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Kaiser Daily Global Health Policy Report

In The News

WHO Makes Recommendations For HIV Testing, Treatment Among Adolescents

“The [WHO] on Monday launched new recommendations to address the specific needs of adolescents both for those living with HIV and those who are at risk of infection,” Xinhua reports (11/25). “The number of adolescents infected by [HIV] has jumped by one-third over the past decade, the U.N.’s health agency said …, blaming gaps in care programs,” Agence France-Presse writes (11/25). “More than two million adolescents between the ages of 10 and 19 are living with HIV worldwide,” VOA News notes, adding, “Approximately 70 percent of these young people are in sub-Saharan Africa” (Lazuta, 11/25). In addition, there was “a 50 percent increase in reported AIDS-related deaths in this group compared with the 30 percent decline seen in the general population from 2005 to 2012,” a WHO press release states (11/25). According to The Guardian, the recommendations “call for more tailored approaches to testing and counseling and better, more immediate, access to treatment if young people test positive,” and “more support to disclose their status to their families and to stick to treatment regimes, the organization said” (Ford, 11/26).

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India's Delay On Global Fund Grant Caused HIV Drug Shortages, Live Mint Reports

India’s “health ministry sat on a $187 million international grant offered to the National AIDS Control Programme (NACP) for some 18 months, causing drug shortages that left about one million HIV-positive Indians treated under the program without drugs and testing kits for at least five of those months,” Live Mint reports. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which provided the grant, “has written a 20-page note charging the National AIDS Control Organization (NACO) and the ministry with endangering the lives of HIV patients across the country through the inaction,” according to the news service, which reviewed a copy of the note. In the memo, “the Global Fund said it would not allow civil society to be subjected to service interruptions ‘traceable to government decision-making,'” Live Mint writes. The news service ran its story without a “promised” statement from NACO, and the Global Fund “did not respond to questions Mint sent to the agency on November 18,” Live Mint notes. The news service summarizes the Global Fund note and includes comments from two activists and an unnamed official (Krishnan, 11/25).

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WHO Confirms Additional Polio Cases In Syria

“The [WHO] said on Tuesday that additional polio cases had been confirmed in two new areas of Syria, including near Damascus and in the northern city of Aleppo near Turkey,” Reuters reports. “‘In addition to 15 polio cases in Deir al-Zor province, Syria, two additional cases have been confirmed, one each in rural Damascus and Aleppo,’ the organization said,” according to the news agency (Holmes, 11/26). Earlier this month, “the virus [had] been confirmed in 13 of 22 children who became paralyzed in the northern province of Deir al-Zor,” Reuters notes in a separate article (Holmes, 11/25). “A comprehensive outbreak response continues to be implemented across the region,” according to a WHO press release, which notes, “Seven countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of five years” (11/26).

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ONE Analysis Finds Disparities In AIDS Progress Among African Countries

“Progress in the battle against AIDS is widely divergent in different African countries, so much so that to talk about ‘AIDS in Africa’ as one epidemic needing a single approach has become an anachronism, campaigners said on Tuesday,” Reuters reports. “In an analysis of the state of the global fight against [HIV/AIDS], the advocacy group ONE said that while some African countries had reached a ‘tipping point’ against the disease, others lag far behind,” the news service writes. “Leading the pack are countries such as Ghana, Malawi and Zambia, where governments, international donors and civil society leaders have worked together, the report said, and as a result have made dramatic progress against HIV/AIDS,” according to Reuters, which adds, “Yet at the same time other countries — such as Cameroon, Nigeria and Togo — lag far behind, often hampered by a lack of political will to tackle HIV, inadequate funding, poor delivery systems and stigma against marginalized populations where HIV infections are more frequent.” The news service notes, “The ONE report said one of the most serious problems for the global HIV/AIDS fight is a lack of money” (Kelland, 11/26).

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Officials To Meet In Thailand To Discuss Food Demands, Nutrition Gaps In Asia Pacific

“Representatives of the U.N., governments, [non-governmental organizations (NGOs)] and private sector farming are expected to gather in Bangkok, Thailand, on [November 26] for a two-day forum on how to fill the Asia-Pacific’s growing food demands and nutrition gaps in a region more devastated by natural disasters than any other worldwide,” IRIN reports. “Forum topics will range from best health interventions in the critical first 1,000 days of a child’s life (conception to age two) to the potential of oil and rice fortification for boosting micronutrient intake,” the news service notes (11/25).

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Militants Release 11 Pakistani Teachers Seized During Polio Vaccination Campaign; Karachi Suspends Immunizations

“Militants released on Tuesday 11 teachers who had been kidnapped in Pakistan’s lawless northwest during a polio vaccination campaign last week, local officials said,” Reuters reports. Islamist militants seized the teachers “on November 21 from a school in the Khyber tribal agency, one of the semi autonomous tribal areas along [the] border with Afghanistan,” the news agency writes, noting, “A tribal elder, speaking on condition of anonymity, said the militants freed the teachers on condition the government stop sending polio teams to the area” (Ahmed, 11/26). A “[p]olio vaccination campaign was suspended in three districts of Karachi over security concerns on Monday, officials said,” Pakistan Today reports. “[S]ources said that the fresh campaign was scheduled to start from Monday but the administration failed to provide proper security to the polio teams,” so immunizations were suspended, the newspaper writes, noting, “More than a dozen anti-polio workers have been killed by extremists in various areas of the country” (11/25).

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E.U. Signs $287M Development Grant With Ethiopia, Including Funding For Maternal Health

“The European Union signed a development grant with Ethiopia on Monday worth 212.4 million euros ($287.26 million) to help finance road construction and projects targeting maternal health and drought resilience,” Reuters reports. “The package includes 49 million euros earmarked for road building. Another 50 million euros will be [available] to help fight the effects of drought in the country’s arid south and east and 40.4 million euros will go to improving maternal health,” the news agency writes, adding, “Earlier this month the United Nations said Ethiopia was making slow progress in improving maternal health and that the rate of maternal mortality — dying in childbirth — was among the highest in the world” (11/25).

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Fears Of Disease Outbreaks, Food Insecurity Mount In Somalia's Puntland After Cyclone

“Two weeks after a tropical cyclone struck the northeast coast of Somalia, killing more than 100 people and thousands of head of livestock, important infrastructure lies in ruins and fears of an outbreak of waterborne diseases are mounting,” IRIN reports. “‘For four days, the cyclone brought heavy rainfall, icy winds, flash floods, and mudslides. Roads, houses, mosques, schools and farms were destroyed. Fishing boats sank. Water sources were damaged,’ according to Adeso, a humanitarian and development agency,” the news service writes, adding, “A lack of humanitarian access has exacerbated the situation” (11/25).

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Children To Be Immunized Against Measles, Polio In Philippines

“Around 33,000 children are to be immunized against measles and polio in typhoon-hit Tacloban city” in the Philippines, BBC News reports, noting the WHO, “which is supporting the government campaign, fears possible outbreaks of disease.” According to the news service, “Huge numbers — including many children — were left homeless, and many are surviving in cramped, unhygienic conditions in damaged buildings.” BBC writes, “The aim is to immunize all under-fives in Tacloban City,” adding, “The children will also be checked for malnutrition and given vitamin A drops to help boost their immune systems” (Mazumdar, 11/25).

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UNAIDS Highlights Link Between GBV, HIV Infection

“The U.N. says gender-based violence [GBV] is a serious violation of human rights and increases the risk of HIV infection,” VOA News reports, noting the International Day for the Elimination of Violence against Women was observed on Monday. According to UNAIDS, “every hour 50 young women become newly infected with HIV,” and [m]any of those infections are related to violence,” the news service writes. “‘In some countries where there’s a high prevalence, it’s been shown that women who are subjected to intimate partner violence, sexual violence, are 50 percent more likely to be HIV-positive than other women,” UNAIDS Director of Rights, Gender, Prevention and Mobilization Mariangela Simao said, VOA notes, adding, “She said empowering women would help end the violence” (DeCapua, 11/25).

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South African Grant Scheme Reduces Girls' Dependence On 'Sugar Daddies,' Study Shows

“Government grants to help poor children in South Africa also play an important role in reducing HIV risk from ‘sugar daddies’ who prey on teenage girls, a study said on Tuesday,” Agence France-Presse/GlobalPost reports. “In a wide-ranging probe published in the Lancet Global Health, researchers in Britain and South Africa interviewed 3,500 teenagers and followed this up with another interview a year later,” the news agency writes, noting the study “is the first to analyze a grant scheme that is taking place in real life and on a massive scale, rather than in carefully controlled research conditions.” According to AFP, “These systems ‘can substantially reduce unsafe partner selection by adolescent girls,’ said the paper.” While the program “helped wean girls off dependence on ‘sugar daddies,’ [it] did not reduce their exposure to other HIV risks, such as having unprotected sex when drunk,” nor did the program reduce HIV risk among boys, the news service notes (11/25).

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NPR Examines Issue Of Child Marriage

NPR’s “Parallels” blog and “All Things Considered” audio program examine the issue of child marriage. “Across the developing world, it’s estimated that one in three girls still marries before age 18; one in nine before age 15,” the blog writes, and relays the story of 13-year-old mother Christina Asima in Malawi, where “law permits marriage at 15 with parental consent, and merely ‘discourages’ it at younger ages.” The blog notes that, “in many places, offering up a daughter for marriage can bring parents a dowry, or pay down a debt,” adding, “Many soon become pregnant, which can have devastating consequences.” The blog continues, “When a girl marries young, experts say she’s often little more than a servant and vulnerable to domestic violence.” “Parallels” highlights the efforts of the Girls Empowerment Network, which creates girls’ clubs to promote “skills for public speaking, negotiating and standing up for oneself, even in front of the whole village” (Ludden, 11/25).

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Medicines For Malaria Venture Supports Research With 'Malaria Box'

Deutsche Welle examines Medicines for Malaria Venture’s (MMV) “Malaria Box,” which “holds 400 diverse compounds that kill the malaria parasite” and is distributed “free of charge to any researcher who wants it.” According to the news agency, “MMV aims to incite them to develop new, market-ready drugs based on one of the 400 compounds in the box.” DW adds, “Up to now, MMV has sent malaria boxes to 160 research groups in 27 countries, mainly to Europe and North America, but also to South Africa, India, Brazil and Uganda, for instance” (Osterath, 11/26).

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European Drug Agency Recommends Two TB Drugs For Approval

“European drug regulators gave their backing on Friday to two new medicines for multidrug-resistant tuberculosis (TB), an infectious disease that affects some 450,000 people worldwide each year and for which there are few effective treatments,” Reuters reports. “The European Medicines Agency (EMA) said its support for marketing authorizations for Otsuka’s TB drug Deltyba and for Para-aminosalicylic acid Lucane … were part of efforts to tackle the growing public health challenge of antibiotic resistance,” the news agency writes (11/22). “‘Multidrug-resistant tuberculosis is associated with a very high mortality rate and poses a significant public health threat as individuals infected with drug-resistant strains are unable to receive adequate treatment and can potentially spread their infection,’ EMA said in a statement on its website,” Bloomberg states (Gerlin, 11/22). The Wall Street Journal notes TB “infected an estimated 8.6 million people in 2012, killing 1.3 million of them” (McKay, 11/22).

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FDA Approves H5N1 Vaccine For Use In Epidemic

“The Food and Drug Administration [FDA] said Friday it has approved a vaccine made by GlaxoSmithKline Plc for use in the event of an H5N1 bird flu epidemic,” Al Jazeera America reports (11/24). “H5N1 made news around the globe last year when two groups of researchers published [papers] on mutations that could make the virus transmissible between ferrets, an oft-used model for the dynamics of human infections,” The Scientist notes, adding, “With an estimated 50 percent to 60 percent mortality rate in people, mutations that allowed the virus to pass from human to human could cause a massive epidemic” (Akst, 11/25).

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Editorials and Opinions

Intensified Efforts To Diagnose, Treat TB Needed In Philippines

Following Typhoon Haiyan in the Philippines, “[l]ack of shelter and continued bad weather are leading to widespread acute respiratory infections, which the Philippines Department of Health officials say are becoming the biggest public health threat since the typhoon,” Kari Stoever, vice president of external affairs at Aeras, writes in the Huffington Post’s “Global Motherhood” blog. “Medical authorities also worry about leptospirosis, a water-borne parasitic disease endemic to the Philippines, diseases that thrive in tropical, unsanitary environments like cholera, typhoid fever, dysentery, other infections spread through crowded evacuation centers and shelters,” she adds.

“While the Philippines work to save lives and rebuild communities, diseases like tuberculosis (TB) often become ‘opportunistic’ in these situations — taking advantage of interruptions in treatment, malnutrition, stress and weakened immune systems,” Stoever continues. “In the Philippines, several TB control projects and treatment centers were located in Tacloban, the hardest-hit city in the Philippines, and while it’s too soon for reports on the full extent of any damages, the destruction was so vast that the treatment regimens of most TB patients in the area were surely interrupted,” she notes, adding, “Intensified efforts to diagnosis new cases of TB and ensure access to treatment is imperative to halt the immediate spread of TB” (11/25).

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Opinion Pieces Address Humanitarian Relief Efforts In Philippines

The following is a summary of several opinion pieces from two authors published in separate blogs from The Guardian that discuss post-disaster relief efforts in the Philippines.

  • Cecil Laguardia, Poverty Matters Blog: “When we touched down in Tacloban, the desolation and bleakness seemed to engulf a wide area — it was no longer the city I knew,” Laguardia, a Filipino aid worker, writes in her second post in the blog (11/26). In a previous post, she “describes challenges faced after typhoon Haiyan” (11/21).
  • Caroline Séguin, Global Development Professionals Network: “With so many health facilities damaged or destroyed, the health care needs are significant, especially since the living conditions exacerbate the risk of respiratory tract infections, pneumonia and waterborne diseases,” Séguin, the emergency coordinator for Médecins Sans Frontières (MSF), writes, adding, “In such an apocalyptic situation, the need for mental health services is overwhelming.” She states, “Immediately following the typhoon there was an influx of organizations of varying sizes and with differing capacity to deliver assistance,’ including MSF, and notes “the Filipino people — locals and people from other parts of the country — are doing the lion’s share of the relief work” (11/25).

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Recent Releases

USAID To Observe 16 Days Of Activism Against Gender Violence

“Beginning on the International Day for the Elimination of Violence against Women (November 25) and ending on International Human Rights Day (December 10), USAID joins the global community in observance of the 16 Days of Activism against Gender Violence,” the agency announced in an email bulletin on Monday. “USAID is committed to working in collaboration with other U.S. government agencies, non-governmental organizations, faith-based communities, private sector companies and women and men around the world to eliminate gender-based violence,” the bulletin states (11/25).

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Blog Examines Next Steps For USAID's Focus On Eradicating Extreme Poverty

Noting USAID Administrator Rajiv Shah last week delivered a speech at the Brookings Institution on eradicating extreme poverty, Beth Schwanke, senior policy counsel at the Center for Global Development (CGD), writes in CGD’s “Rethinking U.S. Development Policy” blog, “Shah’s speech primarily focused on the big picture of what [an] increased focus on eradicating extreme poverty would take, including an emphasis on public-private partnerships coupled with recipient country reforms, increased efforts in fragile states, and a renewed emphasis on resilience.” She adds, “Now that Shah has laid out his vision, I hope we’ll hear from him and others in the coming months precisely how USAID will work to end extreme poverty … And I’ll be listening for far more specifics on how USAID will work with other partners, from USG agencies, to the [multilateral development banks (MDBs)], to country partners, to private enterprise” (11/25).

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'Science Speaks' Blog Highlights Event On PEPFAR's Orphans, Vulnerable Children Program

The Center for Global Health Policy’s “Science Speaks” blog reports on an event held last week in Washington, D.C., which examined PEPFAR’s Orphans and Vulnerable Children Program. At the event, Sibongile Gladys Gule, Penelope Masiya, and Nomthandazo Ntuli spoke with session moderator Richard Lui about “how PEPFAR programs to reach the most helpless of people in the path of the AIDS epidemic changed their lives,” according to the blog (11/25).

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UCSF Interviews Ambassador Eric Goosby

In an interview posted on the University of California San Francisco’s (UCSF) webpage, Ambassador Eric Goosby, who earlier this month stepped down as head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, speaks with UCSF Senior Public Information Representative Laura Kurtzman “about the challenges he faced [while in office] and about what lies ahead in a world where 35 million people — nearly the population of California — are infected with HIV.” The interview notes that Goosby this month will return to UCSF, “where he earned his medical degree and completed his residency,” to “lead a new center on implementation sciences” (11/25).

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Blog Features Interview With Gates Foundation's Global Health President

Xconomy’s “Bio Beat” blog features a two-part interview with Trevor Mundel, president of the Bill & Melinda Gates Foundation’s global health operations. Journalist Luke Timmerman speaks with Mundel about the challenges of implementing global health programs and working with the private sector (11/25). In the first installment, Mundel “talked about his personal reasons for leaving the pharmaceutical industry to work on global health problems, and how the foundation makes decisions on how to spend its money,” the blog notes, adding that in the second installment, he “is talking more about how the foundation interacts with pharma and biotech companies” (11/26).

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GAVI To Provide Support For Inactivated Polio Vaccine

“The GAVI Alliance is to begin providing support for the introduction of inactivated poliovirus vaccine (IPV) as part of routine immunization programs in the world’s 73 poorest countries, GAVI’s Board decided [on Friday],” a GAVI press release states. “This decision will enable the Alliance to help countries reach more children with important vaccines, and play a complementary role supporting the efforts of the World Health Organization (WHO) and the Global Polio Eradication Initiative (GPEI) in eradicating polio as part of implementing the polio endgame strategy,” the press release adds. The press release also discusses the board’s decisions on additional vaccines (11/22).

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MSF Film Series Shows Group's Strategies For Community-Based HIV/AIDS Care

On Monday, Médecins Sans Frontières “launche[d] a film series titled See What We See to counterbalance rhetoric presenting progress as all-pervasive and the fight against HIV/AIDS as almost won,” an MSF press release states. “The See What We See films reveal what MSF medical staff witness and also highlight proven strategies for community-based care that puts more people on treatment earlier and helps them adhere to treatment in the long-term,” according to the press release (11/25).

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