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Kaiser Daily Global Health Policy Report

In The News

Global Community Reacts To Death Of Nelson Mandela, Reflects On His Contributions To Global AIDS Response

“Nelson Mandela, who led the emancipation of South Africa from white minority rule and served as his country’s first black president, becoming an international emblem of dignity and forbearance, died Thursday night. He was 95,” the New York Times reports (Keller, 12/5). “Tributes began flooding in almost immediately for a man who was an iconic global symbol of struggle against injustice and of racial reconciliation,” Reuters notes, adding, “U.S. President Barack Obama said the world had lost ‘one of the most influential, courageous and profoundly good human beings that any of us will share time with on this earth’” (Cropley/Fletcher, 12/5). “Madiba’s ‘long walk to freedom’ gave new meaning to courage, character, forgiveness, and human dignity. … He will be remembered as a pioneer for peace,” U.S. Secretary of State John Kerry said in a statement (12/5). “Mandela’s commitment to overcome prejudice and hate inspired not only his determination to break down barriers between different races, but also to eliminate discrimination against those living with HIV, calling on people to give publicity to HIV/AIDS and no longer to hide it,” WHO Director-General Margaret Chan said in a press release (12/6).

Mandela “devoted much of his time to advocating for access to HIV treatment, ending stigma and ensuring all babies are born HIV free,” UNAIDS writes in a press statement, adding, “He used his stature and presence on the global stage to persuade world leaders to act decisively on AIDS and tuberculosis” (12/5). “[T]he spark he ignited in fighting AIDS, poverty, hunger and supporting more than 50 charities in his lifetime will continue to live on, advocates say,” the Huffington Post’s “Impact” blog writes (Goldberg/Prois, 12/6). “Mandela defied the stigma and shame that kept AIDS deaths cloaked in euphemism across Africa — because, even though by that point [in 2005, when he announced his son had died of AIDS,] 800 people were dying of AIDS in South Africa every day, no one would say so out loud,” the Globe and Mail notes (Nolen, 12/5). “After Mr. Mandela left office in 1999, he campaigned for more research into HIV/AIDS, for education about safe sex and for better treatment for those affected,” according to BBC News (12/5). “Mandela’s most significant contribution to the fight against AIDS may have been his intervention at the international AIDS conference in Durban in July 2000,” where he delivered “a speech that changed the AIDS agenda,” “rallied world opinion to the side of action and muted the opposition of the South African government to treatment,” The Guardian adds (Boseley, 12/5). Devex highlights “some of his most memorable quotes on education, global health and poverty” (Villarino, 12/6).

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World Bank President Announces Targets For Universal Health Coverage

“Ensuring greater access to affordable health care is a crucial factor in alleviating poverty and promoting economic growth, World Bank President Jim Yong Kim said Friday in announcing ambitious targets for preventing and treating chronic illnesses in developing countries,” the Associated Press reports. “The consensus among many familiar with development and poverty alleviation is that providing universal health coverage is vital for economic development, said officials attending a conference in Tokyo,” the news service writes (Kurtenback, 12/5). “Kim has very specific goals: reducing the number of people impoverished by health care expenses by half to 50 million in 2020, and to zero by 2030,” the Wall Street Journal notes (Obe, 12/6).

“Universal health coverage is not only morally correct, but vital for a country’s economic development,” Kim told the conference, according to Agence France-Presse. “The gathering was aimed at spreading the take-up of universal health care to developing nations, with the emphasis on how it could boost growth in poorer countries,” AFP adds (12/5). “Both universal health care and disaster management take investments. But Mr. Kim said that political will, rather than financing, is the biggest obstacle, at least for universal health care coverage,” the Wall Street Journal writes (12/6).

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Still No Consensus On Food Security, Trade Facilitation On WTO Meeting's Final Day

“A consensus still eludes the 159 member nations of the World Trade Organization (WTO) on issues of trade facilitation and food subsidy on the final day of the ninth ministerial talks of the group,” the Financial Express reports. “After hectic parleys with India and the U.S. that lasted until early Friday morning, another informal meeting by WTO Director General Roberto Azevedo with all members also failed to yield results,” the newspaper writes, adding, “Indications are that a final declaration from the summit may be delayed to either late Friday evening or even Saturday morning” (Surabhi, 12/6). “India wants a solution to its demands to exempt food security plans from being counted under subsidy spending caps, while the U.S. is concerned surplus from India’s food program may get dumped onto world markets,” Bloomberg notes. “Failure to reach an agreement on a Bali package including trade facilitation would diminish confidence in the 159-member [WTO], its spokesman Keith Rockwell said yesterday,” the news agency writes, adding, “Members have been negotiating the Doha round of trade talks for 12 years and this week’s meeting is seen as the last chance for a deal” (Chatterjee, 12/5).

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House Committee Adviser Says Passage Of U.S. Foreign Aid Bill In 2014 Unlikely, Devex Reports

Speaking at the 2013 Council of International Development Companies Conference on Wednesday, Nilmini Rubin, House Foreign Affairs Committee senior adviser for global economic competitiveness, said “the chances of seeing a comprehensive U.S. foreign assistance bill pass through Congress in 2014 [are] ‘close to nothing,’” Devex reports. “Funds for everything are tight. Funds for development are even more tight, because development benefits people who don’t vote,” she said, adding, “Things are moving in different ways on foreign assistance. It’s just unlikely you’re going to see a foreign assistance bill move through Congress. We’re not even getting ‘must-pass’ bills through,” the news service writes. “She noted that despite the gridlock on Capitol Hill, aid-related legislation is moving through Congress,” Devex adds (Igoe, 12/5).

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Gates Foundation's 'Reinvent the Toilet' Challenge Questioned By Experts

“Bill and Melinda Gates’ competition to produce a high-tech toilet for the developing world has been questioned by toilet experts,” SciDev.Net reports. “An environmental engineer and an NGO worker have criticized the Bill & Melinda Gates Foundation for funding the development of advanced toilets that would be too expensive to provide sanitation for the 2.5 billion people without access to a toilet,” the news service notes, adding, “The foundation should instead focus on cheaper technologies and ways to get toilets into communities in a sustainable way, they say.” The news service notes, “The Gates Foundation launched the Reinvent the Toilet Challenge in 2011 to inspire researchers to design toilets that work without water or electricity, and transform waste into energy and water” (Kennedy, 5/12).

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IRIN Examines Maternal Health Challenges In Typhoon-Stricken Philippines

“The massive destruction of health care facilities, with disruption to access and delivery as well as protracted displacement caused by Typhoon Haiyan (local name Yolanda) will further undermine precarious maternal health provision in the Philippines, warn experts,” IRIN reports. “According to the recently released Multi-Cluster/Sector Rapid Assessment (MIRA), produced by more than 40 agencies across nine provinces, damage to health facilities varied from 50 to 90 percent in typhoon-affected areas,” the news service notes. “Approximately 3.6 million women and girls of reproductive age are among the affected, according to the Philippine Department of Social Welfare and Development (DSWD),” IRIN adds. The news service examines a number of health challenges among pregnant and evacuated women (12/5).

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IRIN Examines PMTCT Efforts In Africa

IRIN examines efforts to prevent mother-to-child transmission of HIV (PMTCT) in several countries in Africa after the WHO “updated its guidelines in July 2012, and added Option B+ to its recommendations.” Previously, “[t]reatment options recommended by the [WHO] to prevent mother-to-child transmission of HIV … have depended on CD4 count tests, which are frequently inaccessible to people living in” rural areas, the news service notes. IRIN highlights successful efforts in Botswana, Uganda and Ethiopia, but notes poor health and transport infrastructure, a lack of commodities, and a shortage of health workers have hindered efforts in Lesotho. The news service also examines questions about the push to give “life-long treatment to pregnant women,” such as the risk of loss to follow-up and tension between women who receive treatment and their partners who do not (12/5).

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Researchers Report HIV Resurgence In Two Patients Who Had Undetectable Viral Loads

“Boston researchers are reporting the return of [HIV] in two patients who had become virus-free after undergoing bone marrow transplants, dashing hopes of a possible cure that had generated widespread excitement,” the Boston Globe reports. “The rebound of the virus shows its persistence, and that it can hide in places in the body where it’s hard to find, said the lead scientist, Dr. Timothy Henrich of Brigham and Women’s Hospital,” who presented the findings at an international AIDS research conference in Florida, the newspaper adds. “Other researchers who heard the presentation said the results were disappointing but the Boston team’s approach and data will dramatically advance strategies for battling HIV,” the Boston Globe writes (Lazar, 12/6).

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Efforts To Eliminate Human African Trypanosomiasis See Successes, Challenges, Guardian Reports

The Guardian examines international efforts to eliminate human African trypanosomiasis, commonly known as sleeping sickness, which “remains endemic in 36 sub-Saharan African countries today, putting some 70 million people at risk.” The newspaper continues, “Elimination efforts have seen developments on multiple fronts: a strong health system in place for early identification of clinical signs and symptoms, a referral system, laboratory diagnosis, and effective treatment.” “As the number of cases continues to fall, the elimination of sleeping sickness rests on the ability for control activities to be integrated into wider health systems,” the newspaper writes, noting, “The challenge with integrated service delivery is that it reveals organizational, logistical and technical deficiencies shortcomings.” According to The Guardian, “Elimination will enable this scourge to fall from the top of global health agenda, but ministries of health will need to ensure that resources and training remain available” (Ebikeme, 12/5).

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H7N9 Bird Flu Not Yet Well-Adapted For Human Transmission, Study Says

“The H7N9 bird flu virus has not yet acquired the changes needed to infect humans easily but it would not be wise to dismiss its potential risk, according to a U.S. study published in the journal Science Thursday,” Xinhua reports. “In contrast to some initial studies that had suggested that H7N9 poses an imminent risk of a global pandemic, the new research found, based on analyses of virus samples from the outbreak in China earlier this year, that H7N9 is still mainly adapted for infecting birds,” the news agency writes (12/5). “Until this year, H7N9 strains had never been reported in humans. But in February, dozens of people in two urban areas of eastern China began to come down with H7N9 flu, and most of them became severely ill,” HealthDay News notes, adding, “When the outbreak was mostly over by the end of May, there were 132 human cases confirmed by a laboratory and 37 deaths — a death rate of nearly 30 percent” (Preidt, 12/5).

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Editorials and Opinions

Donors Should Contribute More To Global Fund To Prevent Forfeiting Conditional Pledges

Noting donors have pledged $12 billion over the next three years to support the Global Fund to Fight AIDS, Tuberculosis and Malaria, $3 billion short of the fund’s goal, a New York Times editorial says the amount is “a vote of confidence in the programs at a time when many nations face fiscal constraints.” However, “[i]t was disappointing that other donors failed to pledge enough money to take full advantage of an offer by the United States, the largest single donor to the fund,” which pledged to “contribute $1 for every $2 contributed by other donors,” the editorial states. “Other countries need to step up,” the editorial writes, calling on Japan, Australia, France and Germany to increase their pledges. “[D]onors have pledged $8 billion, so the American contribution will be only $4 billion,” unless additional pledges are made, and the U.K.’s pledge of $1.6 billion “cannot be more than 10 percent of the total raised over the next three years, so its pledge, too, could be cut if other donors don’t contribute enough,” the New York Times writes, concluding, “That means a lot of money will be forfeited if others don’t step up” (12/5).

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U.S. Government, Private Sector Have 'Indispensable Role' In Emergency Aid

“Something every American needs to know: When it comes to emergency response, and longer term efforts on behalf of child survival and disease reduction, U.S. foreign aid plays an indispensable role,” Marty Martin, global executive officer at Food for the Hungry, writes in the Huffington Post’s “Impact” blog. “U.S. funding, influence and leadership work in collaboration with local, national and international partners to help achieve life-saving successes,” such as programs that reduce disease burden and provide emergency relief aid, he writes. “The private sector and our government must continue to respond to emergency and daily tragedies with all the resources we can spare, together with the rest of the world,” Martin states, concluding, “Please ask Congress to increase, not decrease, that small portion of the budget targeted for poverty-focused health, development and humanitarian aid. And thank the bipartisan supporters in Congress who have long understood that this type of foreign aid is both a smart thing, and the right thing, to do” (12/4).

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'Much Still Needs To Be Done' To Prevent Severe Acute Malnutrition In Children

A Lancet editorial examines the global crisis of severe acute malnutrition in children, noting “19 million children younger than five years had severe acute malnutrition (SAM) worldwide in 2011, most of whom lived in Africa and southeast Asia,” and “more than seven percent of all deaths in this age group were attributable to this disorder.” The editorial states, “These shocking numbers — calculated as part of the 2013 Lancet Series on Maternal and Child Nutrition — highlight how seriously the global problem of SAM should be taken.” The Lancet notes the release of new WHO guidelines for managing SAM in young children, writing, “If the actions recommended in the new WHO guidelines are implemented, many children with SAM could recover each year.” The Lancet concludes, “However, much still needs to be done to address the crisis. Robust data are scarce and many research priorities have been identified. And importantly, interventions must be widely introduced to improve nutrition overall and reduce the numbers of children who develop SAM in the first place” (12/7).

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International Community Must Meet Physical, Mental Health Needs Of Syrian Women Who Experience Violence

“December 10 marks Human Rights Day, which this year celebrates 20 years since the Vienna Declaration and Programme of Action — a reaffirmation of the global community’s commitment to human rights. It is also two decades since the U.N. General Assembly’s Declaration on the Elimination of Violence against Women,” a Lancet editorial states. “The anniversary represents a time to reflect on how far the world has come in protecting the rights, safety, health, and dignity of women, and — in complex conflict situations like Syria — how far we have to go,” the editorial continues, noting the recent release of a report (.pdf) by the Euro-Mediterranean Human Rights Network (EMHRN) that “contains evidence of targeted abuse against women in the country.” The Lancet highlights several of the report’s findings, concluding, “Evidence of violence against women in Syria is mounting. International agencies, non-governmental organizations, and asylum countries supporting Syrian citizens can respond by ensuring their services meet the clinical and psychosocial needs of women who have experienced violence” (12/7).

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Recent Releases

CDC, Other U.S. Agencies Will Continue Work To Make PEPFAR Succeed

Noting President Barack Obama this week signed into law the PEPFAR Stewardship and Oversight Act of 2013, CDC Director Tom Frieden writes in the agency’s newsroom, “Along with our colleagues at the HHS Office of Global Affairs, the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), the Food and Drug Administration (FDA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), our work with PEPFAR over the next decade will be equally pivotal.” He continues, “The heart of what CDC brings to the fight is our ability to share our science and innovation to build capacity across the globe.” Frieden adds, “We are closer today than ever before to reaching our goal of an AIDS-free generation. That is a reason to celebrate and, more importantly, to dedicate ourselves even more to scaling up what works to stop this pandemic” (12/4).

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Blog Posts Highlight Recent Actions Surrounding Global Fund Replenishment

In two posts, the Center for Global Health Policy’s “Science Speaks” blog summarizes a Georgetown University event that took place Wednesday, titled “The Global Fund 2014-2016: Sustaining the Fight Against AIDS, Tuberculosis, and Malaria.” In the first post, the blog includes comments from speakers Mark Dybul, Global Fund executive director; David Stevenson, director of global initiatives at the Canadian International Development Agency; National Institute of Allergy and Infectious Diseases Director Anthony Fauci; former U.S. Global AIDS Coordinator Ambassador Eric Goosby; and CDC Director Tom Frieden (Barton, 12/4). The second post includes comments from Dybul, Stevenson, and Lucy Chesire, executive director of the TB ACTION Group in Kenya and a Global Fund board member, who also spoke at the event, as well as reaction to the pledges from Médecins Sans Frontières and Jeffrey Sachs, director of the Earth Institute at Columbia University (Barton, 12/5). The Center for Strategic & International Studies’ “Smart Global Health” blog presents several videos discussing the Global Fund (12/5).

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Blog Examines Report On Wealthy Nations' Development Policies, Effectiveness Of Foreign Aid

In a post in the Center for Global Development’s (CGD) “Global Development: Views from the Center” blog, Owen Barder, senior fellow and director for Europe at the center, and Petra Krylová, program coordinator in CGD’s Europe office, examine the 2013 results of the CGD’s “Commitment to Development Index, now in its 11th year, [which] gauges whether wealthy countries are pursuing development-friendly policies ­– not just on aid but on many other things which matter for development” (12/4). In a separate post, Barder examines the effectiveness of foreign aid, noting, “According to the OECD, total aid since 1960 has been about $2.6 trillion in cash terms, which works out at about $4.7 trillion in 2013 prices.” He states, “Some aid programs fail, and some of those failures are avoidable. We can continue to improve the value for money of aid, and we have an obligation both to taxpayers and to the people we are trying to help to do so” (12/5).

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NEJM Article Examines Global Efforts To Improve Maternal, Newborn, Child Health

In an article published in the New England Journal of Medicine on Thursday, Zulfiqar Bhutta of the Hospital for Sick Children in Toronto, Canada, and Robert Black of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, examine global efforts to improve maternal, newborn and child health and achieve “the Millennium Development Goal (MDG) 4 targeting a reduction in mortality among children younger than five years of age by two thirds and MDG 5 targeting a reduction in maternal mortality by three quarters, both from 1990 base figures.” They note, “Recent assessment of global statistics suggests that despite major gains, among the 75 so-called Countdown countries that have 98 percent of all maternal deaths and deaths among children younger than five years of age, only 17 are on track to reach the MDG 4 target for child mortality and only nine are on track to reach the MDG 5 target for maternal mortality,” and they examine global mortality trends, causes of death, existing interventions and challenges going forward (12/5).

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