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Recent Releases In Global Health

Lancet Examines Health Workers Lost To International Organizations

A Lancet Comment discusses how developing country doctors and nurses who are recruited by in-country international organizations, research institutions and non-governmental organizations (NGOs) can “prevent government-trained doctors and nurses from contributing to their [national health service] NHS.” The authors write that some of the international organizations “engaged in aiming to promote health and relieve suffering might, in one aspect of their approach, be having the opposite effect.” The article gives an example in The Gambia, where “substantial numbers of Gambian-trained health workers have gone from the NHS to the [UK's Medical Research Council] MRC” in The Gambia and proposes six recommendations including replacing NHS staff and contributing to in-country training (Southall et al., 8/14).

Lancet Calls For ‘Comprehensive Response’ To HIV In IDUs

A Lancet Series article presents a “call for comprehensive responses to HIV in people who use drugs.” The piece discusses the scale of the epidemic, including the regional prevalence of HIV infection in injecting drug users (IDUs), the “dangers of inaction,” including new outbreaks and cost of incarceration. The authors propose a comprehensive response including: changing the risk environment, managing co-infections, increasing access to care, and addressing human rights. The authors lay out a plan for implementation, including the role of governments, who “have crucial parts to play in addressing the structural factors that lead to either enabling or risk-enhancing environments,” ministries of health, donors, providers, researchers and people who use drugs (Beyrer et al., Early Online Publication, 8/14).

Lancet Examines Current Efforts To Prevent, Treat Schistosomaisis

In a Lancet Infectious Diseases Personal View, the authors examine “past and present challenges, and propose a strategy that could potentially lead to worldwide elimination” of schistosomiasis, a disease that infects “over 200 million people.” Specifically, the article looks at drug-based control using praziquantel, which is “highly effective in killing adult worms of all schistosome species” and “controls morbidity well.” However, “because praziquantel does not kill immature schistosomes and cannot prevent reinfection, praziquantel-based control programmes have only a temporary effect on transmission and are limited in their potential to interrupt disease transmission in the long term.” The authors state that they believe “multiple component, integrated control programmes incorporating praziquantel treatment with transmission reduction through other control measures, such as use of molluscicides, environmental modification, health education and promotion, and improved sanitation, is the best option for schistosomiasis control” (Gray et al., 8/11).

“The health and economic effects of schistosomiasis in Africa are not well known, but new information reveals that the neglect of this parasitic infection despite its potential for control through mass treatment with praziquantel represents a monumental global public health disparity,” write the authors of a Lancet Comment highlighting the need to ramp up efforts to make the drug accessible to those in greatest need. “Today we are failing to provide [the drug], costing just a few cents per tablet, and yet when given once yearly to children, this drug could avert a level of morbidity in Africa that exceeds that of malaria or other disease scourges.” The authors write that though praziquantel is “not a panacea” that will solely eliminate schistosomiasis, “[w]ide-scale availability … would have an immediate effect on reversing morbidity in school-aged children and could prevent up to 70 million cases of haematuria, 8.5 million cases of splenomegaly, and 280,000 deaths annually” (Hotez et al., 8/14).

Blog: Expansion Of India’s ‘Badly Broken’ Food System Will Result In ‘Less Food Reaching The Poor’

The author of an Aidwatch blog examines the ongoing debate in India over whether the country should expand its existing and “badly broken” food distribution system, supported by the National Congress Party, and the view held by economists and advocates who “are fed up and want to experiment with vouchers, food stamps, or cash instead of the notoriously leaky bags of grain.” The author concludes that while it is uncertain whether “vouchers or food stamps would reduce the corruption in the system and make sure that the benefits get to more people who need them,” it is “pretty certain what the people of India will get if their politicians vote to expand a broken system: More of a broken system, more injustice, and less food reaching the poor” (Freschi, 8/12).

Blog: HIV Strategies Should Focus More On Girls

“Girls are the center of the HIV epidemic. In many countries, they are hit hardest, yet our prevention strategies have rarely focused on them specifically,” writes the author of a post on the Huffington Post. The author calls the results of a recent vaginal microbicide trial a “big, big deal” that “potentially shifts the power of prevention to the woman.” The author notes that if the gel gets to market, it is unlikely to be accessible to girls, asking, “how do we address those access issues for girls?” The post discusses how the Nike Foundation is “investing in girls’ economic empowerment” and notes the findings of a recent UNAIDS report linking risky sexual behavior with “development issues like education and employment” (Eitel, 8/11).

CFR Assesses Global Health, Launches Global Governance Monitor

The Council on Foreign Relations published a backgrounder on global health as part of its new multimedia Global Governance Monitor. The paper examines the strengths and weaknesses of the “global public health regime,” writing that “[t]he institutional landscape for global health is more populated, diverse, and better resourced than it was twenty years ago. … Yet the effectiveness of this increase in players and resources is often diluted by an uncoordinated and incoherent system.” The paper offers suggestions for strengthening global public health work including: the inclusion of global health on the G20 agenda, integrating health with development policy, expanding “the evidence base for health interventions,” strengthening “regional approaches and cooperation” on global health and anticipating the potential effects of climate change.

In addition to the backgrounder, the council’s Global Governance Monitor features an interactive timeline of international public health, a matrix that examines public health sectors, a map showing regional progress on Millennium Development Goals and a list of global health resources (8/11).

Blog: Obama’s Jobs Bill Cuts MCC Funding

President Barack Obama’s recently-signed jobs bill (HR1586) “rescinds $50 million from the [Millennium Challenge Corporation's] MCC’s FY2010 funds,” according to the Center for Global Development’s “Rethinking U.S. Foreign Assistance Blog.” The post states the cut is “much better than the originally envisioned $150 million rescission,” but notes, “the cut still must come from somewhere.” The author speculates that the Philippines compact will likely “be spared from the recession,” because it has already been approved “[b]ut compacts in Jordan or Malawi are possible targets, or the MCC might work to keep those projects intact and trim the $50 million from other places,” the author of the blog post writes (Dunning, 8/11).

Blog: Goosby Discusses PEPFAR Resources, Marginalized Populations

The Center for Global Health Policy’s “Science Speaks” blog presents highlights from a discussion between Eric Goosby, U.S. global AIDS coordinator, and Jeffrey Sturchio, president and CEO of the Global Health Council. Goosby discussed President Obama’s commitment to the Global Health Initiative (GHI) and PEPFAR, noted that PEPFAR programs have “been able to drop the cost of care about two-thirds in the past 18 months, freeing up resources,” and addressed the importance of “creating opportunities for marginalized communities to access care” (Mazzotta, 8/10).

Blog: Gates Foundation Issues Progress Report On Agricultural Development Grants

A Huffington Post blog looks at six Bill & Melinda Gates Foundation grant recipients – “nonprofit agricultural development organizations [which] are helping hundreds of thousands of poor farmers in sub-Saharan Africa and South Asia grow more productive, profitable, and sustainable crops.” The post, which says the programs have helped farmers “improve their lives,” points to a progress report on the grants that helps the foundation “see what’s been working well in each program, and to adjust our strategies to address unexpected challenges and to adapt to the evolving needs of local communities and individual farmers” (Gates, 8/10).

CFR Brief Examines Wheat And Grain Price Inflation, Food Security

An expert brief posted online by the Council on Foreign Relations examines how the “latest round of wheat and grains inflation” might affect global food security. The article discusses Russia’s ban on grain exports stating, “There are many wheat-producing nations, including the United States, and no inherent reason why even a 100 percent devastation of Russia’s crop need result in a global grains shortage.” The author notes that “markets are often irrational” and explains that Ukraine and Kazakhstan may also ban grain exports, while some countries are rumored to be hoarding grains. If accurate, this “could further drive up market prices. Investment analysts are all over the place in their current forecasts, predicting everything from a 180 degree turnaround in food prices before the end of the year, to absolute doom” (Garrett, 8/9).

Researchers Find Benefits Of Increased Linkage To Care, Preventing Loss To Follow-Up In HIV Model

An Archives of Internal Medicine study describes a “simulation of the HIV epidemic and HIV disease progression in South Africa” developed by researchers so they could compare the current HIV treatment campaign with four strategies that “increase access to antiretroviral therapy.” In the simulation, “universal testing and treatment was associated with a mean (95% uncertainty bounds) life expectancy gain of 12.0 months (11.3-12.2 months), and 35.3% (32.7%-37.5%) fewer HIV infections over a 10-year time horizon. Improved linkage to care, prevention of loss to follow-up, and comprehensive HIV care” provided life expectancy gains and reduced new infections as well, according to the study. They conclude, “Our comparative evaluation of the mortality and transmission benefits of scaling up HIV testing and treatment in sub-Saharan Africa provides several important insights. First, universal testing and early treatment alone have important health and epidemiologic benefits, but we estimate that they provide about half of the benefits of a comprehensive scale-up strategy that also includes improved linkage to care and prevention of loss to follow-up. Second, the mortality and transmission benefits of scaling up HIV testing and treatment have implications for population growth. Finally, we estimate that even under a strategy of comprehensive HIV care it will take longer than a decade to substantially reduce the burden of South Africa’s widespread epidemic (Bendavid et al., 8/9).