KFF Daily Global Health Policy Report

In The News

Ebola Cases In Liberia Possibly Declining But Defenses Must Remain High, WHO Says

News outlets discuss how the number of Ebola cases is possibly declining in Liberia, but the trend does not necessarily signal a slowing of the epidemic, according to a WHO official.

Agence France-Presse: Ebola cases slow in Liberia, but too soon to celebrate: WHO
“The rate of new Ebola infections appears to be slowing in hard-hit Liberia, but the crisis is far from over, according to the World Health Organization…” (Larson, 10/29).

Associated Press: WHO: Ebola decline in Liberia could be real trend
“…The disease is still raging in parts of Sierra Leone and there is still a risk that the decline in Liberia won’t be sustained, Dr. Bruce Aylward, an assistant director-general for WHO, warned reporters…” (DiLorenzo/Cheng, 10/29).

Deutsche Welle: Possible decline in Ebola cases in Liberia
“…Aylward added that experts would be checking to ensure the latest data was not down to cases going unreported…” (10/29).

New York Times: Ebola Slowing in Liberia, WHO Says, but International Support Is Still Necessary
“…At least 13,703 people have been infected by the virus, all but 27 of them in the three worst affected countries, Guinea, Liberia, and Sierra Leone, according to the latest estimates cited by Dr. Aylward. Nearly half of the total is in Liberia…” (Cumming-Bruce, 10/29).

Reuters: Ebola appears to be slowing in Liberia — WHO
“…The WHO comments were echoed by Jeremy Farrar, director of charitable foundation the Wellcome Trust. He too urged caution and said the next few weeks will be crucial to locking in potential gains made through increased international support…” (Miles/Nichols, 10/29).

ScienceInsider: Liberia’s Ebola progress real, but epidemic far from under control
“…The apparent decline in cases could mean that families are hiding patients and secretly burying the dead, but it is more likely that a combination of factors has reduced the spread of the disease, said Aylward…” (Cohen, 10/29).

U.N. News Centre: Signs of Ebola decline in Liberia offer ‘glimmer of hope’ — U.N.
“…[Aylward] stressed that ‘a slight decline in cases on a day to day basis versus getting this thing closed out is a completely different ball game.’ ‘Am I hopeful?’ Dr. Aylward said. ‘I am terrified that the information will be misinterpreted. It’s like saying your pet tiger is under control,’ he told reporters. ‘This is a very, very dangerous disease’…” (10/29).

Washington Post: Rate of new Ebola infections in Liberia is slowing, WHO says
“…On Wednesday, Aylward said that the empty beds in existing Ebola clinics are ‘absolutely’ needed still and that there are no plans to reduce capacity at this time. He said that it is normal to shuffle resources from one hot zone to another as an epidemic spreads but that it is too soon to let down defenses…” (Sun, 10/29).

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News Outlets Report On Obama Administration's Management Of Ebola Response Ahead Of Midterm Elections

News outlets report on the Obama administration’s efforts to manage the response to Ebola in the U.S. and West Africa ahead of Tuesday’s midterm elections.

Foreign Policy: Obama Tries Tamping Ebola Unrest Week Ahead of Election Day
“With the U.S. response to Ebola at home and abroad under attack on the campaign trail, President Barack Obama took his case that his administration is acting decisively and responsibly in addressing the epidemic to the public on Tuesday…” (Francis, 10/28).

The Hill: White House on back foot on Ebola
“The Obama administration is struggling to explain why it has different policies for troops and civilian health care workers responding to Ebola in West Africa. Troops returning from Ebola response efforts in West Africa are now subject to a mandatory 21-day quarantine-like policy. Civilian medical workers are not. … Republicans have seized on the differences as another illustration of policy mismanagement ahead of Tuesday’s midterm elections…” (Wong, 10/29).

Wall Street Journal: Obama Urges U.S. Leadership to Stem Ebola Outbreak
“The White House has ramped up its Ebola response in recent days, rolling out new federal guidelines for monitoring at-risk travelers, naming a czar to coordinate efforts and reassuring a nervous public. Despite these steps on Ebola policy, the Obama administration is still struggling to control the nation’s response to the deadly virus less than a week before Tuesday’s midterm elections…” (Nelson, 10/29).

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Defense Secretary Hagel Approves 21-Day Isolation Period For All U.S. Troops Returning From Ebola-Hit West Africa

News outlets report on U.S. Defense Secretary Chuck Hagel’s approval of a 21-day isolation period for all military personnel returning from Ebola response efforts in West Africa.

CQ News: Hagel Orders Quarantine for Troops Returning from Ebola Mission
“Defense Secretary Chuck Hagel has ordered that all U.S. military personnel returning from Ebola response efforts in West Africa be subject to a 21-day quarantine…” (O’Brien, 10/29).

Foreign Policy: Defense Breaks With the White House on Ebola Response
“In a full split with the White House, the Pentagon will monitor all soldiers returning from deployment to West Africa for 21 days even though not one is expected to treat patients for Ebola. Defense Secretary Chuck Hagel made the decision public on Wednesday, Oct. 29. Previously, only the Army mandated that troops serving as part of the U.S. response to the Ebola outbreak in Liberia, Sierra Leone, and Guinea be held in separate quarters and watched…” (Francis, 10/29).

The Hill: Ebola quarantine ordered for all U.S. troops
“Defense Secretary Chuck Hagel has ordered all U.S. troops returning from Ebola response efforts in West Africa to undergo a 21-day ‘controlled monitoring regimen’…” (Wong, 10/29).

Reuters: Quarantine-like monitoring approved for U.S. troops on Ebola mission
“…Hagel also called for a review of the decision in 45 days to evaluate ‘whether or not such monitoring should continue based on what we learn and observe from the initial waves of personnel’ returning from the West Africa relief mission, Kirby said...” (Alexander, 10/29).

Wall Street Journal: Hagel Approves 21-Day Ebola Isolation Period For Military
“…Mr. Hagel also directed the joint chiefs to develop a detailed implementation plan for the so-called controlled monitoring period, which he will review in 15 days, said Rear Adm. John Kirby, the Pentagon press secretary. It wasn’t clear whether officials had latitude in the implementation process to alter the extent of isolation being required for returning service members…” (Schwartz/Nissenbaum, 10/29).

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Debate Continues Over Quarantining U.S. Ebola Workers When They Return Home

News outlets report on the ongoing debate over quarantining U.S. health workers, troops, and others who have worked in West African nations affected by Ebola when they return home.

NBC News: Dozens Of Volunteers Have Come Back Safe From Ebola Hot Zone
“Close to 50 volunteers have come back safe and well from the Ebola hot zone in West Africa, aid agencies tell NBC News, even as states debate whether to force such workers into quarantine. A look at the numbers from groups such as Doctors Without Borders and the International Medical Corps shows just about 150 people have gone to help fight the epidemic in Liberia, Sierra Leone, and Guinea. Of them, 47 have returned symptom-free…” (Fox/Naggiar, 10/29).

New York Times: Threat of Lawsuit Could Test Maine’s Quarantine Policy
“A nurse who cared for Ebola patients in Sierra Leone was headed for a legal showdown with the State of Maine on Wednesday over whether the state can quarantine her against her will. The dispute is heightening a national debate over how to balance public health and public fears against the rights and freedoms of health care workers, and troops, returning from West Africa…” (Zernike/Fitzsimmons, 10/29).

Wall Street Journal: Maine Nurse Kaci Hickox Says She Won’t Obey Isolation Rules
“A nurse who returned home to Maine after treating Ebola patients in West Africa said Wednesday she wouldn’t comply with a state quarantine, keeping a spotlight on a person hailed by some as a defender of individual rights and criticized by others as risking public health…” (Levitz/Calvert, 10/29).

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Ebola Could Overwhelm U.S. Health System, AP Review Says

Associated Press: AP IMPACT: If Ebola batters U.S., we are not ready
“The U.S. health care apparatus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clusters of cases could overwhelm parts of the system, according to an Associated Press review of readiness at hospitals and other components of the emergency medical network…” (Donn/Burke, 10/29).

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U.S. Health Officials Attend Ebola Meeting In Cuba

News outlets report on a meeting held in Cuba on Wednesday, where U.S. and Cuban health officials discussed Latin America’s response to Ebola.

Associated Press: U.S. sends health official to Cuban Ebola meeting
“U.S. and Cuban health officials sat together in Havana on Wednesday to discuss Latin America’s response to Ebola, the most concrete sign so far of the nations’ desire to cooperate against the epidemic despite decades of tense relations…” (Rodriguez/Weissenstein, 10/29).

Reuters: U.S. attends Ebola meeting in Cuba called by leftist bloc
“…The meeting organized by ALBA, a bloc of leftist-governed countries, aims to coordinate a regional strategy on the prevention and control of Ebola…” (Acosta, 10/29).

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Global Response To Ebola Working But More Resources Needed, U.S. Envoy Says

Reuters: Global fight against Ebola grows but far from won, U.S. envoy says
“U.S. envoy Samantha Power said she will return from West Africa to the United States and the United Nations on Thursday with a message of ‘hope and possibility’ that the global response to the Ebola outbreak is working, but more resources are needed…” (Nichols, 10/29).

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Former NATO Heads Urge Alliance To Join Ebola Fight

Associated Press: Former NATO chiefs urge alliance to fight Ebola
“Two former heads of NATO on Wednesday urged the Western defense alliance to join the fight against Ebola in West Africa. George Robertson of Britain and Jaap de Hoop Scheffer of the Netherlands, who both served as NATO secretary general, said the 28-nation military alliance ‘has access to unique capabilities that could make a difference’…” (Dahlburg, 10/29).

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China Preparing For Potential Imported Ebola Cases; Piot Says Country At Risk

News outlets report on how China is addressing the threat of potential imported Ebola cases.

Associated Press: Ebola expert says China at risk, seeks Japan aid
“A scientist who helped to discover the Ebola virus says he is concerned that the disease could spread to China given the large numbers of Chinese workers traveling to and from Africa. Peter Piot, who is director of the London School of Hygiene and Tropical Medicine, said … China’s controls for infectious diseases have improved and authorities have become more open about public health risks since severe acute respiratory syndrome, or SARS, broke out in southern China in 2002…” (Kurtenbach, 10/30).

Reuters: In Guangdong, nervy Chinese ramp up Ebola watch
“Chinese authorities have identified the southern province of Guangdong, home to Asia’s biggest African population, as a frontline in their efforts to prevent the deadly Ebola virus from entering mainland China. The province bordering Hong Kong has proven susceptible to infectious diseases in the past, shouldering a large share of SARS and bird flu cases, prompting local authorities to take no chances with Ebola…” (Lee, 10/30).

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Two Experimental Ebola Vaccines Move Into Clinical Trials

News outlets report on recent moves to test two different experimental Ebola vaccines.

Associated Press: Swiss agency approves trial for Ebola vaccine
“…Swissmedic said the trial will be conducted among 120 volunteer participants with support from the U.N. World Health Organization. The experimental vaccine is to be initially administered on healthy volunteers who will be sent as medical staff to fight the Ebola epidemic in West Africa…” (10/28).

Reuters: Canadian Ebola vaccine to be tested in Europe, Gabon, Kenya
“Trials of an experimental vaccine developed by the Canadian government and licensed to NewLink Genetics will begin swiftly in healthy volunteers in Europe, Gabon and Kenya, under a program with funding from the Wellcome Trust…” (Hirschler, 10/29).

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Scientific Discovery On Ebola, Filoviruses Has Advanced But More Needed, Experts Say

Nature: The Ebola questions
“…[T]he advances in knowledge about filoviruses [gained since their discovery in the 1960s] have also exposed the gaps. Scientists suspect that more members of the filovirus family remain to be discovered… They are also working to understand which animals naturally harbor filoviruses and why human filovirus outbreaks seem to be rising in frequency: they have occurred in 19 of the past 21 years, and three times this year alone. Finding answers is difficult because outbreaks are unpredictable and laboratory work with filoviruses requires the highest security measures…” (Hayden, 10/29).

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Saudi Arabia Confirms Six New MERS Cases Within 24 Hours

Reuters: Saudi Arabia finds six new MERS cases as outbreak grows
“Saudi Arabia said late on Wednesday it had detected six new cases of the deadly Middle East Respiratory Syndrome (MERS) in 24 hours, the biggest daily jump for months with officials blaming lax hospital procedures…” (McDowall, 10/20).

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Conviction Of Father In Ivory Coast Child Marriage Case Seen As Step Toward Eradicating Practice

Agence France-Presse: Jail for I. Coast dad who tried to marry off 11-year-old daughter
“A father in Ivory Coast was ordered to jail and fined on Wednesday after a court found him guilty for trying to arrange the forced marriage of his 11-year-old daughter. His was the first trial of its kind in the West African nation, and the verdict was seen as an unprecedented step towards stamping out the illegal, but widespread, practice of child marriages…” (10/29).

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Women Residents Of Kenyan Slum Protest Government's Slow Response To Sanitation, Land Rights

The Guardian: Nairobi’s female slum dwellers march for sanitation and land rights
“…About 100 female residents of Mukuru, an informal settlement in south-east Nairobi, traveled across town to wave signs and sing songs in a bid to grasp the attention of a government that has for decades failed to recognize their existence. … Last year, two separate lawsuits were launched by Mukuru’s community leaders: one claiming ownership of the land the slum is on, and another demanding access to sanitation facilities. … But more than a year after filing the lawsuits, neither case has had a hearing date set, and the slum dwellers worry that they will continue to be marginalized despite a widely praised new constitution in 2010, which enshrined the right of all citizens to sanitation and shelter…” (Anderson, 10/29).

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Eastern, Southern Africa Provide Lessons For Reforming Humanitarian Action; South Africa Can Serve As 'Key Player,' U.N. Official Says

U.N. News Centre: South Africa poised to be key player in humanitarian assistance, says U.N. relief chief
“Learning from the experiences of the Eastern and Southern Africa region will be vital in global efforts to reform humanitarian action, a top United Nations humanitarian official said [Wednesday] in Pretoria, South Africa, at the opening of the regional consultation for Eastern and Southern Africa of the World Humanitarian Summit. … ‘South Africa has the resources and capacity to be a key player in humanitarian assistance on the continent,’ she added…” (10/29).

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Countries Bordering Syria Need More Humanitarian Aid Support To Host Refugees, U.N. Official Says

U.N. News Centre: Massive scale-up of assistance needed for countries impacted by ongoing Syria crisis — U.N. relief official
“The ongoing civil war in Syria and its spillover effects continue to inflict a devastating human and humanitarian toll on neighboring Iraq, Lebanon, and Jordan, a senior United Nations relief official said today, warning that rising numbers of displaced persons, increasing pressure on refugee hosting countries, and dwindling international support left the U.N. ‘racing against the clock’ to meet the needs on the ground…” (10/29).

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Editorials and Opinions

Editorials, Opinion Pieces Discuss Various Aspects Of Ebola Epidemic

The following editorials and opinion pieces discuss various aspects of the Ebola epidemic and responses to mitigate the virus’s spread.

Nature: Call to action
Editorial Board

“Science has so far taken a back seat as the Ebola outbreak has continued to spread. Research has deferred to the need to gear up the public health response. But there is a growing sense that, unless science can somehow now change the game, the outbreak will be difficult to bring under control. … Speeding the development of treatments and vaccines is one area in which the international community is trying to move forward. … More of [both high-containment facilities and money for research on diseases that are, thankfully, rare in developing countries], in more places, can only hasten our understanding of Ebola and other diseases. Because one thing is clear: whether it is Ebola virus, another filovirus or something completely different, there will be a next time” (10/29).

Wall Street Journal: ‘The Science’ vs. Ebola
Editorial Board

“Whatever the damage that the White House, liberals and the press corps say Ebola quarantines will do, their reaction to the state-imposed isolation policies has already done far worse. The federal contradictions and false claims of omniscience are adding to public confusion—and may discredit an important tool that the country will need if there is a major outbreak of Ebola or some other pathogen. … Quarantines are a matter of policy more than science — that is, balancing the costs of overreacting to a genuine risk against the benefits of reasonable precautions. The liberals who are ostentatiously portraying these trade-offs as akin to the suspension of habeas corpus are damaging science and especially public safety” (10/29).

Wall Street Journal: The Benefit of a Uniform Response to Ebola in the U.S.
Drew Altman, president and CEO of the Kaiser Family Foundation

“What looks like political wrangling or confusion in federal and state officials’ Ebola responses is a reflection of our complex public health system, which gives certain authorities to the federal government and others to the states. But however explainable as a product of American federalism, officials’ contradictory actions do little to reassure the public in a fast-changing environment where, here in the U.S., fear is as much an enemy as the virus itself. … Having multiple public health standards across the country for a virus that doesn’t care about state borders arguably isn’t good public health policy. Different standards in different states are not only likely to confuse people but could suggest that we don’t really know how to respond or, worse, that there might be an element of political positioning to the response. Americans value states’ rights to make decisions about many things, and our system of public health gives states leeway to tailor responses to their own circumstances. But when it comes to Ebola in the U.S. the enemy now is fear as much as the virus; a uniform response led by national public health professionals would reduce fears” (10/29).

Washington Post: Those who help Ebola patients should be honored, not punished
U.S. Sen. Christopher Coons (D-Del.), chair of the Senate Foreign Relations Subcommittee on African Affairs

“The best way to protect Americans from Ebola is by stopping the virus at its source. … We cannot protect Americans at home without sending Americans to Liberia, Guinea, or Sierra Leone. Instead of demonizing those who volunteer for service, through stigmatizing mandatory quarantines or the imposition of a travel ban, we should be honoring them. … The political pressure for tougher restrictions is mounting, while the need for volunteers to fight the virus is quickly growing. President Obama should issue a guarantee now that those willing to serve will have that service honored and their right to return home protected” (10/29).

New York Times: The Ebola Hysteria
Charles Blow, columnist

Humanosphere: Bill Foege on how to make Ebola worse
William Foege, physician, epidemiologist, and former head of the CDC

Forbes: Why Ebola Quarantines Will Grow Larger — And More Troubling
Scott Gottlieb, resident fellow at the American Enterprise Institute

Nature: Developed nations must not fear sending Ebola help
Tim Inglis, medical microbiologist at the University of Western Australia

Reuters: Why quarantining Ebola patients is a states’ rights issue
Howard Markel, professor of the history of medicine at the University of Michigan and editor-in-chief of the health policy journal, The Milbank Quarterly

Huffington Post: University Doctors: We Need More Support Fighting Ebola in Africa
Sriram Shamasunder, assistant clinical professor of medicine at UCSF and co-founder of the HEAL Initiative, and Phuoc Le, assistant professor at UCSF and the UC Berkeley School of Public Health

The Hill: The vaccine against the virus of oppression
Ali Soufan, former FBI supervisory special agent and CEO of the Soufan Group, and Matthew Daniels, director of the Center for Human Rights and International Affairs at the Institute of World Politics

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'Correct Interpretation' Of Helms Amendment Would Allow U.S. To Support Women, Girls Who Are Raped, Impregnated In Conflict

Huffington Post: Time to Act for Women and Girls Raped in Conflict
Serra Sippel, president of the Center for Health and Gender Equity

“At the Obama administration’s six-year mark we can celebrate much that has been done to further the cause of women and girls here in the United States and around the globe. … But, after six years, President Obama has yet to take a critical step — completely within his power — to provide women and girls raped in conflict the help they need. … Correct interpretation of the [Helms] amendment requires simply that the president use the power of his pen to direct our agencies, including USAID, to properly implement comprehensive care for women and girls. … It is unconscionable that the U.S. is failing to use its considerable power to facilitate access to post-rape care for women and girls [because the Helms amendment is implemented as a complete ban on abortion funding globally]. After six years in office it is time for the president to move beyond words to support those raped in conflict…” (10/29).

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Post-2015 Agenda Should Focus On Sustainable Development

Huffington Post: For Post-2015, International Community Should Focus on Enabling Sustainable Development
Ulysses Smith, chair of the New York City Bar Association’s United Nations Committee

“Now that the high-level meetings have concluded, and the echoing of motorcade sirens has faded from the canyons of Manhattan’s East Side, it is time for the international community to roll up its sleeves and get to the business of deciding the world’s new development agenda, known as the Post-2015 Agenda, the successor to the Millennium Development Goals which expire at the end of next year. … In order to have an impact on the process, and indeed, in order to shape it so that the agenda will be effective and able to anticipate the dramatic changes to come over the next 15 years, the Secretary-General should set forth a vision for a practical development agenda. Such an agenda should focus on enabling development and should exemplify the profound moral understanding of the current proposal while providing a realistic starting point for Member State negotiations” (10/29).

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Rwanda Program Provides Lessons On Providing Cancer Care To Poor

Nature Reviews Cancer: Bringing cancer care to the poor: experiences from Rwanda
Rwanda Health Minister Agnes Binagwaho, Lawrence Shulman of the Dana-Farber Cancer Institute, and colleagues from the Dana-Farber Cancer Institute, the Rwandan Ministry of Health, and Partners in Health

“…[T]he scientific yields of recent decades that have dramatically advanced oncology therapies and saved innumerable lives in developed countries have not reached many of the world’s poor. … To have a major impact on cancer mortality worldwide, we do not need more scientific discoveries but rather the resources, organizational infrastructure, and political will to bring currently available diagnostics and potentially curative treatments to the large proportion of the world’s population who currently do not have access. … In this article, we describe a partnership between the Rwandan Ministry of Health; the NGO Partners In Health; and experts from Boston, USA, in medical oncology, surgical oncology, oncology nursing, pathology, imaging, and other specialties. This partnership aims to strengthen the effort to bring cancer care to Rwanda by supporting Butaro District Hospital…” (Shulman et al., 10/30).

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Tanzania Should Implement Plan To Cut Child Marriage Rates

Inter Press Service: Keeping All Girls in School is One Way to Curb Child Marriage in Tanzania
Agnes Odhiambo, senior women’s rights researcher at Human Rights Watch covering sub-Saharan Africa

“…A new HRW report, ‘No Way Out: Child Marriage and Human Rights Abuses in Tanzania,’ takes a hard look at child marriage in the Tanzania mainland. Four out of 10 girls in Tanzania are married before their 18th birthday. The United Nations ranks Tanzania as one of 41 countries with the highest rates of child marriage. … The Tanzanian government needs to urgently develop and implement a comprehensive plan to curb high rates of child marriage and mitigate its impact. Such a plan should include targeted policy and programmatic measures to address challenges in the education system that put girls at risk of child marriage…” (10/29).

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HIV Presents Specific Challenges In Vaccine Development

Huffington Post: HIV/AIDS Presents an Unprecedented Challenge to Developing a Vaccine
Robert Gallo, director of the Institute of Human Virology

“As the world focuses on Ebola, we must not forget that HIV/AIDS presents a far greater challenge in the world of vaccines. … Unlike Ebola, at the heart of the challenge is that HIV is a human retrovirus, and by nature irreversibly infects an individual permanently in a few days. Thus, unlike viruses for which we have successfully developed vaccines, such as polio, the immune system has no time to recognize HIV and produce antibodies to fight it. HIV has already begun inserting its genes into its human host’s genome. We believe an effective vaccine must achieve ‘sterilizing immunity,’ or the ability to completely block infection at the entry point…” (10/29).

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From the Global Health Policy Community

USAID's DART Leader In West Africa Interviewed About Agency's Ebola Response

USAID’s “IMPACTblog”: Bill Berger: “There is no book on responding to this Ebola crisis… we’re writing it now.”
Morgana Wingard, a photojournalist working with USAID to cover the Ebola outbreak in West Africa, interviews Bill Berger, team leader for the Ebola Disaster Assistance Response Team (DART) in West Africa, about the DART’s experiences on the ground in the region (10/29).

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Blog Post Underscores Importance Of Addressing Maternal Morbidity In Addition To Mortality

Humanosphere: Visualizing maternal morbidity
In this guest post, Amy VanderZanden, a communications data specialist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), notes that while progress has been made on reducing maternal mortality, similar progress has not been realized for maternal morbidity, particularly for women in developing countries. She writes, “While progress on improved maternal health outcomes is encouraging, it is clear that there is still much more to be done to make pregnancy and childbearing a safe and healthy reproductive decision for all women” (10/29).

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Tanzanian Program Trains HCWs To Provide HIV, Other Services To Women Experiencing Violence

IntraHealth’s “Vital”: When HIV and Gender-Based Violence Intersect, Women Suffer in Silence
Mkama Mwijarubi, program officer at IntraHealth International, discusses the relationship between gender-based violence and HIV and the challenges of providing HIV-related services to women experiencing violence, as well as a program in Tanzania that is training health workers to help women experiencing violence access the mix of health and other services they need (10/29).

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