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Kaiser Daily Global Health Policy Report

In The News

Emergency Committee Of International Health Experts Begins Talks On MERS Virus

“International health experts began urgent talks on the Middle East coronavirus (MERS) on Tuesday amid concerns about larger numbers of milder infections possibly going undetected, the [WHO] said,” Reuters reports. “The United Nations agency announced last Friday that it was forming an emergency committee, to convene this week, to prepare for a possible worsening of the SARS-like virus,” the news service notes (Nebehay, 7/9). “The 15-member committee, which includes Saudi Arabia’s deputy health minister Ziad Memish and health officials from six other predominantly Muslim countries, met via teleconference [Tuesday] to decide whether [the virus] represents a public health emergency of international concern,” Bloomberg Businessweek writes. WHO Director-General Margaret Chan “last convened [an emergency] committee to battle the 2009 global flu pandemic,” the news service notes (Bennett, 7/9). “Representatives from all nine countries [affected by the virus] made presentations by video link [on Tuesday], said WHO spokesman Gregory Hartl,” CBC News states (7/9). “The group plans to meet again on July 17,” Bloomberg adds (7/9).

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Devex Interviews European Commissioner For Development On Post-2015 Agenda

“At a Brussels event on Tuesday, Andris Piebalgs, the European commissioner for development, presented recommendations by a high-level U.N. advisory panel on post-2015 global development to an audience of researchers, aid officials and representatives from civil society and E.U. member states,” Devex reports, and provides a transcript of an interview with Piebalgs “on the E.U.’s vision, scope and ambitions for the post-2015 development framework and the next steps in reaching international consensus.” According to the transcript, Piebalgs discusses the panel’s approach to developing the 2015-agenda, describes “new initiatives [that] will be launched to overcome the unfinished business of ‘off-track’ Millennium Development Goals,” and examines the role of “south-south cooperation, particularly among developing and emerging economies,” among other topics (Jones, 7/9).

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Philippines Supreme Court Hears Arguments For, Against Reproductive Health Law

“The Philippines Supreme Court began hearing a last-ditch attempt to block the controversial, long-awaited Reproductive Health Law on Tuesday,” Thomson Reuters Foundation reports. “The Philippines Congress passed the RH bill, which requires authorities down to village level to provide free or low-cost reproductive health services, in December, ending some 13 years of debate on what proponents see as a human rights issue but bishops of the influential Roman Catholic Church oppose on religious grounds,” the news service writes, noting the law would require “government funding for reproductive health services and ensur[e] that all public health facilities provide a full range of family planning methods.” The law — which was supposed to take effect on March 30 but was delayed by the high court in March “for 120 days in response to a petition from pro-life campaigners” – “will not promote abortion, which is illegal in the Philippines, a deeply religious country where around 80 percent of the people are Catholic Christians,” Reuters notes (Win, 7/9).

“The restraining order was issued in response to consolidated petitions of several groups who brought the issue to the court wanting to halt the implementation of the Reproductive Health law soon after its passage last year,” Xinhua reports, noting, “There are 15 petitions challenging the RH Law while six interveners are seeking to uphold its legality” (7/9). “It is the last legal recourse for the Church, which had for more than a decade led resistance efforts to birth control legislation in the mainly Catholic Southeast Asian nation by lobbying and intimidating politicians,” the Philippines Star writes (Punay, 7/10). GlobalPost notes that “multiple legal challenges must be cleared away before [the law’s] enactment” (Winn, 7/9).

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MSF Says Food Insecurity, Disease Worsening In CAR, Calls For More Humanitarian Aid

“The precarious security situation in the Central African Republic (CAR) is worsening seasonal food insecurity and increasing the burden of disease, especially among children, warns a humanitarian official” from Médecins Sans Frontières (MSF), IRIN reports. Ellen Van Der Velden, the head of mission of MSF in CAR, said the group has seen an increase in acute malnutrition and malaria among children, as well as reduced access to health care because of a lack of staff and medical supplies, the news agency notes (7/9). “Attacks and looting were common in Bangui, where a transitional government that includes some of the rebels has failed to keep order, MSF said in a report ahead of a visit by U.N. and European Union humanitarian chiefs on Thursday,” Reuters reports. “No one from the interim government was immediately available to comment on the MSF report on Tuesday,” the news agency writes (Felix, 7/9). “U.N. agencies and many [non-governmental organizations (NGOs)] have withdrawn to Bangui, leaving the majority of the country without aid,” The Guardian notes, adding, “According to MSF, the people of CAR — 4.4 million people spread across a country bigger than France — have effectively been abandoned just when they most need help.” The newspaper continues, “MSF called on relief groups to maintain their commitment to CAR, and allocate adequate resources to respond to the medical and humanitarian crisis in the country” (Tran, 7/9). The newspaper also provides a photo gallery of the health care crisis in the country (7/9).

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Siberian Mobile Clinic Initiative Works To Treat Drug-Resistant TB, NPR Reports

As part of an ongoing series on tuberculosis (TB), NPR’s “Shots” blog and “All Things Considered” program examine an initiative working to treat drug-resistant TB in Siberia, noting, “In parts of Siberia, nearly 30 percent of all tuberculosis cases aren’t treatable by two of the most potent medications, the [WHO] reported last year.” The blog writes, “One Siberian city is tackling the problem with an innovative health program, called Sputnik, affectionately named after the first man-made satellite launched by the Soviet Union in 1957.” Sputnik operates as a mobile clinic, with “teams of nurses [that] orbit like satellites around the sprawling city of Tomsk, finding and treating patients with drug-resistant TB,” the blog notes. According to NPR, “The program is a joint effort between Russia’s Health Ministry and the American non-profit Partners in Health. It’s the first mobile TB clinic of its kind, and it allows health workers to fight the disease among the people who are the hardest to reach — the homeless, the mentally ill and drug addicts.” NPR describes the program and writes, “Sputnik is only one of many ways that the city is fighting drug-resistant TB, but it’s a crucial one, says Alexander Barnashov, a head physician at the Tomsk Health Department.” The blog notes, “The success of Sputnik has prompted other Russian cities to start programs of their own, Barnashov says” (Flintoff, 7/9).

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Editorials and Opinions

Global Health Researchers Must Address Disparities, Local Contexts For Research To Be Meaningful

“[H]ow should global health researchers approach the task of documenting and disseminating their impact in what are these days termed resource-poor settings? What role does a journal have in fostering that process?” Paul Farmer, chief strategist and co-founder of Partners In Health, asks in The Lancet’s “Global Health” blog. “It has long been the case that randomized clinical trials have been held up as the gold standard of clinical research,” he writes, noting, “This kind of study can only be carried out ethically if the intervention being assessed is in equipoise, meaning that the medical community is in genuine doubt about its clinical merits.” He adds, “It is troubling, then, that clinical trials have so dominated outcomes research when observational studies of interventions like those cited above, [such as immunizations among children,] which are clearly not in equipoise, are discredited to the point that they are difficult to publish.” He continues, “Stripping away context, both local and translocal, creates the illusion of equipoise in a world riven by poverty and social disparities,” and asks, “How, then, do we have a body of research where such context matters?”

“All aspects of the research — from prioritizing research questions to interpretation and dissemination of results — must have local involvement and promote a sense of ownership” and “should strive to address two disparities if it is to be regarded as in equipoise: first, the disparities of risk (of both disease and poor outcomes due to lack of access to proven therapies) that constitute the backdrop of global health; and, second, the disparities of training and opportunity that explain why research capacity is heavily concentrated far from the settings in which the burden of these pathologies is concentrated,” Farmer continues. “So what then is the charge of a global health journal?” he asks, and writes, “First, to recognize that the information gleaned from a rigorous observational study may be more useful to program implementation than information derived from what are now reified as clinical trials. … Second, journal editors can help ensure that results are presented in such a way that any study’s methods can be understood and assessed by implementers and by those setting and revising health policy regarding life-and-death matters, including those mentioned above and many others now emerging.” Finally, he adds, “the challenge and promise of a journal dedicated to global health research [is] to value equity over reified notions of equipoise, to insist on intelligibility over arcana, and to pose questions about plans for dissemination of information that is indisputably of relevance to the wellbeing and very survival of many millions who do not yet benefit from already proven interventions” (7/8).

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Creating Sustainable Health Care Solutions For An AIDS-Free Generation In Africa

“[W]ith the recent birth of the one millionth HIV-free baby born to an HIV-positive mother there, hope for an African generation free from this disease is alive thanks to the remarkable impact of antiretroviral drugs,” John Howe, president and CEO of Project HOPE, writes in the Huffington Post’s “Impact” blog. Howe discusses several Project HOPE initiatives that have helped people living with HIV, and he writes, “Much of the great success in the broad fight against AIDS in Africa is attributed to [PEPFAR], a campaign established by former President George W. Bush, and which marks its 10th anniversary this summer.” He continues, “Currently, Project HOPE’s work in Malawi, Mozambique, Namibia, South Africa and Tanzania is conducted in partnership with these countries’ Ministries of Health, PEPFAR and [USAID].” Howe says Project HOPE’s goals mirror those of PEPFAR, by “creating sustainable health care solutions for Africa’s future generations … with the intent of helping people help themselves” (7/9).

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India Should Work To Improve Public Health System In Order To Curb Malnutrition

“Poor sanitation and high morbidity are two key factors explaining India’s high malnutrition burden,” a LiveMint editorial states, adding, “India’s flawed food policy — which has focused solely on cereals such as rice and wheat at the expense of pulses, fruits and vegetables — and stark gender inequality, which causes Indian women to be far more under-nourished than men, are the other key factors that explain why India has struggled to combat malnutrition despite giant strides in reducing poverty.” The editorial continues, “Unfortunately, the food security ordinance which was hurriedly pushed through by the United Progressive Alliance (UPA) government does not address any of these issues,” and by “[c]onflating hunger with malnutrition … the UPA government [has] the political opportunity to score a populist goal, without addressing the root causes of India’s nutritional crisis.”

“While India’s dismal child malnutrition statistics have been receiving greater attention of late, the lack of adequate public health interventions which drives such poor nutritional outcomes, often escapes attention,” LiveMint writes. “The absence of an effective public health network in a densely populated country like ours has resulted in an extraordinarily high disease burden,” the editorial states, adding, “Despite transient and sporadic successes in tackling individual diseases, our public health system remains largely dysfunctional.” Though “investments in public health score on grounds of efficiency, they are not among the safest electoral bets. And the UPA realizes that,” the editorial writes, concluding, “It will perhaps take a while before any Indian politician musters the courage and imagination needed to sell public health investments to an electorate which may often value private goods (such as foodgrains) over investments in public health, which by definition is measured in negative terms: so many cholera deaths avoided or so many flu outbreaks averted. Till then, India will continue to be a happy hunting ground for communicable diseases” (7/9).

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Global Community Must Talk Openly About Young People's Sexual Health To Eliminate Barriers To Information, Commodities

“This World Population Day 2013” — observed Thursday — “the focus is on adolescent pregnancy,” Purnima Mane, president and CEO of Pathfinder International, writes in the Huffington Post’s “Impact” blog. She provides statistics about pregnancy and reproductive health among adolescent girls and states, “These statistics show: we need to talk frankly and openly about young people’s sexual and reproductive health.” She continues, “In virtually every country in the world, there are disproportionate barriers for young people — particularly young women — when they seek contraception or access to information and commodities to practice safer sex. And this must stop. Girls and young women must have access to contraception and information — no exceptions.” She tells the story of Haregnesh Abetneh, a young woman in Ethiopia participating in “a Pathfinder International program that supports girls in Amhara, Ethiopia, to continue their studies,” and writes, “This World Population Day, I hope we will think of girls like Haregnesh and her friends and recommit ourselves to addressing the unique needs of young women and girls.” She concludes, “If we are truly going to meet the goals we ambitiously set forth for 2020 at the Family Planning Summit in London, we must commit to ensuring adolescent girls have the support and resources they need to delay marriage and childbirth, stay in school, and start their adult lives the way each of them want to” (7/9).

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Recent Releases

GAO Report On PEPFAR Recommends Better Information Management

The Center for Global Health Policy’s “Science Speaks” blog highlights “a new report from the United States Government Accountability Office on PEPFAR,” noting it “says improvements in how the program evaluates and communicates its work will be critical to attaining [its] goals” of increasing the number of people on antiretroviral therapy and “‘transitioning’ from providing services and supplies to countries confronting HIV to providing guidance and support.” According to the blog, “The report, [titled] ‘Millions Being Treated, but Better Information Management Needed to Further Improve and Expand Treatment,’ incorporates findings from earlier reports over the last two years on PEPFAR planning, evaluating and reporting, as well as three this year examining PEPFAR drug supply chains, treatment costs and treatment results.” The blog notes, “In the three reports examining components of treatment efforts released in May, the GAO advised that PEPFAR needed to better address weaknesses in recipient country’s management of antiretroviral drugs, gather more comprehensive treatment retention data, and improve the accuracy of its estimates of treatment costs. At the same time, the reports have added up a list of PEPFAR successes” (Barton, 7/9).

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USAID Helping Maximize Value Of Development Aid Through Pledge Guarantee For Health

Noting the approach of the Millennium Development Goals’ 2015 deadline, Ariel Pablos-Méndez, assistant administrator for global health at USAID, writes in the agency’s “IMPACTblog” about the Pledge Guarantee for Health (PGH), an “innovative tool that can help speed the delivery of critical health commodities by six to eight months.” He discusses USAID’s involvement in the program and notes, “PGH provides countries with working capital to help smooth over any delays in donor aid disbursements, giving them time to plan their procurements.” Pablos-Méndez concludes, “We are committed to working with our partners in the international development, financing, and supplier communities to ensure that we maximize the value of every dollar spent, ending preventable maternal and child deaths and changing the face of poverty forever” (7/9).

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Transitioning To Country Ownership Of Health, Development Programs

The Bill & Melinda Gates Foundation’s “Impatient Optimists” blog interviews Sema Sgaier, the lead author of an article published in Health Affairs this week examining “how India has worked in partnership with the Gates Foundation to take over the funding and management of Avahan, an innovative HIV prevention initiative created in 2003 with foundation support.” According to the interview transcript, Sgaier discusses “what it takes to ensure a successful transition to country ownership,” why transitioning to country ownership of health and development programs is important, the role of partnerships in making these transitions, and “the biggest challenges that the Avahan transition faced” in India, among other topics (7/9).

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PLOS Medicine Articles Examine Tobacco Control, Abortion And Preterm Delivery, Global Health Interventions

The PLOS “Speaking of Medicine” blog highlights a number of articles in this week’s issue of PLOS Medicine. According to the blog, the issue includes an article in which researchers “simulated the effect of multiple tobacco control and pharmacological interventions on deaths from heart attack and stroke in India between 2013 and 2022”; a report on how “the link between abortion and preterm delivery in a subsequent pregnancy has disappeared over the last 20-30 years in Scotland”; and an article in which researchers “apply different community or public health evidence frameworks to the same body of evidence for three advocated global health interventions and compare what ratings and policy recommendations result from each” (7/9).

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