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Kaiser Daily Global Health Policy Report

In The News

Countries Agree On U.N. Draft Declaration On TB Ahead Of First-Ever High-Level Meeting

Agence France-Presse: U.N. agrees global plan to battle TB ahead of first-ever summit
“U.N. member states on Friday agreed on a global plan to step up the fight against tuberculosis, the world’s number one killer among infectious diseases, settling a row with the United States over access to cheap drugs…” (9/14).

Deutsche Welle: U.N. wins support to end TB after U.S. dispute
“…The main goal of the agreement is to consolidate support to end the tuberculosis epidemic by 2030. The declaration is expected to include a commitment of $13 billion (€11.2 billion) annually to end the spread of the infectious disease, with an additional $2 billion to fund research for that goal…” (9/15).

The Guardian: Scientists warn of global crisis over failure to tackle tuberculosis
“…More than 10 million new cases of TB are detected every year and about 1.7 million people die of the disease, according to a recent report by U.K. doctors. At the same time, the group describes current global anti-TB measures as ‘woefully inadequate.’ In a letter to Theresa May the group — U.K. Academics and Professionals to End Tuberculosis — says the intervention of world leaders is urgently needed to contain TB as the number of antibiotic-resistant cases continues to rise. The letter urges May to attend the U.N. General Assembly meeting on ending TB on 26 September as the head of Britain’s delegation…” (McKie, 9/15).

VOA News: U.N. General Assembly Hosts High-Level Talks to Combat Tuberculosis
“…The U.N. General Assembly hopes to draw more attention to the problem by hosting its first-ever, high-level meeting on tuberculosis. The meeting will be at the end of September to bolster global efforts to end the disease and help those affected…” (Craig, 9/15).

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U.N.'s 2018 Human Development Index Shows Global Progress, But Concerns Over Health, Education Remain

Deutsche Welle: Human development progress overshadowed by inequality
“The 2018 Human Development Index (HDI) released by the United Nations on Thursday showed that although there have been steady improvements in human development, major concerns about quality of life and education remain. … Norway, Switzerland, Australia, Ireland, and Germany top the rankings in the latest report, while Niger, the Central African Republic, South Sudan, Chad, and Burundi have the lowest scores…” (Mules, 9/14).

The Guardian: Middle classes drive up life expectancy in sub-Saharan Africa
“People in sub-Saharan African can expect to live for 11 years longer than the generation that went before them, new statistics show. … The U.N.’s annual Human Development Index … found substantial global progress since 1990. But researchers warned that the progress made is vulnerable to threats including climate change, conflict, and epidemics, as well as worsening living conditions among the middle classes…” (Ratcliffe, 9/15).

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Media Outlets Discuss Research Examining Cash Payments, Traditional Aid, USAID-Supported Cash-Benchmarking Study

NPR: Which Foreign Aid Programs Work? The U.S. Runs A Test — But Won’t Talk About It
“…[O]n Thursday, the government released the results of the first study in the [cash-benchmarking] series: An evaluation of a program to improve child and maternal health in Rwanda by teaching families about nutrition and hygiene. The experiment found that the program met none of its main objectives. (Offering people the equivalent amount in cash — about $114 — also did not improve their nutrition or health. But providing a much larger cash grant of about $500 did make some difference.) … Asked why USAID would not authorize an interview with [USAID Senior Adviser on Aid Effectiveness Daniel] Handel or any other official to discuss the cash-benchmarking experiments, an agency spokesman declined to comment but provided a statement. It said, in part, ‘cash-benchmarking is not relevant to most of USAID’s programs’…” (Aizenman, 9/14).

Wired: Google-Funded Study Finds Cash Beats Typical Development Aid
“…A number of studies on unconditional cash transfers are underway, but the government agency’s involvement demonstrates a willingness to question whether the status quo is cost effective, says Michael Faye, cofounder and director of the U.S.-based nonprofit GiveDirectly, which distributed the mobile cash in 248 villages in Rwanda, where the study took place…” (Tiku, 9/14).

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U.S. FDA Announces Plan To Address Antimicrobial Resistance

CIDRAP News: FDA plan focuses on antibiotic development, stewardship
“The U.S. Food and Drug Administration (FDA) [on Friday] announced a multipronged strategy to address antimicrobial resistance (AMR) that emphasizes new measures to spur development of antibiotics and alternative therapies, promote antibiotic stewardship in animal health, advance antibiotic resistance surveillance, and enhance regulatory science…” (Dall, 9/14).

Healio: FDA unveils new plan to kickstart drug development for resistant bacteria
“… ‘We cannot count on outracing drug resistance, but we can use stewardship and science to slow its pace and reduce its impact on human and animal health,’ FDA Commissioner Scott Gottlieb, M.D., said in a press conference. ‘To do so, we need an all-hands-on-deck approach to combating antimicrobial resistance in both human and veterinary settings’…” (Bortz, 9/14).

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UNICEF Bolstering Ebola Outbreak Response Efforts In Congo; WHO Reports 92 Deaths

Axios: UNICEF and Congo officials boost efforts to contain Ebola outbreak
“In response to an small uptick in confirmed Ebola cases in the busy urban hub of Butembo in the Democratic Republic of the Congo, UNICEF announced Friday it’s bolstering its efforts there…” (O’Reilly, 9/14).

U.N. News: DR Congo: new cases of deadly Ebola virus, as U.N. steps up response
“…On Friday, WHO, the World Health Organization, said that there were 137 confirmed and probable cases and 92 deaths in the latest outbreak in the east of the country…” (9/14).

VOA News: Community Resistance to Ebola Growing in Congo
“…The U.N. agency is working with community and religious leaders in the city of Beni, where health workers are facing hostility and resistance. UNICEF spokesman Christophe Boulierac said the spread of false rumors and fear about Ebola are endangering efforts to contain the virus…” (Schlein, 9/14).

Additional coverage of the Ebola outbreak response in Congo is available from BBC News, Reuters, and VOA News (2).

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Zimbabwe Works To Contain Cholera Outbreak, Reports 28 Deaths

Deutsche Welle: Zimbabwe struggles to contain cholera outbreak
“The latest cholera epidemic in Zimbabwe has claimed the lives of 28 people, state media confirmed on Sunday. The outbreak was first detected earlier this month in a township outside the capital of Harare and has prompted the government to declare a state of emergency. At least 3,000 cholera cases have been reported in the city, where two million people reside…” (9/16).

VOA News: Cholera Outbreak in Zimbabwe Turns Drug-Resistant
“The United Nations says it is hopeful Zimbabwe will soon contain an outbreak of cholera that has killed more than two dozen people. Efforts are complicated as authorities are fighting a drug-resistant bacterium said to be fueling the spread of the waterborne disease…” (Mavhunga, 9/14).

Additional coverage of the cholera outbreak and response efforts is available from Agence France-Presse/News24BBC News, Becker’s Hospital Review, and VOA News.

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2 Sisters Die Of FGM In Somalia; Activists Raise Concerns Government Not Addressing Issue

The Guardian: Somalia under renewed scrutiny over FGM after two more young girls die
“Two more girls in Somalia have died after undergoing female genital mutilation, just weeks after a high-profile case prompted the attorney general to announce the first prosecution against the practice in the country’s history. … [A]ctivists in the country say the death of the two sisters proves that the government is not moving quickly enough to prevent further incidents…” (Hodal, 9/17).

NPR: 2 Young Sisters Die After Undergoing Female Genital Mutilation
“…The cases underscore concerns about FGM in Somalia, which the U.N. says has the highest prevalence in the world. Ninety-eight percent of women between the ages of 15 and 49 have undergone FGM. The practice is legal in Somalia. Worldwide, the World Health Organization estimates that more than 200 million women and girls have experienced some form of FGM. … The U.N. designates it as a human rights violation…” (Cohen, 9/14).

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NYT Examines Efforts To Prevent, Treat Rheumatic Heart Disease In Rwanda

New York Times: Where a Sore Throat Becomes a Death Sentence
“…In the United States and other rich countries, children with sore throats are routinely tested for strep and quickly cured with penicillin or other cheap antibiotics. But in poor countries, strep throat often goes undiagnosed and can become a long, slow death sentence. Without treatment, it can lead to rheumatic fever and rheumatic heart disease, in which the immune system attacks the heart valves … Experts say programs to educate people about sore throats and strep, and to distribute penicillin widely to local clinics, could help greatly to prevent rheumatic heart disease in poor regions. But even those efforts probably would not wipe it out completely, because not everyone with strep seeks medical attention…” (Grady, 9/16).

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Idlib Offensive Could Dramatically Worsen Humanitarian Situation In Syria, U.N. Official Says

Health Policy Watch: Exclusive: Senior U.N. Official On Syria Calls For An End To Attacks On Health Facilities As International Efforts Mount To Avert Another Humanitarian Catastrophe Over Looming Battle For Idlib
“Panos Moumtzis, assistant U.N. secretary general and regional humanitarian coordinator for the Syria crisis (since September 2017) spoke to Health Policy Watch in an exclusive interview Thursday about the escalating crisis in the Syrian conflict, the continued attacks on health care facilities, and the mounting international humanitarian and diplomatic efforts to try and avert another humanitarian catastrophe in the war-torn nation…” (Zarocostas, 9/14).

Wall Street Journal: The Political and Humanitarian Impact of an Offensive in Idlib
“…United Nations officials warn an offensive in Idlib could result in the worst humanitarian disaster of the 21st century. In previous battles, for smaller opposition pockets in Daraa and East Ghouta, the Syrian government has besieged rebel-held areas to force militants into submission, with civilians suffering from hunger and lack of medicine…” (Osseiran, 9/14).

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U.N. Working To Open Air Bridge In Yemen To Improve Access To Care For Patients With Chronic Conditions; WFP Warns Food Supply Threatened

Agence France-Presse: U.N. seeks to open air bridge to aid Yemeni cancer patients: WHO
“The United Nations is working to open a humanitarian air bridge to take Yemeni cancer patients for treatment at qualified facilities, WHO country representative for Yemen Nevio Zagaria said Sunday. ‘The aim is to help patients suffering from cancer, chronic diseases, and congenital anomalies receive the treatment they need,’ Zagaria said, adding that 12 health conditions had been targeted…” (9/16).

U.N. News: Yemen: mortar attack on U.N. food silo ‘could affect vital aid deliveries to millions’
“Fighting in the Yemen port city of Hudaydah which has damaged a World Food Programme (WFP) storage facility, threatens to hamper efforts to feed millions of people in the war-torn country, it said on Friday. Briefing journalists in Geneva, WFP spokesperson Herve Verhoosel, said that on-going clashes taking place near the Red Sea Mill Silos, which is ‘a critical facility for WFP operations,’ could impact the agency’s ability ‘to feed up to 3.5 million very hungry people in northern and central Yemen for one month’…” (9/14).

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More News In Global Health

Devex: 6 conversations you missed at the World Economic Forum on ASEAN (Rogers/Ravelo, 9/14).

The Guardian: Affordable vaping for smokers in poor countries branded ‘a human rights issue’ (Austin, 9/14).

The Guardian: ‘A lurking beast’: polio casts shadow over Papua New Guinea independence day (Martin/Lyons, 9/15).

The Guardian: ‘She didn’t have the energy to cry’: Timor-Leste and its struggle against malnutrition (Davidson, 9/16).

Health Policy Watch: Asia-Pacific: Two Initiatives To Eliminate Malaria Once And For All (Ueberschlag, 9/13).

Health Policy Watch: New R&D Models And Incentives Necessary To Step Up Fight Against AMR, E.U. Parliament Declares (Ermert, 9/13).

Reuters: Saudi Arabia reports cholera infection in southern province (Kalin, 9/16).

Reuters: Indonesia’s quake-hit Lombok declares health emergency over malaria (Da Costa, 9/15).

SciDev.Net: Worries over vaccination apathy, high child mortality in Pakistan (Shaikh, 9/15).

Xinhua News: Interview: NGO says gov’ts should urgently implement proven interventions to reduce NCDs (Jiangang, 9/16).

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Editorials and Opinions

Lancet Global Health Pieces Discuss Upcoming U.N. High-Level Meeting On TB

The Lancet Global Health: A new era for tuberculosis?
Editorial Board

“…Earlier drafts of the political declaration — the key outcome document of the [first-ever U.N. High-Level Meeting (HLM) on Tuberculosis] — contained reference to the full use of flexibilities in intellectual property rules geared towards maximizing access. Yet, under pressure from the USA and others, the final draft saw these provisions weakened. … There are many priorities in the complex and centuries-long fight against this cruel disease. But to suggest, as did a U.S. representative at the recent civil society hearing ahead of the HLM, that global efforts should focus on improving health systems and new tools, rather than being ‘distracted, as we so often are, into a discussion of access to medicines, intellectual property flexibilities, or compulsory licensing’ is plainly absurd. New tools include new (expensive) medicines and health systems cannot improve if WHO-recommended regimens cannot be afforded. Will the HLM make a difference? Not as long as commercial protectionism trumps social justice” (October 2018).

The Lancet Global Health: Message to world leaders: we cannot end tuberculosis without addressing the social and economic burden of the disease
Priya B. Shete, assistant professor in the Division of Pulmonary and Critical Care Medicine at the University of California, San Francisco (UCSF); Michael Reid, assistant professor at the Division of HIV, Infectious Diseases and Global Medicine at UCSF; and Eric Goosby, professor at the Division of HIV, Infectious Diseases and Global Medicine at UCSF and U.N. Special Envoy for TB

“…[P]urely biomedical or public health solutions are not enough to end the tuberculosis epidemic; countries must implement social policy strategies that can protect tuberculosis sufferers from the financial shocks of this deadly disease. … [The U.N. High-Level Meeting on TB] provides a unique opportunity to underscore the importance of social protection interventions in ending tuberculosis. … [T]o capitalize on the political opportunity that the HLM presents, the tuberculosis community must emphasize to Heads of States and Governments how a successful response to the epidemic needs to extend beyond biomedical solutions, and address all patient barriers to tuberculosis prevention and care. Further, by integrating social protection with tuberculosis care, we can model multisectoral approaches in policy, program, and research that can be used to achieve disease elimination and simultaneously improve economic and development outcomes for the world’s most vulnerable populations” (9/14).

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Combining U.S. Humanitarian Assistance Entities Could Strengthen U.S. Response

Devex: Opinion: A sensible way to strengthen U.S. humanitarian response and leadership
Gregory Gottlieb, director of the Feinstein International Center at the Friedman School of Nutrition Science and Policy at Tufts University, and Howard (Roy) Williams, adjunct assistant professor at Columbia University’s School of International and Public Affairs

“…[T]he right approach [to improving humanitarian assistance] is combining all three relief entities [– USAID’s Office of Foreign Disaster Assistance, USAID’s Food for Peace, and the U.S. Department of State’s Bureau for Population, Refugees and Migration –] under USAID, which would strengthen the U.S.’s ability to meet humanitarian needs, while keeping the refugee bureau intact to skillfully and diplomatically deal with broader refugee and migration issues. Refugee protection and admissions, along with humanitarian assistance, are mutually supportive efforts. It would be the cruelest of ironies for the U.S. to offer more effective humanitarian aid abroad while closing its doors to refugees and silencing America’s strong voice for the protection of refugees and migrants. We urge the administration to follow a more sensible reorganization of humanitarian assistance that creates a single office for assistance and preserves skilled diplomatic protection of refugees” (9/14).

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Donors Should Be More Systematic In Evaluating Development Interventions, Consider Using Cash Transfers As Benchmark

The Atlantic: A/B Testing Foreign Aid
Michael Faye and Paul Niehaus, co-founders of GiveDirectly and Segovia Technology

“How can we innovate in the huge, $140 billion foreign aid sector? The same way we do in the private sector: routine evaluations of what’s working well and what isn’t. Yet donors rarely measure the effectiveness of individual programs, let alone weigh one intervention against another. … Donors should be more systematic in evaluating interventions, and they should consider using cash as a yardstick. Because if an intervention isn’t more effective than cash, then perhaps the donor should switch gears. Cash is simpler, and arguably cheaper and more scalable, than traditional interventions. … This is the minimum role cash transfers can and should play for aid and philanthropy: not as a replacement for all interventions, but as a basis for comparison. There is a deeper question, however, that benchmarking forces us to ask: Who gets to decide what the ‘best’ outcome is? … Divergence between donor and recipient preferences is not surprising, and traditionally we have chosen, paternalistically, to let the donor’s vision win out. But if the goal is sincerely to help the extremely poor live better lives, shouldn’t they have more say?” (9/14).

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Global Food System Should Focus More On Health, Environment

Financial Times: Rising obesity in Africa reflects a broken global food system
Rajiv Shah, president of the Rockefeller Foundation

“…The food production system must … prioritize public and planetary health over purely commercial goals. Global food policies must encourage the production of a diverse range of foods naturally rich in the vitamins and minerals people need to be healthy. … We should also rethink our approach to protein. People need protein to survive, but the main source, animal agriculture, does great harm to our planet. Yet plant-based protein alone is not the perfect answer … Therefore, our challenge is to rebalance plant and animal proteins in our diet to reduce livestock’s impact on our planet. Rising hunger and malnutrition along with declining natural resources and a warming planet threaten our existence. A global food system that is more focused on health and the environment is badly needed” (9/16).

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Nonprofit Heart Surgeon Group Makes Progress In Treating Rheumatic Heart Disease But More Effort Needed From Rwandan Government

New York Times: A Boy Named Chance in a Land Without Heart Surgeons
Denise Grady, science reporter for the New York Times

“…In lower-income countries, where strep often goes undetected, rheumatic heart disease is a huge public health problem, affecting tens of millions of people. This year, about 100 Rwandan patients, desperate for lifesaving surgery, showed up to be screened by Team Heart — which could operate on only 16. It’s tempting to think that if parents could be taught to seek care whenever their children have sore throats, this problem could be wiped out. But it’s not so simple. In interviews, I found that most patients and their parents had no memory of a sore throat. … [M]any more patients than the team could handle needed surgery, and the progress I had hoped to find — like the Rwandan government stepping up to pay for these operations and train doctors and nurses to perform them — still seems to be somewhere over the horizon” (9/16).

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From the Global Health Policy Community

Brookings Paper Examines SDG Progress, Including Current Trends, Challenges

Brookings Institution: How many people will the world leave behind?
Homi Kharas, interim vice president and director; John McArthur, senior fellow; and Krista Rasmussen, research analyst, all in Global Economy and Development at the Brookings Institution, highlight a paper in which they discuss global progress on the Sustainable Development Goals (SDGs), examining current trends and potential challenges to achieving SDG targets (9/14).

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FT Health Discusses Cancer, Alternative Therapies, Features Interview With Dutch Pharmaceutical Accountability Foundation President

FT Health: Cancer and quackery
The latest issue of the Financial Times’ weekly global health newsletter discusses crowdfunding cancer therapies, alternative therapies, and the WHO’s recent report on cancer rates worldwide. The issue also features an interview with Wilbert Bannenberg, president of the Dutch Pharmaceutical Accountability Foundation, “on his plans to fight high drug prices,” and provides a round-up of global health-related news stories (Dodd/Jack, 9/14).

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From the U.S. Government

U.S. Government Supports Ebola Outbreak Response Efforts In DRC, Along Border With Uganda

USAID’s “IMPACTblog”: Temperature Check: Border Screening of Travelers Key to Stopping Ebola from Spreading
Alma Golden, senior deputy assistant administrator for global health at USAID, discusses the importance of border health screening and surveillance efforts in the most recent Ebola outbreak in the Democratic Republic of Congo, as well as U.S. government engagement in the country’s health sector (9/14).

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