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Kaiser Daily Global Health Policy Report

In The News

WHO Approves PrePex Adult Circumcision Device; PEPFAR To Support Countries' Use Of It For HIV Prevention

The WHO on Friday approved PrePex, a medical device for adult circumcision, and “the only adult circumcision method, other than conventional surgery, to gain WHO acceptance,” the New York Times reports (McNeil, 5/31). “PrePex, a three-part device that includes size-adjusted rubber bands and a ring to compress blood flow to the foreskin, … does not require injected anesthetic, sutures, or a sterile environment, and takes a total of five minutes across two visits,” the Center for Global Health Policy’s “Science Speaks” blog reports (Barton, 5/31). In a statement on the device’s approval, the U.S. Office of the Global AIDS Coordinator (OGAC) said, “Medical devices like PrePex™ may change the landscape of voluntary medical male circumcision (VMMC) scale-up by potentially simplifying the procedure and improving men’s experiences.”

Noting “[t]he WHO recommends VMMC as part of a comprehensive package of HIV prevention services,” the statement continues, “[PEPFAR] supports the implementation of VMMC programs in 14 East and Southern African countries including Botswana, Lesotho, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe, and has supported more than two million voluntary surgical procedures as of September 30, 2012.” Ambassador Eric Goosby, U.S. global AIDS coordinator and head of the U.S. Department of State Office of Global Health Diplomacy, said, “The WHO prequalification of PrePex™ represents an unprecedented opportunity to further the safe and rapid scale up of voluntary medical male circumcision programs. PEPFAR is ready to support countries that wish to introduce PrePex™ right away. This announcement will truly help save lives,” according to the statement (5/31).

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U.N. Food Agencies Call For Hunger Elimination By 2025, Food Security And Nutrition To Top African Development Agenda

“Officials of United Nations food agencies on Saturday called for food security and nutrition to be placed at the center of the international agenda for African development, and hunger to be eliminated by 2025,” Xinhua reports (6/1). Director-General of the U.N. Food and Agriculture Organization (FAO) José Graziano da Silva, President of the International Fund for Agricultural Development (IFAD) Kanayo Nwanze, and Executive Director of the World Food Programme (WFP) Ertharin Cousin “were speaking at the Fifth Tokyo International Conference on African Development (TICAD V) in Yokohama,” according to an FAO press release. “Special attention should be given to supporting smallholder farmers to improve global food security and empowering rural women, addressing gender inequalities and enabling them to transform their own lives and the lives of their families and communities,” the press release states (6/1). “They pointed out that in sub-Saharan Africa, [gross domestic product (GDP)] growth generated by agriculture had been shown to be eleven times more effective in reducing poverty than GDP growth in other sectors,” Xinhua writes, adding, “They agreed that reduction of hunger, malnutrition and extreme poverty should remain at the core of the post-2015 agenda, following the deadline for the Millennium Development Goals” (6/1).

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MERS Virus Spreads To Italy, Kills 3 More In Saudi Arabia

“On Friday, Italy’s health ministry reported its first case of [Middle East Respiratory Syndrome coronavirus (MERS-CoV)] was contracted by a 45-year-old man who returned from a trip to Jordan where he visited his son, who had the ‘flu,'” GlobalPost reports (Mattson, 5/31). “The patient was in good condition and was being monitored in isolation, the ministry said in a statement,” Reuters writes, adding, “He was admitted to a hospital in Tuscany with a high fever, a cough and breathing difficulties” (O’Leary, 5/31). “The Italian Ministry of Health has notified the [WHO] of an additional two laboratory-confirmed cases with [MERS-CoV], the WHO said Sunday,” according to Xinhua (6/1). “All three patients were reported to be in good condition and were being treated in isolation,” the Associated Press notes (6/1).

In addition, “[t]hree more people have died in Saudi Arabia from the new SARS-like coronavirus, bringing the worldwide death toll to 30, the [WHO] said on Friday,” Reuters reports in a separate article. “Saudi health officials also told the WHO of a new case in the eastern province of al-Ahsa, increasing the number of cases worldwide to 50, WHO spokesman Glenn Thomas told reporters at a news conference in Geneva,” the news service adds (Kasolowsky, 5/31). “In all, eight countries that have been affected by the virus, including Tunisia, Jordan, Britain, and France,” VOA News notes, adding, “But speaking in Geneva on [May 27], the director-general of the WHO said MERS is a ‘threat to the entire world'” (Hennessy, 5/31). “The [WHO] is not advising restrictions or special screening for travelers, but it has issued recommendations for surveillance that describe what respiratory illnesses hospital personnel should regard as suspicious,” the Washington Post writes (Ehrenfreund, 5/31). The Globe and Mail examines intellectual property issues surrounding the virus (Cyran, 6/2).

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U.N. Completes 1st Phase Of Polio Vaccination Campaign In Kenya's Dadaab Refugee Camp

“The United Nations says it has completed the first phase of an aggressive vaccination campaign to contain a polio outbreak in Kenya’s largest refugee camp,” VOA News reports. “The U.N. High Commissioner for Refugees and the [WHO] issued a statement Friday, saying 288,000 children up to age 15 are being immunized,” the news service adds (6/1). “A four-year-old girl tested positive for polio in Kenya’s Dadaab refugee camp near the Somali border, on May 17,” Thomson Reuters Foundation writes, noting, “Four other cases have been confirmed since” (Migiro, 5/31). “The polio outbreak in Dadaab comes after a similar outbreak in Somalia, where one case has been reported in the capital, Mogadishu,” the U.N. News Centre states (5/31).

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Rumors Spread By Islamic Rebels Hindering Polio Vaccination Campaign In Somalia

“Islamic extremist rebels are fighting a campaign in Somalia to administer a polio vaccine, charging that it contains the virus that causes AIDS or could make children sterile, a battle of words that is frustrating health workers,” the Associated Press reports. “Vaccination workers who walked door to door in the capital, Mogadishu, were turned away by some parents who often didn’t state why they objected to the vaccination,” the news service writes, noting, “Al-Shabab, the rebels linked to al-Qaida, have discouraged many parents from getting their children inoculated against polio, a disease that is an incipient problem in this Horn of Africa nation long plagued by armed conflict and disease, according to health workers who spoke to the Associated Press.” According to the AP, “Al-Shabab did not respond to questions about the allegations that they are spreading rumors against the vaccination campaign.” The news service adds, “Somali government officials say the numbers of parents who reject the immunization campaign are far fewer than those embracing it, but health workers don’t want to leave any unvaccinated” (Guled, 6/1).

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Inexpensive Vinegar Screening Test Reduces Deaths From Cervical Cancer In Large Indian Study

“A simple screening program for cervical cancer using vinegar and visual exams helped reduce deaths caused by the cancer by 31 percent in a group of 150,000 poor women in India, researchers reported on Sunday,” Reuters reports. “If implemented broadly, the screening program could lead to the prevention of 22,000 deaths from cervical cancer in India, and 72,000 deaths in the developing world each year, the team reported at the American Society of Clinical Oncology meeting in Chicago,” according to the news agency (Steenhuysen, 6/2). “Pap smears and tests for HPV, a virus that causes most cervical cancers, have slashed cases and deaths in the United States,” but most developing countries “can’t afford those screening tools,” the Associated Press writes.

“This study tried a test that costs very little and can be done by [community health care workers] with just two weeks of training and no fancy lab equipment,” the news agency continues, noting the health workers “swab the cervix with diluted vinegar, which can make abnormal cells briefly change color” (Naqvi/Marchione, 6/2). Based on the results of the study, which was led by Surendra Shastri of Tata Memorial Hospital in Mumbai, India, “the national government in India and the state government of Maharashtra, the state of which Mumbai is the capital, are instituting screening programs for all women,” Forbes reports (Herper, 6/2).

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Editorials and Opinions

Trade Agreement Negotiations Could Hurt U.S. Efforts To Ensure Global Access To Essential Medicines

“Through their engagement, and their tax dollars, Americans help millions of disadvantaged people around the world by providing access to medical care and essential drugs,” Rep. Jim McDermott (D-Wash.), who is a physician and co-chair of the Congressional HIV/AIDS Caucus, writes in a Roll Call opinion piece. “Unfortunately, we are also currently negotiating sweeping international trade agreements that may curtail our ability to continue helping the poorest of the poor,” he continues, noting, “The Trans-Pacific Partnership [TPP] is being negotiated right now.” He states, “With America’s record of global health leadership in mind, I am troubled by what may happen to access to medicines for the poor around the world as a result of our new trade agreements,” adding, “The critical intellectual property provisions of the pact should protect inventors and developers of breakthrough innovations, but they cannot be so restrictive that they cost millions of lives in less developed countries.”

“At the beginning of TPP negotiations two years ago, for reasons that are unclear, the U.S. asked the other 10 countries to accept new and very rigid intellectual property measures that would greatly limit availability of the affordable generic medicines that the success of U.S.-supported global health programs require,” McDermott continues. “The United States is currently party to many international agreements that include strong intellectual property protections,” but “the U.S.’ current TPP proposal on medicines upends the present well-structured balance by extending monopoly protections much further,” he writes, detailing several provisions within the proposal. “Global health, innovation and access to medicines are top priorities for many members of Congress and should be for this administration,” McDermott writes, adding, “A TPP agreement that exacerbates already-delayed access to generic medicines is unacceptable.” He concludes, “TPP has been called a ’21st Century Agreement,’ but it will be anything but fresh if it makes crucial medicines even scarcer throughout the developing nations of the world” (5/31).

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Disabled Children, Their Communities Would Benefit From U.S. Ratification Of U.N. Convention

“A United Nations report, ‘The State of the World’s Children,’ underscores the moral bankruptcy of Senate Republicans who blocked ratification of a treaty to help disabled people around the world,” a New York Times editorial states. “A United Nations convention would ban discrimination against persons with disabilities and accord them the same rights as those without disabilities,” the newspaper writes, noting, “It has been ratified by 127 countries and the European Union.” The editorial continues, “President Obama has signed it, but, in December, the Senate, though supporting the convention by a hefty 61 to 38, fell five votes short of the two-thirds majority needed for ratification.”

“This was mostly because Senate Republicans caved in to far-right ideologues who contended, erroneously, that the convention would infringe on American sovereignty, usher in socialism, and allow United Nations bureaucrats to prohibit home-schooling or wrench disabled children from their parents’ arms,” the editorial writes. Noting the “report finds that children with disabilities are the least likely to receive health care or go to school and are among the most vulnerable to violence, abuse and neglect, especially if they are hidden away in institutions because of social stigma or parental inability to raise them,” the editorial concludes, “The disabled children and their communities would benefit if the children were accommodated in schools, workplaces, vocational training, transportation and local rehabilitation programs — and if all countries ratified the convention and a related convention on the rights of children” (6/1).

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Nutrition For Growth Event Can Impact Long-Term Development

“One hundred and sixty-five million children fac[e] a life of lost potential and pain” because of malnutrition and subsequent stunting, David Bull, executive director of UNICEF U.K., writes in the Huffington Post U.K.’s “Impact” blog. “However, we know that with the will of governments and expertise of organizations like ourselves, we have the power to change this statistic and improve the lives of millions of children. By addressing chronic malnutrition, we can break the poverty cycle and ensure effective global development,” he continues. “In just over one week, on June 8, the U.K. government will host the Nutrition for Growth Event ahead of the G8, presenting the opportunity to establish long-term change for children, their communities and nations across the world,” Bull notes, adding that the meeting “is an opportunity to bring the public sector and private sector together to ensure that the multifaceted approach, required to end child malnutrition, is delivered.” He concludes, “I hope all those attending the Nutrition for Growth Event see the power they have to impact long-term global development and make the financial commitment necessary” (6/1).

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Caution Over New MERS Virus Warranted

Noting that WHO Director-General Margaret Chan recently “named the Middle Eastern Respiratory Syndrome coronavirus — MERS-CoV or MERS for short — the greatest threat to world health today,” Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, writes in a CNN opinion piece, “But Hong Kong-born Chan can be forgiven a strong reaction. After all, she managed the response to SARS there in 2003, and MERS is a close genetic cousin.” She continues, “No doubt her sense of urgency also stems from the apparently high mortality rate,” which is above 50 percent. Garrett notes, “Both [viruses] cause acute respiratory distress syndrome, or ARDS, and trigger reactions in the human immune system that are so severe, organs throughout the body are devastated” and “[b]oth viruses spread between people through close contact, putting family caregivers and health care workers at risk for infection.”

“Until researchers can determine what animal is the natural host of the virus, and how MERS spreads from the host to humans, each new outbreak is dangerous and mysterious,” Garrett writes, adding, “The science is still unfolding.” She continues, “Sadly, resources for confronting such outbreaks have decreased since the 2008 financial crisis, and MERS has emerged in one of the most difficult regions in the world. Were the virus to reach any of the refugee camps that house more than two million Syrian refugees, a genuine pandemic could ensue” (6/2).

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From the Global Health Policy Community

19 Members Of Congress Send Letter To U.N. Secretary General Urging Body To Take Responsibility For Haiti Cholera Outbreak

Rep. Maxine Waters (D-Calif.) on Friday sent a letter to U.N. Secretary-General Ban Ki-moon, “expressing concerns about the lack of progress in responding effectively to the Haitian cholera epidemic,” Haiti Libre reports. The website notes that the letter, signed by 19 members of Congress, “urges the Secretary General to use his office and his influence to ensure that the United Nations takes responsibility for the introduction of cholera into Haiti and commits an appropriate level of resources to support cholera response efforts.” The website provides the text of the letter (6/1).

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New Alliance For Food Security And Nutrition Recognizes One-Year Anniversary

Noting the one-year anniversary of the New Alliance for Food Security and Nutrition, Tjada McKenna, deputy coordinator for development at Feed the Future, and Jonathan Shrier, acting special representative for global food security and deputy coordinator for diplomacy at Feed the Future, write in the Feed the Future blog, “In the first year of implementation after its launch, the New Alliance has looked to Feed the Future’s innovative, comprehensive approach as a model for fostering transparency and accountability, increasing private investment, expanding access to new technologies, and fostering a supporting policy environment. We are confident that with the collective commitments of our partners, we will carry the momentum forward on these goals.” They outline specific efforts and conclude, “Through Feed the Future, and together with our partners from African and donor governments, the private sector, civil society, and the research community, the U.S. government will continue to be a strong advocate for the New Alliance as we strive to meet President Obama’s challenge to end extreme poverty in the next two decades” (5/30).

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New Initiative Aims To Address Gap In Access To Injectable Contraceptives In Africa, South Asia

“For many women, injectable contraceptives have tremendous advantages: one shot of the popular Depo-Provera protects for three months. It is safe and effective, with almost no risk of unintended pregnancy,” Sara Tifft, a senior program officer for reproductive health at PATH, writes in USAID’s “IMPACTblog.” “Depo-Provera is very popular in sub-Saharan Africa and has great potential to reach millions more women,” she writes, adding, “A new initiative announced at the London Summit on Family Planning in 2012 aims to address this gap in access.” She notes, “USAID, the Bill & Melinda Gates Foundation, DFID, UNFPA, and PATH will bring up to 12 million doses of a new form of Depo-Provera, called Sayana Press, to women in sub-Saharan Africa and South Asia” (5/31).

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CDC Director Highlights Programs Fighting Tobacco Use

In the CDC’s “Our Global Voices” blog, CDC Director Thomas Frieden writes about World No Tobacco Day, recognized on May 31, and “highlight[s] tobacco control programs and initiatives from the [CDC] and many other global public health partners,” including “MPOWER, a set of evidence-based tools developed by the [WHO] to help countries reduce tobacco use.” He notes, “CDC is a key partner in the Global Tobacco Surveillance System, which uses globally standardized surveys for youth and adults to ensure accurate tracking of the number of people who use tobacco as well as monitoring and evaluation of tobacco control policy measures” (5/28).

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USAID Administrator Shah To Answer Nutrition-Related Questions In ONE Google+ Hangout

“To kick off USAID’s Nutrition Week, … ONE, 1,000 Days and GAIN’s Future Fortified campaign on Monday, June 3 at 12:15 p.m. EST [will host a] Google+ page for an up-close-and-personal conversation with USAID Administrator Rajiv Shah,” ONE reports on its webpage. “Shah will be joined by Tjada McKenna, deputy coordinator for development at Feed the Future; Lucy Sullivan, executive director of 1,000 Days; and Candice Kumai, chef, food writer, Iron Chef Judge and nutrition champion for Future Fortified, to address nutrition-relation questions,” according to ONE (5/31).

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