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Kaiser Daily Global Health Policy Report

In The News

Experts Discuss IOM Evaluation Of PEPFAR At Panel Discussion Convened By KFF, CSIS

“Experts addressed the future of U.S. efforts to tackle HIV/AIDS abroad at a panel discussion earlier this week in Washington, D.C.,” GlobalPost reports. “Convened by the Kaiser Family Foundation (KFF) and the Center for Strategic and International Studies’ (CSIS) Global Health Policy Center, the event focused on the policy implications of a recent Institute of Medicine (IOM) evaluation of the U.S.’ largest global health program, [PEPFAR],” the news service writes, noting, “The congressionally mandated IOM report, published in February, heralded PEPFAR as ‘globally transformative’ and made several recommendations to continue the program’s progress on preventing and treating HIV/AIDS. Chief among these recommendations is for the U.S. to help partner countries assume management of their own programs.”

“Panelists discussed priorities for PEPFAR in the coming years, including the need to improve metrics and data, better address the needs of at-risk populations, and ensure sustained program funding,” GlobalPost continues. Obtaining data is “really the challenge of our field,” panelist Jennifer Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation, said, according to the news service. The panelists “acknowledged that the legislation’s reauthorization in 2013 is uncertain, but said that either way, the IOM report provides a path for future global work on HIV/AIDS and related global health issues,” the news service states, adding, “The successful transition of programs to partner countries [was] one of the IOM’s most important takeaways.” Deputy Global AIDS Coordinator Julia Martin, who also appeared on the panel, said, “We’re grappling very seriously with the word ‘transition'” and its meaning for each country, GlobalPost notes. J. Stephen Morrison, CSIS vice president and director of the CSIS Global Health Policy Center, moderated the panel, which also included Chris Collins, vice president and director of public policy at amfAR, the Foundation for AIDS Research, and Kimberly Scott, senior program officer at the IOM, according to the news service. GlobalPost includes a video of the discussion (Miley, 5/2).

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FAO, Famine Early Warning Systems Network Release Report Estimating Death Toll Of Recent Somali Famine

“More than a quarter of a million people are estimated to have died during the recent famine and food crisis in Somalia, and more than half were children under five, making it the worst famine in the past 25 years, according to figures [.pdf] published on Thursday,” The Guardian reports (Ford, 5/2). “Some 133,000 of the Somalis who perished — about half — were children under five, according to FAO’s Food Security and Nutrition Analysis Unit for Somalia (FSNAU), which carried out the study along with the USAID-funded Famine Early Warning Systems Network (FEWS NET),” the U.N. News Centre writes (5/2). “The toll is much higher than was feared at the time of the 2010-2012 food crisis in the troubled Horn of Africa country and also exceeds the 220,000 who starved to death in a 1992 famine, according to the findings,” Al Jazeera notes (5/2). “That’s 133,000 under-five child deaths out of an estimated 6.5 million people in south-central Somalia. That compares to 65,000 under-five deaths that occurred in all industrial countries in the world combined during the same period, a population of 990 million, said Chris Hillbruner, a senior food security adviser at FEWS NET,” the Associated Press writes.

“The two agencies had warned the world as early as fall 2010 that failed rains in Somalia meant a hunger crisis was approaching,” according to the AP. But Hillbruner said, “I think the international community has become used to levels of malnutrition and food insecurity in southern Somalia that in other parts of the world would be considered unacceptable,” the AP notes. “In Washington, U.S. State Department spokesman Patrick Ventrell said the hardest-hit famine regions were controlled by the extremist Islamist group al-Shabab,” the news agency writes, adding, “Ken Menkaus, a Somalia expert at Davidson College, said some elements of al-Shabab bear major responsibility for famine deaths, but that other factors contributed as well, including a corrupt Somali central government and general insecurity that made travel in Somalia dangerous.” The AP notes “Somalia has made great progress since the famine ended in February 2012” (Straziuso/Lee, 5/2).

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NGOs Await U.S. Supreme Court Ruling On Anti-Prostitution Pledge

“Non-governmental organizations (NGOs) are anxiously waiting for a ruling from the U.S. Supreme Court, which heard arguments last week challenging a 2003 law that bars funding for groups working on HIV/AIDS prevention that do not have anti-prostitution policies,” The Lancet reports. “A range of groups including faith-based and conservative organizations say the government’s policy is an unconstitutional infringement of free speech while NGOs say in particular that their overseas health work with sex workers will be limited,” while “other groups, such as the Coalition Against Trafficking in Women, say sex work cannot be separated from efforts to fight public health problems, including the spread of HIV/AIDS,” the journal writes. “The Obama administration has argued in court papers that there is no First Amendment violation because groups ‘have been given a voluntary choice’ of whether to participate and Congress had ‘wide latitude to attach conditions to the receipt of federal funds,'” the journal notes, adding the court is expected to decide the case before the end of June. The Lancet includes comments from several NGO representatives and describes two briefs filed with the court against the policy (Devi, 5/4).

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Members Of Congress Skeptical Over Proposal To Shift Food Aid Funds From Agriculture To USAID

“A proposal by the Obama administration to overhaul the international food aid program has set off a jurisdictional fight among members of several House and Senate committees, threatening to derail the most significant change to the program since it was created nearly 60 years ago,” the New York Times reports. Under the $1.4 billion annual program, the U.S. “provides over half of the world’s food aid,” the newspaper notes. The New York Times focuses on the proposal’s plan to shift food aid money from the Department of Agriculture’s budget to the foreign affairs budget, where it would be controlled by USAID. “The reorganization would also mean that Congressional oversight of the program would shift from the House and Senate appropriations subcommittees on agriculture to the appropriations subcommittees on foreign operations,” the newspaper adds. “Budget experts say Mr. Obama’s proposal will be a tough sell in Congress, where committee members can be parochial and rarely want to give up control of programs,” the newspaper writes and discusses the positions of several members of Congress. “While it is common for committees to allow agencies to move money from one account to another, experts said it was rare for Congressional appropriators to move money and oversight of a program from one agency to another,” the New York Times states (Nixon, 5/2).

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Syria Receives First Shipment Of Non-Lethal Aid From U.S.

“As the debate in the U.S. heats up over just how far to go in aiding Syria’s rebels, the first U.S.-supplied help arrived this week in the form of ready-to-eat meals and medical kits, trucked into Aleppo province from Turkey,” the Wall Street Journal’s “Middle East Real Time” blog reports. “The delivery is the first of a series pledged by the U.S. administration, which has decided to engage more deeply with Syrian rebels by offering the anti-government fighters non-lethal aid directly,” the blog notes, adding, “Last month, Secretary [of State John] Kerry said the U.S. would double its non-lethal assistance to the Syrian opposition. The U.S. pledged a new $123 million, bringing the total U.S. pledge of non-lethal aid to $250 million” (Malas, 5/2).

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India Introduces Amended Food Security Bill To Lower House Of Parliament

“India’s government Thursday introduced an amended food security bill in the lower house of Parliament that would give around 70 percent of the population the right to cheap food grain, a government statement said,” the Wall Street Journal reports. “The ambitious but long-delayed bill will now be debated on by lawmakers in Parliament before a vote,” the news service writes, adding, “The proposed law is expected to be the centerpiece of the Congress party-led ruling coalition’s poll campaign for the general elections scheduled in early 2014.”

“The proposed law aims to supply huge quantities of grain at extremely low prices, after procuring it from farmers at high prices. Food subsidies currently account for more than 40 percent of India’s total subsidy costs,” according to the Wall Street Journal. “Critics say the program may put an unbearable financial strain on the government’s already bloated fiscal deficit,” and they “say large quantities of the food grain meant to be given under the proposed law face the risk of diversion under the program, as it would be implemented through a notoriously corrupt and leaky public-distribution system,” the news service continues (Mukherji, 5/2).

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War In Iraq Impacted Health Care System, IRIN Reports

As part of its special report on the humanitarian impact of the U.S.-led war in Iraq, titled “Iraq: Ten Years On,” IRIN examines the “impact of the 2003 invasion and subsequent conflict on Iraq’s health care system.” The news service writes, “The conflict shattered Iraq’s primary health care delivery, disease control and prevention services, and health research infrastructure. Attempts to resurrect Iraq’s health care system remain hindered by a number of factors, including fragile national security and lack of utilities like water and electricity.” IRIN outlines how the country’s once “robust” health care system has deteriorated, resulting in a lack of trained medical professionals, unvaccinated children, little health insurance, and high rates of mental health issues. However, life expectancy has increased, rates of child mortality have dropped, and government expenditures on health care have increased over the last decade, the news service notes (5/2).

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New York Times Examines Family Planning Policies Under New Egyptian Government

“More than two years after the Egyptian uprising, the country’s new Islamist government … has remained silent about [a] crucial indicator that has surged to a 20-year high: the country’s birthrate,” the New York Times reports in an article examining Egypt’s family planning programs. “The new government of President Mohamed Morsi has continued financing for family planning programs. But health officials have taken a starkly different view of climbing birthrates, presenting the problem as one of economic management — not the size of the population,” the newspaper writes, adding, “Population experts are increasingly alarmed by the government’s silence and its lack of focus on the issue.” The New York Times discusses the history of family planning and contraception programs in Egypt, as well as the current government’s position (Fahim et al., 5/2).

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Media Outlets Examines Gateses' Role In Global Health

Noting philanthropists Bill and Melinda Gates were in Washington, D.C., last weekend at the 150th annual meeting of the National Academy of Sciences, where they “were commended for changing the trajectory of international public health through their foundation, the Bill & Melinda Gates Foundation,” Science interviews the couple on a number of topics, including “why vaccines are the best buy in public health, the urgent need to boost routine childhood immunization in places like northern Nigeria, where coverage is less than 30 percent, [and] the importance of working with local communities, and especially women, to be sure they get culturally appropriate technologies they want” (Roberts, 5/3). In similar news, Business Insider profiles Melinda Gates, “a brilliant, strong-minded businesswoman and philanthropist who’s intent on changing the world,” highlighting her efforts to “champion for women’s rights and reproductive health, arming women around the world with birth control” (Rosenberg/Polland, 5/2).

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Editorials and Opinions

Editorials Endorse Population-Based HIV/AIDS Testing, Prevention Campaigns

The United States Preventive Services Task Force, an independent government advisory panel, on Tuesday published updated guidelines for HIV screening in the U.S., recommending that physicians test all adults ages 15-65, all pregnant women, and younger adolescents and older adults who are at increased risk of infection. The following summarizes two editorials that note the new recommendations.

  • The Lancet: “In just over three decades, AIDS has exacted a severe toll on human health and drawn inspiring responses from patients, researchers, and doctors”; however, “[m]ajor challenges remain,” the editorial states. In the U.S. and the U.K., between 20 and 25 percent of people living with HIV are undiagnosed, The Lancet notes. “[I]mproved access of low-income groups to testing and treatment will undoubtedly require a successful transition to comprehensive health coverage in the USA,” the editorial states, and it “welcome[s]” a new HIV public awareness campaign recently launched in the U.K. “[P]redictable human behaviors transmit the virus — sex, childbirth, and injection drug use,” The Lancet notes, concluding, “Along with the ongoing task of providing antiretrovirals to some 34 million people living with HIV worldwide, comprehensive provision of information and health care will be key in meeting the exacting challenge of minimizing new infections” (5/4).
  • New York Times: If the “more than 200,000 Americans [who] are infected but don’t know it … could be detected and treated with antiviral drugs, they would be less likely to suffer severe illness and premature death and less able to spread the virus to others through sexual intercourse or needle-sharing,” the editorial states. “The advice comes on the heels of reports that strong antiviral drugs administered shortly after infection virtually eliminated active virus from a Mississippi baby and several patients in France, an achievement that underscores the crucial importance of early detection,” according to the New York Times. Though “[t]hese reports, which need to be confirmed by further studies, were not considered by the task force, … they add to hopes that the world could, by committing sufficient resources to detection and treatment, finally bring the AIDS epidemic under control,” the editorial concludes (5/2).

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Leaders Preparing Post-2015 Development Agenda Must Recognize Value Of Investment In Early Child Development

“Considerable progress has been made over the past decade towards Millennium Development Goal 4,” which aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015,” WHO Director-General Margaret Chan writes in a Lancet opinion piece. “The number of deaths among children younger than five years has declined from 12 million in 1990 to 6.9 million in 2011,” she notes and asks, “But do the surviving children have an equal chance to realize their human potential, achieve social justice, and contribute to sustainable development?” She states, “The global community has an obligation to ensure that all children develop to full capacity, not only as a human right but also for equitable prosperity and sustainable progress of societies.”

“Three areas are critical foundations for healthy child development: stable, responsive, and nurturing caregiving with opportunities to learn; safe, supportive, physical environments; and appropriate nutrition,” Chan notes. “The reason we have to ensure that child development stays on a healthy track is because we now know much more about the consequences of it being off course,” she states, adding, “Adverse early experiences — e.g., unstable caregiving, deprivation of love or nutrition, and stresses associated with neglect and maltreatment — greatly increase the likelihood of poor health across the entire life course.” She writes, “As in the case of child survival, the promotion of early child development requires common understanding, shared commitment, and united action across government sectors and by all development agencies and institutions.” Chan concludes, “As world leaders are preparing the post-2015 development agenda, the time is right to recognize that investment in early child development is essential, not only for good health but also for sustainable development” (5/4).

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From the Global Health Policy Community

Scientists, Global Health Advocates Call For Strengthening PEPFAR In Letter To Obama

“Three weeks after President Obamas budget proposal for fiscal year 2014 appeared, sustaining support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, while cutting funds to [PEPFAR], and hacking global TB funding, physicians, scientists, and global health advocates are weighing in,” the Center for Global Health Policy’s “Science Speaks” blog reports. “A letter [.pdf] sent to President Obama [Thursday] from 21 organizations that are part of the Global AIDS Policy Partnership, begins by expressing appreciation for the administration’s leadership, highlighted by the Blueprint [for an AIDS-Free Generation], and by its continued investment in the global AIDS response demonstrated by its support for the Global Fund,” the blog notes, adding, “But those commitments, the letter tells the president, make the proposed cuts all the more damaging, as they will derail planned progress.” The blog notes, “The signers, which include amfAR: The Foundation for AIDS Research, AVAC: Global Advocacy for HIV Prevention, Elizabeth Glaser Pediatric AIDS Foundation, Treatment Action Group, the HIV Medicine Association, and the IDSA Center for Global Health Policy, which produces this blog, urge the president to support congressional efforts to strengthen PEPFAR above the budget request, while defending its Global Fund request” (Barton, 5/2).

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CSIS Book Examines Obama Administration's Health Diplomacy Opportunities

The Center for Strategic & International Studies (CSIS) blog describes a new book (.pdf), titled “The Changing Landscape of Global Health Diplomacy,” that presents analyses of “opportunities for global health diplomacy in Barack Obama’s second term.” The studies, compiled by a CSIS Global Health Policy Center working group, “show that the world of global health diplomacy is quite dynamic at the moment, with new partners setting trends while traditional actors are reconfiguring their views and practices,” according to the blog. “As the Obama administration moves into a second term, there are numerous opportunities for U.S. diplomats to coordinate on global health goals with middle-income countries such as Brazil, Chile, Mexico, and South Korea; to learn more about how Russia and China continue to build their outreach and assistance capacities; and to strengthen existing relationships with Canada, Japan, and Europe to shore up support and innovation in the global commitment to public health,” the blog states (Bliss, 5/2).

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Global Leaders Need Input From Community On Hunger, Food Security

Noting “the G8 Summit in Northern Ireland this June will focus, in part, on the intersection of hunger, food, nutrition,” Sam Dryden, director of the Bill & Melinda Gates Foundation’s Agricultural Development initiative, writes in the foundation’s “Impatient Optimists” blog, “As our global leaders draft agendas and assemble working groups, however, it is critical that they also seek out and listen to the voices of … farmers and community leaders on the ground in Africa and in the labs, marketplaces, and government offices throughout the continent.” He notes this week, “African civil society groups and farmers organizations together sent a letter to Prime Minister David Cameron, calling upon the G8 to align their investments in agriculture with the priorities of African governments and their smallholder farmers,” and he describes community representatives from Africa, Asia and elsewhere attended the recent Hunger, Nutrition, and Climate Justice Conference in Ireland. “I applaud this effort and it is high time we in the broader development community did more of this — listen more than we talk and orient ourselves and our work around the needs and wants of families and communities on the ground,” he concludes (5/2).

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Examining The Need For Effective Tools To Diagnose Typhoid

In the second post in a series in USAID’s “IMPACTblog” highlighting the agency’s work in global health, Stephen Baker and Jeremy Farrar of the Hospital for Tropical Diseases in Vietnam, write, “The lack of a robust, sensitive, and easy-to-use diagnostic test is one of the most serious barriers to the control and prevention of typhoid fever.” They continue, “The lack of effective diagnostics means it is more difficult to identify patients, provide effective treatment and prevent the disease from spreading, especially for drug-resistant typhoid,” adding, “For policymakers, ministries of health, and others, this lack of diagnostics obscures the true impact of the disease, and reduces the sense of urgency that is required to address it.” However, “[w]e don’t have to wait for next generation diagnostics to make a strong case that international organizations and national governments should invest in the control and prevention of typhoid,” they write, continuing, “Timely case identification and management with antibiotics has dramatically reduced case fatality rates, and access to clean water and basic sanitation will provide the best long-term solution” (5/2).

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