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Kaiser Daily Global Health Policy Report

In The News

Global Community Observes World Polio Day

“As the global community marks World Polio Day on Thursday, recent events show there is both cause for celebration and concern,” AllAfrica reports. “There have been 296 cases of polio caused by the ‘wild type’ virus so far this year, compared to 171 cases during the same period last year, according to the Global Polio Eradication Initiative, a public-private partnership spearheaded by the [WHO],” the news service writes (Shiner, 10/24). “Wild poliovirus (WPV) cases in Nigeria, Afghanistan and Pakistan — the last three endemic countries — are down 40 percent compared to this time last year,” the Global Polio Eradication Initiative notes in an article on its webpage, adding, “At the same time, however, the urgency of interrupting transmission in these countries is only reinforced by the tapering outbreak in the Horn of Africa and this week’s reports of two suspected polio cases in Syria.” The article highlights a special Livestream event, “World Polio Day: Making History,” presented by Rotary and Northwestern University’s Center for Global Health, which will take place at 6:30 p.m. EDT on Thursday (10/24).

Marking the day, the Wall Street Journal’s “India Real Time” blog reports on India’s progress toward eradicating the disease, noting the country “is just four months away from being declared polio free by the [WHO]” (Thacker, 10/24). In related news, VOA News examines the polio response in Pakistan, where “a Taliban ban on vaccinations and attacks on health workers” are hindering vaccination efforts (Behn, 10/23). In a separate article, VOA highlights the launch of “an emergency campaign to vaccinate 700,000 children under the age of 15 in [South Sudan's] Equatoria state against polio by the end of the week after a child in the state was diagnosed” with the disease last month (10/23). PANA/AfriqueJet examines polio vaccination efforts in Cote d’Ivoire, noting “[m]ore than 7.5 million Ivorian children, aged 0-5 years, will be vaccinated against polio when the third round of the nation’s national immunization program begins on Friday, according to health officials” (10/24).

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Afghanistan IG Finds Delays, Overpayments On USAID-Supported Hospital Construction Project

“A U.S.-funded effort to build a 100-bed civilian hospital in eastern Afghanistan has fallen almost two years behind its planned completion because of poor contractor performance and deficient internal controls, according to an inspector general’s audit [.pdf],” Bloomberg reports (Capaccio, 10/23). “The Special Inspector General for Afghanistan Reconstruction (SIGAR) said that construction of the 100-bed hospital in Gardez, Paktiya province, was 23 months behind schedule,” and “[i]t accused USAID’s implementing partner, the International Organization for Migration (IOM), of ‘weak internal controls’ that led to overpayments of at least $507,000,” Agence France-Presse writes. “USAID issued a statement saying that it was conducting an audit into the project, and would ‘take swift action to address any problems and recover funds’ if the allegations were proved to be true,” the news agency notes (10/23).

“In a letter to Rajiv Shah, the administrator of USAID, and William Hammink, USAID’s mission director in Afghanistan, John Sopko, who runs SIGAR, commended USAID’s intent to conduct an audit to determine whether there were additional contractor overpayments that needed to be returned to the U.S. government,” CNN’s “Security Clearance” blog notes (Crawford, 10/23). Richard Danziger, a spokesperson for IOM in Afghanistan, “pointed out that the hospital is being built in an active war zone,” Stars and Stripes writes, adding he said, “Under such circumstances, delays in project implementation are regrettably not unusual.” Danziger continued, “IOM will fully cooperate with a financial audit, which we are confident will show these [overpayment] allegations to be incorrect,” according to the news service (Standifer, 10/23). Politico’s “Morning Defense” blog notes, “[T]he IG’s underlying message about the hospital — that it’s too big and expensive for Afghans to manage and keep up on their own — reveals the office’s broader concerns about what could happen when U.S. funding dries up” (Brannen et al., 10/23).

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Updated Case Report Shows Mississippi Infant Remains 'Free Of Active HIV Infection'

“A three-year-old Mississippi child born with HIV and treated with a combination of antiviral drugs unusually early continues to do well and remains free of active infection 18 months after all treatment ceased, according to an updated case report published Oct. 23 in the New England Journal of Medicine,” a Johns Hopkins Medicine press release reports. “Early findings of the case were presented in March 2013 during a scientific meeting in Atlanta, but the newly published report adds detail and confirms what researchers say is the first documented case of HIV remission in a child,” the press release adds (10/23). “The doctors, however, are hesitant to declare the child fully cured but said they now have ‘compelling evidence’ that HIV-infected infants could be functionally cured if antiretroviral therapy begins within hours or days of infection,” Xinhua writes (10/23).

“‘We want to be very cautious here. We’re calling it remission because we’d like to observe the child for a longer time and be absolutely sure there’s no rebound,’ said Dr. Katherine Luzuriaga, a University of Massachusetts AIDS expert involved in the baby’s care,” the Associated Press notes (Marchione, 10/23). “A couple of tests have found very low-level indications of HIV in the girl’s blood, but doctors cannot tell if they are false positives or simply remnants of the eradicated virus,” HealthDay notes (Thompson, 10/23). “A federally funded study set to begin in early 2014 will test the early-treatment method used in the Mississippi case to determine whether the approach could be used in all HIV-infected newborns, the doctors said,” according to Xinhua (10/23).

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Media Coverage Of WHO TB Report Continues

Media outlets on Thursday continued to write about the WHO’s new tuberculosis (TB) report, published Wednesday. “The Global Tuberculosis Report 2013 … confirms that the world is on track to meet the Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50 percent reduction in the mortality rate by 2015 (compared to 1990),” the U.N. News Centre reports (10/23). However, the report “warns that many of these gains risk being lost if multidrug-resistant TB [MDR-TB] is not brought under control,” VOA News notes (Schlein, 10/23). In addition, “[t]he agency estimated that roughly three million TB cases, or one out of three, were not picked up by health systems in 2012,” according to CIDRAP News.

“The WHO also said only 94,000 of an estimated 450,000 MDR-TB cases were detected, signaling that progress toward diagnosis and treatment goals is ‘far off-track,'” CIDRAP adds (Roos, 10/23). “Meanwhile, the number of people diagnosed with XDR-TB, a highly drug-resistant form of the disease with few treatment options, also rose sharply, to 2,230 cases in 2012, from 1,464 in 2011,” the Wall Street Journal writes (McKay, 10/23). “The report’s release comes as a letter dispatched to the White House yesterday and signed by 65 physicians” urged the Obama administration to increase funding for TB programs, the Center for Global Health Policy’s “Science Speaks” blog notes (Barton, 10/23).

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Media Outlets Continue To Cover Save The Children Report On Progress Against Child Mortality

News outlets on Wednesday continued to cover Save the Children’s new report on progress against child mortality. “The ranking of 75 emerging and developing countries not only considered the decrease of child deaths, but also examined efforts made to achieve equal chances of survival for boys and girls and for children from rich or poor families,” Deutsche Welle writes, adding, “The report went on to evaluate the sustainability of national child mortality reduction polices” (Gorzewski, 10/23). Xinhua reports on China’s progress, writing, “China has reduced its child mortality rate, improving its ranking to seventh among the 75 countries that account for most of the world’s maternal and child deaths, according to the report published by Save the Children” (10/23).

The Inquirer/AllAfrica notes the report “speaks of recent improvements in child health thereby putting Liberia among 25 countries tracked to meeting the goal of two-thirds reduction in child mortality rates by 2015” (10/23). FirstPost states, “India is among the top 10 nations that have made the greatest strides in reducing child mortality since 1990,” according to the study (10/23). Other countries “among the top 10 nations that have made the greatest strides in tackling” child mortality equitably and sustainably include Niger, Liberia, Rwanda, Indonesia, Madagascar, China, Egypt, Tanzania and Mozambique, Agence France-Presse/Mail & Guardian reports (10/23). “At the other end of the spectrum lie Haiti, Papua New Guinea and Equatorial Guinea, with slow and unequal reductions in under-five mortality rates and low levels of investment in health and nutrition,” according to Save the Children, BBC News writes (10/23).

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IRIN Examines Potential Rollout Of HIV/AIDS Vaccine

An IRIN analysis examines how nations need to prepare for the distribution of a future HIV/AIDS vaccine. “Increased attention to the delivery of HIV prevention and treatment programs is needed to prepare communities for a potential rollout of a vaccine, which will most probably be partially effective, experts say,” IRIN writes. The analysis highlights ongoing vaccine research and quotes several experts, including Mitchell Warren, executive director of AVAC; Michael Merson, director of the Global Health Institute at Duke University; Naresh Pratap Kc, director of Nepal’s National Centre for AIDS and Sexually Transmitted Disease Control; and a UNAIDS spokesperson. Those interviewed discuss lessons learned from other vaccines, donor community awareness, HIV testing methods, and the need for outreach to “communities who carry the heaviest burden of HIV risk and infection,” according to IRIN (10/23).

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Devex Interview Examines Role Of PPPs In Development Of Global Health Technologies

On the sidelines of “a high-level panel discussion held at the European Parliament in Brussels on the value of cross-sectoral partnerships to develop and deliver high-impact, cost-effective global health technologies,” where “speakers discussed the challenges of developing innovative and effective responses targeted at poverty-related and neglected diseases and conditions in low- and middle-income countries,” Devex correspondent Eva Donelli interviewed Renate Baehr, executive director of Deutsche Stiftung Weltbevoelkerung — which, along with PATH, hosted the event. According to the interview transcript, Baehr “explained how public-private partnerships can provide a range of opportunities and skills to advance innovative work on global health research and development” (10/23).

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Editorials and Opinions

Opinion Pieces, Editorial Address World Polio Day

The following is a summary of two opinion pieces and an editorial marking World Polio Day, which is observed annually on October 24.

  • James Shannon, Huffington Post U.K. blog: “While people are still at risk of contracting this disease, our efforts to eradicate polio — and to keep it at bay after eradication — must be sustained,” Shannon, chief medical officer for GlaxoSmithKline, writes. “Across the public health community, we must keep collaborating and keep innovating if we are to better understand polio and find new measures to tackle it. And, if we do manage to eradicate polio, we will need to ensure that it does not resurface,” he continues (10/24).
  • Ohid Yaqub, The Guardian’s “Political Science” blog: “The issue of attitudes to vaccination strikes me as severely underestimated,” Yaqub, a tutorial fellow at SPRU, University of Sussex, writes, adding, “In their zeal for eradication, some may be tempted to think that the rewards of eradication will be so self-evident that that it doesn’t matter whether people wanted to be vaccinated or not, so long as we manage to inoculate them somehow.” He highlights “a major review of literature on vaccination attitudes” he conducted with colleague Sophie Castle-Clarke and others, and concludes, “For me, the question is not ‘can we eradicate polio?,’ but ‘can we do it sustainably?’ We should not shy away from trying to answer it honestly with a new research agenda” (10/24).
  • Nigeria’s Leadership: “The world marks World Polio Day today against the backdrop of a determined effort by Nigeria to shed the toga of ‘polio exporter’ in the West African sub-region,” the newspaper states, and provides a history of Nigeria’s efforts against the disease. The editorial concludes, “The war against polio can be won within the next two years, if we sustain the current tempo and claim ownership of the fight. It is our cause. We owe our children nothing less” (10/24).

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WHO TB Report Reveals 'Massive Disconnect' In Global TB Response

Noting the release of the WHO’s Global Tuberculosis Report 2013 on Wednesday, which “declared multidrug-resistant TB (MDR-TB) a ‘public health crisis,'” ACTION Director Kolleen Bouchane writes in the Huffington Post’s “The Big Push” blog, “The new WHO report reveals massive disconnect between what is clearly a crisis situation and a lackluster global response to TB — a disconnect demonstrated by the $2 billion we are lacking annually to mount a smart and effective response to TB in the low- and middle-income countries where it is needed most.” However, she continues, “the solutions to this crisis are multifaceted, long-term, and outlined in the ‘priority actions’ of the WHO report,” which include replenishing the Global Fund to Fight AIDS, Tuberculosis and Malaria. “Nearly 90 percent of international donor financing for TB is provided by the Global Fund, and its programs have put 11 million people on TB treatment,” Bouchane notes, concluding, “Thanks to the WHO, we have the evidence. We know what we need to do. What we need now is visionary leadership, particularly the delivery of commitments and new resources for the Global Fund” (10/23).

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More Public, Government Support Needed To Reduce Global Child Mortality

Noting several Save the Children initiatives to raise awareness and funds to combat child mortality, including the World Marathon Challenge, “a relay race where kids team up and attempt to run a full marathon distance and to beat the world marathon record,” Save the Children President and CEO Carolyn Miles writes in the Huffington Post’s “Global Motherhood” blog, “Through U.S. government leadership and global commitment, the number of deaths to children under five declined to 6.6 million in 2012, from 12.6 million in 1990.” She continues, “While this is good news, we need to do better. … [W]e need to do more in three areas where we have not yet made sufficient headway: reaching the poorest children with life-saving measures, ensuring all newborns get proper care; and providing children with good nutrition so they stay healthy and strong enough to fight off life-threatening illnesses.” Miles adds, “With adequate public support and appropriate levels of government investment in these areas, we can dramatically cut child mortality and give hope to families that their babies will have more than a slim chance of reaching age five” (10/23).

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Global HIV/AIDS Response Must Include Children

“One of the most under-reported tragedies of the HIV epidemic is that children continue to be left behind in the HIV response,” Eliane Drakopoulos of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) writes in a Devex opinion piece. “Weak health systems, lack of medical personnel trained in treating children, stock-outs of critical medications in countries with high HIV prevalence rates, lack of money for transportation, fear of stigma — these are all a big part of the problem,” she states, adding, “Another serious problem is the lack of good treatment options for children,” as “most pharmaceutical companies — including those that manufacture generic formulas — do not see a return on investment in pediatric HIV medicine.”

“At the [EGPAF] we are working to ensure that children are a part of the global effort to eliminate HIV/AIDS. But the international community can and must do more to both prevent children from acquiring HIV, and effectively treat and care for those who do acquire the virus,” Drakopoulos continues. “Governments must prioritize early HIV diagnosis, treatment, and care for children, and also tackle the key barriers to effective diagnosis and treatment of HIV in children,” she states, adding, “The pharmaceutical industry must develop less expensive fixed-dose combination drugs suitable for infants and children living in resource-poor settings and make necessary pediatric medicines locally available at the lowest possible cost” (10/23).

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Development Aid 'Can And Has Worked,' But Can Achieve Greater Impact If 'Refocused'

Highlighting two recently published or upcoming books that argue “aid has failed,” Charles Kenney, a senior fellow at the Center for Global Development (CGD), writes in a Devex opinion piece, “I do think the evidence shows that aid can and has worked, even if much of it hasn’t. Indeed, it may even be that most aid doesn’t work, or at least is far from as efficacious as it might be. But that’s a reason to focus on quality, not a reason to give up.” Kenney outlines several steps he says might make aid more valuable, and he concludes, “Aid can work, sometimes spectacularly. And if we refocused aid, we’d see even more impact. So when it comes to evaluating aid, I think the key question is ‘does it focus on safety, leverage, and learning?'” (10/23).

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Recent Releases

USAID Assistant Administrator Reflects On WHO TB Report

“I applaud the [WHO] on the release of the Global Tuberculosis Report 2013, which includes among its recommendations, a call to action to reach millions of people still awaiting quality tuberculosis (TB) care and a stronger approach to fighting the emerging threat of multidrug-resistant TB,” USAID Assistant Administrator for Global Health Ariel Pablos-Mendez writes in the agency’s “IMPACTblog.” He continues, “While this year’s report is an important reminder that TB continues to claim millions of lives globally, it also demonstrates that significant progress in preventing, detecting, and curing people of the world’s second biggest infectious killer can be made through strong political will, adequate resources, and a focus on the poorest and most vulnerable communities around the world” (10/23).

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Capitol Hill Briefing Highlights USAID's Role In Global Health R&D

The Global Health Technologies Coalition’s (GHTC) “Breakthroughs” blog reports on a Capitol Hill briefing — which took place Tuesday and was sponsored by GHTC and PATH — “focused on the critical role USAID plays in supporting lifesaving global health research and development (R&D) for new health tools.” The blog adds, “Panelists also stressed the need for policymakers in Congress and across the U.S. government to support the development of new and innovative health products.” The blog summarizes panelists’ comments and concludes, “We are at a critical juncture in much of the global health R&D currently underway, and USAID will be instrumental in ensuring these technologies come to fruition” (Taylor, 10/23).

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USAID Fellow Discusses How Science Can Improve Global Food Security

USAID’s “IMPACTblog” features an interview with Jon Colton, a new Jefferson Science Fellow with USAID, who “will support the Feed the Future initiative’s work to scale up promising technologies that help smallholder farmers improve global food security.” Colton discusses how his background as a mechanical engineer and industrial designer has allowed him to work on “projects in the area of humanitarian design and engineering such as medical facilities, immunization equipment such as plastic hypodermic needles, cold chain equipment and facilities, farming tools, medical devices, bio-mass fueled stoves, and charcoal makers,” according to the blog. With Feed the Future, he is “investigating how mechanical technologies, such as seed drills, two-wheel tractors, drip irrigation, no-till farming, weeders, threshers, and winnowers, can be applied to the sustainable intensification of farming — producing more food on the same land and with less manual labor,” he said, the blog notes (10/23).

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MSF Officials Discuss Organization's Withdrawal From Somalia

In the PLOS “Speaking of Medicine” blog, Unni Karunakara, Médecins Sans Frontières (MSF) international president from June 2010 through September 2013, and Jean-Christophe Dollé, MSF representative to Somalia since June 2013, “describe the challenges faced by Médecins Sans Frontières’ TB program as the organization withdrew from Somalia in response to increasing violence,” according to the blog introduction. “When MSF closed operations in Somalia, MSF doctors and nurses were treating more than 300 TB patients, including 14 MDR-TB patients,” they write, discussing the contingency plans that were implemented to ensure patients continued to receive treatment. “Our hospitals and aid programs were the difference between life and death for hundreds of thousands of Somalis,” they write, adding, “But there are limits to what our organization can accept in terms of risks for our staff and compromise of our humanitarian principles” (10/23).

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