Kaiser Daily Global Health Policy Report
Friday, March 19, 2010
There were an estimated 440,000 cases of multidrug-resistant tuberculosis (MDR-TB) around the world in 2008 – one-third of which were fatal, according to a new WHO report on drug-resistant TB, the Los Angeles Times reports (Maugh, 3/19). The WHO report, based on data from 2008, found that almost half of all drug-resistant TB cases were in China and India, Reuters reports (Fox, 3/18).
According to the Associated Press, data was missing from some countries, creating a "gap in the global TB picture." The report said that with current data, it is "impossible at this time to conclude whether the (drug-resistant TB) epidemic worldwide is growing or shrinking," AP reports (Cheng, 3/18).
The report still cautions against the spread of drug-resistant TB and notes that more must be done to achieve global control, the Guardian writes. "Countries face enormous hurdles in accelerating access to diagnostic and treatment services for drug-resistant TB, and previous efforts to address this epidemic have clearly been insufficient," the report said (Boseley, 3/18).
According to a WHO press release, "There is an urgent need to obtain information, particularly from Africa and those high MDR-TB burden countries where data have never been reported: Bangladesh, Belarus, Kyrgyzstan, Pakistan and Nigeria." Based on data from the countries reporting, in some parts of the world, one in four TB cases are MDR, defined as "resistant to at least isoniazid and rifampicin, the most effective anti-TB drugs," according to the release. For instance, 28 percent of newly diagnosed TB patients in one region of northwestern Russia were found to have MDR-TB in 2008, the press release notes. "This is the highest level ever reported to WHO. Previously, the highest recorded level was 22% in Baku City, Azerbaijan, in 2007," it adds (3/18).
Elsewhere – in "Orel, outside Moscow, and Tomsk in Siberia" – the WHO said there had been "a remarkable decline" in MDR-TB over the last five years due to implementation of control efforts, the U.N. News Centre writes. In addition, neighboring "Estonia and Latvia also reversed rates of the disease," according to the news service.
"In Africa, estimates show 69,000 cases [of MDR-TB] emerged, the vast majority of which went undiagnosed," U.N. News Centre writes (3/18). A low percentage of MDR-TB cases are reported in Africa compared with other regions, "due in part to the limited laboratory capacity to conduct drug resistance surveys," according to the WHO press release (3/18).
The AP writes: "Again citing missing data, the agency says 'it has not been possible to conclude whether an overall association between (drug-resistant) TB and HIV epidemics exists.' In Estonia, Latvia and Moldova, WHO said people infected with both HIV and TB were more likely to develop drug-resistant TB. But there is no information from many countries across Africa where the most people with HIV live" (3/18).
The report said of extensively drug-resistant TB (XDR-TB) cases, defined as resistent to first- and second-line drugs: "No official estimates have been made on the number of XDR-TB cases, but there may be around 25,000 a year with most cases fatal," according to the WHO press release (3/18). "Not all countries have the surveillance systems to pick up cases of XDR-TB ... So far, 58 countries have confirmed at least one case of XDR-TB," the Guardian reports (3/18).
"Funding needed for MDR-TB control in 2015 will be 16 times higher than what is currently available in 2010," according to the WHO press release, which highlighted the financial challenges associated with controlling its spread. "There is an urgent need to expand and accelerate in countries access to new, rapid technologies that can diagnose MDR-TB in two days rather than traditional methods which can take up to four months," the release said (3/18).
Global funding for efforts to fight malaria, which stood at $2 billion at the end of 2009, have "helped to contain the disease," but is "far short of the estimated $6 billion required annually to expand" efforts to fight it, the Roll Back Malaria Partnership said on Thursday, Reuters reports. The statements came as the partnership released a report (.pdf) that examined a decade's worth of global funding for malaria and its impact on fighting the disease (Hardach, 3/18).
The report, authored by the WHO, UNICEF and PATH, "shows that external funding for malaria control by the Global Fund to Fight AIDS, Tuberculosis and Malaria, World Bank, and the U.S. President's Malaria Initiative (PMI) totalled almost US$4.6 billion between 2003 and 2009," the majority of which has been "directed at Africa, where 90 percent of global malaria deaths occur," according to a multi-group press release.
"Considerable improvements in child and maternal health have been recorded in a third of malaria-endemic African countries where malaria interventions have reached high coverage, including Ethiopia, Rwanda, United Republic of Tanzania, and Zambia," according to the release (3/18).
Reuters continues: "'In all the countries where there is sufficient financing, we are reaching our goals,' said Awa Marie Coll-Seck, executive director of the partnership, which is backed by the World Health Organisation. … In Zambia, for example, the number of deaths from malaria fell by 66 percent between 2001-2002 and 2008, according to the report. The number of children hospitalised with malaria fell 55 percent over that period."
Despite such gains, "Coll-Seck said malaria remained a leading cause of child mortality in Africa. The partnership said last year the disease was claiming a life nearly every 30 seconds. In worst-hit countries it consumes 40 percent of public health spending," the news service writes (3/18).
"Over the last decade, malaria prevention and control have been among the best investments in global health," Michel Kazatchkine, executive director of the Global Fund, said in the press release. "In no other area has there been such a direct and rapid correlation between resources committed and impact on disease as with investments made in recent years to fight malaria, AIDS, and tuberculosis. This progress is fragile, however, and 2010 is a key year for donors to decide if the health-related [Millennium Development Goals (MDGs)] can be met," he said.
The Global Fund will hold a meeting in October 2010 "where governments will make financial pledges for 2011–2013, a crucial period that will determine whether the health-related MDGs can be reached by 2015," according to the release (3/18).
"Facing a squall of condemnation from aid groups and opposition politicians," following statements by Canadian Foreign Minister Lawrence Cannon that Canada's G8 maternal and child health initiative would not include family planning, Prime Minister Stephen Harper "disavowed his foreign minister Thursday, promising that the federal government would include contraception programs in its maternal-health foreign-aid initiative," the Globe and Mail reports.
"The government is seeking a dialogue with the countries of the G8 to save the lives of mothers and children all over the world," Harper said during an address to the House of Commons. "We are not closing the door to any option, and that includes contraception, but we do not want a debate, here or elsewhere, on abortion" (Ibbitson, 3/18).
In response to Cannon's statements on Tuesday, "Opposition MPs immediately slammed the government over the issue, accusing it of being blinded by a social conservative ideology. They argued that the promotion of contraception would save more lives, by reducing unwanted pregnancies, deaths from unsafe abortions and the spread of HIV/AIDS," CBC News reports. According to the newspaper, Cannon admitted he had misspoken on the policy (3/18).
The Globe and Mail adds Cannon "insisted that this government would not fund new family planning initiatives that include the option of abortion, though other G8 governments might choose to do otherwise" (3/18).
"An assessment [for rebuilding Haiti after the January earthquake] prepared by foreign experts for the U.N. ... calls for a system that guarantees universal access to primary care, quality services and essential medication," the Wall Street Journal reports.
The assessment "recommends 'massive investment' in training for Haitian medical professionals and decentralization of care, which has been concentrated in the capital while neglecting the rest of the country," the newspaper writes in a story examining Haiti's healthcare infrastructure now that many of the medical aid workers that were in the country immediately after the quake have left.
"The health ministry is still in shambles; more than half of medical professionals are living in tents. Doctors without Borders, the nonprofit medical group, runs at least 500 of the 1,600 hospital beds in Port-au-Prince. The capital's General Hospital has more foreign than local medical staff," according to the Wall Street Journal. The article includes quotes from a PAHO official, a Haitian health ministry employee and aid workers (Jordan, 3/19).
Meanwhile, while the response to the earthquake shifts from a "short-term emergency response to long-term rebuilding," USAID has "established an interagency task force to coordinate work," Government Executive reports. "The Haiti Task Team, announced late last week, will replace the initial Response Management Team and includes military service members, and representatives of the Health and Human Services, Homeland Security, and State departments. Paul Weisenfeld of USAID will lead the group" (Lambertson, 3/18).
On Thursday, two senior Treasury Department officials said the Obama administration is getting close to a final agreement with other nations to cancel Haiti's debt to the Inter-American Development Bank (IADB), the Associated Press/ABC News reports.
According to the officials – who "spoke on condition of anonymity" ahead of the bank's annual meetings, which begin Friday in Cancun, Mexico – a final deal should come this weekend. "The Cancun conference will be attended by representatives from Latin American and Caribbean nations as well as the United States and China, two major donor countries to the Washington-based lending institution," the AP/ABC News writes (Crutsinger, 3/18).
Also on Thursday, Luis Moreno, who heads the IADB, said there was a lot of support among donors to cancel Haiti's debt of $1.2 billion, according to Reuters. "Most of our shareholders have expressed a desire to do a debt relief of the outstanding amount owed by Haiti, of which the IADB has $441 million," Moreno said. He added, "I think we will come to a conclusion on how to do that debt relief" (Wroughton, 3/18).
At the conclusion Wednesday of a two-day meeting of donors, lenders, U.N. agencies and aid groups, as well as representatives of Haiti's government, a statement announced that a target of $3.8 billion would be given to Haiti over the next 18 months to help rebuild the country, Reuters/Washington Post reports. The meeting was held ahead of a donors conference in New York on March 31, according to the news service. "The World Bank's director for the Caribbean, Yvonne Tsikata, described $3.8 billion as an 'initial figure' contained in the [Post-Disaster Needs Assessment] PDNA document draft," that came out of the meeting held in the Dominican Republic, Reuters reports (Jimenez, 3/18).
Former Presidents Bush, Clinton To Visit Haiti
"Former Presidents George W. Bush and Bill Clinton will visit Haiti together Monday, their first joint visit to the disaster zone," writes the Dallas Morning News (Gillman, 3/19). The former presidents have been overseeing a "relief fund for the country after it suffered a devastating earthquake in January," The Hill's "Washington Scene" reports. "Clinton's office said details about the trip are forthcoming, but that the two former presidents would be accompanied by the Clinton-Bush Haiti Fund's Board of Directors, which includes former White House chief of staff Josh Bolten and former Senate Majority Leader Bill Frist (R-Tenn.)" (O'Brien, 3/18).
Lancet Study Finds Level Of HIV Services For IDUs 'Is Poor In Many Countries'
A Lancet study performed a systematic review of HIV prevention and treatment services targeting injecting drug users (IDUs) globally based on the availability of "core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes." The authors conclude, "although the number of countries with core HIV prevention services is growing … worldwide, there are few countries in which the level of intervention coverage is sufficient to prevent HIV transmission" (Mathers et al., 3/20).
"HIV continues to spread among IDUs in many different countries, and the need for scaling up prevention and treatment is urgent," according to Lancet comment. The authors recommend "framing the issue in community health-economic terms might be the most useful for immediate policy change. Long-term sustained efforts to protect the health of individuals who use both licit and illicit drugs might require that policy makers acquire a basic scientific understanding of drug use and addiction, and frame policies toward drug users within a public health and human rights perspective" (Jarlais/Arasteh/Gwadz, 3/20).
Lancet Comment Examines How 'Two Camps' Of HIV Prevention Can Inform Unified Approach
Sucessfully supporting the prevention of 12 million new HIV infections, as proposed by the PEPFAR five-year strategy, "will require resolving a deep gulf dividing the prevention community," a Lancet comment writes. "One camp sees that multiple sexual partnerships drive infection in generalised epidemics in eastern and southern Africa, dispersed through the broad population. The other emphasises the large number of already infected individuals, particularly the many existing discordant couples, and stresses widespread HIV testing," according to the journal. The piece explores lessons drawn from both components and presents a priority system for approaching prevention strategies (Shelton, 3/20).
CSIS Commission On Smart Global Health Policy Releases Final Report
The CSIS Commission on Smart Global Health Policy report, released on Thursday, "marks the culmination of nine months of deliberation by the Commission – a group formed to develop actionable recommendations for a long-term U.S. strategic approach to global health." The report – "A Healthier, Safer, and More Prosperous World" – lays out a five-point global health policy agenda, which aims to "advance America's core interests … making better use of the influence and special capabilities of the United States, motivating others to do more, and creating lasting collaborations that could save and lift the lives of millions worldwide." A webcast of the report's release is available online (3/18).
Blog Features Series Examining QDDR
In anticipation of the imminent release of the State Department's Quadrennial Diplomacy & Development Review (QDDR), Modernizing Foreign Assistance Network's "ModernizeAid" blog has a series featuring analysis of the QDDR by development experts. The first post raises questions that should be asked when the QDDR findings are released (Ingram, 3/16). A second post highlights the importance of a presidential study on global development (Unger, 3/17). A third post discusses the need for an "elevated, streamlined, and empowered 21st century U.S. development agency" (Beckmann, 3/18).
Blog: Foreign Aid Reform A Top Priority, But Legislation Won't Move Until Next Year, House Foreign Affairs Chair Says
"This morning the Chairman of the House Foreign Affairs Committee, Howard Berman, told an audience at the Center for American Progress that foreign assistance reform will continue to be a top priority of his, but that real movement of legislation will likely not happen until next year," according to the U.S. Global Leadership Coalition's blog (Smith, 3/18).
Blog: Millennium Villages Project Needs Better Evaluation
A Center for Global Development "Views from the Center" blog post critiques the Millennium Villages Project. "The big problem with the enterprise is that the effect of the MV intervention is not being as carefully evaluated as it should be. Without sound evaluation, it simply cannot be known – regardless of what is observed today at MV sites – whether the money devoted to the MVs is accomplishing its goals," according to the blog (Clemens, 3/18).
Blog: Highlights From Recent Malaria Honoree Breakfast
Modernizing Foreign Assistance Network's "ModernizeAid" includes some quotes from speakers at the Malaria No More Policy Center's recent Champions Breakfast. Rear Admiral Tim Ziemer (ret.), the coordinator of the President's Malaria Initiative, and Ezekiel Emanuel, a senior health advisor at the Office of Management and Budget, were honored. The blog notes the major "takeaways" from the breakfast:
"1. With the right resources and political backing, USAID is more than capable of leading major, interagency efforts on global health and development – and they should lead these efforts.
2. The President remains committed to development and global health, and he is pushing his high-level staffers to make sure we are getting the best results possible" (3/17).
Symposium Highlights Need For New Technology To Address Growing Global Food Needs
Several studies released during a symposium held in Washington, D.C., on Wednesday highlight the importance of agricultural innovation and the development of new technologies for "meeting growing global food, feed, fiber and industrial needs," according to a Global Harvest Initiative press release. The release features several study highlights and comments researchers made during the symposium (3/17).
PLoS Medicine Explores Factors Influencing Country Adoption Of New Vaccines Into National Immunization Programs
A PLoS Medicine looks at how adoption of the Haemophilus influenzae type b (Hib) vaccine in low-income countries is effected by "country-level economic, epidemiological, programmatic and policy-related factors, as well as the role of the Global Alliance for Vaccines and Immunisation (GAVI Alliance)." The authors conclude, "This study substantiates previous findings related to vaccine price and presents new evidence to suggest that GAVI eligibility is associated with accelerated decisions to adopt Hib vaccine. The influence of neighboring country decisions was also highly significant, suggesting that approaches to support the adoption of new vaccines should consider supply- and demand-side factors" (Shearer et al., 3/16).
UNICEF, WHO Provide Expectant Mothers With ARVs, Antibiotic Take-Home Kits
Out of concern that the first prenatal check up will be the only time expectant mothers with HIV are able to make it to the clinic, the Lesotho government began distributing drug kits, complete with antiretrovirals (ARVs) and antibiotics, as well as instructions, to help prevent mother-to-child transmission (PMTCT) of HIV, UNICEF writes. According to the piece, the WHO and UNICEF plan to begin providing color-coded take-home "Mother to Baby Packs" in Lesotho and four other countries in eastern and southern Africa by July (Bloemen, 3/16).
Blog Highlights Role Of Global Health Reporting
"Without investigative reporting, our understanding of the key roles government leaders, global trade policies and agricultural practices, pharmaceutical companies and medical practitioners play in a variety of health issues is diminished," according to a post on the Nieman Foundation's "Watchdog" blog which examines global health reporting. The article highlights the contributions of former Nieman fellows to the coverage of global health (Giles, 3/15).
Blog: U.S. Agencies Team Up To Bolster Medical Education In Africa
In an effort to fulfill PEPFAR's commitment to train 140,000 health worker, as part of its five-year strategy, the NIH, together with PEPFAR, the CDC and the Department of Defense have joined together to launch a program aimed at strengthening medical education in sub-Saharan Africa, according to the Center for Global Health Policy's "Science Speaks" blog. "The NIH says it will also serve a related objective: strengthening developing country medical education systems and enhancing clinical and research capacity in Africa," the blog writes (Shesgreen, 3/17). The Kaiser Policy Tracker includes links to an NIH press release announcing the initiative (3/15).
Blog: PEPFAR's Focus On Health System Strengthening Is 'Not So Simple'
A post on the George W. Bush Institute's blog that addresses "the thoeory" of diverting some money from U.S. HIV programs in Africa to strengthen "general health systems" there, includes a quote from former U.S. Global AIDS Coordinator Mark Dybul, now a fellow the institute. According to Dybul: "HIV itself reduces the capacity of an already strained and stretched health workforce in countries hard hit by the epidemic. In Kenya, health workers are twice as likely to be infected as the general population. In Zambia, 38 percent of exits from the work force were due to HIV. In Swaziland, 4 percent of nurses are lost each year from HIV." He concludes, "Unless prevention, treatment and care of HIV are available and effective, there is little hope of building a strong health work force and, therefore, a strong health system" (3/15).
Study Uses Mathematical Model To Investigate Reach, Cost-Effectiveness Of HIV Test-And-Treat Strategy
An AIDS study describes the impact of test-and-treat HIV interventions under various conditions, using a mathematical model. The researchers report that though the model "shows that such an intervention can substantially reduce HIV transmission … that impact depends crucially on the epidemiological context" and "testing every year and treating immediately is not necessarily the most cost-efficient strategy." The authors "also show that a test-and-treat intervention that does not reach full implementation or coverage could, perversely, increase long-term ART costs," according to the study (Dodd/Garnett/Hallett, 3/13).
Clinical Infectious Diseases Explores Problem, Proposes Solution To 'Antibiotic Pipeline Problem'
A Clinical Infectious Diseases public policy piece examines the lack of new antibiotic drug candidates in the drug pipeline and suggests possible solutions to bolster available drugs in the future. "[T]he antibiotic pipeline problem can be solved by bringing together global political, scientific, industry, economic, intellectual property, policy, medical and philanthropic leaders to develop creative incentives that will stimulate new antibacterial research and development (R&D)," the authors write, before describing their support for the development of an initiative "to develop 10 new, safe, and effective antibiotics by 2020." The piece also notes President Barack Obama's commitment to a transatlantic task force focused on coming up with "solutions to the antibacterial drug pipeline problem…" (3/9).
The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2010 Henry J. Kaiser Family Foundation. All rights reserved.