KFF Daily Global Health Policy Report

In The News

WHO Warns Polio Could Spread Across Syria, Beyond

“The WHO issued a warning stating that there is high risk of infectious polio disease spreading across Syria and beyond, after 10 cases were confirmed among young children in the eastern Syrian province of Deir al-Zour,” RT News reports. “Along with Syria, seven neighboring countries have announced plans to start emergency vaccinations in response to the risk, according to the WHO,” the news service notes (10/30). According to the Atlantic Wire, these countries include “Lebanon, Jordan, Iraq, Turkey, Israel and Egypt” (Ohlheiser, 10/29). “The situation is ‘a wake-up call,’ says Marc Sprenger, director of the European Centre for Disease Prevention and Control (ECDC) in Stockholm,” Nature writes, noting “Europe is surprisingly vulnerable” as many countries “dropped their guard” after the WHO declared the region free of polio in 2002, resulting in “incomplete” surveillance systems and “suboptimal vaccination rates” in some countries (Butler, 10/29). In February, the WHO confirmed poliovirus was “found in sewage samples in two areas of greater Cairo,” the Globe and Mail states, adding, “The virus was also isolated this year in sewage samples collected in Israel, the West Bank and the Gaza Strip” (Ha, 10/29).

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Media Coverage Of UNFPA State Of World Population Report Continues

News outlets continued their coverage of the UNFPA’s State of World Population 2013 report, which was released on Wednesday and “seeks to offer a new perspective on teenage pregnancy, looking not only at girls’ behavior as a cause of early pregnancy, but also at the actions of their families, communities and governments,” the U.N. News Centre reports (10/30). According to the report, titled “Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy,” “the underlying reasons for pregnancy in the young needed to be tackled,” including “keeping more girls in school until they are 18, providing quality sex education and access to health services, educating boys and men about girls’ rights, and enforcing laws against child marriage,” The Guardian writes (Ford, 10/30). “Placing high emphasis on developing human capital of young girls, and giving them the opportunity to make sexual reproductive choices for themselves, not only promotes the health and protection of young girls, it also gives them a seat at the global development table,” according to Inter Press Service (Erakit, 10/30).

“The U.N. report also illustrates the extent to which teen pregnancies perpetuate poverty — since pregnant girls often leave school — and harm a country’s economic productivity,” the Wall Street Journal notes, adding, “Brazil, for example, would have additional productivity equal to $3.5 billion a year if teenage girls delayed pregnancy until their early 20s, the report says, while India’s would be $7.7 billion higher” (Muñoz, 10/30). The report “notes the lifetime opportunity costs related to adolescent pregnancy range from one percent of annual GDP in China to 30 percent of annual GDP in Uganda,” VOA News writes (Schlein, 10/30).

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Early HIV Treatment Is Cost-Effective Over Long Term, Study Says

“Treating people with HIV soon after they become infected is cost-effective over the long term, according to a study out Wednesday [in the New England Journal of Medicine] that focused on South Africa and India,” Agence France-Presse reports. “By projecting the treatment costs over time and accounting for the effects of better health and fewer infections, researchers found long-term economic benefits in both countries,” the news agency writes (10/30). “While most of the benefits of early treatment were seen in the HIV-infected patients — fewer illnesses and deaths — there were also added health care and economic cost savings from reducing HIV transmission, according to the study,” HealthDay News reports (Preidt, 10/30).

Study co-author Rochelle Walensky of the Massachusetts General Hospital (MGH) said, “In short, early [antiretroviral therapy (ART)] is a ‘triple winner’: HIV-infected patients live healthier lives, their partners are protected from HIV, and the investment is superb. … This study provides a critical answer to an urgent policy question,” according to AFP (10/30). Co-author Kenneth Freedberg, director of the MGH Medical Practice Evaluation Center and professor of Medicine at Harvard Medical School, said, “We believe that continued international public and private partnerships can make [early HIV treatment cost effective] in other countries as well. With this kind of investment, we foresee dramatic decreases in infections and illness that could save millions of lives over the next decade,” an MGH press release states (10/30).

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Poultry Market Closures Effective In Preventing Human Cases Of Bird Flu, Study Shows

“Shutting down live poultry markets is extremely effective in preventing human cases of avian flu and should be considered if the disease reappears this winter, researchers in China reported” in a study published in The Lancet on Thursday, the New York Times reports (McNeil, 10/30). “[R]esearchers from Hong Kong and China said that while closing markets during the height of the first outbreak of H7N9 in April may have been costly, it reduced human infections dramatically and should be done again if cases rise as feared,” Reuters writes. “The findings — of a more than 97 percent reduction in the daily number of human cases of the new H7N9 strain after the markets were closed compared with before — should give policymakers confidence that the economic costs of shutting markets is balanced by significant health gains,” the news agency notes (Kelland, 10/31).

“But experts, including the authors, warned that shutting such markets permanently would be impractical because consumers in many countries demand live birds, and small farmers cannot afford refrigerated slaughterhouses and trucks,” the New York Times writes, adding, “Even temporary shutdowns create economic problems but should be considered, they said” (10/30). “Although closing live poultry markets in some circumstances can reduce human exposure to the H7N9 virus, this measure alone is unlikely to eliminate the threat of bird-to-human transmission, Guillaume Fournie and Dirk Pfeiffer of the Royal Veterinary College in London wrote in an accompanying journal editorial,” HealthDay News notes (Preidt, 10/30).

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Scientists Discover SARS-Like Virus In Bats

“A decade after SARS swept through the world and killed more than 750 people, scientists have made a troubling discovery: A very close cousin of the SARS virus lives in bats and it can likely jump directly to people,” the Wall Street Journal reports. “The findings create new fears about the emergence of diseases like SARS, or severe acute respiratory syndrome,” the newspaper writes, noting, “The virus spread quickly from person to person in 2003 and had a mortality rate of at least nine percent” (Naik, 10/30). “Scientists have long suspected bats to be the natural reservoir for coronaviruses such as the one responsible for SARS (severe acute respiratory syndrome),” according to Science. “The animals have been identified as the source of many dangerous viruses, such as Nipah and Hendra, and have also been linked to Ebola and the new coronavirus causing a SARS-like illness, dubbed MERS,” the magazine notes. “The new results cannot resolve whether the original SARS virus moved directly from bats into humans or via an intermediate host, says Columbia University virologist Ian Lipkin, who was not involved in the work,” the magazine writes, adding, “But it shows that a similar coronavirus ‘has the potential to infect people without an intermediate host'” (Kupferschmidt, 10/30).

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Two Studies Among Monkeys Show Potential For New HIV Treatment

“Antibodies derived from the blood of HIV-infected people suppressed the virus in the blood of monkeys in two studies that suggest the experimental approach may improve AIDS therapy or point the way toward a cure,” Bloomberg reports (Bennett, 10/30). “The two studies, published on Wednesday in the journal Nature, involve the use of rare antibodies made by 10 percent to 20 percent of people with HIV that can neutralize a wide array of strains,” Reuters notes (Steenhuysen, 10/30). “Two groups, from Harvard Medical School and the National Institute of Allergy and Infectious Diseases, performed the first trials of these antibodies,” BBC News reports (Gallagher, 10/30). “The study results ‘could revolutionize efforts to cure HIV’ if the approach is found to work in people, said a commentary published Wednesday by the journal Nature along with the monkey studies,” the Associated Press writes (Ritter, 10/30). According to Nature, “both teams plan to move their research into human trials” (Ledford, 10/30).

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Cameroon Facing Malaria Outbreak, ARV Shortages

“Nearly 800 people have died in a recent malaria outbreak in northern Cameroon, one described by public health officials as ‘a severe and sudden epidemic,'” CNN reports. “Doctors treating more than 12,000 victims of the disease say those who died in the past three weeks were mostly young children and pregnant women,” the news service writes. According to CNN, “a panel of Cameroonian journalists on state radio [on Wednesday] criticized the government for not spreading the news about the outbreak and not requesting international aid,” and “[o]bservers have criticized President Paul Biya of ignoring the mounting malaria death toll as he focuses on lavish preparations to celebrate his 31 years in the presidency November 6” (10/30).

In similar news, “[t]he government of Cameroon says it cannot supply antiretrovirals [ARVs] to half of the patients who need them because of a drastic shortage of the drugs,” VOA News reports. According to health officials, the number of patients receiving HIV treatment has increased from about 28,000 in 1998 to about 200,000 this year, “but government assistance to treat HIV/AIDS has remained stagnant,” the news service notes. VOA states, “Minister of Public Health Andre Mama Fouda attributed the shortage to the increasing number of people receiving [ARVs]” (Kindzeka, 10/31).

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South Sudan Is Polio-Free; Sample Contamination Responsible For False-Positive Lab Results

“South Sudan and [WHO] officials have reassured locals and the international community that South Sudan is polio-free, after they found that three reported cases of the crippling disease were misdiagnoses,” VOA News reports. Noting the samples sent to Nairobi for analysis were discovered to have been contaminated, South Sudanese Health Minister Riek Gai Kok “said the mistaken diagnoses in South Sudan were discovered after the U.S. [CDC] took the unusual step of doing a second round of tests on the South Sudan samples, seeking to confirm the outbreak,” the news service writes. “Gai says there are still concerns that an ongoing polio outbreak in Somalia could enter South Sudan,” VOA notes, adding, “The Global Polio Eradication Initiative, a public-private partnership led by the WHO, has said the Somalia outbreak has already spread to Ethiopia and Kenya” (Green, 10/30).

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Editorials and Opinions

Editorials, Blog Address Spread Of Polio In Syria

The following is a summary of two editorials and a blog post addressing polio in Syria, where the WHO on Tuesday confirmed 10 of 22 suspected cases of the disease.

  • Baltimore Sun: “The re-emergence of polio in Syria, which had been virtually eliminated in that country over the last two decades, inevitably will increase the misery of civilians caught up in the conflict. But it also has profound implications for the rest of the world,” the newspaper writes. “Delivering vaccine in a country wracked by civil war represents the biggest obstacle health officials face in trying to contain the disease,” the editorial states, noting the U.N. is “unable to reach many areas of the country where government and opposition forces are locked in combat and refuse to guarantee the safety of health workers trying to enter contested areas.” The newspaper adds, “Breaking such deadlocks so that vaccinations can resume ought to be a priority for peace talks between Syrian opposition groups and the government of President Bashar al-Assad scheduled for next month, and the U.S. should use whatever influence it has to make sure the issue receives the attention it deserves” (10/30).
  • New York Times: “Civilians have paid a terrible price ever since President Bashar al-Assad of Syria used force to crush peaceful protests that began in 2011, touching off a full-scale civil war,” the editorial states. “Now comes another trial: the country’s first outbreak of polio in 14 years,” the newspaper writes. The U.N. “has asked its members for $1.5 billion to provide food, schooling and medicine to vulnerable Syrians,” which “is short of the need,” the editorial states, adding, “The best way to help the Syrians is to end the war. The next best thing is to mitigate the suffering by contributing generously and by pressuring both sides in the conflict to allow aid workers to deliver essential supplies” (10/30).
  • Walt Orenstein, Bill & Melinda Gates Foundation’s “Impatient Optimists” blog: “Polio’s return to Syria reinforces the urgent need to interrupt transmission in the remaining endemic countries: Pakistan, Afghanistan and Nigeria,” Orenstein, a professor and associate director of the Emory Vaccine Center at Emory University, writes in the blog. “These countries serve as reservoirs where the poliovirus is transmitted from person to person in a continuous chain,” he states. “The good news is endemic countries have made remarkable progress this year,” Orenstein writes, adding, “We must capitalize on this progress to finally end polio in the endemic countries and eliminate the chance of it emerging anywhere else” (10/29).

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Development Agenda Must Address 'Brain Drain' Of Doctors From Africa

“Economic development goals must address the flow of high-skilled health care professionals to more fortunate countries. Source countries, recruiting countries, and the international community should address brain drain and improve health care inequity,” Kassahun Desalegn, department head and assistant professor of dermato-venereology at the University of Gondar’s College of Medicine and Health Sciences in northern Ethiopia and a 2013 New Voices Fellow at the Aspen Institute, writes in a Thomson Reuters Foundation opinion piece. “As a professor of medicine, I also train medical and paramedical professionals and have noticed many newly graduated professionals choose to immigrate to the U.S., Europe, the Middle East and other rich African countries like Botswana and South Africa rather than practice at home,” he states, noting, “Nearly 30 percent of African doctors leave to work abroad after graduation.”

“Strengthening the health care workforce in developing countries is an important component of international development policy,” Desalegn continues. “First, African governments should provide much better compensation for doctors” with “[i]mproved wages, pension, housing, tax benefits, childcare, and medical insurance,” he states, adding, “Destination countries should also avoid recruiting doctors from countries with critical health manpower shortages” and “instead should improve and expand their education systems to train the health care workers they need and ensure the sustainability of their own health care systems” (10/30).

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Continued Investment Necessary To Maintain, Improve Progress Against TB

In order to defeat tuberculosis (TB), “we need to invest in treatment and ensure that it reaches all those who are infected because otherwise, we will not be able to break the back of this epidemic,” Lucy Chesire, executive director and secretary to the Board of the TB ACTION Group, writes in the Huffington Post’s “Impact” blog. “This week, TB advocates from all around the world, including Lucica Ditiu (the executive secretary of the Stop TB Partnership based in Geneva), are gathering in Paris at the 44th Union World Conference on Lung Health,” she notes. “As we get closer to the Global Fund Pledging Conference which will take place in Washington, D.C., on December 3, the critical role the Global Fund plays in fighting TB — recent results indicate it has helped provide treatment to 11 million people and is responsible for three-quarters of all international financing for TB — will be top of mind for advocates and others at the TB conference,” Chesire writes and includes a transcript of an interview with Ditiu. “If the Global Fund doesn’t reach its [funding] target, the fragile progress that we have seen in TB over the past 10 years will be eroded and we will never … stop the spread of drug-resistant TB or save lives,” Ditiu said, according to the transcript (10/30).

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Controversial Family Planning Advertising Would Spur Discussion, Behavior Change

Writing in the Huffington Post’s “World” blog, Christopher Purdy, executive vice president of DKT International, discusses the benefits of controversial condom advertising in Ethiopia, Pakistan, and the Philippines, saying such ads have “provided opportunities to bring the conversation about family planning out of the bedroom and into the open.” He continues, “Family planning programs, by contrast, have generally kept their promotions asexual, choosing to show happy families, responsible fathers, and mothers who are healthy and cheerful. … I think we’re missing an opportunity here.” Purdy says more provocative advertising for other family planning methods, such as oral contraceptives, might spur discussion and behavior change (10/30).

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From the Global Health Policy Community

U.S. Should Continue, Expand TB Technical Assistance

“Through [USAID], the [CDC], and [PEPFAR], the U.S. provides either directly or indirectly more than 70 percent of external technical assistance provided to national TB programs, according to WHO estimates. The U.S. also is a major supporter of the Global Fund, pledging nearly a third of the organization’s funding since its creation in 2002,” Nellie Bristol, a research fellow with the Global Health Policy Center at the Center for Strategic & International Studies, writes in the center’s “Smart Global Health” blog. Summarizing the findings of the WHO’s recently released global TB report, she writes, “But adequate funding continues to be an issue. TB already has the smallest budget of the three largest infectious disease programs prioritized by the U.S.” Bristol adds, “Donors other than the U.S. should increase contributions to ensure countries can tap the expertise they need to build sustainable, self-sufficient national TB programs that can effectively treat TB and reverse trends in drug resistance. In the meantime, U.S. efforts to help countries with the task need to continue, and to the extent possible, be increased” (10/30).

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Sachs Discusses Efforts To Replenish Global Fund

The Center for Global Health Policy’s “Science Speaks” blog provides highlights of a meeting hosted by the Friends of the Global Fight on Wednesday, where Jeffrey Sachs, director of the Earth Institute at Columbia University and special adviser to the U.N. Secretary-General on the Millennium Development Goals (MDGs), spoke about replenishment for the Global Fund to Fight AIDS, Tuberculosis and Malaria. “Sachs said the Global Fund aims to raise $15 billion for life-saving interventions for the most poor from 2014 to 2016, which means countries need to pledge at a minimum $5 billion per year for the next three years — a paltry sum compared to the billions given in bonuses to Wall Street every year and spent on global wars, he said,” the blog writes (Aziz, 10/30).

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Five Strategies To Achieve MDGs From Health Worker's Perspective

“To close the gap and successfully achieve the [Millennium Development Goals (MDGs)], I believe that Jamaica should embrace some applicable strategies outlined in the 2012 Women Deliver Report on Regional Consultations,” Victoria Melhado, a nurse living in Jamaica, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. She outlines five suggested strategies, including the integration of health services, a greater focus on “increasing access and diversity in family planning services,” youth engagement, strong partnerships and adequate funding, and greater political will. She concludes, “We must remain united as we close the gap to achieving our goals with our Jamaican people and with the global community” (10/30).

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TB Activists Demand Zero Deaths, New Infections, Stigma At International Conference

“Tuberculosis (TB) activists and representatives of affected communities stormed the opening of the Stop TB Symposium at the [44th Union World Conference on Lung Health on Wednesday] in Paris, demanding faster progress towards eliminating TB and a target of zero TB deaths,” a Stop TB Partnership press release reports. Treatment Action Group (TAG) TB Project Director Colleen Daniels spoke to the audience, challenging “the delegates assembled to be more ambitious and aim for zero TB deaths, zero new infections and zero suffering and stigma,” the press release notes (10/30). Video of the demonstration and additional information on TAG’s “Zeroes Campaign” is available online (10/30).

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