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Kaiser Daily Global Health Policy Report

In The News

WHO Reports Drop In TB Deaths Last Year, Warns Undiagnosed Cases, Drug Resistance Threaten Progress

“Global efforts to rein in tuberculosis [TB] helped cut the death toll to 1.3 million last year, but drug-resistant forms of the disease are sparking huge concern, the WHO said Wednesday,” Agence France-Presse reports (10/23). “In its annual report on tuberculosis, the [WHO] said the world was on track to meet U.N. goals for 2015 of reversing TB incidence and cutting the death rate by 50 percent compared to 1990,” Reuters writes, adding, “Yet around three million people with TB are being missed by health systems” (Kelland, 10/23). “Finding these missed cases is one of the biggest challenges in TB care and control, the WHO’s report says,” according to BBC News, which notes, “Twelve countries including India, South Africa and Bangladesh account for the majority of undiagnosed individuals” (Briggs, 10/23).

“The agency on Wednesday also noted a rise in drug-resistant strains, which require more toxic and expensive drugs,” the Associated Press reports (10/23). “Approximately 16,000 people were diagnosed with multidrug-resistant tuberculosis [MDR-TB] in 2012 but were not given the treatment they needed to stay alive and prevent the spread of the disease,” the report says, according to The Guardian. “As the problem of MDR-TB grows, so do the waiting lists for the expensive and lengthy courses of treatment — it can take two years to cure somebody,” the newspaper notes (Boseley, 10/23). “Chief among the suggestions the WHO offers for meeting its 2015 targets are ‘reaching the missed cases’ and greater ‘high-level political will and leadership and more collaboration among partners including drug regulatory authorities, donor and technical agencies, civil society and the pharmaceutical industry’ to address TB as a substantial public health crisis,” Al Jazeera writes (Hayoun, 10/23). “The report is based primarily on data provided by WHO’s Member States,” the agency notes in a press release (10/23).

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Report Evaluates Countries' Progress In Equitably, Sustainably Combating Child Mortality

In a new report (.pdf) published Wednesday, “Save the Children is highlighting progress in combating child mortality in many developing nations in Africa, while also warning of the need to address inequalities to help children have a better chance of surviving” in other regions, VOA News reports. According to the report, “the world has made ‘remarkable’ improvements in child health, but that kids in poor and rural areas, as well as girls and infants, remain more at risk of dying,” the news service writes (10/23). “The report introduces a new approach to assessing efforts in 75 developing countries to reduce child deaths,” a Save the Children press release states, adding, “For the first time, the findings show both how quickly progress is being made towards this U.N. goal, but also whether progress is equitable — across different social and economic groups — and sustainable, measured in terms of political will and stability.” The report, titled “Lives on the Line,” highlights Niger’s success in reducing child mortality, which “has benefited children across all income groups, boys and girls equally, and in rural areas as well as urban slums,” according to the press release (10/23).

“The report urges governments to focus on preventing infant deaths, which have fallen much less than those of other children under age five, and on addressing the malnutrition it says underlies almost half of child deaths,” VOA writes. “It also says countries can make greater gains by instituting routine immunizations, promoting breastfeeding, the use of treated bed nets, and ensuring proper nutrition for mothers during pregnancy,” according to the news service (10/23). In addition, Save the Children is calling on the U.S. government to “[c]ontinue to provide global leadership and robust funding for addressing maternal, newborn and child health issues and nutrition; [f]ulfill commitments made to addressing nutrition at the Nutrition for Growth conference including reducing stunting by two million by 2017; [i]ncrease efforts to ensure that a skilled health worker is within reach of every child and announce concrete ways the U.S. plans to do this at the Third Global Forum on Human Resources for Health in Brazil in November 2013,” the press release states (10/23).

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Mexico Fourth Country In Hemisphere Affected By Cholera Strain Introduced To Haiti In 2010

Since the beginning of September, Mexican health authorities have recorded 171 cholera cases “in Mexico City and states to the north and east,” NPR’s “Shots” blog and “Morning Edition” report. “Since it was introduced into Haiti — very likely by United Nations peacekeeping troops from Nepal who were billeted at a camp with poor sanitary facilities — cholera has sickened 715,000 people in Haiti and the Dominican Republic (which share the island of Hispaniola) and Cuba,” and now Mexico, the news service notes. “Jon Andrus, deputy director of the Pan American Health Organization, says it was all but inevitable that cholera would spread beyond the Caribbean,” the blog writes. “It was always a major concern that it would be exported to other countries, as has recently happened in Mexico,” Andrus said, according to the blog. NPR discusses the implications of the latest cholera outbreak and the disease’s potential to spread to other countries (Knox, 10/23).

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China Confirms New H7N9 Infection In Zhejiang Province

“China confirmed a new human case of the deadly H7N9 strain of bird flu on Wednesday, the second infection reported in October after a summer lull,” Reuters reports. “A 67-year-old farmer in Jiaxing city in the eastern province of Zhejiang has been hospitalized with the virus, the official Xinhua news agency said, citing provincial health authorities,” the news service writes, noting, “Zhejiang has recorded the highest number of H7N9 infections anywhere in China.” Reuters adds, “Chinese authorities have reported at least 136 laboratory-confirmed human cases of the H7N9 infection” (Martina, 10/23).

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San Francisco Chronicle Profiles Garment To Help Prevent Postpartum Hemmorhage

The San Francisco Chronicle profiles “a simple, neoprene garment developed for postpartum use by a [University of California, San Francisco (UCSF)] researcher,” meant “to prevent [women] from going into shock, oxygen loss and organ failure due to excessive bleeding during birth.” According to the WHO, “[p]ostpartum hemorrhage is the leading cause of deaths in mothers, accounting for as many as 100,000 deaths a year worldwide,” the newspaper notes. UCSF professor and nurse midwife Suellen Miller “has worked for more than a decade to study [the device] in clinical trials and encourage the widespread use of the garment,” the newspaper writes, noting the WHO “added the garment to its influential list of recommendations to treat postpartum hemorrhage last year” and PATH “named the device one of the top 10 breakthrough innovations that can save mothers’ lives.” According to Miller, who sells the device for $60 under the brand name LifeWrap, “the technique to properly wrap a woman in the garment is easily learned and can be taught to people without medical training,” the newspaper writes (Colliver, 10/22).

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SciDev.Net Profiles New Director Of U.K. Charity Wellcome Trust

As Jeremy Farrar assumes his new position as director of the Wellcome Trust, one of the world’s largest funders of biomedical research, “hopes have been raised that his experience of science in Southeast Asia may advance the trust’s activities in developing nations,” SciDev.Net reports. “Farrar is recognized as a leading figure in tropical medicine research,” having “spent the past 17 years as director of the Oxford University Clinical Research Unit (OUCRU) in Vietnam,” where “he studied diseases such as dengue fever, SARS (severe acute respiratory syndrome) and bird flu,” the news service writes. “There has been press speculation that Farrar’s experience in the developing world could lead to the trust strengthening its focus on capacity building in this part of the world,” the SciDev.Net notes and highlights several recent articles. “But Farrar tells SciDev.Net that it is too early to comment on such matters,” the news service continues, adding, “‘First, I need to listen to people,’ he says. ‘I see this as an evolutionary process and hope to be in post for many years. There is time to listen, stand back and take a long-term view'” (Panela, 10/22).

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Editorials and Opinions

Family Planning Options Essential For Strong Societies, Economies

“‘Unmet need,’ in the context of family planning, is a rather mundane term that masks an urgent social justice and human rights issue,” Kesetebirhan Admasu, minister of health in Ethiopia, writes in an AllAfrica opinion piece. “Policymakers, public health professionals and donors must provide the necessary leadership, commitment and resources to” provide the millions of women who lack contraceptive choices with access to family planning options, he writes. He discusses Ethiopia’s efforts to improve health care access for its population by training and equipping “38,000 government salaried health extension workers,” as well as implementing the Health Development Army initiative “to mobilize three million women volunteers across the country.” Noting Ethiopia will host the third International Conference on Family Planning (ICFP) in November, Admasu concludes, “When people are able to plan their families, we will have societies where health systems are stronger, economies more productive, and rights more realized” (10/22).

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Polio Making Comeback In Middle East

“[I]t’s clear that polio — which just two years ago was on the verge of eradication, with active cases confined to just three countries — is resurgent, and the news is grim,” Laurie Garrett, a journalist and senior fellow for global health at the Council on Foreign Relations, writes in a Foreign Policy opinion piece, noting several suspected cases of the disease recently have been reported in war-torn Syria. In fact, “[a]s of October 16, the number of 2013 active polio cases found in the three ‘endemic nations’ (Afghanistan, Pakistan, and Nigeria) are far outnumbered by the toll in new outbreaks outside those countries: 99 children have contracted the disease in endemic nations, versus 197 in outbreak areas like the Horn of Africa, which had been free of polio,” she states. “The world has struggled for decades to eradicate polio — a global effort that has cost billions of dollars and millions of man hours,” Garrett writes, adding, “But politics and religion can foil even the best technology and financing.” She describes efforts to eradicate the disease in several Middle East countries, and the challenges those efforts face (10/22).

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GMO Crops Would Help Africa Improve Agricultural Yields, Alleviate Food Shortages

Describing a recently published Washington Post article that “described the conflict in Tanzania between those who suffer from food shortages caused by drought and pestilence and those who hold deep suspicions about the genetic engineering of crops, which might help grow more food,” a Post editorial states, “The doubters about genetic modifications seem to have the upper hand in Tanzania at the moment, and that is disturbing.” The editorial continues, “Genetically modified crops can increase yields, which lag in Africa behind those of the rest of the world.” The Washington Post adds, “Surely, there is no harm in a vigorous debate about genetically modified food; if people don’t understand it, the benefits will never be realized. But it is a shame to abandon these crops based on irrational fears and suspicions” (10/22).

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Malnutrition Response Should Integrate Health Care, Agricultural Support

Writing in the Huffington Post’s “World” blog, Segal Family Foundation Founder Barry Segal and Julie Carney and Jessie Cronan of Gardens for Health International examine “why an increasing number of clinics and hospitals are including agriculture extension programs as part of their approach to treating malnutrition.” They write, “Seventy percent of malnourished people in the world are engaged in agriculture; if we want to dramatically reduce rates of malnutrition, there is widespread consensus that agriculture has to be a part of the solution.” They continue, “[W]e need to start thinking about the seeds and support we provide through the lens of improving long-term health and nutrition,” adding, “By broadening the definition of health care beyond immediate medical interventions and by pushing those interventions beyond the clinic walls and into kitchen gardens and backyards, we believe that it is possible to dramatically reduce malnutrition among vulnerable farm families” (10/22).

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Development Of New Malaria Drugs 'Deserves Our Complete Support'

Writing in The Guardian’s “Global Development Professionals Network” blog, Colin Sutherland, head of immunology and infection at the London School of Hygiene and Tropical Medicine, reviews recent studies on the effectiveness of malaria drugs used in Asia and Africa, examining whether they show drug resistance is increasing. “Clear answers are yet to emerge but there is growing concern that the parasites may have started developing processes that may one day make them fully resistant to artemisinins,” he writes, adding, “Whereas some have already labeled this phenomenon ‘resistance’ there is as yet little evidence of a negative effect on public health: the combination drugs, by and large, are still working in the Mekong countries.” Sutherland highlights a Guardian live chat from July that “addressed recently observed changes in the effectiveness of malaria drugs in Cambodia and neighboring countries,” and he discusses recently published research from Mbita, Kenya.

“Do these findings mean we are now seeing resistance to [artemisinin combination therapy (ACT)] in Africa? I do not think this is the case,” he continues, adding, “Nevertheless, there is concern that slow clearance is the first step along the pathway towards malaria parasites becoming fully resistant to artemisinins.” “The effort to accelerate development of the next generation of malaria drugs therefore deserves our complete support,” he states, concluding, “The drug development pipeline is expensive and time-consuming, but we cannot afford to let this process falter as we seek to control malaria across the globe” (10/22).

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Recent Releases

CGD Blog Examines Impending Departure Of U.S. Global AIDS Coordinator Goosby

Noting Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, is expected to step down from his post “later this year,” Amanda Glassman, director of global health policy and a senior fellow at the Center for Global Development (CGD), and Jenny Ottenhoff, policy outreach associate at the center, write in the center’s “Global Health Policy” blog, “As CGD has done for similar leadership transitions, we are working on a report to examine the future direction of PEPFAR and consider which tasks PEPFAR’s next leader should put near the top of the program’s list of priorities.” They state, “One preliminary conclusion: Goosby’s successor will certainly face programmatic challenges, but the political ones may prove to be more difficult,” and they provide examples (10/22).

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U.S. Continues To Support Displaced Persons In Iraq

National Security Staff Senior Director for Multilateral Affairs and Human Rights Stephen Pomper and Kelly Clements, deputy assistant secretary in the Bureau of Population, Refugees, and Migration, write in the State Department’s “DipNote” blog about a recent trip to Iraq “to ensure that U.S. government humanitarian programs and policies are still responding to the needs of displaced people on the ground.” They continue, “Starting in 2003, the U.S. government has provided $2.6 billion in humanitarian assistance to displaced Iraqis, getting much-needed food, health care, education, and basic economic support to help rebuild their lives.” Pomper and Clements outline several U.S. initiatives and conclude, “Looking ahead, the U.S. government remains firmly committed to assisting Iraq as it takes on increasing responsibility for its displaced citizens. Our efforts and support remain vital to ensuring that Iraq shoulders this responsibility and that displaced people have a place in their nation’s future” (10/20).

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Meeting Examines Intersection Of Population, Health, Environment

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Vicky Markham, founding director of the Center for Environment and Population (CEP), reports on a recent U.N. General Assembly side event, a Women Delivering Development meeting organized by the Woodrow Wilson Center, Aspen Institute, Sierra Club and CEP. “The meeting brought together a diverse group of influential leaders to be updated on the sweet spot of where population, health and environment (PHE) intersect, and make concrete recommendations for how a PHE-integrated approach can help solve key international development issues,” she writes, and provides an overview of the event (10/21).

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