effort, called End Polio Now — Make History Today, comes during a critical phase for the Global Polio Eradication Initiative [GPEI],” according to an article from Rotary International. “The estimated cost of the [GPEI’s] 2013-18 Polio Eradication and Endgame Strategic Plan is $5.5 billion,” and current funding commitments, “announced at the Global Vaccine Summit in April, total $4 billion,” the article writes, noting, “Unless the $1.5 billion funding gap is met, immunization levels in polio-affected countries will decrease.”

“We will combine the strength of Rotary’s network with our resources, and together with the other partners in the Global Polio Eradication Initiative (GPEI), we will not just end a disease but change the face of public health forever,” Jeff Raikes, chief executive officer of the Bill & Melinda Gates Foundation, said in a recorded message shown at the Rotary International Convention in Lisbon, Portugal, on Tuesday, according to the Rotary article (Nixon/Grahl, 6/25). “Only 69 cases of polio were reported globally so far this year as of June 19, and an independent board monitoring the global eradication effort recently said halting transmission of the disease by the end of 2014 is ‘a realistic prospect,'” the Wall Street Journal writes, adding, “The number of cases has declined substantially from 1,352 reported in 2010, and the virus is endemic in pockets of only three countries: Pakistan, Afghanistan and Nigeria” (6/25).

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Seven Sub-Saharan Countries Have Cut New HIV Infections In Children By 50% Since 2009, Report Says

“Seven countries in sub-Saharan Africa, the world’s worst-hit region in the global AIDS epidemic, have cut the number of new HIV infections in children by 50 percent since 2009, the [UNAIDS] program said on Tuesday,” Reuters reports (Kelland, 6/25). “This is according to the latest progress report [.pdf] on the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan), which was launched in July 2011 at the U.N. General Assembly High-Level Meeting on AIDS,” the U.N. News Centre states (6/25). “The goal of the program is to reduce mother-to-child transmissions by 90 percent and to reduce the number of AIDS-related maternal deaths by 50 percent by 2015,” CNN notes (Christensen, 6/25). “The seven countries seeing decreases include Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa, and Zambia — with two others, United Republic of Tanzania and Zimbabwe, making substantial progress since 2009,” Medical Daily writes (Weller, 6/25). “Ghana showed the greatest decline in new infections since 2009 at 76 percent, followed by South Africa at 63 percent,” according to UPI.com (Butler, 6/25). “In total, across 21 countries where the protection of children from HIV has been prioritized under UNAIDS’ global plan, 130,000 fewer children have tested positive, which is a reduction of 38 percent since 2009,” The Guardian adds (Boseley, 6/25).

“The progress in the majority of countries is a strong signal that with focused efforts every child can be born free from HIV,” UNAIDS Executive Director Michel Sidibé said, adding, “But progress has stalled in some countries with high numbers of new HIV infections. We need to find out why and remove the bottlenecks which are preventing scale-up,” Reuters writes (6/25). The Global Plan initiative was spearheaded by UNAIDS and PEPFAR, the U.N. News Centre notes. Ambassador Eric Goosby, U.S. global AIDS coordinator and head of the State Department’s Office of Global Health Diplomacy, said, “We have the tools required to reach the Global Plan’s goals, and recent data show that we are moving ever closer to their realization. … This month, as U.S. Secretary of State John Kerry announced, the one millionth baby will be born HIV-free due to PEPFAR’s support. Now, we must all continue working together to see the day when no children are born with HIV, which is within our reach,” according to the news service (6/25).

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GlobalPost Examines Efforts To Reduce Child Mortality In Bangladesh

In an article published as part of a GlobalPost special report titled “The Seven Million,” the news service examines child health in Bangladesh, writing, “Counter to the common perception of Bangladesh as hopelessly impoverished, the country has made dramatic strides in reducing overall child mortality in recent decades.” The news service continues, “Bangladesh’s child and maternal health statistics are better than those in India, where the economy and resources far exceed those of its poorer neighbor to the East.” GlobalPost writes, “There is no single, simple answer to how Bangladesh has managed to come so far. Rather, a multifaceted set of factors has improved child health, and the country is trying to close in on the remaining weaknesses.” The article discusses these factors, including improved macroeconomic conditions, which “have contributed to more education and better health”; the strong presence of non-governmental organizations (NGOs); and the spread of information about hygienic deliveries and newborn care by birthing centers and female health workers. However, “[c]hallenges to reduce child deaths increase in hard-to-reach parts of Bangladesh, especially in the east, which lags behind in a range of health indicators, from birth control to immunization,” according to Shams El Arifeen, director of the center for child and adolescent health at the International Centre for Diarrhoeal Disease Research (icddr,b), the news service notes.

For the ongoing special report, GlobalPost “correspondents in Africa and Asia will examine the progress and challenges that developing countries face as they fight to reduce deaths of the nearly seven million children under age five who die every year, largely due to preventable causes,” according to the article (Yee, 6/25).

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Editorials and Opinions

Opinion Pieces Address Supreme Court 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 recusing herself. The following editorials and opinion pieces address the ruling.

  • Aziza Ahmed, Huffington Post’s “Politics” blog: “The Court’s ruling in favor of free speech is a victory for sex worker organizations, public health institutions and activists, and feminist allies against those that promoted the pledge, including (unfortunately) other feminist organizations,” Ahmed, assistant professor at Northeastern University School of Law, writes. These groups “cannot effectively implement harm-reduction programs where the laws criminalize the very populations that are being served,” and furthermore, “criminalization of both sex work and their clients drives the sex industry underground and enables harassment of sex workers,” she states. “The struggle to end the spread of HIV will continue. This decision moves us in the right direction by bringing U.S. regulations in line with its purported goals, supporting the many organizations working with sex workers, and continuing the ongoing struggle to shift laws and regulations to better address the needs of the most vulnerable,” she continues (6/24).
  • Celeste Watkins-Hayes, The Atlantic: Watkins-Hayes, chair of the African-American studies department at Northwestern University, discusses her experience as principal investigator of the Health, Hardship, and Renewal Study, and the importance of groups that provide non-judgmental services. “I am not suggesting that we ignore the serious ethical, legal, and social concerns that sex work raises. There absolutely is a place for discussions about eradicating sexual exploitation wherever it rears its head,” she writes, adding, “But to attack the problem by requiring HIV/AIDS organizations to explicitly and actively oppose prostitution as a condition of funding, rather than allowing them to take a neutral stance that allows them to focus first and foremost on risk reduction, is counterproductive in the fight against HIV/AIDS and other sexually transmitted diseases.” She concludes, “The effectiveness of the programs, and the utility of our public funding, would be compromised. The Supreme Court took an important step in protecting these crucial goals” (6/25).

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Despite Challenges, Malaria Eradication Is Practical Policy Option

In a post in The Lancet Global Health, Jenny Liu of the University of California, San Francisco’s Global Health Group and colleagues examine malaria eradication efforts, highlighting progress made against the disease and writing, “This progress is encouraging, but is worldwide eradication of human malaria possible? If so, is it a worthwhile goal and should we commit to it?” They write that eradication is “probably” possible, “however, substantial challenges exist.” They highlight six major challenges: “[T]he burden of malaria is still great and it is widespread”; “drug and insecticide resistance are on the rise”; “increased mobility of people not only makes containment of resistance difficult, but also threatens the introduction or reintroduction of malaria parasites to receptive areas”; “Plasmodium vivax, the second major human malarial parasite species, “is harder to diagnose and failure to successfully treat its dormant liver stage results in relapses that can fuel onward transmission”; “extreme events, such as wars or natural disasters, greatly disrupt malaria control and elimination activities, and can lead to substantial resurgence”; and “as malaria becomes rare, persuasion of governments to allocate finances to maintain effective elimination or post-elimination programs is increasingly difficult.”

“These six factors present notable challenges on the road to eradication,” Liu and colleagues note, adding, “However, all have potential solutions resulting from substantial international collaborative efforts that range from basic research to improvements in policy and financing arrangements.” They write, “Is eradication worth it? Probably yes, but the answer is dependent on the temporal and spatial perspective,” and continue, “Should we eradicate malaria? Yes, because the alternative policies are untenable.” They state, “Imagine a world in which the goal was merely to control malaria — i.e., reduce it to a level at which it is no longer a major public health problem,” and write, “Such a situation will be expensive, unstable, and is an unappealing policy option for the 21st century.” They add, “The practical policy option, and the one that will be less costly in the long term, is to pursue a global policy of progressive elimination, aggressive control in the high-burden areas, and eventual eradication.” The authors conclude, “With adequate and sustained commitment, the task can be achieved” (July 2013).

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To Continue Legacy Of Rio+20 Conference, International Community Must Rally Around Post-2015 Development Agenda

“The [Millennium Development Goals (MDGs)] have been a powerful galvanizing force for efforts — from the global to the local level — to reduce poverty, provide basic health and education, and promote gender equality,” U.N. Under-Secretary-General for Economic and Social Affairs Wu Hongbo writes in the Huffington Post’s “World” blog. “Yet there is enormous potential to do more in the remaining time before we reach the deadline of 2015. And even if we were to reach all the MDGs, we know there is still far more to do in order to eradicate extreme poverty and address climate change and other growing environmental threats,” he continues. At the Rio+20 conference last year, “governments recognized that future goals in the post-2015 era must be equal to the complex challenges facing the world today, and in coming decades,” he states, adding, “Without action now, climate change and other environmental threats have the real potential to set back social and economic progress for future generations.”

U.N. Member States “are now deliberating on the goals that can propel a new sustainable development agenda, and will present a proposal to the General Assembly in 2014,” Wu notes. “It is expected that sustainable development goals will be set that are transformative, universal and equitable, with sustainable development at their core,” he writes, adding, “The new goals will guide all economies — developed and developing alike — on more sustainable development paths. That is why Rio+20 agreed that the goals should be universal and applicable to all countries.” He continues, “This is a collective undertaking that requires all countries to cooperate to secure our common future. It also requires the engagement of all actors, particularly business and industry and other major groups of society, in developing and deploying many of the technologies that will be needed.” Wu adds, “If the positive legacy of Rio+20 is to be realized, the international community will need to rally around an ambitious set of sustainable development goals in 2015, and agree concretely on how we will work together to achieve them” (6/25).

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From the Global Health Policy Community

Blogs Address President Obama's Travel To Africa This Week

President Obama this week will travel to South Africa, Senegal and Tanzania, his second trip to sub-Saharan Africa since taking office. The following is a summary of blog posts addressing the visit.

  • Center for Strategic & International Studies’ (CSIS) “Smart Global Health” blog: The blog provides video of a CSIS-hosted press briefing to discuss President Obama’s upcoming trip from June 26 to July 3. According to the blog, the briefing was attended by Jennifer Cooke, director of the CSIS Africa Program; Richard Downie, deputy director and fellow for the CSIS Africa Program; and J. Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center (6/25).
  • Tom Hart, ONE blog: “President Obama can highlight the incredible progress that so many countries on the continent are making — including massive gains in health and agriculture — and demonstrate how the less than one percent of our budget that goes toward aid to Africa can make a huge difference to those in need,” Hart, the U.S. executive director of ONE, writes, adding, “He also can highlight the need to look at our partnership with the continent in a new way — through trade, investment and the incredible entrepreneurial spirit of Africa’s youth” (6/25).
  • Lawrence MacDonald, Center for Global Development’s (CGD) Global Prosperity Wonkcast: “To get a sense of what this trip means for Obama’s African legacy and the expectations of his hosts,” MacDonald, vice president of communications and policy outreach for CGD, talks with CGD vice president for programs and senior fellow Todd Moss and visiting fellow Scott Morris. “So far, Todd notes, Obama’s record on Africa is overshadowed by that of his predecessor, who launched both the Millennium Challenge Corporation (MCC), a new aid program that largely focuses on Africa, and [PEPFAR], a multibillion-dollar effort to respond to the pandemic ravaging much of the continent,” MacDonald notes, adding, “Scott argues in Obama’s defense that the 2007-08 global financial crisis that awaited Obama when he took office and subsequent slow economic growth and tight budgets have made it a tough time to launch initiatives that require new money” (6/25).
  • Tom Murphy, Humanosphere: Development blogger Murphy provides a short roundup of news and opinion pieces published about the upcoming visit, quoting journalist Geoffrey York for the Globe and Mail, Tolu Ogunlesi in The Guardian, the Center for Global Development’s Sarah Jane Staats, Staats’ colleague Todd Moss, and Deputy National Security Adviser Ben Rhodes (6/25).

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Congressional Briefing Highlights Midwives' Global Impact

“Four seasoned midwives — with a combined century of experience in building strong societies by promoting the health and safety of mothers and their babies — delivered a compelling case last week at a congressional briefing for the United States to lead a movement to strengthen midwifery at home and around the world,” Vince Blaser, deputy director of the Frontline Health Workers Coalition, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. “There is simply no reason that 48 million women should have to [give birth without the presence of a skilled birth attendant] — especially with the highly effective and cost-friendly intervention of trained and supported midwives ready and willing to deliver on the frontlines of health care, the panelists said,” Blaser notes, and discusses what Congress is doing “to harness this power of midwifery in developing countries and here at home” (6/25).

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State Department Cable Addresses Civil Society Engagement With PEPFAR

The Center for Global Health Policy’s “Science Speaks” blog summarizes an unclassified “State Department cable sent to embassies around the world earlier this month and released Monday” that discusses civil society engagement under PEPFAR (Barton, 6/25). “One of the major goals outlined in the document is to increase civil society involvement in HIV/AIDS planning and implementation, both for the U.S. government and its partner countries,” the cable’s summary states (6/13). “Science Speaks” includes comments on the cable from Chris Collins, vice president and director of public policy at amfAR, The Foundation for AIDS Research, and Matt Kavanagh of Health GAP (Global Access Project) (6/25).

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Lancet Infectious Diseases Highlights Issues To Be Discussed At IAS Conference

Noting that “[f]rom June 30 to July 3 many of the world’s leading HIV/AIDS researchers, practitioners, and allied professionals will converge on Kuala Lumpur, Malaysia, for the 7th International AIDS Society Conference on Pathogenesis, Treatment, and Prevention,” an editorial in the latest issue of The Lancet Infectious Diseases says the journal includes content that “has been specially selected to reflect some of the key issues in HIV/AIDS with articles on monitoring and treatment and reviews on the search for a cure and the biology and effects of HIV superinfection.” The editorial notes “[o]ne of the key themes of the conference is co-infection” and describes several of the articles (July 2013).

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