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Kaiser Daily Global Health Policy Report

In The News

Open Letter From Doctors Calls For Action To Prevent Further Syrian Health System Collapse

In a letter published in The Lancet on Monday, more than 50 “doctors, including Nobel Prize winners, say Syria’s health system is at breaking point as medics are forced to flee the fighting,” BBC News reports. The group writes that the situation in Syria, which is in the midst of civil war, is “arguably one of the world’s worst humanitarian crises since the end of the Cold War,” according to the news agency. The letter “warns that horrific injuries are going untended; women are giving birth with no medical assistance; men, women, and children are undergoing life-saving surgery without anesthetic; and victims of sexual violence have nowhere to turn to,” BBC writes (9/16). “The signatories, who span five continents, cite figures suggesting 469 health workers are currently imprisoned and about 15,000 doctors have fled the country,” The Guardian states, adding, “In Syria’s largest city, Aleppo, there are just 36 physicians, compared to 5,000 before the civil war began, they say.” The letter “demand[s] access to treatment for patients and for perpetrators of attacks to be held accountable” and “says governments supporting the opposing sides in the civil war should use their influence to stop the attacks and the U.N. and international donors must do more to increase support to Syrian medical networks,” according to newspaper (Siddique, 9/16).

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Los Angeles Times Examines How Civil Society Organizations Established To Address AIDS Help Marginalized Populations

The Los Angeles Times profiles Mitr Trust, a community organization in New Delhi, India, that “was established to battle the spread of HIV/AIDS.” But “like many such community organizations, Mitr is also increasingly responsible for helping some of the most marginalized people emerge from society’s shadows, providing medical care and financial counseling, even minting political activists,” the newspaper writes. The lesbian, gay, bisexual and transgender communities and others most affected by HIV “still suffer discrimination and violence” in many countries, but “as the global fight against the epidemic enters its fourth decade, the campaign’s effect on civil society is emerging as one of its most profound legacies,” the newspaper notes.

“Major international donors, including the Gates Foundation, the U.S. government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have aimed spending at community-based groups that work with at-risk populations,” the Los Angeles Times reports. “In India, targeted interventions are widely credited with helping prevent HIV/AIDS from exploding,” the newspaper notes and includes quotes from Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program and Center for Public Health & Human Rights; Sonia Correa, who studies sexuality policy at the Brazilian Interdisciplinary AIDS Association; and UNAIDS Executive Director Michael Sidibé (Levey, 9/15).

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Global Fund Money Helping Myanmar Provide ART For More People

Al Jazeera examines how a Global Fund to Fight AIDS, Tuberculosis and Malaria grant is helping Myanmar provide antiretroviral therapy (ART) to its HIV-positive population. “Since 2010, when the Global Fund resumed work after pulling out of the country in 2005 due to government restrictions on its staff, Myanmar has seen improvements, said [Myint Shwe, manager of the country's national AIDS program],” the news agency writes. The article profiles several AIDS treatment and care centers, as well as patients. Peter Paul de Groote, head of mission in Myanmar for Médecins Sans Frontières (MSF), “said that, while the new Global Fund money would have an impact, national practice would also need to change” in order for more qualified patients to receive treatment, according to the news agency. “Additional resources will also be required as the total number of people eligible for treatment in the country will increase. … However, achieving this is not only a matter of financial resources for drugs, but also the overall availability and capacity for enrollment needs to improve — by looking into better treatment models and implementing increased, decentralized care and treatment,” de Groote said by email, according to Al Jazeera (Lewis, 9/14).

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Honduras, Ukraine Challenge Australian Laws On Tobacco Marketing At WTO

“Ukraine and Honduras are reviving a dispute at the World Trade Organization (WTO) challenging Australian laws that impose uniform drab green packaging and large graphic health warnings for cigarettes, diplomats said on Friday,” Reuters reports. “Tobacco firms say the Australian rules, which outlaw logos, infringe their trademarks,” the news agency writes, adding, “The WTO complainants say the rules create illegal obstacles to world trade.” The WHO “sees Australia’s campaign, which has so far defeated the tobacco industry’s legal challenges, as heralding a ‘brave new world of tobacco control,’” Reuters states, noting six million people die of tobacco-related causes annually, according to the WHO (Miles, 9/13). “The first country to challenge the law was Ukraine, in March 2012,” Agence France-Presse/Fox News reports, noting, “The process was put on ice eight months later at Ukraine’s request, before being reactivated last month, but the dispute settlement panel has not yet been formed” (9/13).

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Singapore Reports Recent Surge In Number Of Dengue Fever Infections

“Singapore has reported a jump in dengue fever infections in recent weeks, and the epidemic is likely to drag on for a few months longer than usual, according to experts,” the Wall Street Journal’s “South East Asia Real Time” blog reports. With more than 16,000 cases reported so far this year, “the outbreak in terms of infections has proven to be the worst on record,” according to the blog. “The five deaths this year, however, are less than the previous worst year, 2005, when 27 people died and 14,006 people were infected,” the blog writes. “No vaccine or specific treatment is available for dengue, although a [WHO] official says a vaccine may be available as early as next year,” according to the blog. In Singapore, which is still in peak dengue season, “the government has stepped up its educational campaign to try to prevent breeding of mosquitoes and is advising people likely to be exposed to the virus to use repellents,” the blog states (Raghuvanshi, 9/15).

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Editorials and Opinions

Lower Number Of Child Deaths Should Be Celebrated, But More Needs To Be Done

UNICEF, the World Bank and the WHO on Friday released a new report (.pdf) showing that the number of early childhood deaths worldwide has decreased by half since 1990, but approximately 18,000 children under age five continue to die daily. The following opinion pieces address the report and its implications.

  • Melinda Gates, Huffington Post’s “Impact” blog: Noting that the number of deaths among young children has decreased each year for the last 50 years, Gates, co-chair of the Bill & Melinda Gates Foundation, writes, “The report is very important from a policy perspective” because “[i]t tells us which children are still dying and what they’re dying from.” She continues, “It also indicates we still have work to do delivering two relatively new vaccines for diarrhea and pneumonia, because they’re still the leading causes of death among children. And it proves we have to pay more attention to newborn health, because as we get better at saving older children a greater proportion of mortality happens in the first month of a baby’s life.” Gates says the successes should be celebrated before engaging in “important conversations about how to make sure health systems deliver all this life-saving care in a single, integrated package that reaches all families at all stages of life” (9/13).
  • Caryl Stern, Huffington Post’s “Global Motherhood” blog: The numbers in the report are “heartening … but they’re clearly not enough,” Stern, president and CEO of the U.S. Fund for UNICEF, writes. “The number of children who die from things we can prevent should be ZERO. And it can be. With new vaccines, technology and programs, we can finish the job we started — but only if we work faster, better and together,” she continues. “Just as there is no single reason why children under five die, there is no single solution. But this report demonstrates that simple solutions work, and that now is the time to redouble our efforts,” Stern states, adding, “We won’t achieve any of this, however, without determination and action.” She says readers can sign a letter to President Obama urging action because “[h]ealthy children are more likely to live longer, stay in school and be productive members of their society, creating benefits that reverberate through future generations” (9/13).

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Opinion Pieces Address U.N.-Supported Survey On Rape, Violence Against Women

The Lancet Global Health on September 10 published a U.N.-backed report examining rape and sexual violence against women in six Asia-Pacific countries. The report showed that of 10,000 men surveyed in Bangladesh, China, Cambodia, Indonesia, Papua New Guinea, and Sri Lanka, nearly one-quarter admit to committing rape, often against their own partners. The following opinion pieces address the report and its implications.

  • Nur Hasyim, The Independent: “The study reveals two important findings. First, it demonstrates how widespread violence against women is,” Hasyim, founder and national coordinator of Aliansi Laki-Laki Baru (New Men Alliance) in Indonesia, a pro-feminist men’s movement, writes. “Second, it gives us insight into why this is the case,” he states, saying the report showed “sexual entitlement” to be a major driver. “The seeds for change have been planted, both at a policy and grassroots level,” Hasyim writes, noting workshops he runs in Indonesia for men who have perpetrated violence. “Once men understand the true consequences of their attitudes and behavior, they feel stronger, more respected, when they exercise the right not to use violence, not to strive to be dominant over women,” he writes, adding, “We have a long way to go, but we are on the right path” (9/13).
  • Jessica Mack, The Guardian: “The study is loaded with critical findings that, after first depressing you, have the potential to revolutionize the way we design gender-based violence policies and programs and even how [we] talk about these in society,” Mack, a freelance writer and gender consultant, writes. She summarizes many of the survey’s findings, writing, “Gender-based violence is resident in all corners of society, with causes and consequences more numerous and complex than any other issue being tackled. The solution is not just stricter rape laws, or more conversations with our sons, or more safe houses. It is all of these things and more, all at the same time and for a very long time.” She concludes, “We need more data, more eerie delving into the minds and realities of perpetrators — not to give them platforms or excuses, but to face this head on. That is when the change comes” (9/13).

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Fathers' Participation Important To Reducing Mother-To-Child HIV Transmission

In a Reuters opinion piece, Mary Mwanyika-Sando, the maternal and child health coordinator at Management and Development for Health and a New Voices fellow at the Aspen Institute, writes that fathers are key to preventing mother-to-child HIV transmission (MTCT). “[W]ith the right [antiretroviral (ARV)] treatments, we can reduce the risk of transmission from mothers to children to below five percent,” but “Tanzania’s current [MTCT] rate is 25.7 percent,” Mwanyika-Sando writes. “This is not because of poor services or treatment,” she continues, adding, “Tanzania has made significant progress by integrating preventative HIV transmission treatments within the reproductive, maternal, newborn and child health services. The missing piece of this intervention is fathers.” Mwanyika-Sando says that “shame imposed by societal norms” for women living with HIV “is one of many barriers that hinder complete delivery of comprehensive services needed to speed up the reduction of HIV transmission.” She calls for “African countries to make adjustments in their health systems to accommodate men and update their country’s policies to cater to specific needs that will reduce the barriers to men’s participation in treatment programs” (9/13).

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Recent Releases

USAID, PEPFAR Brief Addresses Hormonal Contraception Use, HIV Risk

“While evidence of a tie between some injectable hormonal contraceptives and an increased risk of HIV acquisition remains incomplete, that potential risk must be balanced against the life-saving benefits of preventing unintended pregnancy, a brief [.pdf] from USAID’s Office of Population and Reproductive Health says,” the Center for Global Health Policy’s “Science Speaks” blog reports. The brief, prepared in collaboration with PEPFAR, “concludes that the search for conclusive evidence of acquisition risk, as well as for safe, affordable technologies to prevent both unintended pregnancy and HIV acquisition, continues,” the blog notes (Barton, 9/13).

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FAO, USAID Urge Continued Surveillance, Action To Prevent Spread Of Avian Flu Viruses

The U.N. Food and Agriculture Organization (FAO) “has issued a new warning to the international community that the H7N9 and H5N1 avian influenza viruses continue to pose serious threats to human and animal health, especially in view of the upcoming flu season,” an FAO news article reports. Noting “USAID support has enabled FAO to help countries at risk dramatically improve surveillance capacities,” the article adds, “FAO and USAID stress that more work is required.” The article continues, “In the short term this includes continued, targeted surveillance … throughout the [poultry] production and marketing system, contingency planning and compensation scheme development. … In the longer-term fight against H7N9 and other viruses, FAO and USAID are urging countries to invest in improving the way they market and sell poultry” (9/16).

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Blog Discusses NTDs' Impact On G20 Goals

World leaders at the 2013 G20 summit debated the Syrian civil war and chemical attacks in the country, but did not discuss “another crisis that is happening in Syria and around the developing world at large: an epidemic of cutaneous leishmaniasis and other [neglected tropical diseases (NTDs)],” the Global Network for Neglected Tropical Diseases’ “End The Neglect” blog reports. In Syria, “the conflict and subsequent break down of public health has led to a resurgence of the disease,” the blog reports, adding, “While reports cannot be verified, it is estimated that there are more than 100,000 new cases of leishmaniasis across the country and in the growing refugee camps outside Syria.” The blog writes that NTDs “pose a significant threat to the goals of the G20 to promote food security, financial inclusion, and human resource development.” Sabine Vaccine Institute CEO Michael Marine tells the blog, “The G20’s efforts to improve nutrition and help build a skilled workforce will fall short if we do not the tackle other barriers that prevent people from working” (Gunderson, 9/13).

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