Global News Round Up

Politics & Policies

Donors have lost their focus on aid effectiveness in the last decade, limiting aid’s impact. Here we report on new results of one of the few measures of aid “quality” – the Quality of Official Development Assistance (QuODA).

The US midterm election was a partial rebuke to President Donald Trump. But although Trump’s legislative agenda has largely come to an end, his ability to affect global health through non-legislative means remains vast.

One of the largest Ebola outbreaks in history shows no signs of slowing — and the Trump administration barred US health experts who want to help at the outbreak’s epicenter in the Democratic Republic of Congo from traveling there.

The British parliament is urging the government of Prime Minister Theresa May to make antimicrobial resistance (AMR) a ”top five policy priority” in a new report.

Programs, Grants & Awards

On November 4-6, 2018, Health and Human Services Deputy Secretary Eric Hargan will attend the Fifth Global Health Security Agenda (GHSA) Ministerial Meeting in Indonesia, which will officially launch the next five-year phase of GHSA, known as GHSA 2024.

Research

Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys.

We provide new empirical and methodological findings problematising evidence, evaluation and measurement when using asset-based approaches and co-production to improve health and address inequalities.

CDC’s global health security work focuses primarily on countries with weaknesses in their health systems, because these countries are vulnerable to global disease threats that could adversely affect the health and economy of the United States at the national, state, and local levels.

Diseases & Disasters

Food, clothes, medicine: the people of Yemen just want the same life as us.  After spending years amid Yemen’s devastation, we have seen conflict and hardship overtake millions of ordinary people.

Scientists believe the STD mycoplasma genitalium—Mgen—infects 1-3% of the population. However, it often doesn’t cause symptoms or is easily confused with better-known conditions.

The first treatment for sleeping sickness that relies on pills alone was approved recently by Europe’s drug regulatory agency, paving the way for use in Africa, the last bastion of the horrific disease.

Although the WHO has not yet declared the latest Ebola outbreak an international public health emergency, its latest report warned that the volatile security situation is making the risk of disease spread to neighboring countries very high.

The withdrawal of a major international aid organization threatens to leave tens of thousands of tuberculosis patients in North Korea without the medication they need and could spiral into a severe crisis if it is not addressed soon, according to health experts familiar with the situation in the North.

Technology

Cancer scientists have combined ‘liquid biopsy,’ epigenetic alterations and machine learning to develop a blood test to detect and classify cancer at its earliest stages.

Low levels of public confidence in vaccines in the European Union are pushing immunization rates down and the number of disease outbreaks up, according to an expert report.

Environmental Health

Air pollution is a silent public health emergency, killing 7 million people every year and damaging the health of many, many more.  Despite this epidemic of needless, preventable deaths and disability, a smog of complacency pervades the planet.

Equity & Disparities

Women provide most of the world’s frontline health care in their roles as nurses and community health workers, but they are underrepresented in leadership positions.

Women, Maternal, Neonatal & Children’s Health

In a call for concrete policy pledges from governments across the world to tackle the problem, the UN health agency reports that more than nine in 10 youngsters breathe air that is so polluted, “it puts their health and development at serious risk”.

Many migrant children separated from their parents at the U.S. border, some of them very young, have landed in shelters where they often experience stress, neglect and minimal social and cognitive stimulation. The latest findings tell a cautionary tale about the psychiatric and social risks of long-term deprivation and family separation as children transition to adolescence.

About 80 percent of an estimated 8 million children in orphanages or other institutions are not orphans, according to Lumos, a charity founded by “Harry Potter” author J.K. Rowling, which aims to have no children living in institutions by 2050.

 

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New American Public Health Association policy statements address gun suicides, tuberculosis prevention, global food security and more

Summaries of 2018 APHA policy statements adopted by the Governing Council in San Diego

San Diego, Nov. 13, 2018 – The American Public Health Association Governing Council adopted 12 new policy statements at its 2018 Annual Meeting and Expo in San Diego today, covering topics from gun suicides to tuberculosis prevention, global food security and more.

The following are brief descriptions of the 12 policy statements adopted by the Governing Council at the Annual Meeting. One of the new policy statements is a latebreaker, meaning it was not open to the same review as the other 2018 policy statements and will serve as an interim policy statement until reviewed by the Governing Council at its regular 2019 meeting. For more information on any of these policy statements, email policy@apha.org.

These brief descriptions are not comprehensive and do not include every point, statement or conclusion presented in the policy statements. For the full policy statements, which will be posted in early 2019, visit www.apha.org.

20181 Reducing global child mortality rates — Noting that one child younger than 5 worldwide dies of diarrhea every minute and that oral rehydration salts and zinc treatment can prevent many such deaths, calls on federal officials to appoint a U.S. global “Children’s Champion” charged with coordinating U.S. activities to reduce diarrhea-related mortality and serving as a global voice for children’s health. Encourages U.S. global health programs to fund investments to improve the supply of oral rehydration salts and zinc, fund innovations in home-based diarrhea treatment, and train local health providers in treatment guidelines, among other measures. Urges public health professionals and organizations to support efforts to reduce diarrhea-related deaths in young children and work toward increasing public-private partnerships that scale up oral rehydration salts and zinc treatment by at least 30 percent within three years.

20182 Addressing potential health impacts of fracking — Because unconventional oil and gas extraction — often known as fracking — poses a range of known and unknown risks to public health and the environment, including risks to drinking water, air quality and worker health, recommends that unconventional oil and gas development cease and that a strategic phase-out of existing development be encouraged where possible. Calls for policies that explicitly compare the economic and public health trade-offs of fracking, that require environmental impact assessments and that minimize greenhouse gas emissions. Encourages federal, state and local agencies to adopt a precautionary approach to unconventional oil and gas activities, including discouraging the use of chemicals with unknown health risks. Also calls for the elimination of unconventional oil and gas exemptions from federal worker safety rules and encourages federal health officials to establish an industry-wide worker health registry.

20183 Ensuring a healthy energy future — As communities move toward to non-fossil fuel and alternative energy sources, calls on stakeholders across sectors to monitor, evaluate and support effective strategies to transition to healthier, more efficient energy supplies. Regarding coal, calls on the Mine Safety and Health Administration to vigorously enforce worker health and safety standards. Also calls on officials to suspend new coal-fired power plants and cancel plans for future plants. Urges Congress to set fuel economy and emissions standards for vehicles, and urges car manufacturers to begin a complete phase-out of fossil fuel-dependent vehicles. Encourages federal officials to develop effective energy efficiency standards for homes and commercial buildings, and calls on people, families, businesses and governments to expand the adoption of alternative energies, such as wind and solar.

20184 Reducing gun-related suicides — With U.S. suicide rates increasing by nearly one-third over the last 20 years and considering that guns are involved in more than half of U.S. suicide deaths, calls on advocates and professional associations to adopt and promote guidelines for mental health providers on screening for guns in the home and to equip them with information on local offsite gun storage options. Urges state public health agencies to collaborate with public safety and mental health agencies to advocate for increasing the availability of temporary gun storage outside the home. Calls on public health agencies to partner with gun owners and suicide prevention professionals to advocate for increased funding for gun-related suicide research, including research on developing effective marketing campaigns on gun-related suicide prevention.

20185 Understanding, treating violence as a public health issue — With national data showing an increase in violent deaths, such as gun-related homicides and suicides, as well as research finding long-term health effects from childhood exposures to violence, calls on health departments to collect, analyze and report data on violence, including details on how violence impacts historically marginalized communities. Encourages community health programs to start programs that detect and interrupt the transmission of violence using professionally trained workers. Also encourages health providers to screen patients for domestic violence, past exposure to violence and behavioral problems that can lead to violence, all while using a trauma-informed and culturally competent approach. Calls on federal, state and local governments to invest in public health approaches to violence prevention, and recommends that federal agencies help establish an active surveillance system for monitoring violence in communities.

20186 Regulating electronic nicotine delivery products — With the use of electronic nicotine delivery systems increasing among all U.S. demographic groups and little known about their long-term safety or efficacy in helping people quit cigarettes, calls on the Consumer Product Safety Commission to add nicotine to its list of substances covered by regulations and to require special packaging and warning labels for such products. Also calls on Congress to amend the Prevent All Cigarette Trafficking Act to include electronic nicotine delivery systems. Encourages federal agencies and health organizations to fund research on the short- and long-term health effects of such products on both users and those subject to secondhand exposures. Calls on state and local officials to enact laws prohibiting the use of electronic nicotine delivery systems in enclosed public spaces and places of employment.

20187 Preventing tuberculosis among health workers — With tuberculosis causing nearly 2 million deaths worldwide in 2016 and with health care workers at higher risk of infection than the general population, urges national and state governments to develop and implement policies that strengthen workplace health and safety programs that focus on prevention and education. Calls for workers’ compensation programs that provide adequate tuberculosis treatment and counseling, paid leave and death benefits. Recommends workplace programs that have rigorous respiratory protection components, improve exposure control efforts inside hospitals, promote new diagnostic strategies, and provide counseling to help workers cope with the side effects of tuberculosis treatment. Calls on the Centers for Disease Control and Prevention to increase funding for tuberculosis research, including more support for research efforts focused on developing a vaccine for the disease.

20188 Advancing the health of refugees — With global instability contributing to historic levels of displaced people and knowing that refugees face significant health challenges, calls on the U.S. government to fully invest in and cooperate with the international community in efforts to prevent conflict and to reaffirm the New York Declaration for Refugees and Migrants and its goal of coordinating a multi-sector response to the refugee crisis. Encourages U.S. officials to work with state and local partners to coordinate housing, educational and health needs among refugees. Urges health care systems and providers to tailor their services to meet the needs of refugees, including the use of trauma-informed, culturally competent care. Calls on the U.S. government to work cooperatively to ensure safe passage for refugees, and urges the international community to adopt legal protections for displaced people.

20189 Achieving health equity in the U.S. — With research documenting clear disparities in morbidity and mortality, particularly among racial and ethnic minority groups, calls on federal officials and members of Congress to fully fund the Affordable Care Act, the National Prevention Strategy and Implementation Plan, and the National Partnership for Action to End Health Disparities. Calls on federal public health agencies, as well as public health organizations, to develop and implement evidence-based toolkits that communities can use to reach vulnerable populations. Calls on state and local officials to support social policies to improve education, income, housing, jobs and transportation, and urges state and local government to work with urban planners and health professionals to integrate health considerations into planning, policy and decision-making. Encourages people and communities to advocate for the enforcement of civil rights and disability laws.

201810 Supporting global food security — With hunger still a daily challenge for more than 815 million people worldwide, calls on U.S. leaders to ensure adequate funding for U.S. Agency for International Development programs that improve food security and encourages leaders to fund efforts focused on preventing and mitigating the effects of climate change on world food production. Encourages U.S. leaders to sign or ratify relevant United Nations conventions that support food security, such as the Convention on the Rights of the Child, the UN Resolution to Support Breastfeeding, and the Convention on the Elimination of All Forms of Discrimination Against Women. Urges the U.S. government, foundations and other donors to mobilize funding and resources to increase the scale, scope and impact of food security efforts. Calls on U.S. officials to support the creation of a system to collect and interpret global dietary data.

201811 Addressing police violence as a public health issue — With law enforcement violence — including death, injury, trauma and stress — often disproportionately affecting marginalized populations, calls on federal agencies, localities and states to add death and injury by legal intervention to their list of reportable conditions. Calls on Congress to fund the National Institute of Justice and the Centers for Disease Control and Prevention to conduct research on the health consequences of law enforcement violence, with a particular focus on disproportionate burdens among people of color, people with disabilities or mental illness, people living in poverty, people experiencing homelessness, immigrant populations, and lesbian, gay, bisexual and transgender populations. Urges governments and law enforcement agencies to review policies that can lead to disproportionate violence against specific populations. Calls on governments to allocate funding from law enforcement agencies to community-based programs that address violence and harm without criminalizing communities, including restorative justice programs.

LB-18-12 Opposing family-child separations at the U.S. border — With the separation of immigrant children and families at the U.S.-Mexico border a public health crisis with the potential for long-lasting negative health impacts, calls on federal officials to permanently halt such separations unless there is an imminent, ongoing threat to the child’s safety in a respective parent’s care. Urges the federal government to collect relevant data to ensure that children and parents can be located if separated. Calls on federal officials and agencies, as well as contractual partners, to offer culturally competent resources and support to reunite separated families. Urges public and private funding agencies to support additional research to understand the mental, physical, spiritual and cultural consequences of separating families, including the separation of lactating mothers and their babies. Recommends that such research examines the roles and history of racism, xenophobia and inequality in the creation of family separation policies.

IH Section’s Mentoring Applications OPEN

The Global Health Mentoring Program applications for mentors and mentees is now open. Applications and information on the program can be found here: https://aphaih.org/global-health-mentoring-program/

Applications for this cohort (January 2019 – September 2019) will be accepted until November 29, 2018  at 11:59 PM US Eastern Time.

For questions please email: ih.gh.mentoring@gmail.com

Dengvaxia’s FDA Priority Review: Is the global health community settling on a Dengue vaccine?

The Food and Drug Administration (FDA) announced on October 30th that Dengvaxia’s, Sanofi Pasteur’s dengue vaccine, file has been accepted for priority review within the regulatory agency. With this announcement, the FDA will ensure that a decision will be declared on approval in the United States within six months for the world’s first licensed vaccine protecting against this flavivirus. While this declaration by the FDA displays an improved pragmatic approach to addressing neglected tropical diseases (NTDs), this vaccine has created controversy throughout the global health community. This vaccine is licensed in twenty countries to date and implemented into country wide vaccination programs. However, the concerns accompanying this recombinant, live, attenuated, tetravalent dengue vaccination have led to a discontinuation of this technology with a loss of confidence in several nation states. The Philippines, the first country to complement their vaccination program with this vaccine, has even instructed Sanofi to reimburse the $70 million the country spent to vaccinate 830,000 children. This has caused many global health experts to doubt the impact this vaccine can have throughout the world – causing many to wonder if the global health community is settling on a dengue vaccine.

The dengue virus is estimated to cause 400 million infections each year spanning each of the World Health Organization’s (WHO) regions. This arbovirus belongs to Flaviviridae family and is spread to humans through the bite of an infected female Aedes aegypti mosquito and to a lesser extent from the Aedes albopictus species. The dengue virus has four unique serotypes, DEN-1, DEN-2, DEN-3, and DEN-4, which has caused an effective vaccine to be eluded for centuries. When a person is infected with one certain serotype, the person gains life-long immunity to that serotype. However, if that person contracts a different serotype, it increases the risk of the person developing severe dengue. This phenomenon is called antibody-dependent enhancement (ADE) which allows the different serotype to enter cells more efficiently due to the previously created antibodies from the initial serotype. The symptoms that dengue causes depend on primary or secondary infection. Primary infection results in an acute febrile illness that is typically cleared by the immune system within seven days, while secondary infection can lead to dengue hemorrhagic fever or dengue shock syndrome causing serious morbidity and mortality. The dengue virus currently has no approved treatments – highlighting the importance of an effective and safe vaccine for children and adults alike.  

The significant setbacks for Dengvaxia first arose when Sanofi Pasteur released interim studies concerning children aged 2 to 16 receiving the vaccine who were seronegative. This information was released on November 29, 2017 and revealed that among dengue-seronegative participants, recipients had increased rates of hospitalization for virologically confirmed dengue (VCD) and severe VCD in the vaccine group than in the group not administered the vaccine. These risks were significantly elevated in patients who were aged 2 to 8 years of age and became evident earlier than those aged 9 to 16 years of age. When this data became available, it led to the Strategic Advisory Group of Experts on Immunization (SAGE) of the WHO to reconvene and update their guidance on Dengvaxia. On April 18, 2018, SAGE recommended that for countries considering implementing Dengvaxia, every individual should be screened to determine their serological status with only seropositive persons receiving the vaccine.

The flavivirus genus includes other NTDs including the Zika virus, Japanese Encephalitis, West Nile Fever and Yellow Fever in addition to the Dengue Virus. The symptoms of each these ailments can present almost identically, especially in their milder forms, seeming almost flu-like in nature. When considering these identical disease presentations and the WHO’s recommendation to prescreen individuals for Dengvaxia, health care professionals must turn to dengue serological testing to ensure best practice – if the vaccine is accidentally given to a person with, for example, the Zika virus with no previous case of dengue due to a misdiagnosis from medical history, this would increase the risk of morbidity and mortality if dengue was contracted subsequently. The gold standard for serological testing is isolation and characterization of the virus, like PCR; however, this typically takes six or more days to receive the results and can be burdensome with it’s cost on a public health care system. A more common approach is enzyme immunoassay (ELISA) which is cost effective and less time consuming. However, in areas where two or more of the aforementioned flaviviruses exist, there is IgG cross reactivity between the viruses causing false positives for the dengue virus when ELISA is used. This often rules out the use of ELISA due to a common vector, Aedes aegypti, being able to spread two or more of these viruses within the same zone. Since the dengue virus is endemic throughout the developing world, dedicated health care professionals in these areas often don’t have funds, technology, or training in order to utilize the gold standard, PCR, in dengue testing — further highlighting the health disparities that exist on this earth. This leaves a major barrier to giving proper care to a large portion of humanity including administering this vaccine safely.

With the addition of rapid, accurate dengue test for the serological status of individuals that is in the pipelines (although no estimate of how soon it will be developed has been released yet), this vaccine will certainly find its niche in the global health society. However, this niche will exclude an enormous percentage of humans that would benefit from a safe and effective dengue vaccine. Those individuals that are currently seronegative and those who don’t have access to well-funded public health care system will continue to be at risk for developing the fatal consequences of the dengue virus. Global health leaders need to continue to promote and demand a vaccine that will ensure protection for a greater majority of people. Although this vaccine will serve some well, health care professionals must not settle until the dengue virus and each neglected tropical disease is properly addressed.

Attending APHA in San Diego this year? Visit us at one of our IH section events or meetings and attend our sessions!

We hope that you are as excited as we are for the 2018 APHA Annual Meeting in San Diego! The APHA Annual Meeting represents the largest delegation of public health professionals of its kind and provides opportunities to learn, network with your peers and participate in meaningful public health discussions.

We believe that the greatest opportunity to get engaged and make the most of your APHA membership is through participation in your APHA Sections or Special Interest Groups (SPIGs), so we strongly encourage you to attend our business meetings and socials.  It’s a great way to network with your colleagues in the field of International Health and learn how to become more involved in our Section.  Below are a few events you may find beneficial to add to your calendar. Check out our complete IH section program list at APHA here: APHA 2018 – IH program highlights

International Health Special Sessions 

Session 3338.0  Forty Years since Alma Ata:  Achieving Health for All – Past, Present, and Future

Monday, November 12, 3:00 pm -4:30 pm: Collaborative Session (APHA Global Health-IH-MCH)

Session 4166.0 Health, Health Equity, and War: What is Happening in Yemen, Mexico, Syria and Gaza?

Tuesday, November 13, 10:30 am – 12:00 pm

Session 4274.1  Defending Women’s Rights in the Context of the Global Gag Rule

Tuesday, November 13, 1:00 pm – 2:30 pm:  Collaborative Session (IH-RSH)

International Health Section Awards Reception and Open House

Session 444.0  Tuesday, November 13, 6:00 pm – 9:00 pm.  (all IH members are welcome)

International Health Luncheon

Session 511.0  Wednesday, November 14, 12:30 pm – 2:00 pm  (tickets required)

International Welcome Desk

Please visit the International Welcome Desk next to the APHA Meeting Registration Area to let us know you arrived and to ask any questions.

IH Section Booth at the Public Health Expo

You can also visit us at the International Health Section booth in “Everything APHA” located in the Public Health Expo.  We would enjoy telling you about our Section benefits and learning from you what would be meaningful to you as an IH Section member in the future.

If you are new or need a refresher on getting the most out of the Annual Meeting, please join us at the Navigate & Network event on Sunday morning (details below).

Navigate and Network: APHA 2018

Sunday, November 11, 9:30 – 11:00 AM, Ballroom 6CF – SDCC

Please do not hesitate to contact Jay Nepal, membership committee co-chair at jnepal360@gmail.com, if you have any questions or comments.

We look forward to see you in sunny San Diego!