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Kaiser Daily Global Health Policy Report

In The News

WHO Confirms 10 Polio Cases In Syria, Warns Disease Could Spread Across Region

The WHO on Tuesday “confirmed 10 polio cases in north-east Syria, the first confirmed outbreak in the country in 14 years, and warned that the disease could spread across the region,” the Associated Press reports (10/29). “Tests confirmed polio in 10 out of 22 children in Deir al-Zour Province in northeastern Syria who became ill this month, said [WHO spokesperson] Oliver Rosenbauer,” the New York Times writes, adding, “Results of tests on the other 12 children are expected soon, he added” (Cumming-Bruce, 10/29). “Most victims are under two years old and are believed never to have been vaccinated against the crippling disease or to have received even a single dose of the oral vaccine instead of three which ensure protection, Rosenbauer said,” France 24 notes (10/29).

“WHO spokesperson Glenn Thomas added that health authorities in Syria and neighboring countries had already begun the planning and implementation of the comprehensive outbreak response,” according to the U.N. News Centre (10/29). “The United Nations and other health agencies are in the middle of a two-week campaign to immunize 2.4 million children in Syria against the disease,” VOA News notes, adding, “Rosenbauer says plans are afoot to begin large-scale polio immunization campaigns in neighboring countries in early November” (Schlein, 10/29). “Genetic sequencing of the virus found in Syria is expected within the next [few] days, which will identify the geographic origin of the first polio outbreak in the war-torn country since 1999,” Reuters notes (Nebehay, 10/29).

Additional coverage is available from ABC News/Good Morning America, Al Jazeera America, Bloomberg, CIDRAP News, Deutsche Welle, GlobalPost, NPR’s “All Things Considered,” NPR’s “Shots,” PBS NewsHour, Reuters, and UNICEF.

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Blockades Preventing Food, Medical Supplies From Reaching Civilians In Syria, Reuters Reports

“Forces loyal to [Syrian] President Bashar al-Assad have used partial sieges to root out rebel forces from residential areas during the civil war, … [b]ut a recent tightening of blockades around areas near the capital is causing starvation and death, residents and medical staff say,” Reuters reports in a feature story examining “how blockades are being used as a weapon in a war that grew out of pro-democracy protests in the summer of 2011, increasing an already grave humanitarian crisis.” The news agency writes, “Food and medicine, which could be used by the warring parties, are rarely allowed to enter besieged areas and the movement of civilians in and out is restricted,” as “[b]oth sides use checkpoints to mark territory and prevent the movement of enemy fighters and supporters.” Reuters details a lack of food and medical supplies in different parts of the country, noting, “Local doctors sent Reuters videos showing six cases of death from malnutrition. Most of the victims were children” (10/30).

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7.3M Adolescent Girls Give Birth In Developing Countries Annually, UNFPA Report Says, Expresses Concern

“Around 7.3 million girls under the age of 18 give birth each year in developing countries, risking death and suffering that can only be addressed by changing social attitudes, a U.N. report said Wednesday,” Agence France-Presse reports (Ritchie, 10/30). In the report, “[t]he U.N. Population Fund [UNFPA] expressed particular alarm about the dangers facing girls 14 or younger, who account for two million of the 7.3 million births to women under 18 in developing countries,” the Associated Press writes, adding, “This group faces the gravest long-term social and health consequences from giving birth as teens” (Vinograd, 10/30). “The number of pregnancies is even higher and about 70,000 adolescents die every year in the developing world of childbirth-related causes — about 200 a day,” the Thomson Reuters Foundation notes.

“The report highlighted data which suggest that adolescent pregnancies are now less frequent in 54 developing countries, especially among girls under 15, though progress is slow,” Reuters writes, adding, “But in some regions the number of girls giving birth is projected to rise” (Caspani/Moloney, 10/30). “[A] review of U.N. data on fertility shows that [Bangladesh, Chad, Guinea, Mali, Mozambique and Niger] are countries where, in stark contrast to trends not only in the industrialized world but also among developing nations, overall fertility rates have fallen very little,” the Financial Times notes (Cohen, 10/30). The 2013 State of World Population report, titled “Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy,” “offers a new perspective on adolescent pregnancy, looking not only at the girls’ behavior as a cause of early pregnancy, but also at the actions of their families, communities and governments,” a UNFPA press release states (10/30). “The UNFPA said greater efforts should be made to keep girls in school, teach them about sexual health and change attitudes to gender roles,” Deutsche Welle adds (10/30). Devex features an interview with UNFPA Executive Director Babatunde Osotimehin (Stephens, 10/30).

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Devex Examines Potential For Reform Of U.S. Food Aid Program

“For months, U.S. development officials, [non-governmental organization (NGO)] leaders and President Barack Obama have championed changes to the nation’s 50-year-old system for delivering food to developing and crisis-afflicted countries,” but “[f]or any of the momentum gained from those efforts to make a difference this year, reform advocates will have to resort to pushing incremental changes when the bill goes to conference Wednesday,” Devex reports. “Even without a comprehensive food aid reform package on the table — like those proposed by Obama in April under the House bill — reform supporters are hopeful the conference committee can still free up some cash for more flexible spending options, while getting a foot in the door for bigger changes down the road,” the news service writes. Devex includes comments from several food security experts (Igoe, 10/29).

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France, Qatar, Oman Report New MERS Cases

“France [on Tuesday] reported a probable Middle East respiratory syndrome coronavirus (MERS-CoV) case in a person who recently traveled to Saudi Arabia, while the [WHO] offered new details on a MERS case reported in Qatar [on Monday],” CIDRAP News reports. “The patient in France is a 43-year-old who recently returned from Saudi Arabia, the French health ministry said in a statement, but it did not specify whether the patient attended the Hajj pilgrimage in mid-October,” the news service writes, noting, “If the case is confirmed, it will be the third MERS case in France.” The news service adds, “Meanwhile, the WHO confirmed Qatar’s seventh MERS case,” noting, “The agency said the patient, a 23-year-old man, works in an animal barn owned by Qatar’s last previous case-patient” (10/29). In related news, “Oman has reported its first case of the deadly MERS coronavirus, local newspapers said on Wednesday, the fourth Gulf Arab country where the strain has been found since it emerged in Saudi Arabia last year,” according to Reuters. “Omani newspapers quoted Health Affairs Undersecretary Mohamed bin Saif al Hosni as saying that the patient was admitted to a hospital in Nizwa, an oasis town south-west of Muscat, suffering from a chest infection,” the news service writes (Aboudi, 10/30).

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BRICS Agriculture Ministers Meet To Discuss Climate Change, Food Security

“Agriculture ministers from BRICS countries met [in Pretoria, South Africa,] on Tuesday to address the negative effects of climate change on world food security,” Xinhua reports. “The gathering, the 3rd of its kind, will culminate in the signing of a joint declaration which will demonstrate BRICS’ determination to meet the challenges confronting food security,” the news service adds, noting, “BRICS is an acronym for world’s major emerging markets, namely, Brazil, Russia, India, China and South Africa.” South African Agriculture, Forestry and Fisheries Minister Tina Joemat-Pettersson said at the conference, “It is my expectation that we will emerge from this meeting with a shared sense that it was instructive, successful and well worth the investment and effort we have made to be here,” according to Xinhua. “She urged BRICS countries to urgently and significantly accelerate agricultural and food production, so that people on the continent can enjoy sustainable access to safe, nutritious and affordable food,” the news service notes (10/29).

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African Judges Meet To Discuss HIV/AIDS-Related Human Rights, Legal Issues

More than 50 African judges and magistrates on Tuesday met at a workshop in Nairobi, Kenya, to share HIV/AIDS-related experiences with human rights and the law, Xinhua reports. “Kenya’s Supreme Court President Willy Mutungai said the meeting will provide an opportunity for judges and magistrates to discuss effective strategies and programs for judicial education so as to help ensure the various judiciaries are able to make informed decisions on HIV-related human rights issues,” the news service writes (10/30). “The dialogue held from Monday to Thursday aims to bring forward recommendations of the Global Commission on HIV and the Law in increasing awareness among key constituencies on issues of rights and law with respect to HIV and boosting civil society’s ability to campaign, advocate and lobby,” Bernama writes, noting, “The workshop is organized by the Judiciary Training Institute and Kenya Ethical and Legal Network in partnership with the United Nations Development Programme (UNDP-Kenya) and UNAIDS” (10/30).

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India Spending Less Than Planned Expenditure For TB Budget

“Confronting a slowing economy and a large budget deficit, India has significantly reduced its planned expenditure on fighting tuberculosis, the airborne disease that kills more adults here than any other infection and has become increasingly more drug resistant, a review of government plans and budgets shows,” the Wall Street Journal’s “India Real Time” blog reports. “In India, in the fiscal year ending March, a review of budget documents shows that the country’s TB department spent about 20 percent less on TB than originally budgeted,” the blog notes. “India’s TB program aimed to treat 8.3 million TB patients from 2012-2017, which includes 120,000 patients with multidrug-resistant TB, according to the program’s annual report,” the blog writes, adding, “For these patients, anti-TB drugs will cost 17.97 billion rupees, or $292 million, the report says. But the report says the budgeted amount for these medicines is only 14.37 billion rupees, or $233 million.” According to the blog, “When asked about the potential shortfall, Dr. [K.S.] Sachdeva of India’s TB program, said the difference between the amount needed and the amount allocated was likely a printing error, and that he would investigate further” (Shah/Anand, 10/30).

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The Guardian Examines GAVI Mid-Term Review, Ongoing Meeting

The Guardian examines the GAVI Alliance’s 2013 Mid-Term Review report, which “says [the group] is on track to enable developing countries to immunize an additional quarter of a billion children by 2015, but acknowledges that it needs to improve on equity.” GAVI “will assess its progress in Stockholm, Sweden, on Wednesday,” when “[a]bout 150 participants are expected to gather in the Swedish capital, including GAVI’s partners (WHO, UNICEF, World Bank, and Bill & Melinda Gates Foundation), donors and potential donors, implementing countries, the private sector, civil society, members of parliament and vaccine manufacturers.” According to The Guardian, “GAVI has secured total funding of $7.4 billion for 2011-15, but has yet to begin planning for after 2015” (Tran, 10/30).

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Editorials and Opinions

Donors Should Fulfill Global Fund's Replenishment Appeal

“One of the greatest successes in development aid in the past decade has been the Global Fund to Fight AIDS, Tuberculosis and Malaria,” Jeffrey Sachs, director of the Earth Institute at Columbia University and special adviser to the U.N. Secretary-General on the Millennium Development Goals (MDGs), writes in a Project Syndicate opinion piece, noting the fund is appealing for $5 billion annually for another three years. He recalls the state of the three epidemics in 2000, progress made against them, and the formation of the Global Fund. “Aid for health has worked. The world has benefited enormously from the triumph of generosity, professionalism, common decency, and good sense,” Sachs writes, adding, “Yet the battle to mobilize adequate financing remains.”

“It seems likely that the U.S. government will agree to contribute one-third of the $5 billion if the rest of the world delivers the remainder,” Sachs states, adding, “The United Kingdom recently made a strong pledge, and the world now awaits the announcements of Germany, Canada, Australia, Japan, and other long-standing and new donor countries in Europe, the Middle East, and Asia.” He concludes, “Millions of people around the world will live, or die, depending on what these governments decide in December. May they, and we, choose life” (10/29).

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'Urgent Need' To Overcome Barriers To HPV Vaccination

“After just one year, Rwanda reported vaccinating more than 93 percent of its adolescent girls against the human papillomavirus (HPV) — by far the largest cause of cervical cancer,” GAVI Alliance Chief Executive Officer Seth Berkley writes in a Project Syndicate opinion piece, noting, “Vaccine coverage in the world’s richest countries varies, but in some places it is less than 30 percent.” He asks, “How is it that Rwanda, among the world’s poorest countries — and still recovering from a brutal civil war — is able to protect its teenage girls against cancer more effectively than the G8 countries?”

“Alarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate,” Berkley writes. Though “[i]t is still not clear why this is happening,” he continues, “Whatever the reason, unless coverage for all three doses increases, cervical cancer and pre-cancer rates will increase.” Berkley adds, “So it is worth remembering that even in wealthy countries, there is an urgent need to overcome challenges in protecting the hardest-to-reach girls, who often are at high risk of HPV infection” (10/29).

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AIDS 2014 Presents Opportunity To Showcase, Learn From Australia's Inclusive AIDS Response Model

“It has been a fascinating week in Australia planning for the AIDS 2014 conference and one of the highlights has certainly been attending this year’s annual Australasian HIV/AIDS conference in sultry Darwin,” International AIDS Society Executive Director Bertrand Audoin writes in the Huffington Post U.K.’s “Lifestyle” blog. “AIDS 2014, from all the discussions here, will be an opportunity to showcase how an inclusive national response to the epidemic, with a strong focus on the best science, and a strong focus on fighting stigma and discrimination, can lead to good positive results,” he states. “With AIDS 2014 being the last International AIDS Conference before the United Nations’ post-MDG plans push us to integrate HIV programs into global health programs, we need to learn from the Australian model here and make sure we do in fact incorporate sexual health and other global health issues such as non-communicable diseases, health system strengthening, law reform and global stigma and human rights, into an AIDS conference that will be even more meaningful and stay relevant as it reflects a multitude of new voices from outside of the sector,” he concludes (10/29).

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Recent Releases

Understanding HIV 'Treatment Cascade' Critical For Program Success

In a joint post in the Center for Global Development’s (CGD) “Global Health Policy” blog, senior fellow Mead Over and research assistant Yuna Sakuma examine the issue of retention with respect to HIV treatment, which they note was discussed at the October 2 PEPFAR Scientific Advisory Board meeting. “For years even the friendliest critics of the global struggle against AIDS have pointed out that [simply counting the number of patients on treatment] unfairly neglects the people who are not put on treatment and then die, largely because their deaths are uncounted except in so far as they increase the treatment ‘coverage rate,'” they write, examining the so-called “treatment cascade” and some of the data presented at the meeting.  They continue, “Even if a proper measure of retention in treatment yields a less pessimistic estimate of the attrition in the treatment cascade, the enormous loss of patients throughout the treatment cascade remains a glaring reminder of the need to better understand the causes of patient loss at every stage in the cascade and how these losses can be stemmed” (10/29).

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Blogs Examine Report On TB R&D Funding

“The 2013 Report on Tuberculosis Research Funding Trends: 2005-2012 presents eight years of funding data” and “finds that after seven years of slow and unsteady increases in funding, TB [research and development (R&D)] investors reported a drop in spending in 2012 that threatens to undermine the tenuous gains made since 2005,” Mike Frick, project officer at the Treatment Action Group (TAG), writes in the Global Health Technologies Coalition “Breakthroughs” blog about the organization’s new report on funding for TB product development. He outlines the report’s findings, concluding, “Donors from all sectors in high-, middle-, and low-income countries must recommit to meeting the funding levels required to accelerate TB R&D and end the global TB epidemic” (Taylor, 10/29). The Center for Global Health Policy’s “Science Speaks” blog also discusses the report, noting that 65 TB experts last week sent a letter (.pdf) to the White House outlining the role of USAID in supporting TB programs (Barton, 10/29).

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Capitol Hill Briefings Examine Health Inequities, Cholera In LAC

The Global Network for Neglected Tropical Diseases’ (NTDs) “End the Neglect” blog describes two Capitol Hill briefings held last week “discussing the regional inequities in health and the cholera epidemic” in Latin America. According to the blog, a briefing titled “‘Public Health in Latin America’ was hosted by Representative Sam Farr of California on Wednesday, October 23, as part of an ongoing monthly briefing series called ‘Latin America on the Rise.'” In addition, an “event on Thursday October 24, titled ‘Conquering Cholera in Haiti and the Dominican Republic: The Untold Story of Progress,’ provided members of Congress, their staff and partners in health issues an update on the status of the control efforts of the cholera epidemic on the Island of Hispaniola,” the blog notes, summarizing comments made by experts at both events (Corona-Parra, 10/29).

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Gates Foundation Blog Examines New Vaccine Discovery Partnership

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Trevor Mundel, president of global health at the foundation, examines the Vaccine Discovery Partnership, “a new initiative that will lead to better and more effective approaches to vaccine research and development.” The new effort “will be a way for our foundation to work directly with pharmaceutical companies on promising new vaccines for global health,” he states, adding, “We will work with each company individually to identify a promising set of research projects that are aligned with our foundation’s priorities.” Mundel notes, “GlaxoSmithKline (GSK) and Sanofi are the first two companies with whom we’ve signed agreements” (10/29).

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USAID MCHIP's Estimation Tool Helps Evaluate Programs Addressing Postpartum Hemorrhage

In a post in USAID’s “IMPACTblog,” Susan Moffson, senior program officer of the agency’s Maternal and Child Health Integrated Program (MCHIP) program, examines a partnership with the Directorate of Health Services in Jharkhand state in India “to pilot an innovative approach for estimating the number of women who use a uterotonic drug after birth to protect them from [postpartum hemorrhage (PPH)].” She writes, “USAID/MCHIP’s innovative estimation tool makes it possible to build an accurate picture of whether a country is doing everything it should to stop women from dying of this preventable condition. … Such programs would ensure that oxytocin is available to women who give birth with trained health care workers, and that misoprostol is available to women who give birth at home. These combined efforts could save the lives of countless women, no matter where they give birth” (10/29).

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New Issue of 'Global Fund News Flash' Available Online

The Global Fund to Fight AIDS, Tuberculosis and Malaria has published Issue 28 of its newsletter, the “Global Fund News Flash.” The issue focuses on how “the Global Fund is improving the way it approaches treatment programs in countries with high rates of” HIV and TB, highlights a $65 million donation to the Global Fund by the Tahir Foundation, and discusses how robots are helping to dispense medicines in a South African pilot project (10/30).

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