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Kaiser Daily Global Health Policy Report

In The News

As President Obama Travels To South Africa, Deteriorating Health Of Nelson Mandela Overshadows Visit

“President Obama is headed to South Africa [Friday] on the second leg of a one-week trip to the African continent,” NPR’s “The Two-Way” blog reports (Peralta, 6/28). “Obama left the United States on Wednesday for Senegal, South Africa and Tanzania — his second visit to sub-Saharan Africa since taking office,” according to CNN, which adds, “The trip aims to bolster investment opportunities for U.S. businesses, address development issues such as food security and health, and promote democracy” (Karimi, 6/28). “Obama is receiving the embrace you might expect for a long-lost son on his return to his father’s home continent, even as he has yet to leave a lasting policy legacy for Africa on the scale of his two predecessors,” the Associated Press/Washington Post writes, noting “Presidents Bill Clinton and George W. Bush passed innovative Africa initiatives while in the White House and passionately continue their development work in the region in their presidential afterlife.” Obama’s “signature Africa policy thus far has been food security, through less prominent programs designed to address hunger with policy reforms and private investment in agriculture,” the AP writes, noting on Friday “he drew attention to Feed the Future, a public private partnership initiated by his administration that he said has helped seven million small farmers in developing nations” (Corey-Boulet, 6/28).

However, the trip is being “overshadowed by the deteriorating health of anti-apartheid icon Nelson Mandela” in South Africa, CNN notes (6/28). “South Africans awaited fresh word on Friday about the fate of Nelson Mandela as a heady blend of rumor and official reports deepened concerns over his health despite an assurance from [President Jacob Zuma’s] office on Thursday that Mr. Mandela’s condition had stabilized,” the New York Times reports (Walsh/Lyman, 6/28). “Mandela, who spent 27 years behind bars for his struggle under white minority rule and went on to become South Africa’s first black president, became a leading AIDS campaigner after completing his single term in office,” Agence France-Presse writes, noting UNAIDS Executive Director Michel Sidibé on Thursday hailed Mandela “for his role in breaking the silence and shame surrounding the deadly disease” (6/27).

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House Subcommittee Hearing Addresses Research On NTDs

According to witnesses testifying on Thursday before the Subcommittee on Africa, Global Health, Global Human Rights and International Organizations of the House Foreign Affairs Committee, “[p]romising scientific work is under way against a variety of tropical diseases that affect more than one billion people worldwide, … [b]ut many treatments and vaccines still are in the experimental stages, and big drug manufacturers lack incentives to get such products approved,” CQ HealthBeat reports. Rep. Christopher Smith (R-N.J.), who chaired the hearing, titled “Addressing the Neglected Diseases Treatment Gap,” said treatments for neglected tropical diseases (NTDs) are important because “[w]hat yesterday was a disease affecting a tiny population in a remote area of the world can tomorrow become an unexpected global epidemic,” the news service notes. CQ HealthBeat includes comments from researchers with the FDA, the NIH, the pharmaceutical industry and other organizations who testified at the hearing (Reichard, 6/27). A video of the hearing is available online from the subcommittee (6/27).

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Devex Examines Efforts To Reform U.S. Food Aid Program

“President Barack Obama’s sweeping overhaul of U.S. food aid may seem doomed as Congress chips away at his proposal in the coming days … [b]ut behind the scenes, advocates are setting the stage for incremental reform that would have seemed unlikely even several months ago,” Devex reports. The news service describes recent movement on budget negotiations and the Farm Bill, which the House failed to pass last week, and states, “The tug of war over the budget will continue, but perhaps the more interesting question revolves around how that money will be spent” through the Food for Peace program. “Resistance to Obama’s plan [to allow more flexibility in food aid spending] comes from U.S. farmers, the shipping industry and aid partners who have publicly said that the plan would put them out of business and set the economy back,” but “USAID Administrator Rajiv Shah insists that only 300 of 15,000 U.S. shippers would be affected and the value of America’s total agriculture would drop by 0.2 percent,” according to Devex.

“[W]hile sweeping reform may prove unattainable this year, reform advocates remain busy brainstorming ideas that could be attached to various pieces of legislation or floated early with the Office of Management and Budget, which will begin crafting a fiscal 2015 budget in the coming weeks,” Devex writes, highlighting several examples. “Everyone expects reform to take years, but support appears to be higher than during the former George W. Bush administration, including among fiscal conservatives who see the reduction of in-kind food donations as a way to save money,” the news service notes (Rosenkranz/Morales, 6/27).

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Wall Street Journal Examines Shortage Of TB Drugs In India

Noting “India faces a potential shortage of a critical medication for drug-resistant tuberculosis that could deepen an already acute drug-shortfall-problem in the country with the highest burden of the deadly contagious disease,” the Wall Street Journal reports, “Tuberculosis officials in several Indian states said this week that their stocks of kanamycin, an injectable antibiotic commonly used to treat drug-resistant TB, are running low, and an Indian government official acknowledged that the country has only a three-month supply left.” According to the newspaper, “The potential shortage would be the latest of several that India is facing with its TB drugs, and is particularly worrying because sporadic supplies of medications for drug-resistant forms of the disease can actually fuel further drug resistance.”

“Since January, pediatric TB drugs have been in short supply in many Indian states, according to TB officials,” the Wall Street Journal writes, noting, “The central government also has been unable to provide sufficient rifampicin, the most powerful TB drug, and another medicine, streptomycin.” The newspaper adds, “The shortages have so angered tuberculosis patients and activists that they held a rare protest outside the federal health ministry in New Delhi Wednesday” (Shah/McKay, 6/27).

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WHO Official Speaks About Importance Of Clean Cooking Alternatives

Deutsche Welle interviews Maria Neira, director of public health and environment at the WHO, about the push for clean cooking alternatives. “Almost half of the world’s population is still cooking like in the Stone Age,” Neira said, adding, “Everybody has the right to access clean energy to cook, to heat their house, to have a proper life, to have light as well, and it’s not the case at the moment.” She added, “I think that by providing access to clean energy at the household level, we will also provide the opportunity for girls to use their time going to school. They won’t be as vulnerable to violence as they collect the wood, they will have a dignified way to cook. Safe water and safe energy and the right to have clean air to breathe every day should be a major determinant of our health — we need to fight for it” (Coehlo, 6/27).

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Editorials and Opinions

Four Steps Congress Can Take To Reform U.S. Food Aid Program

“It is time to come together to support a package of reforms [to the U.S. food aid program] that will work on the ground and ensure a strong constituency for American food assistance,” George Guimaraes, president and CEO of PCI; Crispian Kirk, president and CEO of OIC International; and Ellen Levinson, executive director of the Alliance for Food Aid, write in a CQ Roll Call opinion piece. “It is not a question of whether one approach is better than the other; a variety of approaches are needed to fight hunger and meet food needs,” they write, adding, “We propose a four-part, common-sense solution that assures America remains the world leader in fighting hunger through effective and accountable programs.”

“First, Congress should reauthorize and maintain funding for the Food for Peace, Food for Progress, and McGovern-Dole International Food for Education and Child Nutrition programs,” the authors state, continuing, “Second, we urge Congress to continue supporting the use of $400 million of Food for Peace funds for capacity-building programs that target poor populations where hunger is a daily challenge,” but “add flexibility to use development assistance funds to support the training and technical assistance associated with these programs.” They write, “Third, Congress should increase funding for international disaster assistance to give the president greater flexibility to provide cash support to victims of disaster and to buy food aid close to where an emergency occurs — if it is available,” and add, “Lastly, legislation is needed to secure long-term support for an effective plan to cut hunger and improve food systems in developing countries, a ‘Global Agriculture, Food and Nutrition Security Act’” (6/26).

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Working Together To Improve Nutrition Worldwide

“In a short period of time, [the global health community has] succeeded in creating a new nutrition paradigm. Now it is time to translate this new approach into measurable successes in reducing malnutrition and its lifelong consequences,” Ellen Piwoz, lead for the nutrition team in the family health division of the Global Health Program at the Bill & Melinda Gates Foundation, writes in a Thomson Reuters Foundation opinion piece. Citing The Lancet series on maternal and child nutrition, the Nutrition for Growth summit, and the Scaling Up Nutrition (SUN) Movement, Piwoz states, “This isn’t just about feeding children today, it is about nourishing a stronger future for years to come.” She continues, “By working together, we can alleviate malnutrition. This global movement is not about all of us doing the same thing — it is about each of us doing our part, building on progress and contributing to a shared goal and vision — improved nutrition for children, women and families” (6/27).

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International Community Must Step Up Humanitarian Response To Crisis In Syria

“The health and humanitarian response to the crisis in Syria is being severely hampered by a lack of coordination and insufficient funding,” public health doctors Adam Coutts and Fouad Fouad write in a Lancet opinion piece. They provide several statistics about the crisis, noting that, across the country, “seven million people are in urgent need of humanitarian assistance and more than 5.1 million are internally displaced,” and “[t]he U.N. has called for $5.2 billion for a regional response plan that includes support to neighboring Lebanon and Jordan.” They state, “According to WHO, Médecins Sans Frontières (MSF), and field work by the authors, there have been exponential increases in communicable disease outbreaks of measles, typhoid, leishmaniasis, acute diarrhea, and hepatitis,” and “[t]he combination of rising summer temperatures and poor or absent sanitation poses severe risks for epidemic outbreaks in coming months.”

“Although assistance has increased, it remains insufficient to meet the exponentially growing needs,” Coutts and Fouad continue. They highlight the response of non-governmental organizations (NGOs), which “provide services ranging from storage facilities, water supplies to clinics, medical equipment, and food baskets,” noting, “However, divisions in response coordination are clearly apparent with many identical projects being duplicated by international and local NGOs.” They add, “Meanwhile, within Lebanon and Jordan, which have received the largest numbers of refugees, the pressure on domestic health systems is immense.” The authors state, “The international community must now seriously view the ever worsening humanitarian and health situation as a threat to regional security and their own national interests,” adding, “For immediate and pragmatic options, serious efforts are required to effectively coordinate the response capacity of the hundreds of small groups, associations, and NGOs working within neighboring countries and within Syria” (6/29).

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Access To Contraception, Abortion ‘Critical’ To Women’s Health

“Sometimes it does seem there’s a war over women’s bodies, and nowhere does this seem more dangerous than in the large number of regions where abortion is illegal, unsafe and life-threatening,” Luisita Lopez Torregrosa, a columnist for the International Herald Tribune, writes in the newspaper’s “Rendezvous” blog. “Much of Latin America, Africa and Asia — approximately 25 percent of the world’s population — have highly restrictive abortion laws. Few countries across the swath of southern continents, from Africa to Southeast Asia, have enacted abortion-rights laws and measures to protect women’s reproductive health,” she states, noting, “In deeply Roman Catholic and patriarchal Latin America, where anti-abortion church dogma and macho traditions predominate, abortion on demand is allowed nationally only in Cuba, Guyana, Puerto Rico and Uruguay (and in Mexico City, but not in the rest of Mexico).”

“Yet the region has the highest estimated rates of abortions in the world, according to the Guttmacher Institute,” Lopez Torregrosa continues, writing, ‘In most of those countries women seeking abortions go to midwives and other practitioners who use unsafe techniques, and some women perform abortions on themselves with drugs and other abortion-inducing methods.” She highlights the story of Beatriz, a woman from El Salvador who sought an abortion to terminate a high-risk pregnancy and was denied under the country’s laws, though “at the last minute a compromise was reached for a caesarean section to end the pregnancy.” She also quotes Erika Guevara, the director for Latin America and the Caribbean for the Global Fund for Women, and Pamela Barnes, president and chief executive of EngenderHealth (6/27).

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Recent Releases

Blog Examines UNAIDS, PEPFAR Progress Report On Efforts To Achieve AIDS-Free Generation

Noting “in July 2011, UNAIDS launched a joint initiative with PEPFAR … to help achieve the goal of an AIDS-free generation,” Ann Starrs, president and co-founder of Family Care International (FCI), highlights in “The FCI Blog” a report released on Thursday by UNAIDS and PEPFAR “on progress in this important initiative,” called the “Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.” She provides some details from the report and writes, “But their report almost completely ignores the plan’s second target, and in fact the second part of its long title — ‘…and keeping their mothers alive.’” The report “does, at a couple of points, vaguely acknowledge that women’s lives have value even when they are not carrying or breastfeeding babies,” she writes, adding, “Michel Sidibé and Eric Goosby, the heads of UNAIDS and PEPFAR, have both, in many speeches and statements, acknowledged the importance of women, and the right of women living with HIV to get [antiretroviral] treatment for their own health. This report should have reflected that awareness.” Starrs concludes, “I hope and expect that the next progress report for the Global Plan will include a clear discussion of the link between HIV infection, maternal mortality, and women’s health more generally, and what the agencies are doing to address it” (6/26).

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Sequestration-Related Cuts Affecting CDC’s TB Research Program

In a guest post in the Center for Global Health Policy’s “Science Speaks” blog, Coco Jervis, senior U.S. and global policy associate at the Treatment Action Group, examines how sequestration-related cuts are threatening the CDC’s Tuberculosis Trials Consortium, “the leading TB clinical research collaborative in the world,” she says. “Several TBTC sites have already been cut — and more may follow — hampering the TBTC’s ability to enroll patients into trials, narrowing the scope of research, and resulting in a loss of expertise,” she notes, adding, “Reaching the goal of zero TB deaths is well within our reach, but requires greater commitment by the Obama administration and Congress to support strong, sustained investment in new scientific advances to treat, diagnose, and prevent TB. Restoring funding for the TBTC is vital to stemming the TB epidemic and saving the lives of the millions affected by this disease” (6/27).

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Guardian To Host Online Conversation On Drug-Resistant Malaria

On July 3 from 1 p.m. to 3 p.m. UK time (8 a.m. to 10 a.m. EDT), The Guardian’s “Global Development Professionals Network” will host an online conversation addressing the challenges to treating artemisinin-resistant malaria and preventing the spread of the disease. “[W]hat are the ways to tackle drug resistant malaria? What would be the global health costs if artemisinin becomes ineffective? Should all stakeholders now focus on strengthening prevention as opposed to treatment?” the newspaper asks. To join the conversation, “or give your views before the chat, e-mail globaldevpros@guardian.co.uk,” and follow the conversation’s Tweets using #globaldevlive, the newspaper notes (Scott, 6/27).

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