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Kaiser Daily Global Health Policy Report

In The News

World Population Day 2013 Highlights Importance Of Adolescent Pregnancy Prevention

“With 16 million girls under 18 giving birth and 3.2 million of these teens experiencing unsafe abortions each year, the U.N. has focused the theme of 2013’s World Population Day on teenage pregnancy, highlighting the important role that teen girls play in positively impacting future generations and underscoring the importance of providing them with adequate health care and educational resources,” Huffington Post reports. “The United Nations designates every July 11 to highlight issues related to population growth, including environmental sustainability, global development, health care and youth empowerment,” the news service notes (Salass, 7/11). “About 16 million girls under age 18 give birth each year, according to the U.N. Population Fund (UNFPA), which noted that another 3.2 million undergo unsafe abortions,” the U.N. News Centre notes. “UNFPA pointed out that adolescent pregnancy is a health issue: the youngest mothers face a heightened risk of maternal complications, death and disability, including obstetric fistula,” the news service writes, adding, “Their children face higher risks as well. It is also an issue of human rights: adolescent pregnancy often means an abrupt end of childhood, a curtailed education and lost opportunities.”

In his message in observance of the day, U.N. Secretary-General Ban Ki-moon said, “This sensitive topic demands global attention. … When we devote attention and resources to the education, health and wellbeing of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come,” according to the U.N. News Centre. UNFPA Executive Director Babatunde Osotimehin said in a statement, “Today, we call on governments, the international community and all stakeholders involved to take measures that enable adolescent girls to make responsible life choices and to provide the necessary support for them in cases when their rights are threatened,” the news service notes (7/11). In a statement marking the day, U.S. Secretary of State John Kerry noted the current “generation of 1.8 billion young people between the ages of 10 and 24 is the largest the world has ever seen, and will shape the future of the world we live in.” He added, “Whether it’s across the Greater Middle East or Africa, the sheer number of young people is striking, and demands leadership capable of meeting their demands for dignity and opportunity in addition to basic necessities,” including “access to evidence-based comprehensive sexuality education and reproductive rights” (7/11). USAID provides a World Population Day website, including an infographic on adolescent pregnancy (7/11).

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E.U. To Increase Humanitarian Aid To CAR

“The European Union is to increase its aid to Central African Republic [CAR] to tackle a humanitarian crisis gripping the impoverished nation since rebels seized power in March,” Reuters reports. “Kristalina Georgieva, the E.U. commissioner responsible for international cooperation and humanitarian aid, said on Thursday Europe would provide an additional $8 million, bringing its total aid since the start of the year to $20 million,” the news service writes. “Medical charity Médecins Sans Frontières accused the international community this week of turning its back on the mineral-rich nation, which has been devastated by more than a decade of sporadic violence,” according to Reuters, which notes, “Four months after rebels seized Bangui, government and health services across the country are close to collapse and armed groups terrorize civilians, the charity said” (Flynn, 7/11). “Warning that the political crisis gripping [CAR] has affected its entire population, United Nations humanitarian chief Valerie Amos and [Georgieva on Friday] urged the authorities in the strife-torn country to urgently re-establish the rule of law so that assistance and access can continue unimpeded,” the U.N. News Centre adds. “In the first half of 2013, the humanitarian community in CAR has targeted 484,000 people for food assistance and reached 45 percent of them,” the news service writes, noting, “About 8,000 people suffering severe acute malnutrition have received treatment and 123,000 children out of 680,000 targeted have been vaccinated against measles” (7/11).

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U.K. To Invest Roughly $16M In Researching HIV Prevention Strategies For Vulnerable Groups In Southern Africa

“The U.K. government is to invest £10.7 million [$16.2 million] in researching how to prevent adolescents and prisoners, two of the most vulnerable groups in southern Africa, becoming infected with HIV,” The Guardian reports. “The announcement comes as the U.K. reviews its AIDS funding, which totaled £1 billion [$1.5 billion] for HIV programs over the past three years,” the newspaper notes, adding, “International development minister Lynne Featherstone, speaking to The Guardian from Malawi on Thursday, made it clear she felt there has been an imbalance in the way funds are apportioned to HIV, with prevention being relatively neglected.” The newspaper writes, “Spending on antiretroviral drugs in southern Africa massively outstrips spending on prevention, because treatment is highly successful and cost-effective since the prices of antiretrovirals dropped under pressure from campaigners and the involvement of generic drug companies,” while “[b]ehavioral change campaigns, on the other hand, have not had anything like the same good outcomes.” According to The Guardian, “The U.K.’s HIV strategy review will look to preventing infection as the logical way to reduce costs — while infections continue to rise, the drug bill rises too. The strategy is intended to contribute to preventing half a million new infections among women by 2015” (Boseley, 7/11).

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UNAIDS Head Expresses Concern Over HIV Infections Among Couples In Africa

Speaking “on the sidelines of a media forum” in Abidjan on Thursday, UNAIDS Executive Director Michel Sidibé expressed concern over the number of new HIV infections among people in stable relationships in Africa, as well as among young women in some parts of the continent, Xinhua reports. “What is really disturbing us right now is that we are seeing a kind of increase of new infections among stable couples particularly among married couples,” he said, according to the news agency. Despite a decline in the number of new HIV infections in most African countries over the past few years and reductions in HIV-related mortality, “Sidibé said there is still a huge gap on the continent,” the news agency writes. Sidibé called “for prevention to make sure that couples infected had access to early treatment to stop transmission,” according to Xinhua (7/12).

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News-Medical.Net Interviews UNICEF's Chief Of Immunization

News-Medical.Net interviews Jos Vandelaer, UNICEF’s chief of immunization, about immunization programs in developing countries. According to the interview transcript, Vandelaer reflects on the current state of immunization around the world, noting “worldwide, immunization programs reach around 83 percent of all children”; outlines “UNICEF’s role in new vaccine introductions in developing countries”; discusses the impact of vaccine price reductions as a result of partnerships such as the GAVI Alliance; and examines how “immunization [is] used as an entry point for other life-saving interventions,” among other topics (Cashin-Garbutt, 7/11).

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GlobalPost Interviews WHO Technical Lead On MERS

“To put [the Middle East respiratory syndrome (MERS) coronavirus] in perspective and to understand what’s happening and what could happen next, GlobalPost spoke with Dr. Anthony Mounts, WHO’s technical lead on the coronavirus,” the news service reports. Mounts discusses why the agency established an emergency committee to examine MERS, how the virus is similar to SARS, and the likelihood of the virus becoming a pandemic, among other issues, according to the interview transcript (DeFraia, 7/11).

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Editorials and Opinions

Opinion Pieces, Blog Posts Address World Population Day

The following is a summary of opinion pieces and blog posts published in recognition of World Population Day, observed annually on July 11. According to the Huffington Post, “the U.N. has focused the theme of 2013’s World Population Day on teenage pregnancy, highlighting the important role that teen girls play in positively impacting future generations and underscoring the importance of providing them with adequate health care and educational resources” (Salass, 7/11).

  • Pamela Barnes, “Forbes Woman” blog: Noting her attendance at Women Deliver 2013, “the largest meeting of the decade to accelerate progress for women and girls,” held in Malaysia last month, Barnes, president and CEO of EngenderHealth, writes, “With laser-like acuity, we discussed the urgent need to invest in family planning to address the alarming reality that 220 million women want to avoid or postpone pregnancy but lack access to contraception.” She continues, “Investments in family planning offer immense opportunities for women, and the numbers speak for themselves,” and she provides statistics about the reach of EngenderHealth’s programs and the cost-effectiveness of family planning initiatives. She concludes, “I can think of no greater return on an investment than family planning” (7/11).
  • Valerie DeFillipo, Huffington Post’s “Global Motherhood” blog: “Three months after the London Summit on Family Planning, I led a delegation of UNFPA supporters to Ghana,” DeFillipo, director of the FP2020 initiative, writes, noting, “We saw a diverse and inspiring range of maternal health programs — from government hospitals to an entrepreneurial midwife who designed and produced birthing stools with the help of a local carpenter.” She details her visit to various clinics in rural Ghana and continues, “Our work does make a difference. This is what Family Planning 2020 is all about: reaching women, no matter where they live, with the information, services and supplies they need.” She continues, “One year after the London Summit on Family Planning, I am pleased to report that FP2020 continues to build the foundations of a global movement and is accelerating progress towards achieving our goal of reaching an additional 120 million women with lifesaving contraceptive information, services and supplies by 2020.” DeFillipo concludes, “As we move forward into the second year of FP2020, I am convinced and confident that working together, we shall … keep the promises we made one year ago at the London Summit” (7/11).
  • Ariel Pablos-Mendez, USAID’s IMPACTblog: “On July 11, World Population Day, we join the global community in raising awareness on the issue of adolescent pregnancy in the hopes of protecting and empowering millions of girls around the globe,” Pablos-Mendez, assistant administrator for global health at USAID, writes. “Adolescent pregnancy has dire health, social and economic consequences for girls, their communities, and nations,” he states, providing examples. “I believe meeting the reproductive health needs for today’s young people is vital to ensure future generations are able to lead healthy and dignified lives,” he continues, adding, “As the largest bilateral donor for family planning, USAID is uniquely poised to accelerate progress and improve education and access to reproductive health services for youth.” Pablos-Mendez concludes, “Young people are the future, and we want and need their valued contributions to and participation in the social, economic, political, and cultural life of their communities” (7/11).
  • John Seager, Huffington Post’s “Impact” blog: “Around 5.2 billion people were around to mark the first World Population Day back in 1989. Now, less than 25 years later, we’re nearing 7.1 billion,” Seager, president of Population Connection writes. “And nearly all of the growth is happening in nations least able to cope with it, where land, food and water resources are already being stretched to the limit,” he continues, and asks, “So what can we do for the world’s population on this World Population Day?” He writes, “I am asking you to do three things: Demand that your lawmakers support funding for international family planning programs — $1 billion is America’s fair share. Talk to your friends and family about how all women — not just the lucky residents of developed nations — deserve to make choices about their own futures. And above all, speak up for the empowerment of women and girls” (7/11).

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AIDS Vaccine Needed To Achieve AIDS-Free Generation More Efficiently, Cost-Effectively

“No longer is it whether we can achieve an AIDS-free generation. Now, the question is: How long will it take and will it be sustained?” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, writes in a Washington Post opinion piece. “Vaccines historically have played an important role in the control and even elimination of global health scourges such as smallpox, polio and measles,” he notes, adding, “So two important questions regarding an AIDS-free generation are: Is an HIV vaccine needed to reach this goal, and if so, what role will it play?” He continues, “While the road to an AIDS-free generation will be long and arduous, recent progress in HIV/AIDS prevention and treatment has been encouraging,” noting, “Initiatives such as [PEPFAR] and the Global Fund to Fight AIDS, Tuberculosis and Malaria are channeling antiretroviral treatment to millions of people in hard-hit countries.” Fauci adds, “Mathematical models suggest that, by implementing existing HIV/AIDS treatment and prevention tools much more broadly worldwide, we can reach an AIDS-free generation.”

“But without an effective HIV vaccine, reaching that goal will take much longer and will be more difficult, and along the way more people will become infected and more lives will be lost,” Fauci continues. “So while it may be possible, and even likely, to achieve an AIDS-free generation without it, an effective HIV vaccine would get us to an AIDS-free generation faster and, more important, help sustain that accomplishment,” he writes, adding, “To attain and sustain an AIDS-free generation, those who are already infected or at risk of infection must faithfully practice recommended treatment and/or prevention strategies.” Fauci continues, “Contrast this to an HIV vaccine. For it to be effective, a person probably would need to receive a small number of recommended immunizations, possibly just one.” He adds, “When we do succeed, an HIV vaccine will be the main driver to not only accelerate the decline of new HIV infections — and to do so more efficiently and cost-effectively — but also to maintain an AIDS-free generation once we get there” (7/11).

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Frontline Global Health Workers Must Be Included In Decision-, Policymaking Processes

In a Lancet opinion piece, Richard Horton, the journal’s editor, writes, “The indifference of all of us — The Lancet too — to those who actually ‘do’ global health in countries raises questions about just what our efforts really achieve. How can global health succeed if it doesn’t listen to those on the front lines of policymaking in countries we profess to care about?” He describes the experiences of an unnamed policy director in an African ministry of health as she attempts to negotiate the challenges of global health funding and development aid.

Horton notes no one responded to World Bank President Jim Yong Kim when he “asked his audience at a [World Health Assembly] technical briefing on the [International Health Partnership (IHP+)] to tell him bad things about the bank.” Horton continues, “But if President Kim had visited a small room in an African ministry of health instead of the Palais des Nations in Geneva, if he had spoken with someone who never speaks to a president or a director general or an executive director of a global agency, and if he had heard one woman’s bitter passion instead of obsequious trivialities at the World Health Assembly, he would have seen a different world from the one his advisers and the international bureaucracy would have him see.” Horton concludes, “It is the same for [WHO Director-General] Margaret Chan, [UNICEF Executive Director] Anthony Lake, and even [U.N. Secretary-General] Ban Ki-moon. Who really tells these people the truth? Do they sit down and really listen to those who know what is happening in countries? And if they do, does anything change as a result of their listening? 15 minutes with the woman from this African country would tell our global health panjandrums a great deal about the world they preside over. And the problems they choose to ignore” (7/13).

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Recent Releases

USAID Working With Angola To Implement New HIV Treatment Guidelines

Noting the release of new WHO HIV treatment guidelines that “pave the way toward lifelong treatment for all pregnant and breastfeeding women with HIV, regardless of CD4 count or clinical stage,” B. Ryan Phelps, medical officer for PMTCT and pediatric HIV in USAID’s Office of HIV/AIDS, and Melanie Tam, PMTCT intern with the office, write in USAID’s “IMPACTblog” about how Angola, “with support from PEPFAR, USAID Angola and USAID’s partner, ForcaSaude, has begun preparing for the transition to universal treatment.” They continue, “[T]hese new guidelines are the product of over a year of work with dozens of global partners, including USAID. They represent the first-ever consolidated global HIV guidelines, incorporating all age groups, several life-preserving interventions, as well as specific, practical programmatic guidance. And for the first time, these guidelines provide an option for universal, lifelong treatment of pregnant mothers who test HIV-positive” (7/11).

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NTD Community Slow To Engage In Evidence-Informed Policy

“We are concerned that the neglected tropical disease (NTD) academic community has been slow to engage in evidence-informed policy and debate, and may be falling behind international best practice,” Sukrti Nagpal of the Royal Surrey County Hospital in the United Kingdom, and David Sinclair and Paul Garner of the Liverpool School of Tropical Medicine, write in a PLOS Neglected Tropical Diseases opinion piece. “This is borne out of a concern that NTDs are important diseases that need treatments, but that international policies need to stay in line with current international expectations of evidence-informed policy to avoid being discredited,” they continue, adding, “To look for evidence to confirm or refute these concerns, we used appropriate systematic methods, and present our interpretation of these data as a viewpoint at the request of PLOS NTDs editors” (7/11).

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New Issue Of ‘Global Fund News Flash’ Available Online

The Global Fund to Fight AIDS, Tuberculosis and Malaria has published Issue 21 of its newsletter, the “Global Fund News Flash.” The issue focuses on health issues in Ethiopia, highlighting St. Peter’s Hospital in Addis Ababa, “the country’s premier [tuberculosis] treatment center” where “[m]ore and more [patients] arrive with drug-resistant forms of tuberculosis.” The newsletter states, “As scary new strains of tuberculosis emerge, resisting multiple drugs, Ethiopian health workers like Dr. Amha [Fantayeare] are alert to identify all new cases and to aggressively treat existing ones.” The newsletter continues, “‘There could be no place better than St. Peter’s to show how the Global Fund contributes to saving lives,’ Dr. Amha says” (7/11).

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New Issue Of The Lancet Includes Series On Global Kidney Disease

“A series beginning in today’s Lancet seeks to provide a global perspective on kidney disease,” the journal reports in an editorial highlighting several articles on renal issues. “The prevalence of kidney disease is likely to be underestimated,” the editorial notes. The current issue of The Lancet, No. 9887, also includes several articles on H7N9 and maternal mortality in Senegal and Mali, as well as news articles on potential wrongdoings in clinical trial research in Germany and shifts in development aid in Russia (7/13).

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