Global News Round Up

Politics & Policies

Dr. Tedros Adhanom Ghebreyesus has been elected as the new WHO director general.

The State Department on Monday officially announced a broad expansion of the Mexico City Policy, a regulation put in place by every Republican president since Ronald Reagan that prevents foreign nongovernmental organizations that perform or promote abortions from receiving American dollars.

If a serious infectious disease blossomed across the globe today, the US death toll could be double that of all the casualties suffered in wars since the American Revolution.

A report from an expert committee convened by the National Academy of Sciences, Engineering and  Medicine outlines global health priorities and strategies to maintain US leadership.

Programs, Grants & Awards

Each year, the Duke Global Health Institute honors outstanding students and faculty members with several awards.  This year, as is commonly the case, the award conferring committees were hard-pressed to select winners, given the abundance of nominations for highly deserving candidates.

The Global Health Corporate Champions is an activity of USAID’s Global Health Fellows Program (GHFP) II, which is implemented by the Public Health Institute and supported by PYXERA Global. GHFP-II supports the Agency’s thought leadership in building a diverse, technically excellent, culturally competent group of American global health leaders.

Research

The US is on track to end the HIV epidemic within the next decade.

A new report from the WHO and its partners estimates that nearly 1.2 million adolescents die from largely preventable causes every year, that would be 3000 deaths each day.

Researchers have identified the molecular mechanism by which the deadly superbug “Golden Staph” evades antibiotic treatment. These results may provide clues to counter antibiotic resistance.

WHO data shows that nearly half of all deaths are now recorded, a trend that implies improvement in collection of vital health statistics and progress towards attaining sustainable development goals.

Diseases & Disasters

USAID is exploring the merger of its disaster and food assistance offices to create an entity that would manage a $4 billion humanitarian operations.

According to the WHO, there are now 29 suspected Ebola cases in Congo.

According to a new study, risk of dementia is significantly decreased among retirees who volunteer.

A state of emergency has been declared in Yemen after Cholera killed 157 people between April 27 and May 13.

The Nuclear Threat Initiative has joined the global health council to broaden its biosecurity mission.

Technology

The Indian government’s decision to include pneumococcal conjugate vaccine in its Universal Immunization Program is a big public health win.

A severe shortage of the injectable polio vaccine is threatening to hinder polio eradication.

Environmental Health

Stanford University has produced a new report that outlines recommendations to mitigate health impacts of climate change.

There is concern that continued destruction of forests in Asia-Pacific region will hamper the advancement towards meeting the sustainable development goals.

Equity & Disparities

According to a recent UNICEF analysis of 11 countries in the Middle East and North Africa, at least 29 million children live in poverty in the region.

A new Lancet Global Health article discusses lack of gender parity in leadership positions in the field of global health.  Women make up for about 84% of the student body but this number declines sharply to only about 24% in leadership positions.

Maternal, Neonatal & Children’s Health

The underground sex industry notoriously eludes any efforts to officially measure its size, but those of us who study it can say one thing for sure: It’s a booming industry in the US and it’s bigger than you think.

According to a new WHO report, pregnancy related complications are the leading cause of death globally among adolescent girls between 15 and 19 years of age.

Human Rights

About 2 migrant domestic workers die each week in Lebanon; there is growing and urgent need for better policies, laws and enforcement.

UNHCR has opened a 12th camp for residents fleeing the Mosul conflict.

 

 

Mark Green: USAID pick could be a silver lining if he does it right

This post was developed collaboratively by the Section’s Communications Committee.


The Trump administration’s nomination of Mark Green, former congressman, ambassador, and frequent NGO board-sitter, was one of those hard-to-find silver linings in the current political thunderstorm (or downward spiral, if you prefer). He is a political unicorn of sorts, enjoying both bipartisan support from Congress and respect from development professionals, someone who knows how to navigate both the political and technical aspects of the job. Green, a four-term Congressional representative from Wisconsin, also served as the ambassador to Tanzania under George W. Bush and was involved with the creation of PEPFAR. He has served on the board of directors for Malaria No More and the Millennium Challenge Corporation, a bilateral aid agency that administers grants to countries for recipient-led initiatives based on a series of economic and governance indicators. He is currently the president of the International Republican Institute, which promotes democracy, civil society, and good governance practices abroad. Politicians like him, old USAID hats like him, think tanks like him – even aid groups (including ONE and Save the Children) like him.

All of this is lovely, but hold the champagne. The inevitable next question is, what will Mark Green be able to accomplish as head of a hamstrung agency with no money?

As many have been quick to point out, USAID is not without its problems and could benefit from some major reforms. The agency has certainly not been immune to criticism from global health and development commentators, including this Section. Many of its programs have been of questionable utility or badly managed (or both), and it has been slow to respond to calls for its programs to be rigorously and transparently evaluated.

However, USAID may at this point be facing a more fundamental, existential crisis. Explains the AP, “[t]he agency faces a starkly uncertain future, including potentially big budget cuts and the possibility of being folded entirely into a restructured State Department.”

Restructured” in this case meaning disorganized, rudderless, and full of disgruntled and anxious employees.

An additional wrench was thrown in this week (although completely buried under ever more sensationalist headlines) with the announcement that the Global Gag Rule would be expanded to apply to all global health programs:

[T]he State Department [Monday] confirmed that, indeed, a massive expansion of the Global Gag Rule is underway. Whereas previous iterations of the Global Gag Rule only affected funds earmarked for reproductive health, the Trump version encapsulates all US global health programs. This includes programs for AIDS, Malaria, Measles, cancer care, diabetes, child nutrition — everything except emergency humanitarian relief.

In monetary terms, this expands the scope of the Global Gag Rule from about $600 million in reproductive health assistance to $8.8 billion in global health assistance around the world, including the $6 billion anti-AIDS program created by President George W. Bush known as PEPfAR.

So even if Congress pushes back against the administration to preserve USAID’s budget, Mr. Green may not have any recipients to give the money to.

APHA 2017 Section Elections Start May 25th!

The polls for the American Public Health Association’s Section Elections will be open May 25 – June 15.

As an APHA member, selecting Section leadership is an integral part of your Association’s governance. We encourage you to take part in this year’s election.

On May 25, look for an email (subject line: “APHA Voting Information Enclosed”) that will include voting instructions and a direct link to your online ballot.

All you have to do is click on the link, review the candidate statements and VOTE!

Rest assured the site is secure and will prevent anyone from voting more than once.

What’s next for US global health funding?

On April 30th, a bipartisan budget deal was passed which will keep the US government funded through the end of September this year. Although funding for global health programs remains largely intact this year (in some cases, budgets have even increased), the future of US global health funding is looking pretty bleak.

Trump’s “skinny budget” proposal for fiscal year 2018 includes steep cuts of nearly 30% to foreign aid and diplomacy delivered through the Department of State. Additionally Trump’s budget proposes cuts to the United Nations and its affiliated agencies, multilateral development banks like the World Bank, and the complete elimination of funding for the Fogarty International Center. And while we can all breathe a collective sigh of relief knowing that malaria programs, PEPFAR, the Global Fund, and Gavi have been spared, the proposed 25% cut to global health programs is disconcerting to all of us within the international development and global health community.

Although such dramatic cuts in US foreign aid spending impacting global health are rightfully shocking, a recent study published in the Lancet shows that financing for global health programs by all development agencies (which includes bilateral (government to government) assistance, multilateral development banks, international NGOs, and others) has already been slowing significantly in recent years. Between 2010 and 2016, development assistance for health grew annually at only 1.8% compared to 11.3% in the first decade in the millennium and 4.6% in the 1990s.

The United States is currently the largest contributor (in absolute dollar amounts) of bilateral foreign assistance even though we spent only 0.18% of our gross national income (GNI) in 2016 on foreign assistance. As a comparison, the OECD country which spent the most of its GNI on foreign assistance, Norway, spent 1.11%. (Just in case you’re curious, most of our federal tax dollars are budgeted toward defense, social security, and major health programs.)

With Trump touting an “America First” agenda and Americans grossly bigly overestimating the amount the US spends on foreign assistance (on average, those polled guessed 26%), it is probably safe to guess that the general public knows little about how foreign assistance can help contribute to a safer America. Although a majority of US foreign aid goes toward funding critical global health programs (including being the largest funder of HIV/AIDS projects), foreign aid isn’t completely altruistic. Foreign aid also helps bring peace and stability to countries where we can benefit from open trade and less volatile economies. In addition, foreign aid helps keep Americans healthy by preventing the global spread of deadly diseases.

In a recent op-ed for Time magazine, Bill Gates provides the proof in the pudding:

According to one study, political instability and violent activity in African countries with PEPFAR programs dropped 40 percent between 2004 and 2015. Where there was no PEPFAR program, the decline was just 3 percent.

….. A more stable world is good for everyone. But there are other ways that aid benefits Americans in particular. It strengthens markets for U.S. goods: of our top 15 trade partners, 11 are former aid recipients. It is also visible proof of America’s global leadership. Popular support for the U.S. is high in Africa, where aid has such a dramatic impact. When you help a mother save her child’s life, she never forgets. Withdrawing now would not only cost lives, it would create a leadership vacuum that others would happily fill.

As global financing for international health programs is expected to continue to slow, it is critical that the United States continues to provide foreign assistance not only because it keeps Americans safe and our economy healthy, but also because it is the right thing to do. While it’s true that foreign aid is in desperate need of extensive reform and that at some point a few low-income countries will be able to start financing a majority of their own health programs, change doesn’t happen overnight. Another Lancet study found that global spending on health is expected to increase from $9.21 trillion USD in 2014 to $24.24 trillion USD in 2040 with low-income countries growing at 1.8% and per capita spending expected to remain low. Failing to support global funding for health at adequate levels has serious consequences not only for the health and well-being of the millions of vulnerable individuals around the world who depend on our support, but in a world where we are inextricably linked, it also endangers the health and well-being of the American people.

The bipartisan deal reached by Congress provides a small glimmer of hope that Trump’s proposed cuts may be dead on arrival, but in such an unpredictable political climate, our collective cynicism is teaching us to expect the unexpected. Trump’s full budget proposal is expected to be released the week of May 22nd. Until then, let’s make sure we are fully prepared to fight in this uphill battle.

Preventing Rickets Globally

This is a guest blog post by Dr. Mark Strand, IH Section Councilor and Professor in the Pharmacy Practice and Master of Public Health Departments at North Dakota State University.

For the last fifteen years, I have collaborated with a group of scholars to research and prevent nutritional rickets in children. Recently our newest paper was published, a look at the global burden of disease due to rickets, and prospects for reducing this preventable disease of poverty. Rickets is caused by insufficient circulating 25-OH-D (vitamin D levels), as a result of insufficient sun exposure, high amounts of melanin in the skin, or both; as well as inadequate intake of dietary calcium. Therefore, the condition begins at birth in children facing these conditions, and worsens up to age 2 or 3, when self-selection of food, and outdoor play, tend to slow or stop the progression. However, during that time these children have higher rates of pneumonia and other preventable conditions, and if severe, will maintain the skeletal deformities for life.

I am deeply committed to research which provides scientific evidence to explain causes of disease and burden among underserved and vulnerable populations. This has been one of my more satisfying contributions.

My colleagues and I published this paper on nutritional rickets nearly ten years ago: https://www.researchgate.net/publication/7282059_Nutritional_rickets_around_the_world_Causes_and_future_directions

Here is a link to our newest article:
http://www.tandfonline.com/eprint/p5idF3CXdvKph3tBMHhT/full

“You’re #fired”: Why the firing of the US @Surgeon_General matters to #globalhealth

This post was developed collaboratively by the Section’s Communications Committee.


The capital and the news media are in a collective tizzy over the abrupt firing of FBI Director James Comey. Cable news chatter is reaching a fever pitch as talking heads make frequent references to Nixon’s Watergate, though we cannot yet know for sure whether Trump’s house of cards will fall the same way (or, frankly, why on earth he thought this was a good idea).

There is no shortage of rolling heads, and plenty of screaming headlines have rolled with them. While each decapitation dismissal is significant for its own reasons, one that has unfortunately not received as much attention was the firing of US Surgeon General Vivek Murthy at the end of April. Quiet chatter about the sacking has percolated through the domestic public health community, accompanied by a prickly letter from Senate Democrats last week demanding to know why Murthy was axed “[e]specially in light of your Administration’s pattern of politically motivated and ethically questionable personnel decisions.”

As this piece from Vox points out, the reasons why are pretty obvious:

Murthy…holds views on gun control that are at odds with those of the new administration. When President Obama nominated Murthy back in November 2013, the Senate blocked his nomination for more than a year, particularly after the National Rifle Association criticized a letter Murthy had co-signed in support of gun control measures.

Murthy was also a strong supporter of Obamacare. He co-founded Doctors for America in May 2009 — around the time the fight about the Affordable Care Act was heating up. “The country’s main doctor trade group, the American Medical Association, remained neutral on the Affordable Care Act. In founding Doctors for America, Murthy says he saw an opportunity to organize the doctors who very much did support Obamacare,” Sarah Kliff reported.

Most recently, Murthy’s office came out with a report that included clear, evidence-based suggestions about what steps need to be taken to combat the opioid epidemic — but Murthy wasn’t tapped to join President Trump’s recently announced opioid commission.

The implications for public health in the US are pretty obvious. However, this matters on the global health front as well – and not simply because the US is part of the global health picture. In addition to being “America’s doctor,” the surgeon general is in fact a kind of “general” of sorts (technically a vice admiral, equivalent to a lieutenant general). She or he leads the PHS Commissioned Corps, a uniformed service that deploys in public health emergencies, including global ones. PHS officers have deployed in response to humanitarian crises and global health pandemic responses including 2009 influenza pandemic, the 2010 Haiti earthquake, and the west Africa Ebola outbreak.

Past surgeons general have been vocal about the importance of global health. Perhaps more importantly, they also have a distinguished history of being a thorn in the side of the US presidents under which they serve by speaking truth to power on controversial public health issues. One of the most famous examples is C. Everett Koop’s educational brochure on AIDS that he mailed to every household in America in 1988, flying in the face of Reagan’s refusal to publicly reference anything related to the virus or its devastating epidemic. Considering that the position itself has relatively little authority, this kind of thought leadership that champions evidence-based approaches to public health problems, even when they are politically uncomfortable, is all the more important in a world that often looks to the US to set the standards for both science and practice in public health.

Of course, the next surgeon general’s ability to do that is limited under an administration led by a president who still acts like he’s the star of The Apprentice.

Since the election, there has been much (and very much justified) hand-wringing over clear global health setbacks, including looming budget cuts, the Global Gag Rule (and the future of reproductive rights in general), and the potential for ramped up defense spending to drive even more devastation to health through conflict. Doctors take an oath to always do what’s best for their patients. As public health professionals, we have a parallel responsibility to carry out our mission to benefit all people. Dr. Murthy’s legacy of fighting for every life – through his stances on gun control and affordable health care – are an example of this duty exercised faithfully. His final thoughts as surgeon general are striking:

We will only be successful in addressing addiction – and other illnesses – when we recognize the humanity within each of us. People are more than their disease. All of us are more than our worst mistakes. We must ensure our nation always reflects a fundamental value: every life matters.

While there is plenty to ring the alarm about outside the border, it is critical that those of us in global health also lend our voices to our public health allies whose work is focused stateside. We cannot afford to sit out US domestic public health issues, because they inevitably impact the whole world.

Global News Round Up

Politics & Policies

Taiwan is pushing for a last-minute invitation to an annual World Health Organization summit amid rising pressure from Beijing to isolate the island by blocking its participation in international events.

As the burden of such diseases shifts, and the threat of pandemics begins to hit home even in the world’s wealthiest countries, advocates are pushing for the health ministers of the G20 – gathering in Berlin later this month for the first meeting of its kind – to do their bit in supporting global health R&D in tackling neglected diseases, antimicrobial resistance and pandemic preparedness.

A federal court on Friday granted the Trump administration’s request to suspend lawsuits against the Clean Power Plan rule, signaling the likely end of President Barack Obama’s signature climate policy.

Mexico’s Lower House of Congress passed a bill on Friday to legalize the use of marijuana and cannabis for medical and scientific needs.

Liberia’s vice-president has backed US President Donald Trump’s plans to slash foreign aid, saying that the West African country “cannot continue living on handouts.”

On Tuesday night, the United States House of Representatives passed a near-unanimous resolution calling for continued US engagement on the famine in South Sudan.

While the president pooh-poohs foreign aid, health programs supported by organizations in Seattle are saving millions of lives in places like sub-Saharan Africa.

Programs, Grants & Awards

The third annual Seeds & Chips Global Food Innovation Summit started off with a panel titled “How Millennials Are Changing the Food System.”

The international conference on healthcare in a globalizing world ‘SymHealth 2017’, was held on May 4 to 6, 2017 at the Symbiosis International University (SIU), Pune.

The University of Wisconsin-Madison is celebrating a milestone with one of its new programs.  This is the end of the first year of UniverCity Year. The program paired UW students studying city planning with the city of Monona to work on projects within the community.  Next Fall, the program is partnering with Dane County to address issues like affordable housing and pollution in the Yahara waterways.

Research

In this study the prevalence of SP resistance mutations was determined among P. falciparum found in pregnant women and the general population (GP) from Nanoro, Burkina Faso and the association of IPTp-SP dosing and other variables with mutations was studied.

In lung cancer patients who were taking immunotherapy drugs targeting the PD-1 pathway, testing for CD8 T- cell activation in their blood partially predicted whether their tumors would shrink.  The results were published online by PNAS April 26.

Scientists have developed a highly sensitive, inexpensive diagnostic tool based on the CRISPR protein that targets RNA instead of DNA.

Diseases & Disasters

The largest Somali-American community in Minnesota is currently experiencing the state’s worst measles outbreak in nearly three decades.

Somalia is suffering from the largest outbreak in the past five years and the number of people killed is expected to double by the end of June, the United Nations health agency.

Liberia is sending blood samples from people suffering from an undiagnosed disease abroad. The disease had already claimed 11 lives in Sinoe County. Tests for Ebola were negative.

Owing to armed conflicts, natural disasters and increased food prices, international food insecurity rose in 2016.

Exercise addiction is not included in the Diagnostic and Statistical Manual of Mental Disorders, the authoritative guide to defining, classifying and diagnosing mental health disorders. The only behavior-associated addiction in the DSM is gambling. However, a paper that published last month in the British Medical Journal encourages health-care professionals to recognize and understand the risks of exercise addiction.

Technology

Sisu Global Health, a medical device company developing a low-cost auto-transfusion device called Hemafuse, has won the First Mile Innovation Challenge, a global call for innovative solutions that directly address clinical or community hardships in primary healthcare, conducted by The Consortium for Affordable Medical Technologies (CAMTech) at Massachusetts General Hospital’s (MGH) Global Health and GE Healthcare.

The fusion of biology and technology was used to control blood sugar levels in mice with diabetes. The idea, described in Science Translational Medicine, could be applied to a wide range of diseases and drug treatments.  The research team said the findings “could pave the way for a new era of personalised, digitalised and globalised precision medicine”.

WHO announced on Monday that the world’s first malaria vaccine will be field-tested in pilot programs in Ghana, Kenya and Malawi in 2018.

Environmental Health

According to the survey conducted by World Water Council, drinking water standards have improved considerably in India but much more needs to be done to achieve SDG WASH goals.

A new study conducted in Hyderabad, major production hub for the global drug market shows that improper waste water management has led to contamination of water resources with antimicrobial pharmaceuticals.

Equity & Disparities

A new study looks at the distribution of bed nets before and after the launch of an initiative in 2008 called Cover The Bed Net Gap to address the inequities in ITN ownership. They show that this initiative did reduce inequities but also note that some countries did better than others.

A new study reveals that 90% of development assistance goes to people below 60 years of age and that assistance to meet health targets largely ignores the older population.

Maternal, Neonatal & Children’s Health

Artemisinin combination therapies (ACTs), medications widely used against malaria, are safe to administer to women in their first trimester of pregnancy, according to research published today. ACTs had previously been recommended at that stage of pregnancy only in life-saving circumstances.

In a six year trial involving over 20,000 women in 21 countries, researchers have shown that a blood clotting drug tranexamic acid invented in the 1950s reduced maternal bleeding deaths by about a third if given within 3 hours.

A new national survey reveals that American toddlers are more likely to eat french fries than vegetables on any given day. According to the study, one in four 6-11 month old and one in five 1 year olds had no reported vegetable consumption on the days they were surveyed.

Human Rights

According to anti-trafficking NGO and Nepal’s National Human Rights Commission, human trafficking is still on the rise, a trend that seems to continue two years after the devastating earthquakes.  

According to a new report called “Impunity Must End”, nearly 106 Syrian hospitals were hit in 2016 and that aggression against health care facilities and workers continues even after the passing of UN resolution 2286.