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Kaiser Daily Global Health Policy Report

In The News

UNAIDS Reports Overall Progress Against HIV/AIDS, But Says Some Regions Falling Behind

UNAIDS on Tuesday “reported accelerated progress in combating HIV/AIDS in much of the world, with significant decreases in new infections and deaths, but worrying signs persist that some regions and countries are falling behind in the global battle,” the U.N. News Centre reports (11/20). “In a report [.pdf] launched ahead of World AIDS Day, UNAIDS said that new HIV infections have been on the rise in Eastern Europe and Central Asia by 13 percent since 2006, while the Middle East and North Africa has seen a doubling of new HIV infections since 2001,” Xinhua notes (11/20). “The report … argues that the next stage in addressing the global pandemic ought to focus on specific locations and key populations at a higher risk of HIV exposure,” Al Jazeera writes (11/21). “‘Every person counts. If we are going to keep our pledge of leaving no one behind, we have to make sure HIV services reach everyone in need,’ UNAIDS Executive Director Michel Sidibé said,” according to RTT News (11/20). The report includes updated epidemiologic data and highlights the epidemic among children and people over age 50, according to a UNAIDS press release (11/20).

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U.N. Urges Early Testing Of More Children At Risk Of HIV Infection

“More than a quarter of a million children each year are born infected with the virus that causes AIDS, but too few are being tested early to receive treatment and prolong their lives, the United Nations said on Wednesday,” Reuters reports. “Children are the ‘forgotten’ victims of the AIDS epidemic, yet 260,000 babies joined their ranks last year, mainly in sub-Saharan Africa, [UNAIDS Executive Director Michel Sidibé] said” at a press conference in Geneva on Wednesday, the news agency writes, adding he called for HIV diagnostic kits for infants to be improved “and for their ‘still high’ current price of $25-50 to be brought down.” Mahesh Mahalingam, who directs UNAIDS’ global plan for stopping new infections among children, said, “The earlier we can diagnose, the earlier we can treat them which increases chances of child survival. … If we start pretty early they have the same chance of living as any other children,” according to the news agency (Nebehay, 11/20).

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Developing Countries Stage Protest At U.N. Climate Talks; U.N. Report Shows African Countries Vulnerable

“The United Nations climate talks [in Warsaw] are bogging down over the old divide between rich and poor nations on the question of who should pay when climate-related disaster strikes, with developing nations staging a symbolic walkout early Wednesday in protest at what they consider inadequate financial support from wealthy countries,” the New York Times reports. “The new catchphrase is ‘loss and damage,’ shorthand for the fight over financing for the costs of rising seas, powerful storms and persistent drought,” the newspaper writes, adding, “And the issue of whether the United Nations Framework Convention on Climate Change should be modified to require rich nations to bear the cost of disasters exacerbated by global warming is threatening to torpedo the Warsaw talks, which are meant to prepare a global climate agreement to be signed in 2015” (Jolly, 11/20). “The G77+China group of 133 developing countries negotiating a new international deal … to combat climate change walked out of the talks in the wee hours of Wednesday morning to protest developed countries’ reluctance to commit to loss and damage,” Inter Press Service writes (Ciobanu, 11/20). Discussions “did pick up later, and Todd D. Stern, the United States climate delegate, expressed confidence during a news conference that the conflict would not cause the discussions to fail,” the New York Times states (11/20).

In related news, “African countries are increasingly vulnerable to climate change and could struggle to feed and defend their people as temperatures rise, according to a major U.N. report” released at the conference, The Guardian reports. “It will cost Africa approximately $350 billion a year to adapt its farming and infrastructure to climate change if governments fail to hold temperatures to less than 2C and allow them to rise to about 4C, according to the report” from the U.N. Environment Programme, the newspaper states. “‘The plight of Africa is not of our making,’ said Tosi Mpanu-Mpanu of the Democratic Republic of the Congo, lead negotiator for the Africa group of nations,” The Guardian writes. “The developed countries have caused the problem, and Africa [is] asking [those countries] for the funds to help but so far they are not forthcoming,” Mpanu-Mpanu added, the newspaper continues (Vidal, 11/20).

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Rise In Risky Behavior Is Growing Threat To Health, World Bank Report Says

“Risky behavior — smoking, illegal drug use, excessive drinking, unhealthy eating and unsafe sex — is on the rise worldwide and poses a growing threat to health, particularly in poorer countries, according to a World Bank report,” The Guardian reports. “Smoking exacts a particularly high toll,” the newspaper writes, noting, “Nearly 80 percent of the 6.3 million deaths from smoking in 2010 occurred in middle- and low-income countries, says the Risking Your Health report.” The Guardian adds, “The report also notes fundamental differences in being able to change behavior relating to alcohol, tobacco and food” (Tran, 11/20).

“The report concludes that costs and spillovers associated with risky behaviors justify public interventions and that certain policy interventions, when done properly, can improve overall welfare,” a World Bank press release states. “Evidence suggests that legislation tends to be effective, especially when enforcement mechanisms are strong,” the press release notes, adding, “The report highlights that tax policies can be efficient mechanisms to prevent smoking and alcohol consumption” but that “[o]ther forms of interventions, such as information education and communications programs, have been less effective in changing behaviors” (11/20).

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New York Times Reports On Global Fund's Suspension Of Contracts With Bednet Suppliers

The New York Times reports on the Global Fund to Fight AIDS, Tuberculosis and Malaria’s suspension of contracts with two international suppliers of mosquito nets after discovering the companies had “paid bribes to health officials in Cambodia.” The newspaper notes, “Although the suspensions raise the possibility that the world will not get the 200 million nets it needs in 2014, a spokesman for the Global Fund … said he was confident no shortage would develop.” Global Fund Director of Communications Seth Faison said the two companies are “still fulfilling their current contracts” and “hopes to have seven suppliers soon,” according to the newspaper. “Both companies cooperated with the investigation and blamed ‘rogue employees’ at subsidiaries, Mr. Faison said,” the New York Times notes (McNeil, 11/20).

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Bangladesh Sees Major Progress In Health Indicators, Studies Show

“Bangladesh has had 40 years of exceptional progress in health, with infant mortality down, life expectancy up and good disease control, all despite being one of the world’s poorest countries, researchers said on Thursday,” Reuters reports. “‘Over the past 40 years, Bangladesh has outperformed its Asian neighbors, convincingly defying the expert view that reducing poverty and increasing health resources are the key drivers of better population health,’ said Professor Mushtaque Chowdhury from Dhaka’s BRAC University, who co-led a series of studies published in The Lancet medical journal,” the news service writes (Kelland, 11/21).

“The empowerment of women and the reach of [non-governmental organizations (NGOs)] have contributed to Bangladesh’s remarkable success in health care, which has included significant improvements in the survival of under-fives, immunization coverage and tuberculosis control, according to the” studies, The Guardian notes, adding, “Progress in infant, child and maternal mortality has been particularly striking, with an unprecedented reversal in the number of deaths among girls compared with boys.” The newspaper continues, “Looking ahead, the report said that despite annual economic growth of six percent, persistent poverty would continue to limit health progress” (Tran, 11/20).

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Humanitarian Response Continues In Philippines

News outlets continue their coverage of the humanitarian response in the Philippines. “Nearly two weeks after Typhoon Haiyan devastated parts of the central Philippines, experts and activists here are warning that post-disaster reconstruction needs to be more transparent than past efforts, while also focusing on a long-term assistance strategy that goes beyond immediate emergency relief,” Inter Press Service reports (11/21). “The U.N. says it has raised just over a third of the money it needs to provide emergency aid in the central Philippines, 12 days after the region was devastated,” VOA News writes (11/20).

“Ongoing assessments of health care facilities damaged by Typhoon Haiyan (locally known as Yolanda), … show some 41 percent, mostly hospitals, were not functioning as of November 19, forcing patients and their providers to improvise life-saving care,” according to IRIN (11/20). “Aid workers have warned that children in the disaster zone left by typhoon Haiyan are particularly vulnerable, as they set up child-focused services to mitigate the impact,” The Guardian notes (Branigan, 11/20). Gwen Ifill of PBS NewsHour interviews Nancy Lindborg, assistant administrator for USAID’s Bureau for Democracy, Conflict and Humanitarian Assistance, about the challenges of helping those most affected by the storm (11/20).

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WHO Syria Representative Discusses Polio Response In Xinhua Interview

Xinhua interviews Elizabeth Hoff, the WHO representative in Syria, about efforts to stop the spread of polio in the country, noting, “Recent cases of polio infections among Syrian children have prompted the [WHO] and the Syrian Ministry of Health to join forces to fight the outbreak of the viral disease.” According to the news service, “She attributed the outbreak of polio in Syria, which had been polio-free since 1995, to the long-standing conflict gripping the nation,” and she said that while a wide-scale vaccination campaign launched on October 24 in cooperation with the UNICEF and the WHO “was well-received, … to fully rid Syria of the virus, six additional campaigns with four-week intervals are being planned” (11/20).

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Zimbabwe Responds To Watchdog's Warning Of Potential Cholera Outbreak

“Zimbabwean authorities on Wednesday accused an international group of overstating the risks of a cholera outbreak in the sprawling capital city of Harare, ensuring the public that the cholera epidemic that killed 4,000 people in 2008 won’t repeat again,” Xinhua/Global Times reports. Responding “to a 160-page Human Rights Watch report, titled ‘Troubled Water: Burst Pipes, Contaminated Wells, and Open Defecation in Zimbabwe’s Capital’ … Director of Health Services Stanley Mongofa told Xinhua that most places in the city were receiving potable water, including an area that was the epicenter of the deadly cholera outbreak five years ago,” the news service writes. “Human Rights Watch said it produced the report from research it carried out in 2012 and 2013 in Harare, including 80 interviews with residents in high-density suburbs,” the news service notes, adding, “The report comes at a time when the Harare City Council has signed a $144 million deal with a Chinese company to upgrade its aged water treatment infrastructure” (11/21).

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Kenyan Sex Workers Using PEP To Lower Risk Of HIV Infection, BBC Reports

BBC News Magazine reports on how sex workers in Kenya are using post-exposure prophylaxis (PEP) antiretroviral therapy to lower their risk of HIV infection, instead of using condoms, which they say are too expensive. “There are no definitive figures to show how well PEP works. It’s far better, experts say, to prevent exposure the virus in the first place, by using condoms,” the news service writes. “Instead it would be better for prostitutes to take a type of antiretroviral designed to be taken before exposure to HIV — known as pre-exposure prophylaxis (PrEP),” BBC notes, adding, “There are plans to run a pilot program with sex workers in Kenya to see if it could be practical for them to use PrEP as an extra layer of defense” (Deen, 11/20).

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The Atlantic Examines Search For Universal Flu Vaccine

“The sudden outbreak [in 2009 of H1N1] drove home the realization that the world needs vaccines that are more effective and faster to make — not just to reduce the 250,000 to 500,000 deaths from seasonal flu that occur every year but also to prepare for the arrival of new, deadly pandemics,” The Atlantic reports in an article examining how, “[i]n the four years since the 2009 pandemic, researchers have been searching furiously for a better answer.” The magazine continues, “Most scientists call it a universal flu vaccine, because it would protect people against many flu strains, including ones that have yet to evolve. This universal vaccine could ultimately put an end to the annual ritual of getting a flu shot: each jab might protect for years or even a lifetime.” The Atlantic discusses flu vaccine research, how influenza viruses change, and the prospect for a universal vaccine (Zimmer, 11/20).

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Gates Foundation Contest Winners Aim To Develop 'Next Generation Condoms'

The New York Times examines some of “the winners announced Wednesday by the Bill & Melinda Gates Foundation of a contest to create a condom that men would actually use,” noting, “The contest, the foundation said, aimed to decrease unintended pregnancies and sexually transmitted diseases with ‘a next-generation condom that significantly preserves or enhances pleasure.'” According to the newspaper, “The foundation received 812 applications, chose 11 and awarded the winners $100,000 each. They could receive up to $1 million after they develop the ideas” (Belluck, 11/20). Mirror News examines the efforts of one grant recipient “to create the thinnest, strongest condoms ever” using the material “graphene mixed with an elastic polymer such as latex used in traditional condoms” (Pocklington, 11/20).

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Editorials and Opinions

Responsibility Of Replenishing Global Fund Must Be Shared By Wealthy, Developing Countries

“The Global Fund [to Fight AIDS, Tuberculosis and Malaria] is asking for $15 billion for the next three years, of which the U.S. is asked to contribute $5 billion,” Taufiqur Rahman, an international health specialist, writes in The Hill’s “Congress Blog.” “So far, the U.K., France, Japan, Germany, Scandinavian countries, and the Gates Foundation have made major commitments and increased their contributions,” he notes, adding, “While the rich world has a responsibility to provide funds and technical assistance to fight diseases to save lives in low-income countries, the developing countries must also have a similar responsibility toward their citizens.”

“Many low-income countries in Asia, Africa, Latin America, and the Middle East are also taking steps to contribute from their own resources,” but “[a]s of now, only six countries: Botswana, Burkina Faso, Malawi, Niger, Rwanda and Zambia have met … a commitment to cover 15 percent of health care costs from their own resources,” Rahman continues. “Any investment in the Global Fund must be conditional on two actions: (i) prepare the low- and middle-income countries to assume more financial responsibilities for their programs, and (ii) support and facilitate new, quality-assured products [such as medicines and diagnostics] to enter the developing countries’ markets,” he states. “We should fund the Global Fund, no doubt about it,” he adds, concluding, “Our resources are finite but global collaboration can be limitless” (11/20).

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China Should Abolish One-Child Policy

Noting China last week announced it will ease its one-child policy, allowing families with at least one parent who is an only child to have two children, a Washington Post editorial provides a brief history of the policy and writes, “It was an ill-conceived response to the overpopulation fears that had circulated in the West.” The newspaper states, “The one-child policy may have averted 200 million births over three decades. But the tragedy is that the pain and suffering was probably unnecessary.” The editorial continues, “The one-child policy was a stake driven through individual freedom,” and concludes, “Rather than continue to tinker with this misguided philosophy, China should abolish population controls altogether and unleash the ingenuity and energy of its people by allowing every one of them, individually, to make life’s most important decisions” (11/20).

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As Long As Polio Exists Anywhere, World Is At Risk

“[A]s long as polioviruses circulate anywhere in the world, they can be exported to countries that are now poliomyelitis-free and can cause serious outbreaks,” Trevor Mundel, president of the Bill & Melinda Gates Foundation’s Global Health Program, and Walter Orenstein, a professor and associate director of the Emory Vaccine Center, write in a New England Journal of Medicine opinion piece. “Global eradication will require several key actions; these include administering oral poliovirus vaccine to interrupt the transmission of wild-type polioviruses, building and sustaining political commitment, improving routine immunization delivery in remaining reservoir countries, delivering vaccines to children living in areas in conflict, and providing rigorous, ongoing oversight,” Mundel and Orenstein state. “The history of successful eradication efforts over more than two decades has proven that we can finish the job. … [I]f we do not, any country is vulnerable to reimportation of poliomyelitis,” they write, and conclude, “Without question, the best defense against poliovirus is a good offense that eliminates the virus from the remaining reservoirs and truly eradicates the disease” (11/21).

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Stop Polio In Three Endemic Countries To Prevent Its Spread Elsewhere

“One of our worst fears was recently confirmed: Polio has returned to Syria for the first time in 14 years, infecting at least 10 young children,” Siddharth Chatterjee, chief diplomat at the International Federation of the Red Cross and Red Crescent Societies, writes in an Al Jazeera opinion piece. “In Syria, civil war has driven immunization rates down to less than 70 percent, from more than 90 percent in 2010, creating exactly the sort of environment where polio tends to strike,” he states, adding, “Yet even amid the chaos of war, success against polio is possible.” But “[t]he underlying problem is not in Syria or in the Horn of Africa, the site of another polio outbreak this year, but in Pakistan and the other two endemic countries that have never interrupted transmission of the virus: Afghanistan and Nigeria. We must stop the virus there,” he adds. “In the past 25 years, we have gone from 350,000 cases of polio in more than 125 countries to just a few hundred in a handful of countries. These last frontiers are the hardest, but the motivation and plan are there,” Chatterjee continues (11/17).

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Recent Releases

U.S. Officials Comment On Passage Of PEPFAR Stewardship And Oversight Act

In a statement, Acting U.S. Global AIDS Coordinator Deborah von Zinkernagel “commend[s] the U.S. Congress for passing the PEPFAR Stewardship and Oversight Act of 2013, reaffirming its strong commitment to this historic global health program.” She states, “The passage of the PEPFAR Stewardship and Oversight Act demonstrates the United States’ sustained commitment to fighting this deadly disease, but the U.S. cannot do it alone. Achieving an AIDS-free generation is a shared responsibility” (11/19). The Center for Global Health Policy’s “Science Speaks” blog discusses the bill’s passage and includes comments from Reps. Barbara Lee (D-Calif.), Ed Royce (R-Calif.), and Jim McDermott (D-Wash.) (Barton, 11/20).

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NEJM Article Details Rwanda's Human Resources For Health Program

A Special Report in the current issue of the New England Journal of Medicine details Rwanda’s Human Resources for Health Program, “the largest-scale global health partnership ever initiated between American universities and a low-income country,” according to a press release from the program. “Announced by Rwandan President Paul Kagame and former U.S. President Bill Clinton in 2012, Rwanda’s Human Resources for Health Program is a seven-year, $150 million collaboration between the U.S. and Rwandan government and 25 leading U.S. academic institutions,” the press release notes. Ambassador Eric Goosby, former U.S. global AIDS coordinator and head of the U.S. State Department’s Office of Global Health Diplomacy, and Rwandan Minister of Health Agnes Binagwaho both serve as lead authors of the new article, according to the press release (11/20).

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Congress Should Adopt More Flexibility In Food Aid Program

“Congress, through the House/Senate farm bill conference, once again has the opportunity to provide the U.S. international food aid program the flexibility that is essential for our help to be effective in responding to life-threatening disasters,” George Ingram, senior fellow in the Brookings Institution’s Global Economy and Development Program, writes in the institution’s “Up Front” blog, highlighting the humanitarian response to Typhoon Haiyan in the Philippines. “The U.S. government needs the flexibility to purchase food commodities in the most efficient market, which sometimes will be the U.S., sometimes the country affected, and sometimes neighboring countries,” he writes, adding, “The House/Senate conference on the farm bill should adopt not just the modest change of 20 percent flexibility found in the Senate bill, but allow up to 30-40 percent, or, even better, 50 percent of our food assistance to be used for local and regional purchase if that is the most efficient and readily available source” (11/18).

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Blog Discusses Need For New Approach To Transgender Health

Noting November 20 is the Transgender Day of Remembrance, Aysa Saleh-Ramirez, AIDSTAR-One senior technical adviser at John Snow, Inc., writes in USAID’s “IMPACTblog,” “Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (.PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue.” She examines “the need for a new approach to transgender health” that “engage[s] families and schools”; clearly defines “the spectrum of sexualities, genders, and identities”; secures the human rights of transgender communities and creates “a safer environment where they can access appropriate services”; “support[s] employment and education opportunities for transgender persons”; and allows transgender people “to engage with health providers and communities as professionals and peers” (11/20).

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Blog Examines Whether Aid Helping To End Extreme Poverty

In the Center for Global Development’s (CGD) “Views From The Center” blog, CGD President Nancy Birdsall and researchers Christian Meyer and Nabil Hashmi write about the international goal of ending extreme poverty by 2030. “Reaching the goal requires reaching the right places, where most of the world’s poor people live. In those places, it turns out that official aid is playing a small role,” they state and provide data to support their argument. “The bottom line: In the rich world it is worth thinking hard about how to help poor countries in ways that go well beyond aid,” they conclude (11/20).

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