Kaiser Daily Global Health Policy Report
Tuesday, February 9, 2010
At a press conference on Saturday, "Canadian Finance Minister Jim Flaherty said he and his G-7 colleagues would forgive bilateral loans extended to poverty-stricken Haiti, which estimates it could have lost 200,000 residents in the major earthquake that hit last month," Dow Jones Newswires reports. Flaherty also said Haiti's multilateral debt should be nullified as soon as possible (Thiruvengadam, 2/6).
Ahead of the G7 announcement, the Obama administration on Friday declared its support for "international debt relief for Haiti to aid rebuilding efforts," The Hill's "Blog Briefing Room" reports. "The earthquake in Haiti was a catastrophic setback to the Haitian people who are now facing tremendous emergency humanitarian and reconstruction needs, and meeting Haiti’s financing needs will require a massive multilateral effort," said Treasury Secretary Tim Geithner in a statement. "Today, we are voicing our support for what Haiti needs and deserves – comprehensive multilateral debt relief" (Fabian, 2/5).
Also Saturday, "Colonel Gregory Kane, the U.S. Joint Task Force Haiti operations officer, said U.S. involvement in the earthquake-shattered country would last as long as their presence was required," Agence France-Presse reports. "We are in Haiti as long as needed and are welcomed by the government of Haiti," he said, adding that the military component could last between 45 and 50 days, "if you follow historical trends."
The article also looks at the U.S. effort to supply food aid at 16 points around Port-au-Prince. "But with Haitians increasingly angry that a massive international aid effort is not succeeding in reaching them, Kane said supply chains were gradually improving. At Haiti's wrecked port, where the off-angle tilt of gantry cranes still attest to the violence of the January 12 quake, Kane said the flow of goods was now beating pre-quake levels. On Friday the port dealt with the equivalent of 750 20-foot containers, a pittance for major ports, but as much as 15 times more cargo than before the earthquake. Much of it was food aid, he said," AFP reports (Beatty, 2/7).
Despite improvements, a major protest broke out in the Petionville neighborhood of Port-au-Prince, Reuters reports. "It reflected still simmering anger among survivors over problems in the massive international relief effort," the news service writes. "Banging on plastic buckets and waving branches and palm fronds, the protesters surged past piles of earthquake rubble – and a woman bathing by the side of the road – to the city hall in Petionville, where they accused Mayor Lydie Parent of hoarding aid" (Vega, 2/8).
Also, the Associated Press reports that the U.N. has said it would stop sending free medicine to Haiti if Haitian hospitals charge patients for treatment. "U.N. officials said beginning immediately, any hospital found levying fees for medicine will be cut off. But the U.N. would consider continuing to supply non-governmental groups working at private hospitals with drugs if those groups can make a convincing case that none of their patients are being charged," the news service writes.
"U.N. officials told The Associated Press that about a dozen hospitals – both public and private – have begun charging patients for medicine. The officials said they could not immediately provide the names of the hospitals but said they were in several parts of the country, including Port-au-Prince. 'The money is huge,' said Christophe Rerat of the Pan American Health Organization, the U.N. health agency in the region. He said about $1 million worth of drugs have been sent from U.N. warehouses alone to Haitian hospitals in the past three weeks."
According to Rerat, donations are paying for Haitian Health ministry employees' salaries. "A member of the Haitian government commission created to deal with the medical crisis, Dr. Jean Hugues Henry, said he had no knowledge of any hospitals charging for services or medicine," AP reports (Pajak/Dodds, 2/9).
New Outlets Examine Food Distribution; Current, Future Health Concerns
AOL News examines the food distribution plan in Haiti: "The WFP spent 18 days planning the distribution that began this week. Working with eight major partners, including Save the Children and World Vision International, the UN selected 16 distribution points in and around Port-au-Prince. The distribution points are mostly schoolyards or churches with a defendable perimeter. ... In reality, community representatives are supposed to make field assessments of populations in camps by working with knowledgeable insiders to determine who is genuinely at need. But this is one of the most difficult challenges of food distribution in any refugee camp, especially so in an urban environment, with one million newly homeless" (Troutman, 2/7).
The Canadian Press looks into concerns about the approaching rainy season. "The rainy season in Haiti is deadly even in a good year. Now, in a devastated capital city, the early spring rains threaten to cause landslides and bring about health problems in the makeshift camps where more than 500,000 people are living," according to the news service. Mario Nicoleau, an engineer with USAID's office in Haiti, said, "There will be health concerns." Nicoleau added, "The risks will be enormous, and it is difficult to contemplate the unforeseen consequences," Canadian Press reports (Dodds, 2/8).
The New York Times examines the earthquake's effect on the country's tuberculosis control efforts. "In normal times, Haiti sees about 30,000 new cases of tuberculosis each year. Among infectious diseases, it is the country’s second most common killer, after AIDS, according to the World Health Organization," the newspaper reports. "The situation has gone from bad to worse because the earthquake set off a dangerous diaspora. Most of the sanatorium’s several hundred surviving patients fled and are now living in the densely packed tent cities where experts say they are probably spreading the disease. Most of these patients have also stopped taking their daily regimen of pills, thereby heightening the chance that there will be an outbreak of a strain resistant to treatment, experts say," according to the New York Times (Urbina, 2/5).
The Wall Street Journal reports on efforts to accommodate the large number of new amputees in Haiti. "Even before the quake, Haiti's underfunded health-care system lacked resources for people who lost limbs in car accidents or to infections. The situation was complicated by a government that offered little support for the disabled, and a culture in which some people regarded the disabled bad luck because of the economic burden they represented," according to the newspaper. "Healing Hands is among many organizations and private doctors that are attempting to create, virtually from scratch, a system to treat amputees, who need urgent care now and maintenance for decades. The immediate need is for crutches and exercise therapy that will keep remaining muscles functioning. Artificial limbs, once fitted, need to be changed every three to five years, and every six months for growing children," the newspaper reports (Dugan, 2/8).
A study released on Monday found that between 26 percent and 44 percent of artemisinin-based malaria drugs sold in Madagascar, Senegal and Uganda "failed quality testing" because of impurities or insufficient amounts of active ingredient, the Associated Press reports. The study, which was conducted by the nongovernmental U.S. Pharmacopeia program and received funding from USAID, adds to concerns about growing resistance to artemisinin, which is currently the most effective treatment for malaria.
"The study is the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization. It follows evidence from the Thai-Cambodian border that artemisinin-based drugs there are taking longer to cure malaria patients, the first sign of drug resistance," the news service writes (Mason, 2/8).
"The experts subjected 200 samples of anti-malaria drugs to quality-control testing in a U.S. laboratory. They found 44% of the drugs from Senegal failed the testing, followed by 30% from Madagascar and 26% from Uganda. Patrick Lukulay, director of the U.S. government-funded Pharmacopeia programme, said it was a 'disturbing trend,'" the BBC writes.
He said, "It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active [ingredients] or the presence of impurities in the product" (2/8).
According to the AP, the "three-country report also found bad drugs in both the public and private health sectors, meaning governments – some buying medicines with donor funds – are not doing enough to keep poor-quality pills out. All of the drugs tested from the public sector in Uganda, however, passed the quality tests. But 40 percent of the artemisinin-based drugs in Senegal failed." The study also notes that the same drug brands generally had similar results across all sectors, which could help governments that are trying to eliminate substandard drugs.
While the study is not the first to assess the quality of antimalarials in Africa, it is the most rigorous and complete, according to the AP, which notes that similar failure rates were found in previous work that did not focus specifically on artemisinin-based drugs. The WHO has examined malaria treatments in Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania, the AP reports, adding that while the results have not been made public, "Clive Ondari, who worked on the study for the WHO in Geneva, said failure rates in three of those countries were also significantly high. Ghana has already withdrawn more than 20 drugs from the market after receiving the initial results, Lukulay said" (2/8).
In related news, Paul Orhii, director-general of Nigeria's National Agency for Food, Drug Administration and Control said the agency "confiscated N10 million [about $67,000] worth of Lonart, an anti-malaria drug, illegally imported into the country," NEXT reports. "Mr. Orhii said the drugs were intercepted and confiscated by personnel of the agency on routine checks," the news service writes (2/9).
IRIN examines the emergence of resistance to artemisinin in Myanmar. "Preliminary studies in 2008-09 by the Mekong countries of Cambodia, China, Lao PDR, Myanmar, Thailand and Vietnam, show tolerance elsewhere, with the drug proving less effective and taking longer than previously to kill the parasite. The studies, presented late last year at a WHO regional workshop of health officials, show tolerance may have extended to areas along the Myanmar-Thailand, Myanmar-China and Cambodia-Vietnam borders. WHO describes the Mekong countries as the epicentre of plasmodium falciparum resistance to anti-malarial drugs in the world, and the findings have prompted further studies over 2010 and 2011 to confirm increasing resistance," IRIN writes.
The article also looks at the factors involved in spreading drug-resistance and the challenges to prevent it (2/4).
Congressional Quarterly examines concerns among health advocates and international development experts about what President Obama’s FY 2011 budget request might mean to U.S. commitments to particular diseases abroad, such as HIV/AIDS, tuberculosis and malaria.
According to CQ, Obama's request represents an "increase over funding for such programs this fiscal year, [and] it places a new emphasis on maternal and pediatric programs as part of a broader strategy to build stronger comprehensive health care systems, as opposed to the George W. Bush administration’s focus on particular diseases, such as HIV/AIDS, malaria and tuberculosis." Additionally, "The government’s Global Health Initiative pledges to spend $63 billion over six years on global health programs," the news service notes.
"What we’ve done historically over the last number of years, very successfully, is we’ve pursued disease treatment programs with HIV/AIDS, malaria, tuberculosis," Jack Lew, deputy secretary of state for management and resources, said last week. "And what hasn’t happened is the kind of self-conscious building of a sustainable health care infrastructure."
"The administration’s new approach, however, collides with funding priorities that Congress set down during the Bush administration. In 2008, Congress authorized the appropriation of up to $48 billion to fight AIDS and other diseases over the next five years," CQ writes. "AIDS advocates are concerned that such commitments will not be met unless there are significant funding boosts for PEPFAR and the Global Fund."
While "Congress appropriated nearly $110 million more for AIDS programs than Obama requested for fiscal 2010 … with government deficits soaring and Obama proposing a freeze on domestic discretionary spending for the next three years, foreign aid appropriators will be under pressure to rein in spending," CQ writes.
The article includes comments from health advocates who agree and disagree with the Obama administration's global health strategy (Webber, 2/5).
As the number of new H1N1 (swine flu) infections worldwide drops, U.S. health officials on Friday cautioned the virus continues to circulate and can still be deadly, Reuters reports. According to the WHO, H1N1 remains the dominant strain worldwide, but there are reports of the recent emergence of the seasonal flu in Africa and China, according to the news agency.
"Many people believe the outbreak is over and I think it is too soon for us to have that complacency," Anne Schuchat of the CDC said during a telephone briefing Friday, Reuters reports. "This pandemic isn't over yet." Schuchat encouraged Americans who have yet to receive the H1N1 vaccine to do so and parents to ensure children received two doses of the vaccine. So far, 70 million Americans have been vaccinated against H1N1, "which leaves the U.S. government with millions of unused doses," the news service writes (Fox, 2/5).
"The World Health Organization is witnessing an international decline as well, and is discussing criteria for declaring the pandemic over," the Associated Press/Washington Post reports. "One U.S. expert said the epidemic has 'one foot in the grave,' and there are many reasons to believe there won't be another wave later in the year," according to the news service (Stobbe, 2/5).
A poll by researchers from the Harvard School of Public Health released Friday found 44 percent of Americans believed the H1N1 outbreak was over, the Boston Globe reports. Based on telephone interviews with 1,419 U.S. adults, the researchers found "[a]bout 40 percent of parents said their children had been vaccinated, while 13 percent said they intended to have their youngsters immunized against the H1N1 virus by the end of February. Only 21 percent of adults surveyed said they had gotten the swine flu shot or nasal vaccine, although 16 percent said they hope to be vaccinated by the end of this month," according to the newspaper.
"People who chose not to get the vaccine for themselves or their children said their decision was influenced by a belief that the disease was not as serious as once thought, concerns about safety, or confidence that they wouldn’t catch the virus," the newspaper adds (Cooney/Smith, 2/6).
As H1N1 cases worldwide continue to decline, BusinessWeek examines the lessons health authorities have learned from the H1N1 outbreak. The piece highlights how H1N1 exposed areas where the U.S. surveillance systems, vaccine production, mass vaccination campaigns were lacking (Weintraub/Gerlin/Doherty/Serfino, 2/4).
U.N. Launches $538M Aid Appeal For Displaced Persons In Pakistan
The U.N. launched an international appeal Tuesday, calling for $538 million to provide aid in Pakistan for "hundreds of thousands of people displace[d] by army clashes against the Taliban," the Associated Press/Washington Post reports (Toosi, 2/9). Agence France-Presse writes: "The appeal focuses on funds needed to implement the Pakistan Humanitarian Response Plan (PHRP) 2010, which the United Nations, international and local aid groups have drawn up with the cash-strapped Pakistan government." Martin Mogwanja, the U.N. humanitarian coordinator for Pakistan, said, "Considering that the number of IDPs (Internally Displaced People) from Orakzai agency has risen nearly tenfold in the last two months, the emergency in Pakistan seems far from over" (Gilani, 2/9).
Herpes Drug That Lowers HIV Virus In Patients' Blood Does Not Reduce Transmission Rates, Study Finds
"Treating herpes in people who are also infected with HIV does not reduce the chances that they will pass on the AIDS virus," according to a study published last week in the New England Journal of Medicine, the New York Times reports. Though the herpes drug acyclovir lowers the level of HIV in patients' blood, for reasons yet unknown to scientists, the study of 3,400 couples from 14 sites across Africa found there was no difference in the transmission rates between those who received the drug and those who took a placebo. "While acyclovir is cheaper than antiretroviral drugs and has fewer side effects, 'new strategies are needed' to stop AIDS transmission, the authors concluded," the newspaper writes (McNeil, 2/8).
WHO Calls For Health Professionals To Stop Performing Female Genital Mutilation
WHO Specialist Elise Johansen on Friday called for doctors, nurses and midwives in countries in Africa to stop performing female genital mutilation (FGM), the Associated Press reports (2/3). "The practice is still widespread in spite of a global commitment in 2002 to end FGM by 2010," PANA/Afrique en ligne reports. According to the United Nations Population Fund, three million girls are at risk f genital mutilation annually (2/8).
FoxNews.com Examines Budget For WFP Program In Afghanistan
Less than half of the $1.2 billion set aside by the U.N. World Food Program (WFP) program to fund a three-year relief operation in Afghanistan will go to the purchase of food, FoxNews.com reports. According to documents obtained by the news service, the majority of funds will be "spent on shipping, land transportation, handling, office construction and U.N. staffing and administration costs," the news service reports. The news service provides a break down of how funds will be used and links to WFP's proposal (Russell, 2/6).
Cholera Outbreak In PNG Affects 2K And Likely To Grow, Officals Warn
A cholera outbreak in Papua New Guinea (PNG) has affected 2,000 people and risks spreading because of poor water conditions, a WHO representative said Monday, Agence France-Presse reports. Eigil Sorensen, of the WHO, "said the number of deaths so far remained modest at fewer than 50, but the disease continued to spread due to poor water supplies and as infected people, including those with no symptoms of the sickness, travelled around" (2/8). "About 58 percent of the country’s six million inhabitants do not have access to safe drinking water, the UN Development Programme (UNDP) reports," IRIN reports. Despite PNG's government committing more than $4 million to help fight cholera back in September, " [a]s of 5 February, however, just US$900,000 had been released nationwide, leaving provincial authorities and NGOs struggling to cope," according to the news service (2/5).
The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2010 Henry J. Kaiser Family Foundation. All rights reserved.