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Kaiser Daily Global Health Policy Report

In The News

WHO's Tedros, CDC's Redfield Speak About DRC Ebola Outbreak After Visiting Nation; Violence Continues To Hamper Response

CIDRAP News: WHO chief says much larger Ebola outbreak averted
“[Thursday] World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, in a press conference on the Ebola outbreak in the Democratic Republic of the Congo (DRC), said, ‘We have averted a much larger outbreak, and we will not leave when the outbreak ends.’ … The press conference came on the heels of Tedros’s visit to the DRC last week with Robert Redfield, MD, the director of the U.S. Centers for Disease Control and Prevention (CDC). It also comes on a day DRC officials added 5 new cases to the outbreak total and reported new acts of violence…” (Soucheray, 3/14).

STAT: Ebola response is working, WHO director general says, amid criticism and violence
“…The cautiously hopeful remarks from Tedros Adhanom Ghebreyesus, who visited the outbreak zone last week, came just hours after the most recent attack on an Ebola treatment center, one in a series that has plagued efforts to bring this outbreak, now in its eighth month, to an end. As of Wednesday, there have been 927 cases in the outbreak and 584 deaths, making this the second largest Ebola outbreak on record. But Tedros, as he is known, said he is convinced the Congolese government and the international partners working on the response will get the job done…” (Branswell, 3/14).

The Telegraph: WHO chief insists long-running Ebola outbreak is being brought under control
“…Dr. Tedros’s more upbeat assessment was in stark contrast to analysis by Médecins Sans Frontières international president Dr. Joanne Liu last week. She told a press conference that despite deployment of new tools, such as a vaccine and an experimental medicine, there were no signs the outbreak was coming under control as around half of new cases were not from known chains of transmission. But Dr. Tedros disputed this. ‘One good news is that for the last seven months the disease has been contained in the geographical area called North Kivu. It hasn’t spread to other parts of the country and it hasn’t spread to other countries,’ he said. But he said he did not want to underplay the risk the disease continues to pose…” (Gulland, 3/14).

Washington Post: U.S. hopes to send more experts to Congo as Ebola outbreak rages
“The Centers for Disease Control and Prevention hopes to send experts to Congo in the next few weeks to train international and local personnel in the fight against a raging Ebola outbreak that has killed nearly 600 people and is far from under control, the CDC director said Thursday in an interview. Because of the worsening security situation, the CDC experts would not be based in the epicenter of the outbreak, in conflict-ridden parts of eastern Congo. … ‘This is a complicated response,’ Redfield said. The outbreak, now entering its eighth month, ‘is not under control’ and is likely to last through this year and into 2020, he said. ‘This late in the outbreak, and half of the cases are presenting dead,’ he said, an indicator that an unusually high number of infected people are not being identified when they fall ill. … Redfield spoke with the Washington Post after he and other U.S. officials testified before a Senate [appropriations subcommittee] panel about the ongoing outbreak…” (Sun, 3/14).

Washington Times: Rate of Ebola cases dropping but violence, mistrust impede progress warn experts
“…Senate appropriators said they were pleased that President Trump’s fiscal 2020 budget calls for $100 million to support the CDC’s global health security activities … Sen. Patty Murray, Washington Democrat, fired a warning shot, however, saying the administration cannot take its foot off the pedal or enact cuts in other parts of its health budget. She said investments under President Obama helped global responders defeat the worst-ever Ebola epidemic, which killed more than 11,000 in West Africa from 2013 to 2016. ‘We have to remember the dangers of falling back on ‘America first’ rhetoric,’ Ms. Murray said. ‘We cannot do this on the cheap. And we can’t pretend diseases are stopped by borders or walls or bans'” (Howell, 3/14).

Additional coverage of the Ebola outbreak and response, as well as officials’ comments, is available from Agence France-Presse, Associated Press, Axios, GeekWire, The Lancet, Reuters, U.N. News, and VOA News.

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Foreign Policy Examines U.S. Alignment With Less Liberal Nations On Issues, Role At U.N. Commission On Status Of Women Meeting

Foreign Policy: At the U.N., America Turns Back the Clock on Women’s Rights
“The Trump administration is lining up with less liberal nations such as Saudi Arabia and Malaysia at a major United Nations conference on women this month to roll back international consensus on climate change and migration, while seeking to prevent the expansion of rights for girls, women, and LGBT people. The U.S. strategy — detailed in a confidential 96-page draft text under negotiations by delegates to the U.N. Commission on the Status of Women (CSW) obtained by Foreign Policy — underscores the degree to which President Donald Trump’s administration is moving further away from traditional democratic allies on social and cultural matters. Instead, Washington is increasingly aligning itself with Persian Gulf countries such as Bahrain, Saudi Arabia, and Iraq; Malaysia; and some conservative African nations on a range of issues including questions surrounding protections for LGBT individuals and women’s health issues. … A U.S. official declined to respond to questions about its negotiating position but insisted that the Trump administration ‘is against discrimination of any kind’ and is ‘unwavering in its support for women’s empowerment.’ ‘As the world’s largest bilateral donor to global health programs,’ the official added, ‘the United States remains committed to helping women and children thrive, particularly in countries where the need is greatest’…” (Lynch/Gramer, 3/14).

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World Bank Confirms U.S. Nominee David Malpass Only Candidate To Succeed Jim Yong Kim As President

Devex: David Malpass unchallenged to be next World Bank president
“The legitimacy of the World Bank’s presidential appointment process is under renewed scrutiny after U.S. President Donald Trump’s pick, David Malpass, emerged as the only candidate to succeed Jim Kim. Nominations for the position closed on Thursday, and the World Bank confirmed in a press release that Malpass, currently a U.S. Department of Treasury official and a former investment banker, was the only candidate nominated for the job…” (Edwards, 3/15).

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USAID To Fund Family Health Services In Jordan For First Time

Xinhua News: U.S. signs deal with Jordan to fund family health services
“The United States signed an agreement with Jordan on Thursday to fund the Jordanian family health services directly for the first time through U.S. Agency for International Development’s (USAID) Partnership for Health and Family Planning Program. The signing ceremony was held at the Ministry of Health and attended by Ghazi Mansour Al-Zabin, Jordan’s minister of health, and USAID Acting Mission Director Ralph Koehring…” (3/14).

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The Lancet Examines Reaction To WHO Structural Reform

The Lancet: WHO structural overhaul draws mixed initial response
“On March 6, WHO unveiled a major structural overhaul of their 70-year agency. The initial responses have varied from praise for some timely and innovative changes to concerns that some reforms are top-heavy and that some sensitive policy areas appear to have been downgraded…” (Zarocostas, 3/16).

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African Women Who Undergo Caesarean Section 50 Times More Likely To Die Than Women In Wealthy Nations, Study Shows

Agence France-Presse: C-section 50 times more deadly for women in Africa: study
“The death rate among women undergoing a C-section to deliver a baby is about 50 times higher in Africa than in most wealthy nations, researchers said Friday. One in 200 women perished during or soon after a caesarean in a sampling of nearly 3,700 births across 22 African countries, they reported in The Lancet Global Health. By comparison, maternal mortality is approximately one woman per 10,000 operations in Britain. Death rates related to C-sections are roughly the same across most developed countries…” (3/15).

CNN: African mothers 50 times more likely to die after c-section than moms in rich countries, study says
“…The study had some limitations, the authors noted, with a disproportionate number of participating hospitals university-affiliated rather than district hospitals, which act as first-level providers of care for most African women and typically have fewer resources. Also, two-thirds of patients were from middle-income countries, where better levels of care are available than in Africa’s poorest countries. ‘The true morbidity and mortality after caesarean section on the continent is therefore likely to be higher than reported,’ … Anna Dare of the Centre for Global Health Research, St. Michael’s Hospital and the Department of Surgery at the University of Toronto[, wrote in an accompanying commentary]…” (Hunt/Mavhunga, 3/14).

The Telegraph: Maternal deaths from C-sections 50 times higher in Africa than U.K.
“…The findings highlight an urgent need to improve the safety of cesarean operations, say the report authors. ‘Improvement of C-section surgical outcomes could substantially improve both maternal and neonatal mortality, which would lead to key global health gains,’ said Bruce Biccard, professor at the University of Cape Town and lead author of the study. ‘Our findings could potentially inform interventions to improve the safety of C-sections for both mother and baby’…” (Newey, 3/14).

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More News In Global Health

BBC News: Concerns over global resurgence of measles (3/14).

Devex: WHO launches new guideline for community health workers (Roby, 3/14).

The Guardian: ‘There is no tomorrow for me’: Rwanda’s teen mothers — in pictures (Allen-Story, 3/15).

IRIN: Failed aid gambit deepens crisis for Venezuelans at closed Colombia border (Collins, 3/14).

IRIN: In Madagascar, 1,100 measles deaths are more about money than ‘vaccine hesitancy’ (Rabary, 3/14).

Reuters: Botswana’s High Court postpones decision in gay sex case (Benza, 3/15).

Thomson Reuters Foundation: Mosquito-killing drug offers new tool for fighting malaria (Peyton, 3/14).

U.N. News: U.N. welcomes ‘record’ Brussels conference pledge of nearly $7 billion to support Syrians (3/14).

U.N. News: 99 percent of intravenous drug users lack access to health, ‘social services with dignity,’ says UNAIDS chief (3/14).

VOA News: Quarter-Million Children Malnourished as Conflict in DRC Rages On (Arabasadi, 3/14).

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Editorials and Opinions

World Needs Effective Model For Responding To Outbreaks In Unstable Regions

The Telegraph: Attacks on health workers risk Ebola spiraling out of control
Jeremy Farrar, director of the Wellcome Trust

“Health care workers know that responding to Ebola puts them at risk. The virus is highly infectious and often fatal. … But premeditated attacks on the people and facilities providing care for Ebola patients were not thought to be part of the deal. They are now. … Public health measures won’t work [in the Democratic Republic of the Congo] without significant logistical and security expertise, as well as negotiators skilled in conflict resolution. In this situation, all the responders need the full, coordinated backing of other U.N. agencies and global communities to end the outbreak. … [W]e do not have an effective model for dealing with outbreaks in unstable regions. Yet conflict is a major risk factor for infectious disease, while violence and displacement only heighten the need to earn people’s trust in order for any epidemic response to succeed. This, then, is our choice in an increasingly unstable world: act decisively now, and learn to deal with one of the great health threats of our time. Or delay, and risk future epidemics reaching our borders before there’s time to prepare. We must not allow this fire to get out of control before we try to put it out” (3/14).

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Recently Announced WHO Reform Strategy Lacks Specifics, Raises Questions Among Global Health Community

The Lancet: WHO reform continues to confuse
Editorial Board

“The content of a reform for WHO came as somewhat of a surprise to many in the global health community. After Dr. Tedros Adhanom Ghebreyesus, in his inaugural speech, said, ‘I do not believe in perpetual reform and I think WHO staff are reformed out,’ WHO’s Director General unveiled the result of a 20-month-long consultation for reform. Aimed to be ‘the most wide-ranging reforms in the organization’s history,’ according to the accompanying press release, this reform is a substantial top-heavy redesign of the internal structure of the WHO Secretariat. … A week after the speech was given, experts contacted by The Lancet communicated their continuing confusion about this reform. As we go to press, a marked lack of communication surrounds the announcement and a detailed report explaining the specifics of what the reform means for programs, oversight, funding, and staffing is not yet available. In the meantime, the global health community is still holding its breath, waiting to see whether this reform represents a transformational shift in vision for WHO or simply a shuffling of clusters and staff” (3/16).

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Investments In Health R&D, Tax Revenues Important For G20 Ministers To Consider At June Meeting

The Lancet: Investment in health is key to boosting wealth
Editorial Board

“The health and wealth of a nation are fundamentally linked. Healthier populations live longer, more productive lives, leading to greater economic prosperity. A report by the G20 Health and Development Partnership — Healthy Nations, Sustainable Economies — reiterates this now-familiar theme and calls on G20 health and finance ministers to work together, particularly in support of health research and development, to advance health. … However, the report misses the opportunity to convey other health messages that are arguably of even greater importance to finance ministries: for example, major increases in tobacco taxes provide a powerful tool to attenuate the epidemics of cancer and cardiovascular disease. And most countries will require increased reliance on tax revenues to finance universal health coverage — a demand that will only increase as populations age. The report will be presented to ministers ahead of the first joint meeting of G20 health and finance ministers on June 28 in Japan. We urge ministers to take heed of the report’s emphasis on the central role of research and development in advancing human health. Interdisciplinary working is the way forward for health and such joint meetings must become a regular fixture” (3/16).

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From the Global Health Policy Community

Friends Of Global Fight Highlights Efforts To Urge Congress To Increase FY20 Global Fund Appropriation To $1.56B

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria: Letter from Faith Leaders supporting the Global Fund
“146 members of the faith-based coalition The 2030 Collaborative, including former Senator Bill Frist (R-Tenn.), sent a letter to the Chair and Ranking Member of the Senate and House Appropriations Committees and Subcommittees on State, Foreign Operations, and Related Programs (SFOPS) thanking them for their leadership in maintaining robust funding for the Global Fund, and requesting $1.56 billion for the Global Fund in FY20…” (3/14).

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria: What could $210 Million increase to the Global Fund buy?
“Friends of the Global Fight urges Congress to fully fund the Global Fund with an appropriation of at least $1.56 billion in FY20 — an increase of $210 million from last year. The additional $210 million is essential to stepping up the fight to end the AIDS, TB, and malaria epidemics…” (3/14).

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MFAN Releases Statement On Administration's Plan For New Development Finance Corporation

Modernizing Foreign Assistance Network: Plan for New U.S. Development Finance Corporation Includes Strong Role for Development
In a statement delivered on behalf of MFAN, Co-chairs George Ingram, Lester Munson, and Tessie San Martin discuss the Trump administration’s plan for the new Development Finance Corporation, stating that MFAN “is pleased that [the plan] prioritizes linkages with USAID, a strong chief development officer role, and a commitment to accountability.” The co-chairs also outline four recommendations for the agency’s reorganization plan: “ensure accountability for achieving development impact; establish strong linkages with development policies and agencies; lead in transparency; and provide appropriate resources” (3/14).

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Kenya's 'Beyond Zero' Campaign To Reduce Maternal Mortality Must Improve Access To Comprehensive Reproductive Health Services, Including Safe Abortion, HRW Researcher Says

Human Rights Watch: Safe Access to Abortion Crucial to Reducing Maternal Mortality in Kenya
Agnes Odhiambo, senior researcher in the Women’s Rights Division at HRW, discusses Kenya’s “Beyond Zero” campaign to eradicate preventable maternal and child mortality in the country, highlighting criticism that the campaign does not address access to safe abortion. Odhiambo writes, “‘Beyond Zero’ is a high-profile campaign that could mobilize support for [guidelines on reducing morbidity and mortality from unsafe abortions] to be instituted. The campaign could also prompt the government to address the root causes of unsafe abortions which include high rates of teenage pregnancy, lack of access to modern methods of contraception, and lack of access to age-appropriate, comprehensive reproductive health education for girls and young women. A comprehensive approach to sexual and reproductive health is needed to stop the unnecessary deaths of women and girls in Kenya…” (3/14).

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WHO Outlines 8 Ways Organization Supports Health In Syria

World Health Organization: 8 ways WHO supports health in Syria
This post highlights eight “things to know about how WHO works in Syria to save lives and support health despite immense challenges: 1. Detecting and responding to disease outbreaks … 2. Delivering medical supplies despite insecurity, damaged roads, bureaucratic obstacles, and import restrictions … 3. Using mobile teams to reach vulnerable populations … 4. Restoring local health care … 5. Training health workers … 6. Making mental health services more widely available … 7. Supporting Syrians with disabilities … 8. Increasing health coordination and efficiency” (3/14).

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From the U.S. Government

U.S. Announces More Than $397M In Additional Humanitarian Assistance To Syrians Impacted By Conflict

U.S. Department of State: U.S. Humanitarian Assistance in Response to the Syria Crisis
“[Thursday] at the Third Brussels Conference on ‘Supporting the Future of Syria and the Region,’ the United States announced more than $397 million in additional humanitarian assistance for the people of Syria as part of the Regional Refugee and Resilience Plan for 2019-2020. … With this new funding to UNHCR, UNICEF, IOM, non-governmental organizations, and other agencies, the United States is providing urgently needed food, shelter, sanitation and hygiene, medical care, education, and other relief to help assist the nearly 12 million people suffering inside Syria, as well as the nearly 5.7 million refugees in the region. A portion of this funding also helps support the host communities in Lebanon, Jordan, Turkey, Iraq, and Egypt that are generously hosting Syrian refugees…” (3/14).

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