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Kaiser Daily Global Health Policy Report

In The News

IRIN Examines Future Of PEPFAR, Concerns Over Funding

Highlighting a recent visit to Ethiopia by Ambassador Eric Goosby, U.S. global AIDS coordinator and head of the State Department’s Office of Global Health Diplomacy, IRIN reports on the success of PEPFAR in that country and worldwide, noting the program has supported a 20-fold increase in the number of people receiving treatment in low- and middle-income countries since its beginning in 2003. “But experts are concerned that consistent budget cuts in PEPFAR funding could make reaching the goal of an HIV-free generation difficult, if not impossible,” the news service writes, quoting an April 2013 opinion piece by Chris Collins, a vice president and director of public policy at amfAR, The Foundation for AIDS Research.

“But Goosby explained the cuts are being made for three reasons,” including “better and smarter” service delivery, increased participation from country governments, and improved cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria, IRIN notes. “We see our ethical obligation to the patients that are using these services. … We will not renege on that. But we also feel that in order to make sure these services continue, we need to diversify the fund portfolio so others are contributing,” Goosby said, adding, “If we pull back on what we are doing for HIV, it will come right back, without any doubt. We see that in just about every infectious disease, but HIV is notorious for this. So keeping this going becomes the challenge. That’s why we want to emphasize the shared responsibility,” according to the news service (6/6).

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President Obama Names Susan Rice, Samantha Power To Major National Security Posts

“President Obama named Susan E. Rice and Samantha Power to major national security posts on Wednesday, promoting two outspoken voices for humanitarian intervention on a foreign policy team known for its deep caution in dealing with conflicts abroad,” the New York Times reports (Landler, 6/5). “Susan E. Rice, whom Obama named Wednesday to succeed Thomas E. Donilon as national security adviser, and Samantha Power, nominated to follow Rice as U.N. ambassador, will have the opportunity to answer [how ambitious Obama intends to be abroad] as the administration reviews its policy on Syria, winds down the war in Afghanistan and seeks to stop Iran’s nuclear-enrichment program,” according to the Washington Post (Wilson, 6/5). “By choosing two women known as advocates for human rights, including the NATO-led intervention in Libya with U.S. support, Obama signaled a potentially more robust foreign policy in his second term,” CNN writes (Yellin/Cohen, 6/6).

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House Panel Rejects Changes To Food Aid Program Proposed By Obama Administration

“The House of Representatives panel in charge of agricultural funding rejected on Wednesday the Obama administration’s request for a sweeping change to food aid programs that have been in place since the Cold War,” Reuters reports. “It was the second defeat in three days for the White House budget proposal to use up to 45 percent of funding for Food for Peace, the major U.S. food aid program, to buy food from nations near hunger zones instead of American-grown food,” the news agency writes, noting, “The White House in April proposed shifting Food for Peace funding to an international affairs panel and to make large purchases of food from suppliers closer to famine areas, so-called local and regional purchasing. Funds also could be used for food vouchers.”

“The House Appropriations subcommittee on agriculture on Wednesday opted to keep Food for Peace under its control, and at the same time cut the program by 20 percent to $1.15 billion for the next fiscal year,” according to Reuters, which adds, “The Senate voted on Monday to allow a small increase — $20 million — in local food purchase by [USAID] but otherwise rejected the administration package.” Reuters notes, “Although the farm bills pending in the House and Senate would also keep Food for Peace in its current form, the administration still has a few chances to win its way” (Abbott, 6/5).

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Lancet Series Released Before Nutrition Summit Says Malnutrition Accounts For 45% Of All Under-Five Child Deaths

“Malnutrition is the underlying cause of death for at least 3.1 million children, accounting for 45 percent of all deaths among children under the age of five and stunting growth among a further 165 million, according to a set of reports released ahead of a nutrition summit in London,” The Guardian reports. The Lancet published the data in a series of papers on maternal and child health, a follow-up to a similar 2008 series and preceding the Nutrition for Growth meeting taking place this weekend as part of the U.K. presidency of the G8, the newspaper notes. “Saturday’s nutrition summit, co-hosted by the U.K., Brazil and the Children’s Investment Fund Foundation (CIFF), is expected to see financial pledges from rich governments and declarations of commitments from poor countries,” The Guardian writes, noting, “Even if the summit comes up with more money, it will fall far short of the $9.6 billion a year The Lancet says is needed to reduce the number of deaths from malnutrition among under-fives by one million” (Tran, 6/6).

“A group of British non-governmental organizations have been running a campaign in the build up to the G8 summit called Enough Food for Everyone IF, which focuses on a number of measures that could be taken to protect communities that are vulnerable to hunger, and to bolster efforts to address child malnutrition,” a World Food Programme press release states. “The ‘IF’ campaign … will hold a major public rally in a London park on the same day as the [nutrition meeting] to help draw attention to the plight of the world’s hungry,” the press release adds (6/5). On Tuesday, British lawmakers released a report (.pdf) calling on the Department for International Development (DfID) “to expand the number of countries where it has bilateral nutrition programs,” Devex reports, noting, “DfID, in response, said it will announce its future plans on nutrition on June 8 at the U.K.-hosted ‘Nutrition for Growth’ event” (Ravelo, 6/5).

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U.N. Secretary-General Appeals For Philanthropic Investment In Fight Against 5 Deadly Diseases

U.N. Secretary-General Ban Ki-moon on Wednesday “appealed to philanthropists to ‘make a smart investment in the world’s future’ by joining the United Nations in accelerating the fight against five of the most deadly infectious diseases which kill millions of people every year,” the U.N. News Centre reports. “‘Today we have the power and the knowledge to wipe out deaths from five of the world’s biggest health threats: malaria, polio, tetanus, measles and HIV infections in newborns,’ [Ban] told the Second Annual Forbes 400 Summit, which took place at U.N. Headquarters in New York,” the news service writes. “While there has been progress on many of these diseases, most notably polio, malaria and HIV infections, [Ban] stressed that increased engagement from the private sector and the philanthropic community is needed to keep the world on track to a prosperous path” (6/5). Ban also “requested $1 million yearly in the next three to five years to acquire vaccines to eradicate cholera in Haiti,” Prensa Latina notes (6/5).

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USGLC Report Makes Recommendations For U.S. Foreign Policy

The Washington-based U.S. Global Leadership Coalition (USGLC) this week released “a new report on enhancing United States soft power,” Foreign Policy’s “The Cable” blog reports. The report “highlights six recommendations ranging from increased funding for the civilian side of the State Department’s national security staff to more public-private partnerships to new methods of streamlining the interagency process for a more consistent U.S. foreign policy,” the blog writes (Hudson, 6/5). According to the report webpage, “[t]he 2012 ‘Report on Reports’ analyzes more than 30 reports from a wide political spectrum and identifies six areas of broad agreement, focused on making existing initiatives more effective and impactful, and new ideas for innovative approaches to meet the challenges and opportunities of the future” (6/4). Paula Dobriansky, under secretary of state for democracy and global affairs from 2001-2009, said, “President Bush prioritized foreign assistance as an essential component of our national security, and innovative programs like PEPFAR and MCC transformed the way we deliver assistance. The recommendations in this report build on these successes as we make our programs even more effective and essential to our foreign policy,” according to a USGLC blog post on the report (Espinosa, 6/5).

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Editorials and Opinions

USAID Water And Development Strategy A 'First Step In The Right Direction'

“It’s a big moment, and one that has been long awaited: [USAID] has released its first-ever Water and Development Strategy [.pdf] — a roadmap of the U.S. government’s approach to water programming that focuses on efforts to save lives through the provision of sustainable water, sanitation and hygiene services,” David Winder, chief executive of WaterAid America, writes in the Huffington Post’s “Water” blog. “[T]his strategy opens doors to better helping communities to help themselves; to saving lives by establishing water, sanitation and hygiene as strategic U.S. foreign aid objectives towards advancing health and development,” he writes, adding, “My hope is that U.S. missions around the world will now respond to the encouragement provided by this paper and launch initiatives that are sustainable and that can be taken to scale.”

“The key will be how it translates into real partnerships that provide the right services for the people who need them most,” Winder continues, adding, “That is precisely why I am setting my sights on Congressional leadership to enhance accountability towards the poorest of the poor; USAID’s strategy simply doesn’t convince me that its focus on the poor will improve upon its recent spending trends.” He notes the 2013 Water for the World Act is expected to be re-introduced to Congress in the coming weeks and concludes, “USAID’s global Water and Development Strategy is an excellent first step in the right direction and one that offers U.S. missions the opportunity to transform lives through innovative investments in water, sanitation and hygiene that really focus on the many benefits of WASH, such as to health and nutrition. As we look to the next step, passage of the Water for the World Act will ensure that the ripples begun with this strategy will really start to make some waves” (6/5).

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HIV Epidemic Brought About 'Global Health,' Serves As Model For Response To Other Diseases

“The changes wrought by HIV have not only affected the course of the epidemic: they have had powerful effects on research and science, clinical practices, and broader policy,” Allan Brandt of Harvard University writes in an New England Journal of Medicine perspective piece, adding, “Most notably, the AIDS epidemic has provided the foundation for a revolution that upended traditional approaches to ‘international health,’ replacing them with innovative global approaches to disease. Indeed, the HIV epidemic and the responses it generated have been crucial forces in ‘inventing’ the new ‘global health.'” He describes the epidemic’s impact on disease activism, health funding, philanthropy, the cost of essential medicines, and human rights. “These complementary innovations are at the core of what we now call ‘global health’ — which has demonstrated its capacity to be far more integrative than traditional notions of international health,” Brandt writes, concluding, “When the history of the HIV epidemic is eventually written, it will be important to recognize that without this epidemic there would be no global health movement as we know it today” (6/6).

In a related NEJM review article, Peter Piot of the London School of Hygiene and Tropical Medicine and Thomas Quinn of the NIH’s National Institute of Allergy and Infectious Diseases describe the response to the HIV/AIDS epidemic, and write, “This unprecedented global response to the AIDS pandemic can serve as a model for the response to other global health threats.” They discuss advances in treatment and prevention strategies, writing, “An impressive array of evidence-based interventions can be implemented to treat established infections and prevent new ones.” Piot and Quinn conclude, “These programs will require universal access, large-scale implementation, careful monitoring and evaluation, financial and technical resources, and robust commitment. Only then may we begin to see a substantial effect on the global spread of HIV infection” (6/6).

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International Community Must Keep Current MDGs In Sight

Noting “the United Nation’s High Level Panel (HLP) [last week] released its report [.pdf] on recommendations for what should follow the Millennium Development Goals (MDGs) after the deadline to meet them expires in 2015,” Sara Harcourt, policy director at the ONE Campaign, writes in a Thomson Reuters Foundation opinion piece, “The report is a welcome first step in the official U.N. negotiations that will now move forward to galvanize a set of global targets for post-2015.” She continues, “But while everyone’s attention is focused on post-2015, is the world losing interest in the current MDG targets?” She writes, “ONE’s ‘2013 DATA Report: Financing the Fight for Africa’s Transformation,’ released this week, puts the spotlight on the current MDGs and tracks how countries are progressing.”

“Sub-Saharan Africa is a region that is frequently admonished for lagging far behind on the MDGs overall. But ONE’s analysis shows that individual African countries have made remarkable progress,” Harcourt writes. “But we’re not there yet,” she continues, noting “some particularly large countries are lagging far behind and dragging down regional rates of progress.” She examines “what can be done to help accelerate the process,” stating, “There is a clear opportunity in the next two-and-a-half years for the world to stand up and take responsibility for existing commitments, and to accelerate efforts and target resources towards meeting the current MDGs.” She adds, “It’s vital that we don’t just focus on increasing the quantity of resources (although governments need to meet their spending commitments), but realize that quality and effectiveness of limited resources is just as important.” Harcourt concludes, “The world can virtually end extreme poverty within the next generation, but we can’t wait for the next ambitious post-2015 targets. We must seize the opportunity now to sprint to the finish line” (6/3).

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Vaccines Key To Reaching MDG Goal To Reduce Child Mortality, Polio Eradication

“The rise of new and more affordable vaccines in recent years augurs well for the future and provides us with an opportunity to prevent sickness and save lives on a scale that was previously unimaginable,” Siddharth Chatterjee, chief diplomat at the International Federation of the Red Cross and Red Crescent Societies, writes in a CNN opinion piece. “We now have vaccines to prevent nearly 30 diseases,” he notes, adding, “The GAVI Alliance … has contributed to the immunization of more than 370 million children since 2000. The [WHO] estimates immunization programs prevent two million to three million deaths every year.” He continues, “WHO also estimates we have an opportunity to reach an additional 22 million infants who live in hard-to-reach or insecure communities across the developing world.”

“Reaching these populations is the key to achieving humanitarian milestones agreed to by the global community — chiefly, Millennium Development Goal 4, which calls for a significant reduction in child mortality by 2015,” Chatterjee writes. He discusses the role of vaccines in decreasing the number of polio cases by “more than 99 percent,” and notes, “At the end of April, leaders attending the Global Vaccine Summit in Abu Dhabi signaled their confidence in a six-year plan to achieve a polio-free world by 2018.” He examines ongoing efforts to eliminate the disease and writes, “With sustained funding and a commitment to community-led solutions, polio eradication will join a short list of heady, historical achievements that have united the world in solidarity.” He continues, “As health and policy experts debate the merits of earmarking investments for global health, they must remember one thing: vaccines are the most powerful and cost-effective tools available to improve child health and advance human development” (6/4).

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From the Global Health Policy Community

U.S. Global AIDS Coordinator, United Nations Foundation Release Statements On Passing Of Sen. Lautenberg

Ambassador Eric Goosby, U.S. global AIDS coordinator and head of the State Department’s Office of Global Health Diplomacy, on Tuesday released a statement on the passing of Sen. Frank Lautenberg (D-N.J.). “The five-term Senator was a tireless advocate for [PEPFAR] as well as the Ryan White CARE Act,” according to the statement, which adds, “Senator Lautenberg’s tenacious efforts on behalf of those living with and affected by HIV/AIDS had an unquestionable impact at home and around the globe” (6/4). Also on Tuesday, the United Nations Foundation released a similar statement from Maureen Greenwood-Basken, executive director of women, girls and population at the foundation, which reads, “The loss of Senator Lautenberg — a champion for human rights and women’s rights around the world — is deeply felt today. Throughout his career, Sen. Lautenberg was an outspoken proponent of international family planning programs and reproductive health and rights to ensure that women and families everywhere have access to the services they need to live healthy and productive lives” (6/4).

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Inclusion Of NTDs In Report On Post-2015 Development Agenda Represents 'A Milestone'

Noting the U.N. High-Level Panel of Eminent Persons on the Post-2015 Development Agenda released a report last week “set[ting] the stage for the international development agenda, including global priorities and targets leading up to 2030,” Neeraj Mistry, managing director for the Global Network for Neglected Tropical Diseases, writes in the network’s “End the Neglect” blog, “As a South African-born, U.S.-based public health physician, with specific involvement in addressing neglected tropical diseases (NTDs), I read through the document with much interest. Unsurprisingly, I was delighted to see explicit mention of NTDs for the first time in a report of this nature.” He continues, “[E]xplicit mention of NTDs is a milestone in international development. It heralds a move beyond the science- and empathy-based agenda of wealthier countries” (6/5).

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Philippines Senator Discusses Reproductive Health Bill

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, John Murphy, a communications officer and senior writer at the foundation, interviews Philippines Senator Pia Cayetano, a primary sponsor of the Responsible Parenthood and Reproductive Health Act of 2012, also known as the RH Bill. Cayetano discusses her role and challenges faced in pushing the bill through the legislature, her personal experiences as a mother, and the intersection of religion and reproductive health, according to the transcript (6/5).

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