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Kaiser Daily Global Health Policy Report

In The News

Leadership, Cooperation Responsible For 'Remarkable Progress' Against HIV/AIDS In Africa, UNAIDS Report Says

“As the African Union (AU) begins its 21st summit in Addis Ababa, celebrating 50 years of African unity, [UNAIDS] has released “Update,” a new report [.pdf] on the AIDS response in Africa, documenting the remarkable recent progress against HIV on the continent,” a UNAIDS press release reports. “The number of people in Africa receiving antiretroviral treatment increased from less than one million in 2005 to 7.1 million in 2012, with nearly one million added in the last year alone,” the press release states, adding, “AIDS-related deaths are also continuing to fall — reducing by 32 percent from 2005 to 2011 as are the numbers of new HIV infections which have fallen by 33 percent from 2001 to 2011” (5/21). The report “attributes this success to strong leadership and shared responsibility in Africa and among the global community,” according to the U.N. News Centre. The report “also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths,” the news service writes.

“Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 percent of people living with HIV globally,” the U.N. News Centre writes, noting, “In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.” The news service says “[t]he report also stresses AU leadership is essential to reverse the epidemic.” At the ongoing AU Summit, “AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments,” the news service writes, noting, “The AU, UNAIDS and the New Partnership for Africa’s Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, tuberculosis and malaria in Africa” (5/21). In the report, UNAIDS Executive Director Michel Sidibé “emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities,” the press release states (5/21).

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At WHA, World Bank's Kim Endorses UHC To End Extreme Poverty, WHO's Fukuda Says World Unprepared For 'Severe' Disease Outbreak

In a speech delivered to the World Health Assembly, the annual meeting of the WHO’s governing body, “World Bank President Jim Yong Kim said universal health insurance coverage in all countries can help achieve a goal of ending extreme poverty by 2030,” Bloomberg Businessweek reports. “Every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality and affordability,” Kim said, according to the news service (Bennett, 5/21). “Kim said the Bank Group would help countries tackle two major challenges as they advance toward universal health coverage: to ensure no family is forced into poverty because of health care expenses, and to close the gap in access to health services and public health protection for the poorest 40 percent of the population in every country,” and “[h]e outlined five specific ways the Bank Group will support countries in their drive toward universal coverage: ramping up analytic work and support for strengthening health systems; leading an effort to help countries reach Millennium Development Goals 4 and 5 on maternal and child mortality; developing a monitoring framework for universal health coverage, together with the [WHO]; deepening work on the science of delivery; and stepping up efforts to  improve health through action in other sectors that affect whether people lead healthy lives,” a World Bank press release states (5/21).

Also at the meeting, WHO Assistant Director-General for Health Security and Environment Keiji Fukuda discussed the recent outbreaks of H7N9 bird flu in China and the novel coronavirus MERS in Saudi Arabia and “told delegates … that despite efforts since an outbreak of another form of avian influenza, H1N1, in 2009-10, far more contingency planning was essential,” Agence France-Presse reports. “Even though work has been done since that time, the world is not ready for a large, severe outbreak,” Fukuda said, the news agency states. “Rapid-reaction systems were crucial, given that health authorities’ efforts are already hampered by lack of knowledge about such diseases, he insisted,” AFP writes. Fukuda said, “This is an unusual global situation. … We have not seen a comparable situation since 2003, when we had both the SARS virus emerge and then later the H5N1 virus reemerge” (Fowler, 5/21).

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WHO Says Novel Coronavirus Continuing To Infect People, Announces Tunisian Death From MERS

“A 66-year-old Tunisian man has died from the new coronavirus following a visit to Saudi Arabia and two of his adult children were infected with it, the Tunisian Health Ministry reported” on Monday, the Associated Press reports. “His sons were treated and have since recovered but the rest of the family remains under medical observation, the ministry said in a statement Monday,” the news agency writes, adding that the WHO “confirmed the cases of the children, but said one of them was a daughter who was with her father for part of the trip to Saudi Arabia and Qatar” (Schemm, 5/21). “The man, a diabetic, died in hospital in the city of Monastir, ministry spokesman Ibrahim Labassi said,” Reuters reports. “The novel coronavirus, also known by the acronym nCoV and as Middle East Respiratory Syndrome coronavirus, or MERS, belongs to the same family as viruses that cause common colds and the one that caused a deadly outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003,” the news agency writes (Amara, 5/21). “These Tunisia cases haven’t changed our risk assessment, but they do show the virus is still infecting people,” WHO spokesperson Gregory Hartl said, according to the AP (5/21). Cases of the new virus “have been detected in Saudi Arabia, Jordan, Qatar, the United Arab Emirates (UAE), Germany, the U.K. and France,” BBC News notes, adding all of the cases detected in Europe have a connection with the Middle East (5/21).

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UNHCR Working To Contain Cholera Outbreak Among Malian Refugees In Niger

“The United Nations refugee agency [UNHCR] said that they are working to contain a cholera outbreak in Niger in a refugee camp for people fleeing the conflict in Mali,” the Associated Press/Washington Post reports. “On May 11, the government of Niger declared a cholera epidemic,” the news agency writes, noting, “Last year, a total of 110 people died throughout Niger” from cholera (5/21). UNHCR spokesperson Melissa Fleming said at a press briefing in Geneva on Tuesday, “We are responding to the outbreak in the camps by implementing emergency health and sanitation measures, such as increasing the supply of clean water,” as well as “working to spread public health messages in the camps through sensitization campaigns,” according to a UNHCR statement. “Niger is currently hosting some 50,000 Malian refugees,” after “[t]hey fled a conflict in the North of their country which started in early 2012,” the statement notes (5/21).

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More Focus Needed On Health Of Men Worldwide, Lancet Commentary Says

“Men experience a higher burden of disease and lower life expectancy than women, but policies focusing on the health needs of men are notably absent from the strategies of global health organizations,” according to a recent Lancet commentary, a University College London press release reports (Weston, 5/16). “If you look at the top 10 health problems around the world, they are much more common in men. … But the current focus is predominantly on women’s health,” commentary author Sarah Hawkes of the Institute for Global Health at University College London said, NPR’s “Shots” blog writes (Doucleff, 5/18). According to the press release, the commentary argues “that global health institutions should start tackling the social norms and commercial interests that push men to take risks with their health” (5/16).

In the commentary, Hawkes and co-author Kent Buse of UNAIDS “survey the evidence for the role of gender in health status, analyze responses to gender by key global health actors, and propose strategies for mainstreaming gender-related evidence into policies and programs,” they write. The commentary was included in a special theme issue published by The Lancet ahead of the 2013 Women Deliver conference, to be held May 28-30 in Kuala Lumpur, Malaysia (5/18).

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Editorials and Opinions

U.S. Leadership Critical for Global Nutrition Efforts

“Malnutrition is one of the world’s most serious, yet least-addressed, development challenges,” former Senate Majority Leader Bill Frist (R-Tenn.) writes in an opinion piece in “The Hill,” continuing, “While the problem is complex, the solutions don’t need to be.” “This is a critical moment for the U.S. to lead on global nutrition,” Frist says, noting, “What we need are the resources and the political commitment to scale up proven nutrition solutions.” He discusses the successes of PEPFAR and looks to the U.S. HIV/AIDS program for lessons that can be applied to nutrition efforts, writing, “To follow the proven PEPFAR model, we should target resources to benefit the most vulnerable; align resources across all agencies and programs; focus on countries where we have committed partners and country-led strategies; and coordinate efforts internationally.”

Frist says that the “Nutrition for Growth” high-level meeting in London to be held on June 8 “is the perfect opportunity for the Obama administration to announce a bold global nutrition strategy that outlines a multifaceted and multi-year approach to better coordinate and integrate nutrition resources across sectors and agencies, with clearly defined goals and targets, and with the dedicated resources necessary to achieve the strategy’s stated goals.” He adds, “Bipartisan leaders in Congress must step forward and commit to working with the president to make global nutrition a top priority of U.S. development assistance.” Frist concludes, “The moment for turning the corner on global nutrition is here, and it is time for our elected leaders to demonstrate anew how American leadership is the driving force for building a healthier, safer and more prosperous world” (5/21).

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Partnerships Will Help Defeat Malaria

“In the past 10 years, partners working together have reversed malaria’s spread and prevented millions of deaths, mostly of children under the age of five. Yet even with all that progress, malaria still claims a child’s life every minute,” President of Liberia Ellen Johnson-Sirleaf and Global Fund to Fight AIDS, Tuberculosis and Malaria Executive Director Mark Dybul write in the Huffington Post’s “The Big Push” blog. “So we have more work to do,” they state, adding that with existing “tools to defeat this disease,” such as long-acting insecticide-treated bednets and new drugs and diagnostics, “[w]e will achieve greatness by getting it done.”

“Controlling malaria isn’t only a prospect of preventing needless deaths, it is an economic imperative,” Sirleaf and Dybul continue, noting, “Defeating malaria is one of the first steps we can take to speed up Africa-driven economic growth.” They note, “Later this year, the international community will gather to pledge money to the Global Fund for the next three years,” which will provide “the kind of investment where the return will be measured in lives saved, and the increased productivity of developing countries no longer burdened by deaths from mosquito bites.” In addition, “African leaders will continue to demonstrate their own commitment to national health programs both financially and with human resources,” they state. Noting there are fewer than 1,000 days until the deadline for the 2015 Millennium Development Goals (MDGs), the authors conclude that “[m]eeting the health-related MDGs would no doubt be a great accomplishment for our global brothers and sisters, but history will judge us by whether or not we fill our war chest and use our proven strategies and tools to defeat these diseases. As partners in this fight, this is our shared opportunity and responsibility” (5/21).

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Fight Against HIV/AIDS Shows World Can Overcome Health Inequalities

“Poverty and inequity are the world’s greatest killers,” Michel Kazatchkine, U.N. special envoy for HIV/AIDS in Eastern Europe and Central Asia, writes in an opinion piece in The Age, noting, “The developing world bears an extraordinarily inequitable burden of infectious disease, 90 percent of it, and yet these countries represent just 12 percent of all health spending.” He continues, “AIDS is a classic example. Of the 30 million AIDS deaths since the virus that causes the disease was identified 30 years ago this week, 90 percent have occurred in Africa.” However, “against such odds, the face of AIDS has changed from one of desolation to one of hope,” Kazatchkine states, adding, “The global effort to defeat AIDS over the past three decades has demonstrated a long-suspected truth: health should no more be seen as a consequence of economic growth.”

“AIDS is perhaps the pre-eminent example of successful investment in health,” Kazatchkine writes, highlighting the history of the disease and the progress made in prevention, treatment and care. “Several factors have been key to this remarkable progress” in reducing HIV/AIDS mortality, he states, including “activism and social mobilization,” a “global political commitment to funding health,” and “‘innovation’ in the way in which aid is provided through new global mechanisms and partnerships, and in the way it is accounted for — increasingly, based on performance of programs.” However, “[t]he question today is whether this remarkable progress can be sustained and amplified … in a global context that has changed significantly from what it was 10 years ago,” he writes, noting that “while inequities between countries have decreased, and the overall proportion of people in extreme poverty has decreased, the inequities within countries are now increasing everywhere, particularly in middle-income countries and emerging economies.” Kazatchkine continues, “But there is a way forward, as AIDS has shown” (5/22).

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Opinion Pieces Address Maritime Aspects Of Proposed Food Aid Program Reforms

The following opinion pieces address food aid program reforms proposed by the Obama administration in its FY 2014 budget request.

  • Reps. Elijah Cummings (D-Md.), Duncan Hunter (R-Calif.), Nick Rahall (D-W.V.), U.S. News & World Report: “[T]he Obama administration recently proposed restructuring the food aid program as primarily a cash voucher system — effectively handing out cash overseas, not food,” the U.S. Congress members write, adding, “Supporters of this drastic change … are missing important facts about U.S. food aid programs and the U.S. merchant marine.” They continue, “Food aid, carried on U.S.-flag commercial vessels pursuant to cargo preference laws, provides essential cargo for our domestic fleet,” and they note that “merchant mariners and vessels sustained by food aid cargoes have provided 95 percent of the sealift capacity that has supported our troops in Afghanistan and Iraq at a cost dramatically lower than if the Pentagon had to maintain this capacity using wholly government-owned assets and federal employees.” The authors conclude, “Before considering such dramatic alterations to existing food aid programs, we must recognize that there are no viable, lower cost alternatives to replace this vital sealift capacity” and “acknowledge that any such changes would only speed the decline of the U.S.-flag commercial fleet and destroy the livelihoods of the thousands of U.S. seafarers who sail those vessels” (5/21).
  • John Norris, Foreign Policy: Noting “more than half of every dollar spent on U.S. food programs currently goes to shipping and transportation costs rather than lifesaving food,” Norris, executive director of the Sustainable Security program at the Center for American Progress, writes that the maritime industry’s arguments against food aid reform — “that the current food aid system should not be changed because it ‘provides support for our U.S. Merchant Marine’ and is ‘essential to our national defense sealift capability'” — “are perhaps the most risible.” The 1954 law “mandat[ing] that the majority of U.S. food aid commodities be shipped aboard U.S.-flagged vessels … was a reasonable Cold War policy originally meant to ensure that additional ships and their naval crews were available during times of war,” he writes. However, “[t]he Department of Defense has been blunt in saying that it doesn’t need cargo preference to keep a stand-by fleet at the ready,” he says. In addition, “the farce that is ‘American flagging'” means “‘American’ companies can be subsidiaries of foreign corporations,” Norris writes, noting “one of the fiercest advocates against food aid reform has been Danish shipping giant Maesrk” and “[t]he actual number of U.S. maritime jobs affected by reforming food aid would be small.” He concludes, “Congress has all the evidence it needs to do the right thing on food aid. Whether it has sufficient spine is another question entirely” (5/21).

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From the Global Health Policy Community

Medical Education Partnership Initiative Helping Africa Meet Health Care Needs

“During a World Health Assembly side meeting on May 20, I joined U.S. Secretary of Health and Human Services, Kathleen Sebelius, and leaders from across Africa to highlight the contributions the Medical Education Partnership Initiative (MEPI) is making in meeting the priorities of national ministries of health,” Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and U.S. global AIDS coordinator, writes in the State Department’s “DipNote” blog. Goosby discusses the health care worker shortage in Africa and the benefits of MEPI, writing, “MEPI, along with the Nursing Education Partnership Initiative (NEPI), help effectively address that need and support a long-term solution to improve the quantity, quality, and relevance of doctors, nurses, and other health care personnel.” He continues, “The demonstrated success of the MEPI program is an essential ingredient to our shared goal of an AIDS-free generation, but we still have more to accomplish” (5/21).

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CSIS Report Examines U.S. Investments In Women's Health

Writing in the Center for Strategic and International Studies’ (CSIS) “Smart Global Health” blog, Janet Fleischman, senior associate with the CSIS Global Health Policy Center, and Alisha Kramer, program coordinator and research assistant with the center, describe a report on a CSIS delegation visit to Zambia “to examine the opportunities and challenges of strengthening U.S. investments overseas in women’s health.” They write, “The report focuses on three women’s health issues — maternal mortality, cervical cancer, and access to voluntary family planning — and explores how the United States leverages [PEPFAR] and works with its other partners to prioritize women’s health.” They say the Saving Mothers, Giving Life (SMGL) and Pink Ribbon Red Ribbon (PRRR) “initiatives illustrate new ways to make the best use of U.S. investments in women’s health, as well as challenges to achieving health goals,” describe some of these challenges, and provide five priority steps to “achieve real impact in women’s health” (5/21).

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Blog Examines Shift Toward NCDs In Proposed WHO Budget

In the first of a series of blog posts on the future of global health, Council on Foreign Relations Senior Fellow Laurie Garrett writes in her blog, “[T]hough the budget of WHO is woeful, as I will show in this and subsequent blog posts this week, [WHO Director-General Margaret] Chan has the power to persuade the [World Health Assembly] to approve new directions in global health through her choices in apportioning funds.” Garrett describes Chan’s WHO budget proposal, providing several flow charts, and she writes, “Overall, the proposed WHO 2014-15 budget offers startling changes in the mission and direction of the agency, pushing it significantly away from infectious diseases, HIV, TB, malaria, and outbreaks, and towards addressing disabilities, diabetes, heart disease, cancer, and aging.” She continues, “The text of the proposed DG budget does little to explain why these shifts in spending, and therefore in the entire mission of the WHO, are recommended.” Garrett concludes, “It seems to this writer that the WHO’s decision to increase spending in non-communicable diseases at the apparent expense of its own capacity to respond to outbreaks and epidemics is hasty. The world is not yet ready to walk away from humanity’s war with the microbes” (5/21).

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