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Kaiser Daily Global Health Policy Report

In The News

U.S. President Trump's 2018 Budget Blueprint Facing Opposition Over Proposed Cuts To Diplomacy, Foreign Assistance Under State Department, USAID

Agence France-Presse: Trump hits State Department in ‘hard power’ budget blueprint
“President Donald Trump proposed drastic cuts in spending on the arts, science, foreign aid and environmental protection Thursday, in a military-dominated budget blueprint that has already met fierce Congressional opposition…” (Beatty, 3/16).

Devex: Digging deep: How Trump’s budget affects everything from local jobs to foreign stability
“…The budget proposes steep cuts that have been described by congressional and NGO leaders as ‘narrow-minded,’ ‘small-hearted’ and ‘disastrous,’ although it is unlikely to be approved by Congress without significant changes. While the final budget will likely look quite different, many note that this blueprint provides a glimpse into how the Trump administration views foreign aid. The short answer is: with great skepticism…” (Saldinger/Igoe, 3/17).

The Guardian: Trump’s funding cuts to diplomacy and aid would mark retreat from soft power
“…But the rollback of diplomatic, international aid, and domestic programs is likely to face stiff opposition in the U.S. Congress. Lawmakers in Washington from both parties have declared several components of the budget to be non-starters. Mitch McConnell, the Republican Senate majority leader, told reporters last month his chamber would not pass a budget with steep cuts to the State Department and USAID…” (Siddiqui/Quinn, 3/16).

New York Times: A Shift From ‘Soft Power’ Diplomacy in Cuts to the State Dept.
“…Among the nations of the world, only Israel is guaranteed under the budget to keep its level of assistance, which at $3.1 billion a year is far more than goes to any other country. The Trump budget also proposes protecting programs that buy and distribute drugs fighting HIV/AIDS and malaria…” (Harris, 3/16).

Vox: Donald Trump’s first budget outline, explained
“…The budget will not pass in full, and provisions are already provoking political backlash on Capitol Hill. It will be up to Congress to actually implement spending policy; Trump can only offer suggestions. But the document is revealing and important nonetheless. It gives a clear signal of the administration’s priorities on agency spending, and signals that it will support any efforts by Congress to crack down on international programs, environmental protection, and anti-poverty programs…” (Matthews, 3/16).

Wall Street Journal: Trump Seeks Major Cut to State Dept., USAID
“… ‘We are going to be undertaking a very comprehensive examination of how programs are executed, a very comprehensive examination of how we are structured, and I’m confident that with the input of the men and women of the State Department, we are going to construct a way forward that allows us to be much more effective, much more efficient, and be able to do a lot with fewer dollars,’ [Secretary of State Rex] Tillerson said. The secretary of state said in a letter to State Department employees that the budget request is ‘an acknowledgment that development needs are a global challenge to be met not just by contributions from the United States, but through greater partnership with and contributions from our allies and others’…” (Schwartz/McKay, 3/16).

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News Outlets Examine Global Health Funding In Trump Administration’s Budget Blueprint, Including For PEPFAR, Gavi

NBC News: NBC News Covers President Trump’s Global Health Budget Request
“One surprise winner in the proposed Trump administration budget will be HIV/AIDS funding, despite a nearly 18 percent cut to the Department of Health and Human Services. … The budget promises to ‘provide sufficient resources to maintain current commitments and all current patient levels on HIV/AIDS treatment under the President’s Emergency Plans for AIDS Relief.’ … ‘What’s unknown is how this might affect a whole range of other programs that provide HIV support: in awareness, research, prevention, housing, and other areas,” said Dr. Jen Kates, the director of global health and HIV policy at the Kaiser Family Foundation. ‘It’s not a slam dunk by any stretch,’ she added…” (McCausland, 3/17).

NPR: Trump Foreign Budget: HIV Prevention Spared, U.N. And Others Lose Big
“In the introduction to his proposed federal budget, President Donald Trump states clearly that he plans to spend far less abroad and on international issues than did previous administrations. … The President’s budget explicitly mentions international health programs that it does plan to continue to support. The first is Gavi, the Vaccine Alliance … The second is PEPFAR, the incredibly successful anti-AIDS program that started under President George W. Bush…” (Beaubien, 3/16).

STAT: For health community, an unexpected bright spot in Trump budget: vaccines
“…Despite deep proposed cuts to the Department of Health and Human Services and the National Institutes of Health, the budget blueprint released by the Trump administration preserves a billion-dollar commitment to Gavi…” (Facher, 3/16).

Vox: One important exception to Trump’s budget cuts: programs to fight AIDS
“…The budget … ‘provides sufficient resources to maintain current commitments and all current patient levels on HIV/AIDS treatment under the President’s Emergency Plan for AIDS Relief [PEPFAR].’ … ‘While this language [in the budget blueprint] isn’t that clear about amounts,’ said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation, ‘it implies that current commitments will be maintained.’ The budget blueprint is just an early proposal, and it’s possible broader public health cuts could impact money that’s allocated to these programs in the final budget in May. But the administration has signaled its priorities here, and in a proposal that makes very little mention of specific diseases, the attention paid to HIV is notable…” (Belluz, 3/16).

Vox: Trump’s budget on health: 3 losers and 2 winners
“President Donald Trump’s budget blueprint, out [Thursday], includes devastating cuts to health research funding and public health programs — along with some vague commitments to launch a pandemic response fund and maintain funding in the fight against HIV. … We’ve parsed the health winners and losers in the budget for you. Here’s a quick overview. Loser: The National Institutes of Health … Loser: Health services research … Loser: Public and environmental health … Winner: Responding to crises like Zika and bird flu … Winner: The fight against HIV and malaria…” (Belluz, 3/16).

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Trump's Budget Outline Proposes Significant Cuts To Science, Research Agencies, Including 18% From NIH, Elimination Of Fogarty International Center

The Atlantic: All the Ways Trump’s Budget Cuts Science Funding
“President Trump’s budget blueprint, released Thursday morning, is supposed to lay out the administration priorities, and science is clearly not among them. It deals sweeping cuts to science and health agency budgets, and, in some cases, targets specific programs championed by the Obama administration…” (Zhang, 3/16).

Nature: U.S. science agencies face deep cuts in Trump budget
“When it comes to science, there are few winners in U.S. President Donald Trump’s first budget proposal. The plan, released on 16 March, calls for double-digit cuts for the Environmental Protection Agency (EPA) and the National Institutes of Health. It also lays the foundation for a broad shift in the United States’ research priorities, including a retreat from environmental and climate programs…” (Reardon et al., 3/16).

New York Times: Scientists Bristle at Trump Budget’s Cuts to Research
“…[T]he extent of the cuts in the proposed budget unveiled early Thursday shocked scientists, researchers, and program administrators. The reductions include $5.8 billion, or 18 percent, from the National Institutes of Health, which fund thousands of researchers working on cancer and other diseases … Some cuts were singled out for criticism. The proposed budget would eliminate the Fogarty International Center, an NIH program focused on global health. The center, founded in the 1960s, has worked on HIV/AIDS, Ebola, diabetes, dengue, maternal mortality, and numerous other health problems, and trains American and foreign doctors and researchers in developing countries…” (Fountain et al., 3/16).

STAT: Trump proposes shuttering NIH program that promotes medical research overseas
“One of the National Institutes of Health’s only programs devoted to global health research and training is on the chopping block as part of President Trump’s vision for an overhaul of some government agencies. … Public health experts say the closure of the [Fogarty International Center], if approved by Congress, could hamper future responses to the spread of infectious diseases and slow research that could help Americans. … The center has a budget of [$69.2] million — a fraction of the [$5.8] billion in proposed NIH cuts — that today funds 400 research and training projects that involve more than 100 U.S. universities…” (Blau, 3/16).

Washington Post: Science and medicine leaders say Trump budget would be dire for U.S.
“…The leaders of the scientific and medical establishment woke up to that startling news [of large proposed budget cuts] Thursday morning and quickly fired off statements of protest and alarm. This budget, they collectively warned, threatens America’s pre-eminence in science and technology. ‘This is not a budget that’s designed to make America first,’ Rush Holt, chief executive of the American Association for the Advancement of Science, told the Washington Post…” (Achenbach/Johnson, 3/16).

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Women's Rights Campaigners Express Concerns Over Potential UNFPA Funding Cuts Under Trump, Travel Restrictions Imposed By U.S., Home Countries

The Guardian: Trump funding cuts would imperil tens of thousands of women, activists warn
“Funding cuts threatened by the Trump administration will jeopardize the lives of tens of thousands of women and girls, including many who have fled violence in Syria, Yemen, and Iraq, campaigners warn. A total of 27 short-term U.N. Population Fund (UNFPA) projects … are supported by the U.S…” (Ford, 3/17).

Inter Press Service: Travel Restrictions Cast Shadow on U.N. Women’s Meeting: Rights Groups
“Increasing travel restrictions have prevented delegates from attending this year’s U.N. Commission on the Status of Women (CSW), according to several women’s rights groups. The travel constraints go beyond U.S. President Donald Trump’s embattled travel ban on refugees and Muslim-majority countries, which was again blocked by a Federal Judge on Wednesday. … [Women’s rights groups] report that some potential delegates were surprised that they were unable to obtain U.S. visas for the U.N. meeting; others were worried about increasingly strict treatment at U.S. airports; while others were prevented from traveling by their home countries…” (Rowlands, 3/16).

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NIAID Director Anthony Fauci Speaks With Devex About Pandemic Preparedness

Devex: Q&A with Tony Fauci on the state of pandemic security
“Global health agencies face a difficult challenge in protecting people from pandemic threats: They rarely know in advance what the specific disease outbreak will be. … Devex spoke to [Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases,] about what his institute is doing — and what global health organizations need to do — to better prepare governments and health systems for those inevitable, unpredictable threats…” (Igoe, 3/16).

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Polio Eradication Efforts Hampered By Conspiracy Theories, Terrorism

Motherboard: Conspiracy Theories Are the Reason We Still Have Polio
“…The last countries with polio have some important commonalities: They are rankled by terrorism that threatens health workers and makes it difficult to disseminate vaccines. But the root of this is often based in something else entirely: conspiracy theories that have grown out of stark mistrust in power. … Fighting dangerous conspiracy theories, as India has found, is its own important battle, as important and challenging as actually stamping out the poliovirus for good. While the governments of Pakistan, Afghanistan, and Nigeria have committed to the distribution of polio vaccines, they can’t control the underground networks created by Al Qaeda, the Taliban, Boko Haram, and Islamic State, or ISIS. … ‘In all of these cases, the security, violence, and inability to access the populations that need the vaccination have interrupted these efforts,’ said Josh Michaud, [associate] director of global health policy at the Kaiser Family Foundation, a nonprofit research organization…” (Rao, 3/17).

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U.N. Launches Interagency Coordination Group On Antimicrobial Resistance

U.N. News Centre: U.N. announces interagency group to coordinate global fight against antimicrobial resistance
“The United Nations [Thursday] announced the establishment of an Interagency Coordination Group on Antimicrobial Resistance, which will be co-chaired by Deputy Secretary-General Amina Mohammed and World Health Organization (WHO) Director-General Dr. Margaret Chan. … Ms. Mohammed said the creation of the U.N. joint agency group to combat AMR and advise on the global effort, is a sign of how seriously U.N. Member States were taking the threat…” (3/16).

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World Unprepared For Another Ebola-Type Outbreak, Researchers Warn

CBS News: “We are not ready”: Experts warn world is unprepared for next Ebola-size outbreak
“Is the world ready to defend against the next big infectious disease outbreak? It’s one of the biggest threats humanity could face. But experts who have reviewed reports on the global response to the massive Ebola outbreak that swept through West African countries for two years starting in 2014 say we’re ‘grossly underprepared’ to handle a similar health crisis. A team headed by Dr. Suerie Moon, director of research at the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, published their findings from a review of seven major post-Ebola reports in the medical journal The BMJ at the end of January. The team concluded that, while progress has clearly been made by the world’s governments and the World Health Organization (WHO), for instance, there are gaps that could still leave millions of people at risk…” (Mastroianni, 3/16).

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Venezuela's Economic Crisis Leading To HIV Drug Shortages

The Lancet: Venezuela’s economic crisis hampers HIV/AIDS treatment
“Amid an ongoing economic crisis, Venezuela is experiencing shortages of several HIV drugs, including those to prevent mother-to-child transmission of the virus…” (Daniels, 3/18).

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Brazil's Yellow Fever Outbreak Infects More Than 400, Kills 137

Associated Press: Brazil yellow fever cases pass 400; more than 130 dead
“Brazil’s Health Ministry says 424 people have been infected with yellow fever in the largest outbreak the country has seen in years. Of those, 137 have died. An update published Thursday said that more than 900 other cases are under investigation…” (3/16).

The Economist: An outbreak of yellow fever in Brazil
“…At the moment, researchers suspect that the virus causing this outbreak originated from monkeys in either Amazonia or the cerrado, Brazil’s savannah area. If that is confirmed, it will be a textbook example of disease in an animal reservoir spilling over to affect human beings. And it is a reservoir from which the disease is impossible to eradicate…” (3/18).

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Editorials and Opinions

U.S. Foreign Aid Protects Americans 'For A Bargain,' 'Ought To Be Maintained'

TIME: Bill Gates: Cutting Foreign Aid Makes America Less Safe
Bill Gates, co-chair of the Bill & Melinda Gates Foundation

“…[U.S. health and development projects around the world] keep Americans safe. And by promoting health, security, and economic opportunity, they stabilize vulnerable parts of the world. … To stop emerging diseases, we need the infrastructure built by consistent funding of well-run health programs. … A more stable world is good for everyone. But there are other ways that aid benefits Americans in particular. It strengthens markets for U.S. goods … It is also visible proof of America’s global leadership. … Withdrawing now would not only cost lives, it would create a leadership vacuum that others would happily fill. … Protecting Americans, preventing epidemics, strengthening markets, saving lives: aid delivers phenomenal benefits, and for a bargain. It represents less than one percent of the federal budget, not even a penny out of every dollar. It is some of the best return on investment anywhere in government. This money is well spent, it has an enormous impact, and it ought to be maintained” (3/17).

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PEPFAR, Global Fund, South Africa Must Diversify Antiretroviral Drug Suppliers

Financial Times: HIV/AIDS drugs for developing world face threat of disruption
Brian Elliott, chief executive of Procela Consultants

“…Fifteen generic manufacturers supply more than 95 percent of [antiretroviral drugs (ARVs)] to [low- to middle-income countries (LMICs)], of which four supply the bulk — 83 percent. … Reliance on so few suppliers for continuing treatment for millions of people is dangerous because, unlike other diseases, there are no alternatives to ARVs for the treatment of HIV. This dependence creates serious risks. Today, the risk of supply interruption is at a worrying level. … The danger of supply interruptions will increase as the world moves towards meeting the UNAIDS target of ’90-90-90,’ which requires treating 30m people by 2030. … Procurement of AIDS drugs in LMICs is controlled by just three major buyers: the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, and South Africa, who together purchase 80 percent of all LMIC requirements. … To ensure treatment for 30m people by 2030, the major buyers must become much less dependent on so few suppliers. They must allocate their purchases to all manufacturers that meet quality standards, and allow excluded or limited suppliers the opportunity to quickly increase their volumes…” (3/16).

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New WHO Director General Will Inherit 'Daunting Task' Of Fundraising, Reform

Huffington Post: The Global Health Community Looks for its Next Leader
John E. Lange, senior fellow for global health diplomacy at the U.N. Foundation

“…[The WHO executive board] selected three nominees — Tedros Adhanom Ghebreyesus of Ethiopia, David Nabarro of the United Kingdom, and Sania Nishtar of Pakistan — to be considered by all Member States [for the position of WHO director general] on May 23 at the World Health Assembly in Geneva. … [T]he World Health Assembly will reach a decision by secret ballot requiring, in rather complicated rules of procedure, that the director general be elected ‘by a clear and strong majority of Members present and voting.’ … And then the global health community will have its next leader. The new leader will inherit an organization implementing major reforms … that will greatly improve WHO’s ability to respond to international health emergencies and to enhance global health security. One of the new director general’s prime tasks will be to generate the financial support needed for the full panoply of WHO’s activities, which range from eradicating infectious diseases such as polio to setting norms and standards to combating non-communicable diseases to achieving the health-related Sustainable Development Goals and targets. This will be a daunting task, but critical in enabling the World Health Organization to achieve its goal of building a better, healthier future for people all over the world” (3/16)

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From the Global Health Policy Community

Organizations Release Statements In Response To U.S. President's FY18 Budget Blueprint

The following are excerpts of statements from several organizations regarding the president’s FY 2018 budget blueprint, which was released Thursday.

Elizabeth Glaser Pediatric AIDS Foundation: Statement from Chip Lyons on the President’s proposed Fiscal Year 2018 Budget Blueprint
“The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) expresses great concern with the suggested cuts to foreign assistance in the president’s proposed FY 2018 budget blueprint. Such cuts threaten to roll back stunning progress made in recent years toward the goal of ending AIDS in children globally…” (3/16).

Friends of the Global Fight Blog: President’s FY 2018 Budget Blueprint Affirms U.S. Commitment To The Global Fund
“In the preliminary FY 2018 budget blueprint released [Thursday], President Trump announced plans to meet U.S. commitments to the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund). … ‘We welcome the president’s commitment to the Global Fund, which recognizes the extraordinary value and impact that the Global Fund has in saving millions of lives and supporting a more safe, stable, and prosperous world,’ said Friends President Chris Collins…” (3/16).

MFAN: Proposed Cuts to Foreign Assistance Will Reverse Decade-Long Bipartisan Reform Effort
“The Modernizing Foreign Assistance Network (MFAN) is gravely concerned over the proposed … cut from FY17 levels to the International Affairs Budget, and urges Congress to reject such a draconian approach to programs that are central to U.S. interests. These deep and disproportionate cuts would threaten our national security, diminish America’s standing in the world, and reverse progress that has been made in building more accountable and effective development institutions…” (3/16).

ONE: 100+ Christian leaders tell Congressional leadership: Protect foreign assistance
“More than 100 Christian leaders from across the United States are calling on Congress to avoid disproportionate cuts to America’s foreign assistance programs that make up less than one percent of the federal budget. … The signers — representing the Catholic and evangelical communities — include national leaders, pastors, heads of faith organizations, recording artists, and authors…” (3/16).

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CGD Blog Post Examines Language Of President Trump's FY2018 Budget Blueprint

Center for Global Development’s “U.S. Development Policy”: The Foreign Aid Cuts Look to Be Real Enough, But the Trump Administration Doesn’t Necessarily Want to Own Them
Scott Morris, senior fellow and director of the U.S. Development Policy Initiative at CGD, examines President Trump’s FY 2018 budget blueprint released Thursday, writing, “When it comes to foreign assistance, the skinny budget doesn’t quite know what it wants to be, with statements that are both confused and confusing. … Two weeks ago the White House highlighted cuts to international programs in comments to reporters in a pretty clear attempt to demonstrate that it would be putting ‘America first’ in its first year budget. Yet, [Thursday’s] skinny budget seems to want to have it both ways: we are cutting foreign assistance, but only in a few areas are we willing to say so unambiguously. Let’s be clear. The $18.1 billion reduction overall is real and will have real and wide ranging impact in areas far beyond climate funding if Congress goes along. But it is telling that already the administration seems to feel the need to offer the appearance of continuity with long standing U.S. leadership in global health, humanitarian assistance, and multilateral development” (3/16).

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Blog Post Highlights State Department's Role In Addressing Global Development Challenges Through U.S. Foreign Aid, Private Sector Partnerships

U.S. Global Leadership Coalition: The Impact of U.S. Foreign Assistance and Private Sector Partnerships
In light of the proposed funding cuts to the U.S. Department of State and USAID in President Trump’s FY 2018 budget blueprint released Thursday, Sung Lee, deputy policy director at USGLC, discusses several State Department partnerships with other countries and private sector entities to address global challenges, such as the DREAMS initiative, aimed at reducing HIV infections among girls and young women (3/16).

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From the Kaiser Family Foundation

Kaiser Family Foundation Updates Fact Sheet On Key U.S. Government Officials In Global Health

Kaiser Family Foundation: Key Global Health Positions and Officials in the U.S. Government
This updated fact sheet lists U.S. government positions and officials related to global health operations, including links to agencies and officials’ profiles, when available (3/16).

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