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Kaiser Daily Global Health Policy Report

In The News

Departure Of Tim Ziemer, Elimination Of NSC Global Health Security Office Leave Experts Concerned Over U.S. Preparedness

HuffPost: Sudden Departure Of White House Global Health Security Head Has Experts Worried
“Rear Adm. Tim Ziemer, the head of global health security on the White House’s National Security Council, left the Trump administration on Tuesday. The news was announced one day after an Ebola outbreak was declared in the Democratic Republic of the Congo. The departure comes amid a reshuffling of the NSC under newly named National Security Adviser John Bolton, which includes a change in organizational structure that eliminates the office Ziemer led. Ziemer’s staff has been placed under other NSC departments. … Ziemer’s exit follows the departure last month of White House Homeland Security Adviser Tom Bossert, who was another champion of investment in global health security. Bossert left the day after Bolton began as national security adviser. Ron Klain, the former Ebola ‘czar’ under President Barack Obama, told HuffPost the combination of their departures was a blow to global health security…” (Weber, 5/9).

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Trump Administration Requests Rescission Of $252M In 2015 Ebola Funds As Congo Addresses New Outbreak

The Atlantic: Ebola Returns Just as Trump Asks to Rescind Ebola Funds
“…The DRC’s main challenge [in addressing the latest Ebola outbreak] is its lack of resources. … ‘It’ll be the same story in West Africa,” [Emile Okitolonda, who leads the Kinshasa School of Public Health,] lamented, now that the catastrophic outbreak of 2014 is over. ‘Resources will disappear and people will forget.’ The United States is already forgetting. Just as news of the Ebola outbreak broke, Donald Trump asked Congress to rescind $252 million that had been put aside to deal with Ebola, as part of a broader move to cut down on ‘excessive spending.’ That pot of money is the leftover from a $5.4 billion sum that Congress appropriated for dealing with the West African Ebola epidemic in 2015. … Congress has 45 days from the time of Trump’s request to act, during which time the $252 million is frozen. If they vote it down, or simply ignore it, the funds will be spent as intended…” (Yong, 5/9).

Daily Beast: Ebola’s Back — And It Could Be Worse Thanks to Trump
“…In an email, a White House official familiar with the rescission deal told the Daily Beast that ‘The administration understands the risks posed by infectious disease threats such as Ebola, and that quick action is necessary to stop an outbreak at its source.’ Still, the official added that ‘we do not believe the funds proposed for rescission are necessary to respond to the DRC outbreak, due to the increased capabilities of the Congolese government and quick mobilization by partners in country.’ … In a detailed document from the Office of Management and Budget, the request said that the funds are no longer needed because the outbreak related to the actual appropriation has ended — a blinkered approach not shared by the global health community, which clearly sees more of an ongoing threat that needs careful management. … Much of the money in the original [2015] Ebola appropriation was designated to be available indefinitely. According to an analysis by the Kaiser Family Foundation of the bill appropriating the funds, $3.74 billion of the total $5.4 billion was set aside for international response (the rest was for research and development, and domestic response); of that, $1.75 billion, given to USAID for various purposes, was designated ‘to remain available until expended’…” (Levitan, 5/10).

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Health Officials Express Mixed Concerns Over Potential Spread Of Congo Ebola Outbreak; First Cases Likely Appeared In January, WHO Says

Associated Press: Risk of Congo’s latest Ebola outbreak spreading ‘very low’
“The risk of Congo’s latest Ebola outbreak spreading is ‘very low’ because of the remote area, a Congolese disease expert said Wednesday as medical teams arrived on the scene. … ‘The risks of propagation are very low because it is a remote area, it is about 200 kilometers (124 miles) from Mbandaka, the capital of the province of Equateur … so it is unlikely that a patient can leave this area and go to Mbandaka or Kinshasa,’ the capital, said the director of the National Institute of Biological and Bacterial Research, Dr. Jean Jacques Muyembe…” (Wanamilongo/Petesch, 5/9).

Reuters: First reported deaths in Congo Ebola outbreak came in January: WHO
“Cases of hemorrhagic fever were reported in an area of Congo that is facing an Ebola epidemic as far back as December and the first deaths were reported in January, a spokesman for the World Health Organization said in the capital Kinshasa on Thursday…” (Ligodi, 5/10).

STAT: WHO officials fear latest Ebola outbreak in Congo could spread to big cities
“The new Ebola outbreak on the western edge of the Democratic Republic of the Congo has ignited serious concern at the World Health Organization, with signs pointing to an epidemic that may have been underway for weeks or months. Though there are only two confirmed cases at this point, preliminary investigations point to cases in several locations that may date back as far as early this year, Dr. Pierre Formenty, the WHO’s top Ebola expert told STAT. There is also fear that two health care workers may be among the infected, which happens often in Ebola outbreaks and can fuel the disease’s spread…” (Branswell, 5/9).

Thomson Reuters Foundation: Congo Ebola outbreak met with rapid response after West African crisis
“…On Tuesday, Democratic Republic of Congo confirmed two cases of [Ebola]. That same day, WHO helicoptered in a team of experts to the scene and released $1 million in funding. ‘I think with this rapid response we will be able to contain it,’ WHO emergencies director for Africa, Ibrahima Soce Fall, told the Thomson Reuters Foundation. ‘Very clearly’ the U.N. agency learned its lesson from the [2014 West African Ebola epidemic], he added…” (Peyton, 5/9).

Additional coverage of this story is available from Agence France-Presse, Axios, Bloomberg, The Hill, PBS NewsHour, Quartz, and VOA News.

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Gaps In Breastfeeding Practices Between Developed, Developing Nations Larger Than Expected, Must Be Closed, UNICEF Report Says

CNN: The countries where 1 in 5 children are never breastfed
“…A new UNICEF report released Wednesday that ranks countries by breastfeeding rates shows that in high-income countries, more than one in five babies is never breastfed, whereas in low- and middle-income countries, one in 25 babies is never breastfed. Among the high-income countries, Ireland, France, and the United States had the three lowest breastfeeding rates…” (Howard, 5/9).

Deutsche Welle: Breastfeeding rates too low in developed countries, UNICEF says
“More than 800,000 child deaths a year could be prevented by breastfeeding, according to a new report released Thursday by U.N. child protection unit UNICEF. Stressing the benefits of nursing for both maternal and infant health, the report says babies are still more likely to be breastfed in developing countries than in the world’s richest nations…” (Goebel, 5/10).

Devex: UNICEF: Babies from high-income countries 5 times less likely to be breastfed
“…Just four percent of babies in low- and middle-income countries are never breastfeed, while 21 percent of babies in high-income countries never receive breastmilk. The gap is higher than some experts may have expected, said Maaike Arts, an early childhood nutrition specialist at UNICEF…” (Lieberman, 5/10).

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Testing Individual Units Of Donated Blood For Zika Likely Not Cost Effective, Study Shows

Associated Press: Study finds little bang for the buck in Zika blood testing
“Screening blood donations for the Zika virus netted only a few infections at a cost of more than $5 million for each positive test result, according to new research. … The study, published Wednesday by the New England Journal of Medicine, found that the blood donation testing requirements offered little bang for the buck. It also raised questions about whether a cheaper testing method should be used…” (Stobbe, 5/9).

HealthDay News: Is Testing for Zika in U.S. Blood Supply Worth the Cost?
“…The grand total cost of screening approached $42 million, the study found. Put another way, it cost nearly $5.3 million to catch one Zika-positive donation…” (Norton, 5/9).

STAT: Testing for Zika virus in blood donors finds few infections — at a cost of about $5.3 million each
“…Dr. Susan Stramer, senior author of the study and vice president of scientific affairs at the American Red Cross Biomedical Services, said that moving to test blood donations in small pools as opposed to individually would cut the cost of Zika screening in half. And it would bring Zika screening in line with the way the Red Cross and others test for the variety of pathogens they look for in blood donations, including HIV, West Nile virus, and hepatitis B and C…” (Branswell, 5/9).

Wall Street Journal: Risk of Zika Infection From Blood Transfusion Is Low, New Study Says
“…After causing an explosive epidemic in 2016, Zika has largely receded; many people are now immune to the virus, making it difficult for it to circulate, scientists say. There have been 5,700 symptomatic cases of Zika since 2015 in U.S. states and 37,229 in U.S. territories, namely Puerto Rico, between 2015 and the beginning of May, according to the Centers for Disease Control and Prevention…” (McKay, 5/9).

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More News In Global Health

CNN: Jimmy Carter calls U.S. exit from Iran nuclear deal ‘serious mistake,’ then talks health (Howard et al., 5/10).

Devex: Cities and NCDs: The struggle toward a smoke-free Kathmandu (Ravelo, 5/10).

Reuters: Peru declares alert over suspected Guillain-Barre outbreak (Cervantes/Taj, 5/9).

Xinhua News: Anger in Zambia after audit reveals abuse of Global Funds (5/10).

Xinhua News: Uganda completes first round of cholera vaccination (5/9).

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Editorials and Opinions

U.S. Congress Should Reject President Trump's Proposed Rescission Package, Especially In Light Of DRC Ebola Outbreak

Foreign Policy: Ebola Is Back. And Trump Is Trying to Kill Funding for It.
Laurie Garrett, former senior fellow for global health at the Council on Foreign Relations

“As U.S. President Donald Trump announced his decision to pull out of the Iran nuclear deal, the White House discreetly released an official proposal to cut funding for children’s health programs, Medicare, and Ebola responses. The two policies may seem unrelated, but they share the same basic design — assuming vast national security risks simply for the sake of dismantling former President Barack Obama’s legacy. … Trump’s decision to eliminate the Ebola funds was announced at nearly the same time as the World Health Organization issued a bulletin declaring a new outbreak of Ebola in the Democratic Republic of the Congo. … There is no good reason to rescind the $252 million in funds to combat the deadly virus, at a time when there are signs of a renewed outbreak that could pose a threat to Americans, except if the goal is to destroy a program created by Obama … Trump has repeatedly demonstrated his disdain for science, services for the poor, diplomacy, and foreign assistance. … He has no one in his inner circle to explain how a program for hospital hygiene in Monrovia, Liberia, decreases the likelihood that a traveler unknowingly infected with a dangerous pathogen will turn up in a hospital in Dallas. Members of Congress should reject Trump’s entire rescission package, as it does nothing to reduce the deficit they created with their enormous tax cut package and everything to harm the health and safety of the American people” (5/9).

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3 Ways To Save Time, Control Costs When Responding To Infectious Diseases

The Hill: Infectious diseases can be tackled, here are 3 solutions
Robert C. Bollinger, professor at the Johns Hopkins School of Medicine and founder of emocha

“Time is the greatest enemy in the treatment of any disease. The amount of time that passes before a patient is diagnosed, then how much longer it takes for that person to get connected to care, begin treatment, and so on. This could mean the difference between lives saved or lost and costs contained or uncontrolled. … There are three ways that time can be saved to better address both known and unknown infectious diseases. 1. Recognize the disease as soon as possible. … 2. Implement preventive and treatment strategies … 3. Adherence and comply with treatments laid out … We must … support greater investment in the global research and public health capacity to diagnose, access, and adhere to prevention and care for infectious diseases, as soon as possible” (5/9).

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New Book Considers Progress, Next Steps In Efforts To Address AMR, Urges More Action

Project Syndicate: Where Are We in the Fight Against AMR?
Jim O’Neill, honorary professor of economics at Manchester University and former chair of the Review on Antimicrobial Resistance

“…To mark the second anniversary of the British government’s Review on Antimicrobial Resistance (AMR), which I had the honor of chairing, two members of the Review team — Anthony McDonnell and Will Hall — and I have published a new book: Superbugs: An Arms Race Against Bacteria. In it, we discuss the Review’s 10 recommended interventions — what I call the Ten Commandments — while considering the progress made so far, and the work that still needs to be done. The first part of the book provides a detailed history of our understanding of bacteria and drug resistance, and points to evidence that drug resistance may now be rising faster than we had assumed. … [T]he second part of the book focuses on solutions, and compiles expert viewpoints from many of those we interviewed for the Review. … Overcoming the AMR threat is entirely feasible. But confronting it will require us to turn words into action. By getting out of our comfort zones now, we can avoid far worse discomfort down the road” (5/9)

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From the Global Health Policy Community

Human Rights, Mental Health Experts Discuss Reasons Congress Should Oppose Gina Haspel As CIA Director

Physicians for Human Rights: The Facts About Gina Haspel and Why We Should Oppose Her Appointment as CIA Head
Donna McKay, executive director at Physicians for Human Rights, discusses CIA director nominee Gina Haspel and her alleged involvement in controversial interrogation techniques, offering reasons why Congress should oppose her appointment. McKay writes, “Making Haspel CIA director would effectively reward the agency’s use of torture and send a dangerous message to torturers around the world to continue their barbarity without consequence. We simply must do better by victims and survivors of torture and ensure these acts remain a part of history, never to be repeated” (5/9).

Physicians for Human Rights: We have evaluated torture survivors. Gina Haspel cannot head the CIA.
Sondra Crosby, associate professor at Boston University and medical consultant at Physicians for Human Rights, and Brock Chisholm, consultant clinical psychologist, founder of Trauma Treatment International, and director of Criterion A Psychology Services, discuss the use of controversial interrogation techniques and impacts on survivors, writing, “We have spent a combined 40 years evaluating torture survivors, and our unique, intimate perspective leads us to just one conclusion: confirming Haspel to lead the CIA would be unconscionable” (5/7).

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African Meeting Highlights Need For Increased Political Leadership In Efforts To End TB

Global Fund to Fight AIDS, Tuberculosis and Malaria’s “Voices”: Spreading Ideas to Help End TB
Eliud Wandwalo, senior disease coordinator for TB at the Global Fund, and Tina Draser, the Global Fund’s regional manager for Central Africa, discuss global efforts to address TB and highlight examples from five countries presented at a late-March meeting of national TB program managers, civil society, and global health partners from 21 West and Central African nations. The meeting also culminated in “a document called the Cotonou TB Declaration, [in which] participants urged governments in West and Central Africa to reduce the proportion of missing TB cases by 50 percent by 2020 and to reduce deaths among those co-infected with TB and HIV by half by 2020. They also called for urgent action to improve childhood TB interventions — prevention, case finding, and treatment — by at least 50 percent by 2020” (5/8).

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CFR Roundtable Discussion With World Bank General Counsel Highlights Connection Between Gender-Based Violence, Economic Development

Council on Foreign Relations: Gender-Based Violence and the Economy: A Conversation with World Bank Group General Counsel Sandie Okoro
Catherine Powell, adjunct senior fellow in the Women and Foreign Policy program at the Council on Foreign Relations (CFR) and professor at Fordham Law School, highlights a recent CFR roundtable where Sandie Okoroa, the World Bank Group’s general counsel, discussed “gender-based violence as part and parcel of economic development.” Powell notes, “The bank has drawn a connection between women’s empowerment and economic development, because research shows promoting gender equality is linked to prosperity and, therefore, ‘smart economics'” (5/9).

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CSIS Releases May 2018 Issue Of Global Health Policy Center Monthly Newsletter

Center for Strategic & International Studies: Global Health Policy Center Monthly Newsletter: May 2018
In the May 2018 CSIS Global Health Policy Center Newsletter, J. Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center, highlights publications, podcasts, and past and upcoming events hosted by CSIS. The newsletter includes links to a commentary by CSIS Global Health Policy Center Senior Associate Katherine Bliss on “the need for intensified engagement in vaccine delivery around the world,” as well as a podcast hosted by Morrison, who speaks with Christopher Murray, director of the Institute of Health Metrics and Evaluation (IHME), about “the future of financing for the global HIV/AIDS pandemic and the efforts to move towards universal health coverage around the world” (May 2018).

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'Pediatrics' Journal Article Highlights Impacts Of Global Warming On Child Health Worldwide

AAP News & Journals Blog: A Call to Action: Climate Change and its Effect on Pediatric Global Health
Catherine Spaulding, immediate-past Section on Pediatric Trainees (SOPT) monthly feature editor for the journal Pediatrics, highlights a “recently released article in Pediatrics, [in which] Dr. Rebecca Philipsborn and Dr. Kevin Chan discuss how global warming will lead to a series of devastating consequences that will disproportionately affect the health and well-being of children around the globe” (5/9).

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Zimbabwean Lawmakers Should Revise Laws To Ensure Adolescent Girls' Rights To Sexual, Reproductive Health

Amnesty International: Zimbabwe: Revise colonial-era health law to ensure adolescent girls’ rights
“Zimbabwe’s colonial-era public health laws must be revised to guarantee the human rights, and the dignity and equality of everyone, including adolescent girls who bear the brunt of existing discrimination, Amnesty International said [Tuesday], ahead of the parliamentary debate on the Public Health Act Amendment Bill. … Public health and human rights experts have called on Zimbabwe’s government to remove age barriers for sexual and reproductive health services and information, and to ensure third party permission for accessing these services is not required…” (5/8).

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Study In Rural Kenya, Uganda Analyzes Predictors Of Early PrEP Adoption

IDSA’s “Science Speaks”: Early PrEP uptake in Africa study gives support for possibility of wider acceptance
Antigone Barton, senior editor and writer of “Science Speaks,” discusses findings from a study analyzing predictors of early PrEP adoption by examining factors increasing the likelihood of PrEP acceptance among people in rural Kenya and Uganda. Barton notes, “The findings point to the possibility, with caveats, that widespread roll-out of the proven HIV prevention measure to individuals at high risks for infection across resource-limited communities is feasible” (5/9).

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From the U.S. Government

USAID Newsletter Focuses On Infectious Diseases

USAID’s “Global Health News”: A Focus on Infectious Disease
USAID’s April 2018 newsletter focuses on infectious diseases. “Scores of infectious diseases threaten humankind — both familiar ones like malaria, HIV, tuberculosis, and neglected tropical diseases, as well as emerging viruses and bacterial infections such as Ebola, H5N1 avian flu, and Zika. April’s Global Health newsletter highlights USAID’s work in malaria, NTDs, emerging threats and previews a new [Smithsonian] exhibit: Outbreak” (April 2018).

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