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Kaiser Daily Global Health Policy Report

In The News

U.N. Committed To Helping Haiti Address Cholera, Ban Says In Response To Congressional Letter

U.N. “Secretary-General Ban Ki-moon told members of the U.S. Congress Friday that the United Nations is committed to helping Haiti overcome a cholera epidemic even though it is refusing to pay compensation to victims who blame U.N. peacekeepers for starting the outbreak,” the Associated Press reports. “Ban was responding to a May 30 letter from U.S. Rep. Maxine Waters [D-Calif.] and 18 other Congressional ‘friends of the people of Haiti’ who expressed concern at the U.N.’s rejection of the claims by 5,000 cholera victims and their families,” the news agency writes. “Ban sent separate letters to the 19 lawmakers outlining measures the United Nations has taken and supported, saying it has devoted more than $140 million to cholera treatment and prevention activities since 2010,” according to the AP. Ban “did not address the issue of responsibility for the epidemic, and he reiterated that the U.N. rejected the compensation claim in February on grounds that the world body has legal immunity from such lawsuits,” the AP writes. Ban wrote, “I would like to assure you that the legal decision does not in any way diminish my personal commitment, and that of the United Nations, to do all we can to help the people of Haiti overcome the cholera epidemic … Achieving this goal will not be easy, but it is possible,” according to the news agency (Lederer, 7/5).

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Former President George W. Bush Calls For Policymakers In Developed Countries To Focus On Saving Lives

“Noting Africa’s impressive progress in reducing new HIV infections, former U.S. President George W. Bush has called on policymakers in developed nations to make life-saving in developing regions one of their priorities,” PANA/AfriqueJet reports. “‘There is no greater priority than saving lives and there has never been a greater program than PEPFAR …,’ Bush remarked Wednesday at the African First Ladies Summit, convened in Dar es Salaam, Tanzania, by the George W. Bush Institute of Dallas, Texas,” the news service notes, adding, “Pink Ribbon Red Ribbon, led by the George W. Bush Institute, has come on board as an innovative approach to bringing public and private partners together to combat two of the leading causes of death in women in sub-Saharan Africa — cervical and breast cancer.” The news service writes, “Since its launch in September 2011, the Pink Ribbon Red Ribbon initiative took Zambia as [a] model country and has demonstrated how existing health platforms, such as PEPFAR, have been leveraged to expand services and accelerate progress against cervical and breast cancer.” PANA/AfriqueJet continues, “Discussants at the summit were unanimous about the need of creating more public and private partnerships in developing health care systems in sub-Saharan countries, because many have competing priorities in dealing with the burdens of disease and poverty” (7/4).

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WHO To Convene Emergency Committee On MERS Virus As Saudi Arabia Reports 1 New Case, 2 Deaths

“The [WHO] is to convene an emergency committee next week on the deadly Middle East respiratory syndrome coronavirus (MERS-CoV), WHO assistant director-general for health security and environment Keiji Fukuda said Friday,” Xinhua reports (7/5). Fukuda “told reporters Friday that the names of the disease experts on the team would be revealed Monday,” the Los Angeles Times writes, adding, “He characterized the move as a precautionary measure” (Brown, 7/5). “Fukuda said there was currently no emergency or pandemic but the experts would advise on how to tackle the disease if the number of cases suddenly grows,” according to VOA News (7/5). “In a study in The Lancet medical journal, researchers from France’s Institut Pasteur in Paris analyzed data on [MERS] clusters and found its likelihood of developing into a SARS-like worldwide epidemic was low,” Reuters notes (Kelland, 7/4). “The Ministry of Health in Saudi Arabia has announced one additional laboratory-confirmed case and two deaths in previously confirmed cases … in Saudi Arabia, according to a [WHO] update” on Sunday, the Global Dispatch reports (Herriman, 7/7). “A two-year-old child died in Jeddah and a 53-year-old man died in Eastern Province, where the outbreak has been concentrated, the ministry said,” Reuters writes in a second article (McDowall, 7/7).

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Essay Examines Issue Of Counterfeit, Substandard TB Drugs

“Substandard tuberculosis drugs sold by pharmacies in poor countries are a growing public health threat, but the problem could be alleviated if governments enforced [WHO] standards,” according to an essay published online by PLOS Medicine, the New York Times reports. “At pharmacies in 17 countries, the authors bought 713 samples of two TB drugs, the antibiotics rifampin and isoniazid,” the newspaper writes, adding, “Nine percent had no active ingredient or, worse, too little: An inadequate dose encourages the growth of drug-resistant TB strains while not curing the patient” (McNeil, 7/1). “The failure rate was 16.6 percent in Africa and 10.1 percent in India,” according to the Wall Street Journal, which notes, “Rwanda’s health minister, Agnes Binagwaho, called [in the essay] for a global treaty to combat fake and poor-quality drugs.” The newspaper adds, “All countries should criminalize the production and sale of fake drugs, and impose tighter standards and regulation to prevent poor-quality drugs from making it onto the market, said Amir Attaran, a professor of law and medicine at the University of Ottawa and another author of the essay” (McKay/Shah, 7/4). The essay “shows the failures in what should be a nearly perfect system for basic TB control, said Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership,” the New York Times writes (7/1).

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U.N. Appeals For Additional Humanitarian Aid For Sahel Region

“The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) says $1 billion is still required for emergency needs in Africa’s Sahel region, which stretches from Senegal in the west to Chad in the east,” VOA News reports. “To date, humanitarian agencies say they have received only about one-third of the requested $1.7 billion needed to help the more than 11 million people in the Sahel who face food insecurity this year,” the news service writes (Lazuta, 7/4). “As of May 2013, 345,000 acutely malnourished children had been treated in U.N. Children’s Fund (UNICEF) and NGO-run nutrition centers,” according to IRIN, which adds, “But despite year-on-year nutrition support, surveys show malnutrition rates of over 10 percent in almost all of the countries, and above the 15 percent threshold in parts of Chad, Mauritania and Niger” (7/4). U.N. Regional Humanitarian Coordinator for the Sahel Robert Piper “said that the agricultural and refugee sectors are particularly underfunded,” VOA notes (7/4). “Other severely underfunded sectors include water and sanitation (11 percent) and health (26 percent), both of which underpin infant nutrition; as well as education (10 percent), and early recovery (8 percent),” IRIN adds (7/4).

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Pakistan Faces Measles Epidemic

“Pakistan has been hit by a measles epidemic that has claimed the lives of hundreds of children since the start of the year, almost as many as in the whole of 2012,” the Wall Street Journal’s “India Real Time” blog reports. “The [WHO] has recorded nearly 30,000 cases and 290 deaths across Pakistan so far in 2013,” the blog writes, adding, “This is up from 15,000 cases and 310 deaths in all of 2012.” The blog continues, “Pakistan’s health authorities from the federal to the district level have struggled to mount a timely emergency response to the epidemic that has swept across the country, particularly in the larger cities of Punjab and Sindh province,” but “behind the epidemic is a routine vaccination program that has been patchily implemented and has failed to protect Pakistan’s children from the most basic childhood diseases.” According to “India Real Time,” “Just over half of children in Pakistan are vaccinated against measles, according to WHO figures,” but “[i]n order to prevent a disease outbreak the vaccination rate for the highly contagious disease such as measles, has to be closer to 95 percent.” The blog provides a brief history of the program, known at the Extended Program on Immunization, writing, “Many doctors described the emergency response to the current measles epidemic as slow and poorly coordinated” (Symington, 7/6).

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India Moving Forward With National Food Security Law

“India has decided to introduce one of the most ambitious food aid programs ever attempted, adding the right to food to others enshrined in Indian law such as free speech and equality of all citizens,” the Wall Street Journal reports. “The government of Prime Minister Manmohan Singh … pushed through the National Food Security Law by executive order on Wednesday while Parliament was in recess,” the newspaper adds, noting the Indian president needs to approve the executive order and “Parliament, which is due to come back into session at the end of July or early August, needs to pass the bill by a simple majority for it to become law” (Mukherji/Roy, 7/4). Under the National Food Security Bill, “India will spend an estimated $4 billion a year on supplying about 70 percent of its population with cheap grain,” according to another Wall Street Journal article (Mukherji, 7/3). The bill “seeks to cover two-thirds of the country’s population and provide 5kg of subsidized food grain per person per month” and “also proposes free meals and maternity benefits for pregnant women, lactating mothers, children between the ages of six months and 14 years, and malnourished children and destitute and homeless people,” BBC News notes (Biswas, 7/3). However, “[q]uestions … remain about how this large and complex program — the most ambitious food aid program ever attempted — will be implemented, and when the roll-out will begin,” the Wall Street Journal’s “India Real Time” blog writes (Mandhana, 7/4).

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Syria Facing Critical Food Shortages, U.N. Food Agencies Say; WHO Warns Country's Health Needs Rising

“The United Nations food agencies on Friday appealed for more funds to help an estimated four million Syrians unable to produce or buy enough to eat as a new report detailed a farming sector severely hit by the conflict,” Agence France-Presse/GlobalPost reports (7/5). “The most vulnerable include the internally displaced, small-scale farmers, herders, casual traders, the urban poor, pregnant mothers, the disabled and chronically sick,” and if conditions persist, the food outlook for 2014 will be worse than the current situation, the report from the U.N. World Food Programme (WFP) and U.N. Food and Agriculture Organization (FAO) said, according to The Guardian (Tran, 7/5). “A fifth of the country’s population is starving, and FAO so far has only received $3.3 million of the $41.7 million the U.N. agency requested to continue its operations in Syria, while WFP needs at least $27 million a week,” Devex notes (Santamaria, 7/5). Meanwhile, “[r]estrictions put in place by the Syrian authorities have increasingly blocked delivery of medicine and medical supplies around the country, even to areas under government control and even as health needs are escalating for people trapped in two years of conflict, the World Health Organization warned on Friday,” the New York Times reports (Mourtada/Cumming-Bruce, 7/5).

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Fighting In Somali City Kills At Least 71 People, Wounds More Than 300, WHO Says

“At least 71 people have been killed and more than 300 wounded in ongoing fighting between rival militias in the Somali city of Kismayo, the World Health Organization said Thursday,” the Associated Press/Washington Post reports (7/4). “The city ‘remains a volatile area,’ the organization said in a statement, ‘with observed increase in fighting among warring factions, and other incidents of violence such as land mines and hand grenade attacks,'” the New York Times notes (Kulish, 7/4). “The WHO, which supports hospitals treating the war-wounded in Kismayo, said injuries and deaths outside the hospital are estimated to be much higher but cannot be confirmed,” Al Jazeera writes, adding, “Several rival factions claim ownership of Kismayo, where Kenyan and African Union forces are now based after driving out the al-Qaeda-linked al-Shabab group” (7/5).

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H7N9 Can Bind To Human Receptors But Relatively Difficult To Transmit From Person To Person

“The new H7N9 virus linked to China’s recent outbreak is well equipped to bind to both avian and human receptors, invade the human lower respiratory tract, and replicate efficiently, a Chinese research team found after putting the virus though its paces in a host of laboratory tests,” CIDRAP News reports, discussing a research letter published last week in Nature (Schnirring, 7/3). “The ability of H7N9 to bind to both ‘human type’ and ‘avian type’ receptors may be one reason why the virus was able to cause so many cases of infection so quickly, experts say,” LiveScience/Huffington Post writes, noting, “The new virus first showed up in China in February, and so far, has infected 132 people, including 39 who have died” (Rettner, 7/3). “There is no need for widespread alarm, however, [an] expert said,” HealthDay/U.S. News adds, writing, “The same aspects of the H7N9 flu that make it so severe — its location in the lower respiratory system, for example — also make it harder to transmit from person to person” (Reinberg, 7/3).

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Editorials and Opinions

First Ladies Play Important Role In Promoting Global Health

Reflecting on her “time as First Lady Laura Bush’s Chief of Staff from 2005-2009” in an opinion piece in the Huffington Post’s “Politics” blog, Anita McBride, executive-in-residence at American University, discusses PEPFAR, saying the program shows Americans’ “generosity” and that “when our political leaders have courage to think big, work together, find common ground, and make tough decisions — they can change the world.” While in Africa last week, “[t]he Bushes hosted the African First Ladies Summit entitled ‘Investing in Women: Strengthening Africa’ highlighting public-private partnerships including Pink Ribbon Red Ribbon, an initiative launched by the George W. Bush Institute. With this initiative, the infrastructure that delivered critical health services to HIV/AIDS patients is now also being used to diagnose and treat cervical and breast cancer,” she notes. McBride discusses Laura Bush’s work with other first ladies to promote issues surrounding “global health, education and the empowerment of women.” She concludes, “Americans have a lot to celebrate in not only their elected presidents but also their first ladies who represent bipartisan commitment to empowering women and improving the health and well-being of the people of Africa and around the world” (7/3).

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International Community Must Continue Efforts To Eliminate Cervical, Breast Cancers

“This week I joined global leaders in Tanzania to launch the latest country to engage with Pink Ribbon Red Ribbon, a campaign begun in 2011 to fight women’s cancers in sub-Saharan Africa,” Nancy Brinker, the founder and chair of global strategy for Susan G. Komen, writes in a Politico opinion piece. “This program leverages the HIV/AIDS platform [PEPFAR], built under President George W. Bush and sustained under President Obama’s Global Health Initiative — to also screen and treat women for cervical cancer and create an entry point to integrate breast cancer services,” she notes. “As former President [George W.] Bush and Mrs. Bush and Tanzanian President Jakaya Kikwete and his wife Salma announce that Tanzania is the latest Pink Ribbon Red Ribbon country, it is worth examining how far we have come in Africa in just a short time,” she states, providing a brief history of the Pink Ribbon Red Ribbon program. “Despite this good work, cancer still metastasizes around the globe,” Brinker adds and provides statistics. She concludes, “We have made measurable progress by setting goals and forging a path when others said it was impossible. But as long as women are still dying from breast cancer at a rate of one every 74 seconds, somewhere in the world, we must continue our vital mission to eliminate this terrible disease” (7/3).

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Americans Can Afford To Invest More In Global Health

“Based on the costs associated with various health commodities and programs, amfAR, The Foundation for AIDS Research, has estimated that the average U.S. taxpayer’s global health contribution” — about $14 — “enables the delivery of HIV/AIDS treatment for one person for two and a half weeks, or malaria treatment for 26 people, or combination vaccines that prevent a variety of diseases for two children,” Chris Collins, vice president and director of public policy at amfAR, writes in the Huffington Post’s “Impact” blog. “If the average taxpayer invested $25 a year in global health through his or her taxes, that would support HIV/AIDS treatment for one person for nearly a month, or malaria treatment for 46 people, or combination vaccines for about four children,” he continues, and provides a link to “an infographic that illustrates what taxpayer contributions to global health buy.” He states, “U.S.-funded global health programs have made an enormous impact over the last decade,” and he provides supporting statistics from two separate studies. “U.S. investments in foreign assistance save the lives of the world’s neediest and serve U.S. diplomatic interests,” Collins writes, concluding, “Now is the time to invest in global health and turn the corner on AIDS and other global health priorities. Given the enormous payoffs, America can afford to do more” (7/6).

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PEPFAR Achievements Deserve Applaud, But More Focus Should Be Afforded To Meeting Contraceptive Needs Of Women Living With HIV

“In recent weeks, global health policymakers, implementers, advocates and others have been celebrating the 10th anniversary of [PEPFAR],” Ward Cates, president emeritus with FHI 360; Rose Wilcher, a technical adviser with the research utilization team at FHI 360; and Heidi Reynolds, deputy director for HIV/AIDS and other infectious diseases for the MEASURE Evaluation Project based in the Carolina Population Center at the University of North Carolina at Chapel Hill, write in the Huffington Post’s “The Big Push” blog. “At the heart of these celebrations has been attention to the incredible gains that have been made in preventing mother-to-child transmission of HIV (PMTCT),” they state, adding Secretary of State John Kerry marked the anniversary by noting one million infants have been born free of HIV as a result of PEPFAR efforts. “But this isn’t the full story,” they state, adding, “As we applaud the milestones associated with greater access to [antiretroviral (ARV)] prophylaxis for PMTCT, we should also take stock of how meeting the contraceptive needs of women living with HIV also contributes to fewer infections among children and better outcomes for mothers.”

“Closer examination of data from several studies suggests that many of the women who have benefited from ARV prophylaxis during and immediately after pregnancy did not want to become pregnant in the first place,” they continue, noting, “Although the numbers vary across studies, about two-thirds of HIV-positive women report that their most recent pregnancies were unintended.” They state, “Stronger efforts to prevent unintended pregnancies among women with HIV — through both renewed commitments to increase access to contraception globally and better integration of family planning services into HIV platforms — will not only accelerate progress toward eliminating HIV transmission to infants, but also minimize the risks that unintended pregnancy poses to HIV-positive women.” They conclude, “As family planning interventions become a more routine component of HIV programs, hopefully future PMTCT milestones reported by PEPFAR will highlight not only the number of infants born free of HIV, but also the number of women living with HIV whose need for family planning has been met” (7/3).

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Recent Releases

World Bank Announces $700M Bond Issuance For GAVI Alliance Immunization Programs

“Millions of children in the world’s poorest countries stand to benefit from a $700 million bond issue, whose proceeds will help fund immunization programs by the GAVI Alliance,” a World Bank press release reports. “The transaction — with buyers on five continents — was by far the largest by the International Finance Facility for Immunization (IFFIm) since its inaugural benchmark in 2006 raised $1 billion,” according to the press release, which notes, “The size and global reach of this new benchmark issuance highlights the impact of IFFIm as a Socially Responsible Investment (SRI), helping protect millions of children from deadly diseases by supporting GAVI’s work in strengthening health systems and purchasing vaccines” (7/2).

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CSIS Report Examines Indonesia's Role In Global Health Diplomacy

A new report (.pdf) from the Center for Strategic & International Studies (CSIS), titled “Indonesia Steps Up Global Health Diplomacy,” describes recent steps by some of the country’s leaders to more formally engage in international health activities, according to the report homepage. The report summary states, “The country’s health minister has become chair of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The president is co-chairing a high-level panel advising the U.N. secretary general on the global development agenda beyond 2015. And in September, Indonesia will host a conference of Asia-Pacific finance and health ministers to discuss ideas for funding universal health coverage in the region” (Hiebert, 7/3).

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