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Kaiser Daily Global Health Policy Report

In The News

President Trump Expected To Sign Bill Extending PEPFAR Through 2023, VP Pence Says

Associated Press: Trump to sign bill extending HIV/AIDS program, Pence says
“President Donald Trump will soon sign legislation to extend a 15-year-old HIV/AIDS program that has helped millions, primarily in Africa. HIV/AIDS advocates welcomed the news and immediately called on Trump to drop efforts to cut federal funding for the life-saving program. Vice President Mike Pence made the announcement Thursday at a White House event marking World AIDS Day on Saturday. The Senate late Wednesday passed legislation extending for five years the President’s Emergency Plan for AIDS Relief, or PEPFAR, and advancing the bill to the White House for Trump’s signature. The House passed an identical measure in mid-November…” (Superville, 11/29).

Devex: High-level support for PEPFAR, with budget cut proposals looming
“…Despite a busy end-of-year schedule, the U.S. Senate passed the bipartisan PEPFAR Extension Act of 2018 late Wednesday. The 3 ½-page, straightforward bill amends the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 to extend its end date from 2018 to 2023. While the legislation passed easily, there were concerns earlier this year that the reauthorization would be politicized, which would have stalled the process and perhaps led to a situation where the program’s mandate would have been extended through the annual appropriations process rather than through legislation…” (Saldinger/Igoe, 11/30).

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More Than 60 Global Health Organizations, Experts Urge Trump Administration To Increase FY20 Funding To Counter Biological Threats

Homeland Preparedness News: Groups seek funds countering biological threats
“The Nuclear Threat Initiative (NTI) has joined over 60 global health security organizations in calling for bolstered funding in the Trump administration’s 2020 budget request to counter biological threats. The groups forwarded correspondence to Secretary of Health and Human Services and Chair of the newly established U.S. Biodefense Steering Committee Alex Azar, advocating for a fiscal year 2020 funding request reflecting the nation’s commitment to advance the Global Health Security Agenda (GHSA), a partnership of more than 64 countries and organizations launched in 2014…” (Clark, 11/29).

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Devex Discusses U.S. Foreign Assistance Review In 'Long Story Short' Episode

Devex: Long Story Short #37: U.S. foreign assistance review, explained
“Earlier this year, United States President Donald Trump alluded to a foreign aid review — the outcome of which is expected to set the tone for another round of harsh White House budget proposals. Since the announcement, little has been revealed about the process and the few signals the administration has sent have been mixed. In this episode, senior reporter Michael Igoe and engagement editor Kate Midden discuss what we know about the foreign aid review, what we don’t — and what it means for U.S. aid…” (11/29).

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Congo's Ebola Outbreak Now 2nd Largest In History With 426 Confirmed, Probable Cases, WHO, Health Ministry Say

Associated Press: Congo’s Ebola outbreak now 2nd largest in history, WHO says
“Congo’s deadly Ebola outbreak is now the second largest in history, behind the devastating West Africa outbreak that killed thousands a few years ago, the World Health Organization said Thursday. WHO’s emergencies chief, Dr. Peter Salama, called it a ‘sad toll’ as Congo’s health ministry announced the number of cases has reached 426. That includes 379 confirmed cases and 47 probable ones. So far this outbreak, declared on Aug. 1, has 198 confirmed deaths, with another 47 probable ones, Congo’s health ministry said…” (Anna, 11/29).

Additional coverage of the DRC Ebola outbreak is available from ABC News, Al Jazeera, CIDRAP News, HuffPost, and Reuters.

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AIDS-Related Deaths Among Adolescents Slowing But About 80 Will Die Daily By 2030 Without Accelerated Progress, UNICEF Warns

U.N. News: 80 adolescents a day will still die of AIDS by 2030, despite slowdown in epidemic
“By 2030, around 80 adolescents will be dying of AIDS every day if ‘we don’t accelerate progress in preventing transmission,’ the head of the United Nations Children’s Fund (UNICEF) said on Thursday. In a report released on Thursday, ‘Children, HIV and AIDS: The World in 2030,’ current trends indicate AIDS-related deaths and new infections are slowing, but the downward trajectory is not happening fast enough…” (11/29).

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U.K. Reaches U.N. Goal Of Diagnosing, Treating 90% Of People Living With HIV In Country

The Guardian: U.K. meets U.N. target in drive to end HIV epidemic
“The U.K. has hit a significant U.N. target on the way to ending the HIV epidemic by succeeding in diagnosing and effectively treating more than 90 percent of people with the virus. Public Health England said there were an estimated 102,000 people with HIV in the U.K. last year, of whom eight percent — 8,200 — were believed to be unaware of their infection…” (Boseley, 11/29).

Additional coverage of this story is available from BBC News and CNN.

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Number Of Global Measles Cases Up 31% In 2017; Gaps In Vaccination Coverage To Blame, WHO/CDC Joint Report Says

CNN: Measles cases surged globally in 2017 due to gaps in vaccine coverage, health agencies say
“Measles cases around the world surged 31 percent from 2016 to 2017, according to a new report jointly published by the World Health Organization and the U.S. Centers for Disease Control and Prevention…” (Thomas, 11/29).

New York Times: As Measles Surges, ‘Decades of Progress’ Are in Jeopardy
“…The increase in measles, a highly contagious scourge that had been nearly eradicated in many parts of the world just a few years ago, was ‘deeply concerning,’ the organizations said in a report on the fight to eradicate measles…” (Gladstone, 11/29).

TIME: Measles Cases Spiked Worldwide Last Year Due to ‘Gaps in Vaccination Coverage’: New Report
“…The fact that measles cases are surging even in countries that had largely eliminated the disease suggests that reluctance to getting the vaccine may be to blame, according to health officials. ‘Gaps in vaccination coverage’ resulted in 110,000 deaths, according to the WHO…” (Ducharme, 11/29).

Additional coverage of the measles report is available from CIDRAP News, NBC News, Reuters, and VOA News.

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2 Of 3 Children In Need Of Humanitarian Aid In Central African Republic, UNICEF Says

Thomson Reuters Foundation: Rising numbers of ‘skeletal’ children as Central African Republic violence surges
“Starving, hiding in the bush or with armed groups, two in three children in the Central African Republic need aid, the United Nations said on Friday, as surging violence, attacks on humanitarians, and funding shortages raise the specter of famine…” (Lazareva, 11/30).

U.N. News: Armed groups threaten every child in Central African Republic, UNICEF warns
“…The report, ‘Crisis in the Central African Republic: In a neglected emergency, children need aid, protection — and a future,’ finds that life has become harsher and more dangerous for children: thousands are trapped within armed groups, with thousands more subject to sexual violence. Beyond the direct threats associated with the conflict, the country is suffering from a severe humanitarian crisis: 1.5 million children now require humanitarian assistance, an increase of 300,000 since 2016; over 43,000 children below five years old are projected to face an extremely high risk of death due to severe acute malnutrition next year; and one in four children is either displaced or a refugee…” (11/29).

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Lawsuit Filed In U.S. District Court Alleges PAHO/WHO Profited From Work Of Cuban Physicians

New York Times: Cuban Doctors Accuse International Agency of Profiting From Their Work
“As a member of Cuba’s international medical mission, Dr. Ramona Matos Rodríguez received $400 a month while posted in Brazil, a small fortune in her home country. It was not long before she figured out that physicians from other countries also working in Brazil’s ‘More Doctors’ program were taking home 20 times as much. Even the Pan American Health Organization, an international agency affiliated with the United Nations that brokered the arrangement, received a percentage for the doctors’ work. … PAHO, a division of the World Health Organization, made about $75 million off the work of up to 10,000 Cuban doctors who earned substandard wages in Brazil, according to the allegations in a lawsuit filed on Friday in the United States District Court in Miami. … The suit is the first against an international agency over compensation from Cuba’s medical mission. … Although novel, the suit faces an uphill battle: International organizations like the World Health Organization have broad immunity from civil actions…” (Robles, 11/29).

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More News In Global Health

Devex: Q&A: Why a 25-year-old agreement still matters for women and girls (Rogers, 11/30).

Devex: Q&A: Why knowledge is power when it comes to HIV/AIDS (11/30).

Devex: DFID promises ‘no accounting tricks’ to count CDC profits as aid (Edwards, 11/30).

Devex: U.K. counterterrorism bill could hinder humanitarian work, aid groups say (Edwards, 11/29).

New York Times: In Yemen, Lavish Meals for Few, Starvation for Many and a Dilemma for Reporters (Walsh, 11/29).

Science: Ethics aside, does the CRISPR baby experiment make scientific sense? (Cohen, 11/28).

STAT: China halts genome editing research that led to claimed birth of CRISPR babies (Joseph/Begley, 11/29).

STAT Plus: Once-a-day pills for combating HIV are a better deal than some people think (Silverman, 11/29).

U.N. News: New Syria fighting represents ‘giant powder keg,’ warns aid veteran, as he leaves U.N. stage (11/29).

USA TODAY: Poor health conditions of Central American migrants worry Mexican, U.N. health officials (Dudar, 11/29).

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Editorials and Opinions

World AIDS Day Opportunity To Recognize, Build Upon Role Of U.S. Leadership In Global HIV/AIDS Response

The Hill: We can build on 15 years of U.S. leadership in the global AIDS response
Charles Holmes, co-director of Georgetown University’s Center for Global Health and Quality and co-chair of the WHO global HIV services quality working group

“World AIDS Day is always a good time to celebrate the enormous progress the world has made in combating the HIV epidemic and to recognize the U.S.’s exemplary leadership that has spanned multiple administrations and eight Congresses. This is especially the case after [this week’s] Senate passage of the PEPFAR Extension Act of 2018, passed earlier this month by the House and which is now on its way to the White House. … However, as UNAIDS reported earlier this year, we have miles to go before we actually end AIDS. … We must tighten up the gaps in our programs; doing so will magnify their impact. In addition to our relentless focus on our progress, we need to more closely examine our shortcomings through the lens of health care quality. … This includes developing national policy and strategy frameworks for quality and infusing better data and quality standards into health programs, whether for maternal, newborn, and child health, or HIV and TB. PEPFAR and the global community have recently taken substantial strides towards improving the quality of HIV programs. … 15 years of historic U.S. investment in PEPFAR and the Global Fund have created the foundations we need to be able to save millions more lives, while protecting entire societies against the destabilizing force of this epidemic. … It is my hope this World AIDS Day that our leaders in Congress and in the administration remember this history, and can envision the bright future ahead for millions of people if we remain committed to this fight” (11/29).

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Ivanka Trump Discusses Trump Administration's Proposed Actions Against Countries That Fail To Address Human Trafficking

Washington Post: The Trump administration is taking bold action to combat the evil of human trafficking
Ivanka Trump, adviser to the president of the United States

“…Every government in the world has a moral obligation to do all in its power to stop [human trafficking] within its borders. That is why President Trump took strong action on Thursday to hold accountable those governments that have persistently failed to meet the minimum standards for combating human trafficking in their countries. Specifically, the president will limit the number of national-interest waivers and restrict certain types of foreign assistance for nearly two dozen governments of countries identified as ‘Tier 3’ by the State Department’s Trafficking in Persons Report. … The United States is an extraordinarily generous nation, but this administration will no longer use taxpayer dollars to support governments that consistently fail to address trafficking. The most urgent types of assistance to these countries will continue, including humanitarian aid and lifesaving global health programs such as HIV treatment and Ebola preparedness and response. But the new restrictions will hold these governments accountable while providing further incentive for them to live up to their responsibility to end this scourge. The United States will encourage Tier 3 countries to step up efforts to eliminate human trafficking, including the establishment of new laws and national action plans…” (11/29).

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Using Health To 'Humanize' Climate Change Narrative Could Help Accelerate Efforts To Reduce Impacts

The Lancet: Humanizing health and climate change
Editorial Board

“The 2018 report of the Lancet Countdown on health and climate change by Nick Watts and colleagues published on Nov. 28 provides a snapshot and direction of travel for 41 global indicators at the intersection between health and climate change. … Health potentially holds the key to humanizing climate change conversations, contributing to more rapid and effective behavior change — and it therefore matters how it is positioned. … Individual engagement and action contributes to a growing wave of change. This does not negate the need for engagement at international policy level and for governments to better use their powers, but this can be accelerated and complemented by harnessing the collective voice of individuals. The Lancet Countdown on health and climate change reports on the facts and data. Using those to capture imagination and to influence behavior change increases impact. Although much of the damage already caused to our planet may be irreversible, it is still within reach to alter the course of the next generation’s inheritance. Using health to humanize the narrative will help realize that goal” (11/28).

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Identifying Countries At Risk Of Climate-Related Instability, Humanitarian Crises Key To Targeting Efforts, Reducing Impacts

Foreign Affairs: Climate Shocks and Humanitarian Crises
Joshua Busby, associate professor of public affairs at the University of Texas at Austin, and Nina von Uexkull, assistant professor in the Department of Peace and Conflict Research at Uppsala University and associate senior researcher at the Peace Research Institute Oslo

“…[S]everal risk factors make some countries more vulnerable than others to the consequences of climate change. Three stand out in particular: a high level of dependence on agriculture, a recent history of conflict, and discriminatory political institutions. Research suggests that in countries that display some or all of these risk factors, climate extremes are especially likely to lead to disastrous outcomes, including violence, food crises, and the large-scale displacement of populations. We have used these factors to identify the countries that are most at risk from climate-related instability and humanitarian crises in the coming years. In doing so, we hope to provide an early warning to policymakers about where climate impacts are likely to prove most destabilizing in the short term, and where efforts to minimize their effects are most needed. … The risk factors we identify are, naturally, not the only conditions that can contribute to instability and humanitarian crises. But unabated climate change is likely to amplify the challenges of these high-risk countries in decades to come. They will see more extreme consequences, and their already fragile governments will become even more hard pressed to manage violence and feed their populations. Understanding where instability is most likely to occur is an important first step to reducing risk” (11/29).

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Ending Malnutrition Requires Action Against Climate Shocks, 'Heroic Effort' From World Leaders, Civil Society

Thomson Reuters Foundation: Changing climate for zero hunger: Why nutrition matters
Kathy Spahn, president and CEO at Helen Keller International

“…Malnutrition is the single greatest threat to child survival today … Good nutrition is critical to the healthy growth and development of children … [and] is also an essential driver of economic growth. … Evidence shows that a set of high-impact nutrition actions can save hundreds of thousands of lives annually. …The new U.N. data warn that ending malnutrition also requires immediate action to help vulnerable communities become more resilient to climate shocks. … [A]ctions [like finding better ways of assessing and quantifying levels of food insecurity and increasing investments in nutrition] — combined with holistic programs to fortify key staple foods with micronutrients, strengthen and diversify rural livelihoods, and empower small-scale farmers to increase production of drought-resistant, nutritious crops — can protect communities from food crises. … Ending malnutrition by 2030 will require a heroic effort from world leaders — and ordinary citizens everywhere…” (11/29).

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Expedited Development Of Effective, Affordable, Accessible Vaccines Vital To Defeating Infectious Diseases

STAT: Vaccines: our greatest hope in defeating AIDS, Ebola, TB, and other infectious diseases
Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative

“…The development of [Merck’s] Ebola vaccine candidate is a remarkable success story. It shows how public and private sectors can collaborate when they have a shared commitment to develop a highly effective and urgently needed vaccine. We need to foster even more effective multi-sector partnerships to address other established public health threats like HIV and tuberculosis (TB), and to proactively prepare for other infectious disease threats that will emerge in the future. … Researchers working on both HIV and TB vaccines must redouble their efforts to expedite the development of promising candidates and use emerging insights in immunology to hasten the design and development of even better ones. Success will only come from innovative science and creative partnerships between the public and private sectors, much like those that were formed during the 2014-2016 Ebola crisis. Defeating HIV and TB will ultimately depend on vaccines being affordable and accessible across the globe, particularly in the places where the burden of these diseases remains unacceptably high” (11/30).

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From the Global Health Policy Community

'Science Speaks' Discusses Senate Passage Of PEPFAR Extension Act, Poses Questions About Funding

IDSA’s “Science Speaks”: Senate extends PEPFAR, while funding remains a question
Antigone Barton, senior editor and writer of “Science Speaks,” discusses the U.S. Senate’s passage of the PEPFAR Extension Act of 2018, writing, “[W]hether the acknowledgement of what needs to be done will be matched by the funding the work will require remains a question. With a $50 million increase for PEPFAR proposed by the Senate, and the $41 million increase for USAID’s TB program proposed by the House in the air, Congress, facing a Dec. 7 deadline, has yet to pass a funding bill for fiscal year 2019” (11/29).

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Organizations Call On International Community To Take More Action On HIV Treatment Access, Fill Gaps In Global AIDS Response

AIDS Healthcare Foundation: AHF Urges World Leaders not to Waver in the War on AIDS Ahead of the Argentina G20 Summit
“Despite claims that some countries are winning their battles against HIV and with global AIDS funding in decline, the G20 must do all it can to ensure the Global Fund is fully funded and hard-won progress is preserved…” (Mills, 11/29).

Médecins Sans Frontières: Pharmaceutical corporations are failing children with HIV
“Ahead of a Vatican City meeting on scaling up HIV diagnosis and treatment for children, Médecins Sans Frontières (MSF) criticized pharmaceutical companies for their delays and failure to develop appropriate formulations of HIV medicines for children. Developing countries are struggling to provide HIV-positive children with World Health Organization (WHO)-recommended treatments, because pediatric versions of these antiretroviral drugs are not available where they are needed…” (11/29).

Médecins Sans Frontières: UNAIDS report overlooks significant aspects of the global HIV response
“UNAIDS’ World AIDS Day 2018 report is selectively silent on persistently high AIDS mortality and looming treatment rationing in light of donor disengagement…” (11/29).

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Blog Posts Recognize World AIDS Day, Explore Various Aspects Of Ongoing Epidemic

Global Fund to Fight AIDS, Tuberculosis and Malaria: Young Women at the Epicenter of HIV
“…In South Africa, the country hardest hit by the HIV epidemic, girls aged 15-19 are eight times more likely to be living with HIV than boys their age. On this World AIDS Day we put a spotlight on South African teens like Zandile, Sinazo, Axola, Carol, and Mivuyo — young women growing up at the epicenter of the HIV epidemic…” (11/29).

IntraHealth International’s “VITAL”: 3 Ways to End the Global HIV Epidemic — Locally
The IntraHealth Editorial Team recognizes World AIDS Day and writes, “Here are three ways we in the global health community can work locally to help countries build the skills, systems, and self-reliance that will finally put the epidemic to bed. 1. Make the health workforce a priority. … 2. Foster local partnerships to better serve local clients — sustainably. … 3. Strengthen local capacity…” (11/29).

World Economic Forum: How living with HIV and AIDS has changed, more than 30 years on
Johnny Wood, writer for WEF, discusses the history of the HIV/AIDS epidemic, including advancements and challenges (11/29).

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Continued Investments In Malaria Vaccine Development, Other Prevention Tools Necessary To 'Turn The Tide,' Malaria Vaccine Initiative Director Says

Global Health Technologies Coalition’s “Breakthroughs”: As the global fight against malaria stalls, malaria vaccine development could be primed for breakout
Ashley Birkett, director of the Malaria Vaccine Initiative at PATH, discusses the stalled progress against malaria and the potential development of a malaria vaccine, writing, “[W]hile the current fight may have plateaued, the lesson of the last decades is that a unified, well-funded assault on malaria — one committed to developing a variety of tools and making them widely available — can produce substantial progress. If we continue to invest in malaria vaccine development, and fund other promising work now underway to create a new generation of drugs, insecticides, diagnostics, and other tools, while strengthening the programs and systems that deliver them, we can turn the tide. And from there, we can confidently set our sights on eliminating and eradicating the disease forever” (11/27).

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BMJ Opinion Publishes Collection Of Articles On Global Health Disruptors

BMJ Opinion: Global health disruptors
This collection of articles on global health disruptors contains articles on various topics including climate change, noncommunicable diseases, urban development, the digital revolution, the global health care market, research and development, China’s Belt and Road initiative, the erosion of multilateralism, SARS and Ebola, the Bill & Melinda Gates Foundation, the role of civil society organizations, the Doha declaration, the WHO Framework Convention on Tobacco Control, the 2008 financial crisis, the Millennium Development Goals, and global health partnerships (November 2018).

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From the U.S. Government

PEPFAR Announces $100M Investment To Address Key Gaps In HIV Epidemic, Leverage Capacities Of Faith-Based Organizations

PEPFAR: PEPFAR Will Invest $100 Million To Address Key Gaps Toward Achieving HIV Epidemic Control Including Through Faith-Based Organizations and Communities
“In advance of World AIDS Day 2018, Vice President Michael Pence announced [Thursday] that the United States government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), will invest $100 million to address key gaps toward achieving HIV epidemic control and ensuring justice for children, including by leveraging the unique capacities and compassion of faith-based organizations and communities. … This new commitment will support comprehensive, family, and client-centered HIV services through new and existing PEPFAR partners…” (11/29).

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White House, U.S. Agencies Recognize World AIDS Day 2018, Reflect On Progress

CDC’s “Morbidity and Mortality Weekly Report”: World AIDS Day — December 1, 2018
This post recognizes World AIDS Day, which takes place annually on December 1, and highlights U.S. efforts and progress made against the HIV/AIDS epidemic (11/30).

NIH: NIH Statement on World AIDS Day December 1, 2018
In an NIH statement on World AIDS Day, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and Maureen M. Goodenow, director of the Office of AIDS Research, discuss the achievements of the research community in efforts to control the HIV/AIDS epidemic (11/30).

USAID: World AIDS Day 2018
“The theme for World AIDS Day 2018 is 15 Years of Saving Lives through American Leadership and Partnerships. As the year draws to a close, we reflect on the impact global partnerships between USAID, PEPFAR, and our implementing partners have had worldwide…” (11/29).

White House: Remarks by Vice President Pence at World AIDS Day Event
During remarks at the White House World AIDS Day event, Vice President Mike Pence discussed the U.S. commitment to HIV/AIDS efforts and highlighted the role of faith-based organizations and communities (11/29).

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U.S. Announces Nearly $131M In Additional Emergency Food Assistance To Yemen

U.S. Department of State: United States Announces Emergency Food Assistance for Yemen
“This week, Secretary of State Michael R. Pompeo announced the United States is providing nearly $131 million in additional emergency food assistance to the people of Yemen, who are suffering from the world’s largest humanitarian crisis and food-security emergency. This brings the total U.S. humanitarian assistance for the Yemen response to more than $697 million since the beginning of Fiscal Year 2018…” (11/29).

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From the Kaiser Family Foundation

KFF Updates Brief Examining PEPFAR's Existing, Proposed Legislation

Kaiser Family Foundation: PEPFAR Reauthorization: Side-by-Side of Existing and Proposed Legislation
This updated brief identifies the PEPFAR authorities that expired at the end of FY 2018 and notes how they are addressed by the reauthorization bills. The brief also provides a detailed comparison of PEPFAR’s authorizing legislation over time (Moss/Kates, 11/29).

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