APHA Component letter to @UNAIDS: South Korea’s #HIV immigration restrictions

After two years, two APHA policy statements (one interim and one permanent), dozens of e-mails (and perhaps just as many drops of blood, sweat, and tears), and a few phone calls, we have finally sent a letter to UNAIDS urging it to revoke its recognition of South Korea’s status as a country without any HIV restrictions – until it actually produces and enforces policies that actually reflect that status.

Heartfelt thanks to Dr. Laura Altobelli, our Section Chair; Mona Bormet, our Advocacy/Policy Committee’s advocacy coordinator; and all of the Components who signed on to this hard-won letter (and the policy proposals that led up to it):

If there is one thing I have learned through this odyssey, it is that the work of advocacy is exhausting. It takes the old adage of “marathon not sprint” to a whole new level. The patience required to work within the boundaries, and according to the rules, of whatever framework you are trying to leverage to produce change can be maddening at times, but I suppose that is the inevitable price we pay to work with others. The larger your advocacy “vehicle” is, the more likely it is to be effective, but the more restrictions you have to work within. Or around, as the case may be.

On a more positive note, we also got a corresponding policy approved for adoption by the World Federation of Public Health Associations at their assembly (which kicked off today!). It will be posted here as soon as it is published, with potentially more letters to follow. Stay tuned.

The full text of the letter, followed by an embedded PDF, is below.

Dear Executive Director Dr. Michel Sidibé:

On behalf of the International Health Section of the American Public Health Association (APHA), we write to notify you of a new APHA policy statement, “Opposition to Immigration Policies Requiring HIV Tests as a Condition of Employment for Foreign Nationals,” which was adopted at the Association’s 2016 Annual Meeting.1 As you may know, APHA was founded in 1872 and is the oldest organization of public health professionals in the world. It has a long-standing commitment to promoting global health and protecting human rights, recognizing that these two go hand-in-hand.

HIV-related travel restrictions are recognized as a violation of human rights and have been well-established as ineffective at reducing the spread of HIV. Such policies further marginalize people living with HIV/AIDS (PLWHA), discourage people from accessing HIV testing and treatment, and reinforce stereotypes and discriminatory attitudes against PLWHA in the general population. According to APHA’s policy statement, “[immigration] policies that mandate HIV testing of [foreign nationals] as a condition of obtaining a visa for employment…have no basis in science and violate migrant workers’ human rights to confidentiality and informed consent to testing, exposing them to exploitation by their employers.”

Increasing awareness of the harms of mandatory testing and accompanying pressure from multilateral institutions and human rights advocates has begun to prompt countries to lift travel bans and change their immigration policies. We recognize that UNAIDS has been instrumental in this effort and laud the organization both in its leadership on this initiative and the progress that it has made. APHA’s policy statement specifically cites the work of the UNAIDS International Task Team on HIV-related Travel Restrictions and notes that “[a]dvocacy efforts using [the Task Team’s findings] have resulted in several countries loosening these restrictions or, in some cases, dropping them entirely: the number was reduced from 59 to 45 countries in 2011 and, as of September 2015, to 35.” APHA’s policy statement calls on UNAIDS and others to “continue to call on all countries that still maintain and/or enforce HIV-related restrictions on entry, stay, or residence to eliminate such restrictions, ensuring that all HIV testing is confidential and voluntary and that counseling and medical care be available to all PLWHA within its borders.” We urge UNAIDS to continue this work to make further progress in the remaining countries that enforce HIV travel restrictions.

The policy statement also recommends that “UNAIDS take steps to ensure that its protocols to research and investigate countries’ HIV-related travel restrictions are sufficiently thorough by monitoring and documenting any reported instances of HIV-related discrimination targeting immigrants, particularly when presented with evidence demonstrating that recognition of a country’s removal of HIV-related travel restrictions is unwarranted, in order to ensure that governments are not able to misrepresent their policies in order to gain undeserved recognition for supporting human rights with regard to HIV/AIDS.”

One such example of misrepresentation of HIV-related immigration policy can be found with the Republic of Korea (ROK), which subjects foreign nationals applying for visas to work or study under several visa categories to mandatory HIV testing.2,3 Recent decisions by the UN Committee on the Elimination of Racial Discrimination4 and the National Human Rights Commission of Korea5 both confirm the ongoing existence and enforcement of mandatory testing for E-2 visa applicants and recommend that they be struck down. Unfortunately, despite this discriminatory requirement, ROK representatives declared at the 2012 International AIDS Conference that their government had removed all HIV-related travel restrictions and, as a result, the country was granted “green” (restriction-free) status by UNAIDS6, while other states with HIV-related restrictions similar to those enforced by ROK7 are still classified as “yellow” on this map. This inconsistency in the application of UNAIDS’ assessment criteria could threaten the progress made on reducing HIV-related travel restrictions. We strongly urge UNAIDS to revoke ROK’s status as a country with no HIV-related travel restrictions until it eliminates all mandatory HIV testing policies.

Finally, we express our continued commitment to the UNAIDS goals of reducing HIV transmission, fortifying the rights of all who live with HIV/AIDS, and eliminating stigma and discrimination.

Sincerely,

Laura C. Altobelli, DrPH, MPH
Chair, International Health Section

Willi Horner-Johnson, PhD
Chair, Disability Section

Randolph D. Hubach, PhD, MPH
Chair, HIV/AIDS Section

Lea Dooley, MPH, MCHES
Chair, Population, Reproductive, and Sexual Health Section

Gabriel M. Garcia, PhD, MA, MPH
Chair, Asian Pacific Islander Caucus

Titilayo A. Okoror, PhD
Chair, Caucus on Refugee and Immigrant Health

Gabriel Galindo, DrPH, MPH, CHES
Chair, LGBT Caucus of Public Health Professionals

Benjamin Mason Meier, JD, LLM, PhD
Chair, Human Rights Forum


https://aphaih.files.wordpress.com/2017/04/apha-rok-hiv-travel-restrictions-letter.pdf

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Vaccine Ping-Pong: GAVI and MSF’s Advocacy Campaign for Vaccine Access

MSF (Médecins Sans Frontières, also known as Doctors Without Borders) recently posted a set of three animated videos about child vaccines as part of their latest advocacy campaign. The first one, titled “We Need Better Tools to Save Lives” is pretty straightforward – it’s a basic explanation of what is needed to vaccinate children, how MSF struggles to fill that need, and a quirky analogy about what it is like to not have that need filled. Simple enough.

The second video is a lot more direct. The show how the number of vaccines in the standard childhood vaccination battery, as well as the cost of those vaccines, have increased in the last decade. The video then takes a direct shot at pharmaceutical companies for keeping vaccine prices high in order to prioritize profits over saving lives. The debate on drug prices is a heated one, and everyone seems to have their own opinion on what “fair prices” for drugs are, but it is clear where MSF stands.

The last video was the one I personally found to be the most interesting. “Dear GAVI, Please Let Us Access Your Discounted Vaccine Prices” talks about how qualified governments are allowed to access GAVI’s low vaccine prices, but NGOs are not given access to them. MSF provides a more detailed description of their perspective on the issue in this press release:

MSF is also troubled by the fact that non-governmental organizations and humanitarian actors are excluded from accessing the GAVI-negotiated price discounts. MSF is often in a position to vaccinate vulnerable groups, such as refugee children, HIV-positive children, and older unvaccinated children who fall outside of the typical age range for standard vaccination programs. However, MSF has not been able to systematically access the lowest prices negotiated by GAVI, having to resort to lengthy negotiations with Pfizer and GSK over the last four years to access the pneumococcal vaccine. While the companies have offered MSF donations, this is not a sustainable, long-term solution for MSF as we work to respond quickly to needs in the field, and wish to expand vaccination of vulnerable groups in an increasing number of countries.

GAVI responded to the MSF campaign in this statement:

First, we agree with MSF – we do all want the same things. We want all children everywhere to be protected by immunisation. In fact, GAVI is proud to include MSF as a member of the GAVI Alliance. They are an active member of the steering committee of the GAVI Board’s Civil Society Organisation Constituency.

MSF first formally raised the issue of access to the same prices GAVI pays for vaccines at the GAVI Board meeting in December 2012. This issue is currently being discussed through the Alliance’s Governance channels. We find it disappointing that MSF, which knows and is engaged in the GAVI Governance process, has chosen to take on this issue as a public campaign.

MSF then offered this statement in response:

Thank you GAVI for publicly acknowledging our request for access to your vaccine prices. MSF has been frustrated by bilateral discussions, which have been ongoing for a few years now, with vaccine manufacturers and the GAVI Alliance on finding a solution for humanitarian actors to access pneumococcal conjugate vaccine at the GAVI price, and we anticipate that accessing GAVI prices for other new vaccines (for rotavirus, HPV) will also be a challenge. We ask GAVI to fast-track this process so that MSF can vaccinate more kids as soon as possible.

We often talk about issues of coordination (or lack thereof) and collaboration between different aid groups and funding organizations in the wake of natural disasters and humanitarian crises. It is interesting to see this kind of friction between different groups who are trying to do exactly that because of how complicated it can actually be.



To protect children right now, we have to use vaccines that aren’t well suited to the job they have to do. Vaccines can’t take the heat — they have to be kept at between 35 and 46 degrees at all times. But we need to use them in some of the hottest places on earth. For this and other reasons, we need better-adapted vaccines to protect children from life-saving illnesses.



Children are now protected with 11 vaccines; up from six vaccines a decade ago. The price of vaccinating a child has sky-rocketed. It cost $1.37 to vaccinate a child 10 years ago, now it’s $38.80. That’s a whopping 2,700 percent increase. So how do we decide how many vaccines children need? Is it based on how much money you can make, or on how many children’s lives can be saved?



The price to vaccinate a child has risen by 2,700 percent over the last decade. Countries where Doctors Without Borders/Médecins Sans Frontières (MSF) works will lose their donor support to pay for vaccines soon, and will have to decide which killer diseases they can and can’t afford to protect their children against. MSF is asking the GAVI Alliance to open up their discounted vaccine pricing to humanitarian actors that are often best placed to respond to vaccinating people in crisis.

The GAVI Alliance is an international public-private partnership whose stated mission is to increase access to immunization for children in poor countries. GAVI co-finances the cost of vaccines with qualifying countries. Participants include governments of developing and donor countries, the World Health Organization, UNICEF, the World Bank, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other philanthropic organizations.

Annual Meeting, Day 2: A Visit to the Hill, Refugees, and the Awards Dinner

This morning I got a preview of what those of you who are signed up for Thursday’s Advocacy Day will experience.  Since I will not be able to stay in DC until Thursday, I decided to take some time while I was here to visit the office of my own Congressman, Representative Michael McCaul.  While the Congressman was not able to meet me himself, I spoke with DoD fellow Christian Lyons (who manages his foreign affairs portfolio) and made my case for global health funding.  While he was very polite and expressed support for my concerns, he was just as eager to raise some issues of his own, so be prepared to answer questions and be on your toes!

After a long walk back from Capitol Hill, I took my “passport” to the Public Health Expo, determined to put my name in for the drawing (go free registration for APHA12!).  Walking around the expo is a great way to scope out job opportunities, pick up stress balls, and get free smoothies.  For me, it is also a great way to get comfortable with meeting and talking to people.  If networking does not come naturally to you (it has always been awkward for me), the best way to get good at it is to practice.

In the afternoon, I attended a session on refugee health.  Those presentations were particularly interesting to me, as I have done some research and writing on the side related to displacement and refugee health issues.  We heard from researchers who work with refugee populations, as well as a very interesting presentation from a representative from Physicians for Human Rights.

At the IH Social this evening, members got together to chat, make connections, and reminisce as we honored this year’s section awardees.  Congratulations to all of this year’s award winners.  Pictures will follow soon!

Global Health News Last Week

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe. Interested parties should register here. Please note that registration will close on October 14th. Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.


POLITICS AND POLICY

PROGRAMS

  • Sanitation and hygiene are sensitive and unpopular subjects, but funding them is essential to fighting disease, ensuring basic rights and meeting millennium development goals.
  • The Gates Foundation’s European director Joe Cerrell comes to the defense of the beleaguered Global Fund to Fight AIDS, TB and Malaria, arguing to improve on its “impressive record and ensure that millions more lives are saved and the progress against global disease is secured for generations to come.”
  • Almost four months into the Horn of Africa crisis, aid agencies are involved in much soul-searching as to whether they could have responded more quickly to the drought and famine.

RESEARCH AND INNOVATION

  • A Japanese company, the Sumitomo Chemical Company, unveiled a new kind of insecticide treated bed net at a product launch in Kenya.
  • Pregnant women who load up on fruits, veggies and whole grains have a reduced risk of having babies with neural tube defects, such as spina bifida or cleft lip, according to one of the first studies to look at the connection between diet and birth defects.
  • A study by Stanford researchers has determined that infant health can be improved when a mother has a low-fat high fiber diet up to a year prior to getting pregnant.
  • A study published in the British Medical Journal says that if current smoking trends continue until 2050, TB related deaths will jump by 40 million.
  • Though young, there is a lot of potential in what mHealth can offer in developing countries. Amanda Glassman shares some ways that it can be improved.
  • Researchers at the University of Washington have reported some highly problematic findings regarding a common method of birth control in eastern and southern Africa. They are problematic in that they indicate a popular injectable hormone, Depo-Provera, used by perhaps 140 million women worldwide (and often in poor settings) signficantly raises a woman’s risk of HIV infection.
  • Test subjects in a Spanish HIV vaccine trial have shown a 90 percent immune response.

DISEASES AND DISASTERS

  • A cohort of American and British researchers say that by investing in AIDS treatments, money can be saved in the long term.
  • What should be the top priorities in global health? Infectious diseases? Neglected tropical diseases (NTDs)? Non-communicable diseases (NCDs)? A research scientist wonders at the confusion amid this sea of bad acronyms.
  • Former US President Carter is leading the fight against guinea worm making a request that WHO members provide $93 million in funding to wipe out the disease.  DfID has committed to support the push against guinea worm by announcing it will allocating £20 million to the effort.
  • The business news channel CNBC has published an extensive report on the lucrative and growing Dangerous World of Counterfeit Prescription Drugs.