SPECIAL NOTICE

1. Special Notice Regarding Changes to the GlobalHealthReporting.org Weekly TB/Malaria Report
[Apr-23-2009]

MALARIA

2. Affordable Medicines Facility for Malaria Announces $225M Initiative To Reduce ACT Cost, Curb Malaria Drug Resistance
[Apr-20-2009]

3. African Countries Call for Increased Efforts To Combat Malaria Ahead of World Malaria Day
[Apr-23-2009]

4. Stakeholders Must Exert 'Extreme Vigilance' To Control Malaria, U.N. Special Envoy for Malaria Chambers Says
[Apr-21-2009]

5. Malaria Remains Major Public Health Problem in The Gambia, Health Official Says
[Apr-22-2009]

TUBERCULOSIS

6. Lancet Examines Call to Action on TB Control Developed at Beijing Meeting
[Apr-17-2009]

7. Inter Press Service Examines TB Epidemic, Efforts To Fight Disease in Swaziland
[Apr-23-2009]

8. International Community Should Ensure Access to Diagnostic, Treatment Services To Control TB in Africa, Blog Entry Says
[Apr-21-2009]

9. Nigeria's High TB Prevalence Result of Inadequate Awareness, Reluctance To Seek Treatment, Health Official Says
[Apr-20-2009]

GLOBAL HEALTH

10. 15 African First Ladies Meet in Los Angeles To Promote Health, Development Initiatives
[Apr-22-2009]

11. New High-Level Commission Will Examine Strategies for Maximizing Global Health Aid
[Apr-22-2009]

12. Lancet Examines Concerns That Obama Administration Could Flat-Line PEPFAR Funding
[Apr-17-2009]

13. Shortage of HIV/AIDS, TB, Malaria Drugs in Ugandan District Could Lead to Treatment Interruption, Drug Resistance
[Apr-17-2009]

SPECIAL NOTICE

On April 27, a new section of the Kaiser Family Foundation’s main Web site, kff.org, focusing on U.S. global health policy, will replace GlobalHealthReporting.org. This new section will provide U.S. policymakers, non-governmental organizations, journalists and others working in the global health arena with timely information, including daily news summaries, a policy tracker tool, and original research and analysis. This new section incorporates a number of key elements from GlobalHealthReporting.org, including the Kaiser video library of rights-free global health-related cover footage. Select content from the Weekly TB/Malaria Report will be included in the new Kaiser Daily Global Health Policy Report, which email subscribers will begin to receive next week.

Back to Top

MALARIA

The Affordable Medicines Facility for Malaria on Friday announced plans to reduce the price of artemisinin-based combination therapies with a $225 million subsidy program, the New York Times reports. The campaign, launched in Norway, aims to prevent malaria-associated mortality and curb the spread of drug resistance (McNeil, New York Times, 4/17). According to Reuters, the Global Fund To Fight AIDS, Tuberculosis and Malaria will manage the project, and the British government and the international drug purchasing facility UNITAID will provide financial support. In addition, the project will receive technical support from the Roll Back Malaria Partnership and a consortium of public and private organizations that includes the World Bank, UNICEF, the Bill & Melinda Gates Foundation, the Clinton Foundation and the Dutch government (Acher, Reuters, 4/17). According to the Times, the U.S. has not contributed to the project at this stage.

Although early plans for the campaign include a $1.9 billion budget, the organizers intend to run the $225 million initiative as a pilot project (New York Times, 4/17). The pilot program will be launched in Cambodia and 10 African countries: Benin, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda. The project organizers intend to expand the project to additional countries in the future, the AP/San Francisco Chronicle reports (AP/San Francisco Chronicle, 4/18). According to the Times, the campaign aims to encourage drug manufacturers to reduce the cost of ACTs by lowering the wholesale private-sector price from $4 per treatment to $1 per treatment and using donor funds to subsidize 95 cents of that dollar. By lowering the wholesale prices to five cents, the stakeholders hope to drive down retail prices enough to curtail the use of older, less-effective malaria drugs, which can contribute to drug resistance (New York Times, 4/17). According to the AP/Chronicle, the subsidy program could reduce retail ACT prices from $6 to $10 per dose to 20 cents to 50 cents per dose (AP/San Francisco Chronicle, 4/18). Olusoji Adeyi, member of the World Bank task force that designed the campaign, said, "For a poor farmer in Cameroon or a poor market woman in Ghana, the difference between 20 cents and $8 is huge."

Although pharmaceutical companies typically sell ACTs to governments for $1 per treatment and to private wholesalers for $4 per treatment, the drugs often cost about 10 to 40 times more than older drugs by the time they reach village health centers, the Times reports. Therefore, by significantly reducing the price of ACTs in retail clinics, the partnership hopes to crowd out older drugs, such as chloroquine and Fansidar, because many malaria parasites have developed resistance to these compounds. In addition, the stakeholders hope to curb the use of artemisinin monotherapies because these drugs might increase the likelihood that parasites will develop resistance to artemisinin. Although the World Health Organization currently recommends the use of ACTs produced by three companies -- Novartis, Sanofi-Aventis and the Indian generics company Ajanta -- several other manufacturers soon are expected to produce drugs that meet WHO standards. According to the Times, the malaria drug subsidy program will undergo a re-evaluation after two years.

Awa-Marie Coll-Seck, executive director of the Roll Back Malaria Partnership, called the subsidy program "a triumph of international cooperation" (New York Times, 4/17). Michel Kazatchkine, executive director of the Global Fund, said the campaign will be "an important part of the global effort to control malaria worldwide," adding that there "is no reason any child should die of malaria anymore" (Reuters, 4/17). According to Kazatchkine, because the international community has access to insecticide-treated nets and effective malaria drugs, "we only need to ensure that all who need these things get them" (AFP/Google.com, 4/17). Norweigan Foreign Minister Jonas Gahr Stoere added, "The age when the world had effective drugs against infectious diseases but let millions die each year because they couldn't afford them is over" (Reuters, 4/17).

Concerns About Malaria Drug Subsidy Program
Bernard Nahlen, deputy coordinator of the President's Malaria Initiative, on Thursday in an interview said the U.S. would need to review more studies proving that subsidies would work before investing in the initiative. According to the Times, when Congress reauthorized the President's Emergency Plan for AIDS Relief last year, the law prohibited donations to AMFm until the U.S. malaria coordinator had "compelling evidence of success from pilot programs." Nahlen said, "I sometimes joke that this is the biggest faith-based initiative in the world of malaria. I'm perfectly willing to be convinced, but sometimes the advocacy gets out ahead of the evidence."

Although Medecins Sans Frontieres endorsed the ACT subsidy plan, the organization also warned that the campaign "jeopardized the future" of artemisinin by allowing subsidies for ACTs sold in blister packs, which allow people to take artemisinin without its companion pill. In addition, a lack of accurate diagnostic tools in many malaria-endemic areas often leads parents to dispense malaria drugs every time a child has a fever, even though some studies have found that 90% of fevers are not related to malaria, the Times reports. According to the Times, subsidies can be "costly and wasteful" in situations where malaria is over-diagnosed and over-medicated (New York Times, 4/17).

Back to Top

Several African countries ahead of World Malaria Day, which is scheduled for Saturday, called for stakeholders to increase efforts to address malaria and contribute to elimination of the disease, the Vanguard reports.

In Nigeria, Vanguard Media Limited, which publishes the Vanguard, announced plans to launch the Vanguard Public Forum on Malaria under the theme, "Winning the War Against Malaria." According to Gbenga Adefaye, Vanguard's editor-in-chief, the forum will bring together policymakers, service providers and community members to develop strategies to control malaria in Nigeria. Adefaye said World Malaria Day "offers a unique opportunity for us in Vanguard to help bring all stakeholders together to ensure that Nigeria does not lag behind in the global control effort." He added that malaria's "devastating impact both on our health and economy is significant enough for us to pay good attention to it and jointly map out a better way to control it." According to the Vanguard, the public forum will include a lecture on malaria in Nigeria, a keynote address by Nigerian Health Minister Babatunde Osotimehin, an overview of Nigeria's malaria program and a paper on the development of artemisinin-based combination therapies. In addition, the 10 Nigerian states with the most effective malaria control programs will receive recognition, and pharmaceutical companies will exhibit malaria drugs and other vector control products. The Vanguard also plans to publish a special supplement on malaria in its May 5 issue (Vanguard, 4/22).

Meanwhile, Dinis Sengulane, Anglican bishop and president of Roll Back Malaria in Mozambique, on Tuesday called for civil society to scale up efforts to control malaria in Mozambique, AIM/AllAfrica.com reports. Speaking during a press conference at the launch of a series of activities to mark World Malaria Day, Sengulane said that despite Mozambique's gains in malaria control, further efforts will be necessary to eliminate the disease. "Let us make every day of our lives a day of struggle against malaria, so that it ceases to be the main cause of mortality among children and adults," Sengulane said. He called for civil society groups to undertake efforts to control stagnant pools that serve as mosquito breeding sites. In addition, Sengulane encouraged people to seek immediate medical attention if they suspect they have contracted malaria and encouraged the public to use insecticide-treated nets to protect themselves and their family members against the disease. According to AIM/AllAfrica.com, RBM's Mozambique chapter during the last two years has distributed more than 200,000 ITNs to households identified as the most vulnerable groups by Mozambique's Ministry of Health (AIM/AllAfrica.com, 4/21).

In Ghana, representatives from the District Malaria Advocacy Teams gathered in the capital of Accra to discuss malaria control efforts at a forum ahead of World Malaria Day, the Ghanaian Chronicle reports. The forum, under the theme "District Leadership Involvement in Counting Malaria Out," included participants from 11 districts who met to review the performance of district-level leadership in supporting effective malaria prevention and treatment programs. The forum also aimed to identify ways in which malaria advocacy could build support for national control efforts. Elias Sory, director-general of the Ghana Health Service, while addressing the forum said that malaria is the leading cause of child mortality in Africa. "Malaria accounts for approximately 40% of public health expenditures in sub-Saharan Africa, 20% to 50% of inpatient admissions and up to 50% of outpatient visits in highly endemic areas," Sory said. She added that despite the economic challenges that malaria presents, scaling up cost-effective prevention and treatment tools could prevent malaria-associated morbidity and mortality and contribute to economic growth (Akuamoah, Ghanaian Chronicle, 4/21).

Editorial Calls for Efficient, Sustainable Malaria Control Strategies
Occasions such as World Malaria Day are "more than mere celebrations, they should be utilized in the most efficient way to develop sustainable measures that can finally roll back malaria," an editorial published in The Gambia's Daily Observer says. According to the editorial, "Science still has no magic bullet for malaria, and many doubt that such a single solution will ever exist." In addition, malaria parasites are developing "unacceptable levels" of drug resistance, and many insecticides are "no longer useful" against mosquitoes that transmit the disease, the editorial says. The editorial continues that the global health community must "expand the use of effective low-cost strategies" to control malaria, such as ITNs and effective medicines. ITN use "results in improvement in maternal health, infant health and survival," and "[p]rompt access to treatment with effective up-to-date medicine, such as artemisinin-based combination therapies, saves lives," the editorial says. Therefore, stakeholders should use the occasion of World Malaria Day to "contemplate on strategies that can permit us to apply these and other measures on a wider scale and monitor them, so that the burden of malaria will be significantly reduced." The editorial also urges health officials to promote public awareness of sanitation and environmental issues that contribute to malaria. It concludes by calling on stakeholders "to forge ahead in engendering sustainable programs that can ensure the elimination of malaria" (Daily Observer, 4/22).

Back to Top

Despite the economic downturn, governments and businesses must sustain funding for malaria control efforts to curb the spread of the disease and reduce malaria-associated mortality, U.N. Special Envoy for Malaria Ray Chambers said Monday, London's Times reports. Chambers spoke during the launch of Malaria No More U.K., an extension of the Malaria No More organization that Chambers founded in 2006 with Peter Chernin, president and chief operating officer of News Corporation.

Chambers called for "extreme vigilance" to control malaria and increased efforts to promote awareness of the disease. Chambers said, "There is a need to continue the donations -- more now than ever before -- because if that support does not continue, malaria will just spiral. We will lose a real chance to make a difference. We need to talk to the private sector and make the best use of the money that is received." He also stressed the importance of sustaining financial support for the Global Fund To Fight AIDS, Tuberculosis and Malaria to ensure that the organization "does not miss a beat and gets replenished as powerfully as it needs to be." In addition, Chambers commended the leadership of British Prime Minister Gordon Brown, who worked with the British government to pledge 40 million British pounds, or about $58.6 million, to an Affordable Medicines Facility for Malaria initiative launched last week to subsidize malaria drug prices and increase treatment access in developing countries.

According to the Times, Malaria No More U.K. aims to ensure that the British government meets its commitment to provide its share of the 100 million insecticide-treated nets pledged last year by the Group of Eight industrialized nations to curb the spread of malaria in developing countries by the end of 2010. British athletes David Beckham, Denise Lewis and Andy Murray on Monday also committed to support the organization and were named members of its leadership council. The three athletes said they were motivated to work with Malaria No More U.K. after learning that basic, inexpensive interventions, such as ITNs, can prevent malaria-associated mortality for entire families. According to Sarah Kline, executive director of the British branch of Malaria No More, the United Kingdom previously did not have an organization dedicated exclusively to raising awareness of malaria. Kline said that considering malaria's high mortality rate -- particularly for children younger than age five -- there is a "desperate need" to increase public understanding and awareness of the disease (Lister, Times, 4/21).

Back to Top

Despite recent strides in malaria control and prevention, the disease remains a major public health problem in The Gambia, Adam Jagne-Sonko, deputy program manager at The Gambia's National Malaria Control Program, said Tuesday, Panapress/Afriquenligne reports. According to Jagne-Sonko, malaria is the leading cause of morbidity and mortality in The Gambia, accounting for more than 40% of hospital visits and for 1,000 to 2,000 deaths annually in the country. In addition, the disease is the primary cause of school and work absenteeism, which affects social and economic development, she said.

Speaking during a press conference organized by NMCP ahead of World Malaria Day, which is scheduled for Saturday, Jagne-Sonko said the occasion would be an opportunity for countries worldwide to share experiences and support collaborative efforts to address malaria. In addition, stakeholders can take advantage of World Malaria Day to generate broad gains in public health and human development, she said. Jagne-Sonko also discussed the importance of monitoring and evaluation at all levels to ensure proper program implementation and identify problems, trends or constraints. Effective monitoring also allows officials to evaluate the impact of interventions and ensure accountability, she said.

According to Jagne-Sonko, The Gambia's malaria control policy "has outlined key intervention areas ranging from malaria case management, malaria in pregnancy, partnership and social mobilization, and surveillance and research, monitoring and evaluation." She said the country recently has undertaken efforts to increase access to effective malaria drugs by providing the artemisinin-based combination therapy Coartem in all public health facilities. In addition, the country has scaled up community mobilization efforts to increase public participation in malaria control initiatives, she said (Panapress/Afriquenligne, 4/21).

Back to Top

TUBERCULOSIS

The Lancet on Saturday examined "The Beijing Call for Action on Tuberculosis Control and Patient Care," which was developed earlier this month by health officials from 27 countries with high burdens of multi-drug and extensively drug-resistant tuberculosis during the Ministerial Meeting of High M/XDR-TB Burden Countries in Beijing. According to the Lancet, the plan features 13 action points, calling in part for universal access to TB diagnostic and treatment services, ministerial collaboration, guaranteed TB drug supply and increased TB advocacy.

The countries also pledged to help mobilize efforts to secure the estimated $2 billion needed over the next two years to finance MDR- and XDR-TB prevention and treatment initiatives. Each country contributed to the plan by developing an MDR-TB strategy, which included needs, budgets, policy factors and resource mobilization. According to the Lancet, the officials plan to meet again in October in Geneva to present their plans and report progress toward meeting their targets.

According to the call to action, increased rates of drug-resistant TB could result from "insufficient and late case detection." Presenters at the meeting indicated that unsupervised distribution of over-the-counter drugs to treat TB also might contribute to the increase in MDR-TB prevalence. According to the Lancet, the private sector provides about 90% of TB drugs in countries such as India and the Philippines. Tido von Schoen-Angerer, director of Medecins Sans Frontieres' Campaign for Access to Essential Medicines, said, "The call for action says a lot of good things." He added that participating countries need a TB framework that outlines a "clear role" for the World Health Organization, similar to the Framework Convention on Tobacco Control.

According to the Lancet, some countries with the highest TB burdens -- such as China and India -- allocate proportionally the least money for prevention and treatment efforts. "Most cases are in Asia but only a small fraction of the funding is in Asia," Katherine Floyd of WHO's Stop TB Department said. Chinese Health Minister Chen Zhu during the meeting presented the results of a recent cross-sectional survey of 47 million people in 31 Chinese provinces, which identified 30,000 TB cases. Of these, 8.32% were MDR-TB and 0.68% were XDR-TB. In addition, 80% of the drug-resistant TB cases occurred among rural populations and the strain primarily affected "young to middle-aged people," Chen said. According to a representative for India's health minister, India has reported XDR-TB cases "but the extent and magnitude have yet to be documented" (Harris Cheng, Lancet, 4/18).

The call to action is available online.

Back to Top

The number of tuberculosis cases in Swaziland has increased from about 1,000 cases annually in 1987 to about 9,600 cases annually today, National TB Control Program Manager Themba Dlamini, said recently, Inter Press Service reports.

In addition, Swaziland has the highest HIV prevalence worldwide, Inter Press Service reports. "This escalation of TB cases can be attributed to the HIV/AIDS epidemic," Dlamini said, adding that 80% of people with TB in the country also are HIV-positive. Swaziland's TB detection rate is 57.7%, below the World Health Organization target of 70%, and the country's TB treatment success rate is 42%, compared with the WHO target of 85%. The increase in drug-resistant strains of the disease also is contributing to the situation, Dlamini said.

Dlamini said that efforts to declare TB a national emergency in Swaziland are underway. According to Inter Press Service, efforts to increase human resources, strengthen and decentralize TB services, and promote education about the disease likely will be scaled up if TB is declared a national emergency. "We needed to do serious lobbying to convince the Ministry of Health and Social Welfare and the National Disaster Management Agency that indeed TB is an emergency," Dlamini said. Swazi Deputy Prime Minister Themba Masuku in an address on World TB Day last month said that the Swazi government is "aware of the plans under way to declare TB as an emergency" and is supporting such efforts in line with the 2005 Maputo Declaration, which declared TB a continental emergency.

Health Minister Benedict Xaba said the health ministry is developing a contingency plan for declaring TB a national emergency that will need approval from NDMA and the
Cabinet and stressed that TB is a priority for the government. Dlamini added that the ministry is "convinced that TB is an emergency" but that the contingency "was not yet approved" when Masuku gave his address on World TB Day. Dlamini added, "For the first time, TB is the third priority after water and sanitation and HIV/AIDS" at the health ministry.

"Many patients are defaulting on treatment because they feel the TB treatment takes [too] long, and it gets worse when they are also taking antiretroviral drugs," Dlamini said, noting that food insecurity also is a "challenge." In addition, an increasing number of clinic nurses have contracted TB because of inadequate infection-control measures. "What's worse is that there are no clear policies on how government would assist nurses who get infected with TB at work," Bheki Mamba, president of the Swaziland Nurses Association, said. Mamba added that clinics also should post "safety precautions" so that TB patients understand "what is expected of them when they visit clinics and hospitals" to minimize the risk of transmitting the disease.

However, the global economic crisis could affect efforts to fight TB in the country, Inter Press Service reports. The Global Fund To Fight AIDS, Tuberculosis and Malaria recently called for a 10% reduction in a $5 million, two-year grant for Swaziland's TB program. Robina Mulenga, a World Food Program officer, added that the country was having difficulty securing foreign aid before the economic downturn began because of its status as a middle-income country. "Now we have to start looking for money within the country because Swaziland is not considered to be in a desperate need for aid," Mulenga said (Phakathi, Inter Press Service, 4/22).

Back to Top

Tuberculosis "remains the most common cause of adult death in some countries" even though the global health community knows "what causes" the disease, "how it spreads" and "how to treat it," Ruth McNerney of the TARGETS Consortium at the London School of Hygiene and Tropical Medicine writes in the Guardian's "Katine Chronicles" blog.

Although "it is no surprise" that TB declined in developed countries "with improving standards of housing, nutrition and education," the "situation in Africa is very different," McNerney writes. She writes that "[p]overty remains endemic" in Africa, contributing to the spread of TB, adding that the situation is "made worse by the HIV/AIDS pandemic, which greatly increases susceptibility to TB." McNerney continues that although the "international community has responded by providing donor aid" through programs such as the Global Fund To Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief, the "battle against TB is not being won" because the "emergence of drug-resistant forms of the disease has set alarm bells ringing."

McNerney writes that despite these obstacles, the international community "could make an impact" by ensuring access to TB diagnostic and treatment services. "Without a means of detecting TB that is accessible to people living in poverty, the prospects of controlling this disease are poor," she writes. She concludes that it is "time to spend our money a little more wisely" and "invest where we might really make a difference" (McNerney, "Katine Chronicles," Guardian, 4/21).

Back to Top

High tuberculosis prevalence in Nigeria is the result of inadequate awareness of the disease and a reluctance to seek treatment among people with TB, Wale Akeredolu, Lagos Island government medical officer, said recently, the Daily Trust/AllAfrica.com reports.

Akeredolu recently called on the government and other stakeholders to increase TB awareness and prevention campaigns. In addition, the government should establish new treatment centers to increase access, Akeredolu said. "The government should make affordable TB treatment accessible to the people through the establishment of treatment centers" throughout the country, he said. He added that people with TB should seek treatment early. Nigeria ranks fifth on the World Health Organization's list of the 22 countries with the highest TB burdens worldwide, according to Nigerian Health Minister Babatunde Osotimehin (Daily Trust/AllAfrica.com, 4/17).

Back to Top

GLOBAL HEALTH

First ladies from 15 African countries met earlier this week at the African First Ladies Health Summit in Los Angeles to discuss efforts to fight HIV/AIDS, tuberculosis, malaria; improve nutrition for children and pregnant women; and promote education for girls, the AP/Google.com reports.

The first ladies met with representatives from several groups -- including the Bill & Melinda Gates Foundation, RAND, USAID, the World Bank and the World Health Organization -- to discuss ways to improve health and development infrastructure in Africa and improve access to inexpensive interventions, such as insecticide-treated nets. The summit was co-sponsored by U.S. Doctors for Africa and African Synergy Against AIDS and Suffering, a group formed by 22 African first ladies (Mohajer, AP/Google.com, 4/22).

Melanne Verveer, U.S. ambassador for Global Women's Issues, said the Obama administration would support efforts to fight HIV/AIDS, TB, malaria and other infectious diseases and promote other issues, such as maternal health care. Ted Alemayhu, founder of U.S. Doctors for Africa and an immigrant from Ethiopia, said he hopes the summit will engage U.S. residents in African health and development issues. "People are not paying too much attention anymore because of the global economy, a number of other things," Alemayhu said, adding, "Even with that challenge, we still have to bring the issue of health care that Africa is suffering from on the global scale." Jean Stephane Biatcha, executive director of African Synergy, added, "I am sure that after these two days of meetings, people will know more about what they do and we will surely see people more interested in one or two projects that they intend to carry out" (O'Sullivan, VOA News, 4/21).

Gery Ryan, a senior behavioral scientist at RAND, said that African first ladies are "probably one of the largest untapped influences and influencers in these places." Sia Nyama Koroma, first lady of Sierra Leone, added, "As first ladies, people listen to us, people want to see us, the crowd goes with us" (Zavis, Los Angeles Times, 4/22). Cora Neumann, an organizer for U.S. Doctors for Africa, added, "First ladies have a unique role. They exist outside the political realm to some degree but have a very powerful role in the communities" (AP/Google.com, 4/22).

In addition to the first ladies from 15 countries -- including Angola, Kenya, Nigeria and Zambia -- representatives from six other African nations, including South Africa, attended the summit. California first lady Maria Shriver and several U.S. celebrities also attended the meeting, VOA News reports (VOA News, 4/21).

Back to Top

The newly formed Commission on Smart Global Health Policy -- a bipartisan group of legislators, pharmaceutical executives and other health experts -- on Tuesday received a mandate to develop a comprehensive strategy for spending the estimated $10 billion allocated annually for global health aid, the Boston Globe reports. The commission, sponsored by the Center for Strategic and International Studies, plans to issue recommendations early next year to President Obama's administration. In addition, the commission will tackle some "controversial" issues, such as whether global health spending focuses disproportionally on Africa and whether high levels of HIV/AIDS funding should be balanced with efforts to promote clean water and prevent diseases such as malaria, according to the Globe (Bender, Boston Globe, 4/22).

Stephen Morrison, head of CSIS' Global Health Policy Center, and Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation, in a paper released Tuesday wrote that one "delicate task" of the commission will be to "decide on the correct balance between HIV and other areas" (Bender, "Political Intelligence," Boston Globe, 4/21).

According to Helen Gayle, president of the not-for-profit organization CARE and former assistant U.S. surgeon general, the group will examine questions, such as, "How does the U.S. capitalize on current investments? What should we be doing more of? What should we be doing differently?" In addition, another important challenge will be to determine "[h]ow do we better measure our impacts?" Gayle said.

According to the Globe, the 26-member coalition will include members of Congress, such as Sens. Jeanne Shaheen (D-N.H.) and Olympia Snowe (R-Maine); former diplomats and intelligence officials, such as Jon Negroponte; former HHS Secretary Donna Shalala; leaders from not-for-profit groups such as the Bill & Melinda Gates Foundation; and executives of corporations such as Coca Cola, Exxon Mobil and Merck. William Fallon, professor at Massachusetts Institute of Technology's Center for International Studies and former commander of U.S. military forces in the Middle East and Asia, will lead the effort. According to Fallon, the U.S. spends a relatively significant amount of funding on global health efforts, but officials could better maximize these resources for long-term gains. "If we could ever get our act together and come up with a comprehensive plan to pool resources ... we can probably get some stuff done," he said. Shaheen added that the commission's efforts will affect not only the countries receiving aid but also the U.S. She said, "Creating a long-term, strategic policy to address global health care challenges will strengthen our national security, our economy and our standing as a moral leader in the world" (Boston Globe, 4/22).

The Kaiser Family Foundation report provides a comprehensive look at the U.S. government agencies and programs involved in the nation's global health response, including their funding and their approaches. It also reviews the key laws governing U.S. global health policy. The report is available online.

Back to Top

President Obama's administration in its fiscal year 2010 budget proposal could flat-line global HIV/AIDS funding at its current level of $5.3 billion, some congressional aides and lobbyists said recently, the Lancet reports. According to the Lancet, the possible funding freeze for global health programs such as the President's Emergency Plan for AIDS Relief might indicate that Obama's "stated goal of expanding prevention and treatment of infectious diseases in poor countries could be on hold" because of the current economic downturn. Although the administration is expected to submit its FY 2010 budget proposal in May, Congress ultimately will determine U.S. funding allocations for PEPFAR, the Global Fund To Fight AIDS, Tuberculosis and Malaria and other global health initiatives. According to the Lancet, final approval of the budget likely will occur during the summer or fall.

According to the Lancet, many administration and State Department officials have not discussed specific funding numbers. Tom Gavin, spokesperson for the White House Office of Management and Budget, said that although the final budget is likely to include an overall increase in spending for foreign operations, flat funding also could be possible as the government focuses on domestic issues during the economic downturn. Obama "had hoped to have been on a path to double foreign assistance within his first term in office," Gavin said, adding, "There are tough choices to be made government-wide in this budget." Sen. John Kerry (D-Mass.), chair of the Senate Foreign Relations Committee, in an interview said that even a slight growth in PEPFAR's budget for FY 2010 "would be a significant accomplishment." Kerry added, "It's going to be a very difficult balancing act."

Although Congress last year authorized an increase in PEPFAR's budget to $48 billion over five years, many advocates have expressed concern that a failure to increase the program's funding to the reauthorization levels could hinder the effectiveness of international health initiatives. David Bryden, program director at the Infectious Disease Center for Global Health Policy and Advocacy, said flat-line funding "would really affect some very successful programs like PEPFAR." According to Bryden, PEPFAR could face financial strain from a budget freeze, particularly because the program has an expanded mandate to improve nutrition and assist AIDS orphans. In addition, many countries have reported an increase in multi-drug resistant tuberculosis cases among HIV-positive people. "We're getting to the point where [antiretrovirals] won't make a difference for a lot of people because they have MDR-TB at the same time," Bryden said.

According to the Lancet, many final decisions about PEPFAR and other global health programs could be delayed until Obama fills key administration posts, such as the global HIV/AIDS coordinator, which has been vacant since January when the administration asked former PEPFAR coordinator Mark Dybul to step down. Smita Baruah, director of government relations at the Global Health Council, said, "In the absence of a coordinator, a lot of this will be put on hold." Baruah added, "It may be that fiscal year 2010 is a holding pattern, and you really turn to fiscal 2011 for real policy." A senior Republican Senate aide, who spoke on condition of anonymity, said government decisions on the foreign operations budget are not yet final. "We're telling people, don't freak out yet. It's a long way from done," the aide said (Zwillich, Lancet, 4/18).

Back to Top

A shortage of HIV/AIDS, tuberculosis and malaria medications in Uganda's northern Gulu district could cause patients to interrupt treatment and lead to drug resistance, Paul Onek, Gulu director of health services, said recently, IRIN/PlusNews reports. According to IRIN/PlusNews, inadequate management of the country's drug supply regularly causes shortages.

More than 2,000 TB patients in the district have begun a six-month treatment regimen and about 1,300 HIV-positive people have received a monthly supply of antiretrovirals from Gulu's largest hospital. However, Onek noted that the district has not received TB drugs since January. Angelo Ojera, HIV focal point in the district, said that some TB patients are taking expired medications and that some HIV-positive people who have malaria have had to purchase drugs from private clinics.

The government has said the shortage of TB drugs is because of a disbursement delay for a grant from the Global Fund To Fight AIDS, Tuberculosis and Malaria. The Ministry of Health is purchasing drugs from Kenya to alleviate the situation until the country's drug supply increases. In addition, a local drug manufacturing plant recently opened and is expected to increase the supply of antiretrovirals (IRIN/PlusNews, 4/16).

Back to Top

Please forward this notice to interested colleagues. __________________________________________________________________

GlobalHealthReporting.org Weekly TB/Malaria Report

The GlobalHealthReporting.org Weekly TB/Malaria Report is published for GlobalHealthReporting.org, a project operated by the Kaiser Family Foundation with major support from the Bill and Melinda Gates Foundation. (c) 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.