“Fighting the Flu with One Hand Tied” – op-ed by Prof. Gostin in the Washington Post

The excellent op-ed by Prof Lawrence Gostin*, “Fighting the Flu With One Hand Tied” in the May 1, 2009 edition of the Washington Post highlights the legal and financial limitations of two of the world’s key public health agencies- the World Health Organisation (WHO) and US Centers for Disease Control and Prevention (CDC).

In reference to the revised 2005 International Health Regulations and the experience with SARS, Prof Gostin points out:

…the frightening truth is that the WHO has no real power. It lacks an effective mechanism for monitoring and enforcing national reporting. Its recommendations to countries are expressly “non-binding.” Countries do not even have to share virus samples with it. Indeed, despite painful negotiations over the past two years, the agency has not been able to persuade Indonesia to share samples of avian influenza, threatening vaccine production and public health preparedness.

Professor Gostin also highlights the grim reality of how the world’s poor are also the most vulnerable to, and the least capable of coping with public health emergencies of international concern.

Perhaps more worrying is the lack of capacity in poor countries to detect and respond to emerging threats. This is of particular concern because influenza often emerges in Asia, where crowded cities and close proximity between animals and humans can breed infectious disease. Although Mexico is the likely center of the current outbreak, the genetic material in the swine flu virus is of Eurasian origin. Many poor countries lack adequate surveillance, early warning systems and modern laboratories; they also have negligible public health infrastructures. Although the revised International Health Regulations urge capacity building, Western governments have donated precious little funding, and the WHO has no mechanism or resources for expanding public health capacities within individual countries.

After shedding some light on CDC’s limited legal authority and resources to effectively respond to swine flu -influenza A (H1N1), Prof. Gostin concludes:

The WHO and the CDC are our frontline defense against infectious diseases that can rapidly mutate and travel across continents. It is easy to criticize these agencies and deprive them of resources. It is much harder, but necessary, to build strong public health agencies to do the vital work that we all rely on, especially in the face of an international public health emergency.

*Professor Gostin is a professor of global health law and faculty director at Georgetown University Law Center’s O’Neill Institute for National and Global Health Law, as well as a member of the World Health Organization International Health Regulations Roster of Experts and director of the WHO Collaborating Center on Health Law.

Gates Foundation Awards Grants to “Unconventional” Global Health Initiatives

On May 4, 2009, the Bill & Melinda Gates Foundation announced grants of $100,000 to 81 unconventional global health initiatives as part of the Foundation’s Grand Challenges Explorations initiative.

These “bold” and “unproven” global health research projects have the goal of improving health in developing countries. The projects focus on the prevention and treatment of infectious diseases, such as HIV, malaria, tuberculosis, pneumonia, and diarrheal diseases.  The grants were awarded to researchers in 17 countries.

2009 winners included:

• Luke Savage and Dave Newman of the University of Exeter in the U.K. will attempt to build an inexpensive, battery-powered instrument to diagnose malaria by using magnets to detect the waste products of the malaria parasite in human blood samples.
• Boitumelo Semete at the Council for Scientific and Industrial Research in South Africa will attempt to develop “sticky nanoparticles” that attach to tuberculosis-infected cells and slowly release anti-TB drugs. The new therapy could shorten treatment time and reduce side effects, using existing medications.
• Eric Lam at Rutgers, the State University of New Jersey in the U.S. will work to develop a tomato that delivers antiviral drugs when eaten.

Applicants were selected from more than 3,000 proposals in the second round.  The first round of 104 Grand Challenges Explorations grants was announced in October 2008.

If you have a bold or innovative global health research proposal and you think you have what it takes, the Gates Foundation is accepting applications for Round 3 of Grand Challenges Explorations through May 28, 2009.

Round 3 topics include:

• Create Low-Cost Diagnostics for Priority Global Health Conditions
• Create New Ways to Induce Mucosal Immunity
• Create New Vaccines for Diarrhea, HIV, Malaria, Pneumonia and Tuberculosis
• Create New Tools to Accelerate the Eradication of Malaria

Health Ministers Accelerate Goals to Diagnose and Treat Drug-Resistant TB

After last week’s World Health Organization (WHO)-sponsored meeting, health ministers from countries with a high disease burden of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) committed towards accelerated goals for the detection, prevention, and treatment of MDR- and XDR-TB. 

The governments present issued a Call for Action asserting that all countries would take action to meet the following goals:

• universal access to M/XDR-TB diagnosis and treatment by 2015;
• removal of financial barriers to TB care;
• development of a comprehensive M/XDR-TB management and care framework;
• sufficient staff are trained and deployed;
• strengthen laboratory systems;
• collaboration with all partners;
• development and implementation of airborne infection control policies;
• sufficient supply of high-quality anti-TB drugs;
• strengthen mechanisms to ensure availability of TB medicines is regulated;
• develop the new tools needed to combat M/XDR-TB.

The Call for Action is a major step in coordinating plans for M/XDR-TB prevention, treatment and care and a commitment to achieve universal access to diagnosis and treatment for MDR-TB patients by 2015.

Learn more facts about MDR-TB and XDR-TB after the jump.

Bill Gates partners with Chinese government to fight TB

 

At a global meeting in China, of health ministers from 27 countries affected by the rise of multi-drug resistant (MDR) TB, Bill Gates and the Chinese Minister of Health Chen Zhu announced an innovative partnership to help fight a serious tuberculosis epidemic in China.  The 5 year initiative will be led by the Chinese Ministry of Health and funded by a grant of $33million from the Bill & Melinda Gates Foundation.

Bill Gates, co- chair of the Bill & Melinda Gates Foundation said that the rise of drug-resistant TB worldwide has created a new urgency to combat the disease, while scientific innovation is leading to new technologies. He explained in his speech, the foundation’s choice of China for this partnership:

“China is taking the threat of TB very seriously, and we’re excited to support its efforts.” He added, “Because of its skill, its scale, its TB burden, its love of innovation and its political commitment to public health, China is a perfect laboratory for large-scale testing of new tools and delivery techniques to fight TB.”

“If China leads in the fight against TB – developing new approaches here in China and demonstrating them to the world – we can see a dramatic drop in the number of TB deaths in the next decade.”

According to the Bill & Melinda Gates Foundation, the goal of the partnership was “to improve detection and treatment of the estimated 1.5 million TB cases that occur each year in China, drawing on the latest innovations in TB control.”

The Chinese Minister of Health, Chen said that the new tuberculosis prevention and control program was a continuation of the successful cooperation between the Chinese Ministry of Health and the Gates Foundation that began on the issue of HIV/AIDS. 

Minister Chen added, “It aims to establish an effective TB prevention model through the exploration of new diagnostic tools and methods. This will not only benefit TB prevention and control efforts both in China and throughout the world, but it also sets an excellent example of the partnership between government and private sectors that is widely promoted by the international community, and we hope it will accelerate the progress of reaching the United Nations Millennium Development Goals.”

Funding from the Gates Foundation will help China introduce new TB diagnostic tests, patient monitoring strategies, drug regimens and health delivery approaches that could significantly improve the effectiveness of TB diagnosis and treatment across the country.

The initiative will be implemented in 6 provinces in China. During the first two-and-a-half years, innovative tools and delivery approaches will be pilot-tested to determine their effectiveness and feasibility. Following the completion of the first two-and-a-half years of this partnership, China will determine how to progressively expand the innovations that have been proven to be effective into 20 cities, diagnosing and treating 50,000 TB patients each year.

The new technologies and innovative delivery methods to be piloted include:

World Bank proposes ‘vulnerability fund’ for poor countries

The World Bank is urging wealthy countries to set up a “vulnerability fund” to aid poor countries hit hard by the global financial crisis.

Ahead of the two day Group of Seven talks, the World bank President, Robert Zoellick said, “I propose that developed countries agree to devote 0.7 percent of their stimulus packages to a vulnerability fund to support the most needy…What began as a financial crisis has become an economic crisis, and is now becoming an employment crisis, and without countries’ action could become a human crisis on a global scale.”

He said the fund proposed by the World Bank was “doable, and would be a very positive outcome of the G20 meeting.”

“The World Bank estimates that from 2009 to 2015 between 200,000 and 400,000 more children will die of hunger each year, or between 1.4 million and 2.8 million. Some 46 million more people may fall into poverty if the global financial crisis persists… The crisis will also impede efforts to achieve Millennium Development Goals, which notably include that of slashing poverty in half by 2015,” Zoellick said.

 

 

Global Fund faces $5 billion funding gap

The Global Fund to Fight AIDS, Tuberculosis and Malaria, which supplies one-quarter of all AIDS funding, two-thirds of tuberculosis funding and three-fourths of malaria funding is facing a $5 billion funding gap for its worldwide programs.Based in Geneva, the Global Fund oversees hundreds of programmes in 136 countries through public-private partnerships that have raised more than 11 billion dollars (8.5 billion euros).

Global Fund Board Chairman Rajat Gupta says the Global Fund’s progress in the fight against AIDS, TB and malaria must be sustained. He says he and other health and business leaders who attended the recent World Economic Forum in Davos, Switzerland were not asking for a bailout but simply calling on donor nations to make good on their pledges to improve the world’s prosperity and its health. Gupta says that the continued support could save nearly two million additional lives in the coming years.

The executive director of the Global Fund, Michel Kazatchkine said he was concerned about the impact of the economic crisis would have on efforts to combat the diseases.

“I’m afraid of the impact the financial crisis will have, first of all on the rich countries which will find it difficult to provide resources but also the impact on poor countries as the crisis will touch them too”.

 

Obama overturns anti-abortion funding policy

The newly elected US President Barack Obama signed an executive order Friday ending the ban on federal funds (usually in the form of U.S. Agency for International Development funds) for international groups that provide abortions, abortion referrals or abortion counseling.

The ban is also known as the Mexico City Policy named for the location of a UN conference where it was first introduced by President Ronald Reagan in 1984. President Bill Clinton a Democrat rescinded the ban in 1993, but the Republican President George W. Bush re- instated it in 2001.

Critics of the policy refer to it as the “global gag rule,” because it prohibits taxpayer funding for groups that lobby to legalize abortion or promote it as a family planning method.

Obama signed the memorandum without coverage by the media on a day following the 36th anniversary of the 1973 landmark Supreme Court ruling in Roe v. Wade that legalized abortion.

The move by Obama to reverse the Mexico City Policy received both praise and criticism from both sides of the abortion debate.

“Women’s health has been severely impacted by the cutoff of assistance. President Obama’s actions will help reduce the number of unintended pregnancies, abortions and women dying from high-risk pregnancies because they don’t have access to family planning,” said Tod Preston, a spokesman for Population Action International.

“Yesterday, President Obama issued executive orders banning the torture of terrorists but today signed an order that exports the torture of unborn children around the world,” said Tony Perkins of the Family Research Council.

“President Obama not long ago told the American people that he would support policies to reduce abortions, but today he is effectively guaranteeing more abortions by funding groups that promote abortion as a method of population control,” said Douglas Johnson, legislative director of the National Right to Life Committee.

In a statement issued with the memorandum Obama said the limitations on funding were “excessively broad” and adding that “they have undermined efforts to promote safe and effective voluntary family programs in foreign nations.” He added that “For too long, international family planning assistance has been used as a political wedge issue, the subject of a back and forth debate that has served only to divide us.I  have no desire to continue this stale and fruitless debate.” Obama also said that he would ask his administration to initiate a “fresh conversation” on family planning and to seek common ground with abortion opponents.

In an accompanying statement, President Obama said he would also work with Congress to restore U.S. funding support for the United Nations Population Fund “to reduce poverty, improve the health of women and children, prevent HIV/AIDS and provide family planning assistance to women in 154 countries.”

According to the Washington Post, lifting the Mexico City Policy would not permit U.S. tax dollars to be used for abortions, but it would allow funding to resume to groups that provide other services, including counseling about abortions.

Scholar’s Corner: Recent Scholarly Works in Global Health Law

 President’s Emergency Plan for AIDS Relief: Health Development at the Crossroads

 

Lawrence O. Gostin
Georgetown University Law Center – O’Neill Institute for National and Global Health Law; Georgetown University Law Center

JAMA, Vol. 300, pp. 2046-48, 2008
Georgetown University O’Neill Institute for National & Global Health Law Scholarship Paper No. 18

Abstract:     
The President’s Emergency Plan for AIDS Relief (PEPFAR) was the largest commitment by any nation to combat a single disease in human history, authorizing up to $15 billion over 5 years. On July 30, 2008, President Bush signed into law the historic reauthorization of PEPFAR, dramatically increasing the financial commitment by authorizing up to $48 billion over 5 years, including $5 billion for Malaria and $4 billion for Tuberculosis. PEPFAR’s global targets are inspiring: treat 3 million people; prevent 12 million new HIV infections, and care for 12 million people, including 5 million orphans and vulnerable children. But, PEPFAR has been mired in controversy. To some, it exemplifies America’s extraordinary compassion and generosity, and to others America’s politicization of public health and unilateral approach to international health. The truth lies somewhere in between. American healthassistance to the developing world stands at a crossroad. As PEPFAR is scaled up, will it provide opportunities to fulfill basic human needs, or will its limited focus pull resources from sustainable, capacity-building support in line with poor country priorities?

Available at SSRN.

Duke University to Establish New Global Health Masters

Add another university to the list of those that have opened their doors to the field of global health.  Duke University is set to join NYU’s Masters in Global Public Health, George Washington’s Masters of Public Health in Global Health, and UC’s recently added Masters of Science in Global Health.  And let’s not forget the LLM Masters of Law global health program at Georgetown University (my not-quite-yet alma mater).

Duke University has approved a new Masters degree–Master of Science in Global Health.  The degree will be offered through the Graduate School and administered by the Duke Global Health Institute. 

“Understanding how to reduce health disparities requires an interdisciplinary perspective, yet the study of health in academic institutions is traditionally confined within disciplinary boundaries,” said DGHI director Michael Merson. “We are proud to be one of the first universities in the country to offer a Master of Science in Global Health that will prepare health professionals, policy makers, researchers and others to approach global health from many perspectives.”

The program focus on disease causation and prevention, global environmental health, global health policy and management, and population sciences and will require an international fieldwork experience of at least 10 weeks.

In recent years, Duke has created a Certificate in Global Health for undergraduates and graduate students, a Global Health Focus Cluster for first- and second-year undergraduates, a Global Health Third Year Study Program for medical students, a postdoctoral fellowship in Global Health, and the Global Health Residency offered jointly by the Hubert-Yeargan Center for Global Health and DGHI.

Apply online to Duke’s Masters program here.

Gates Grant Awarded to Fund School for Global Health

The University of California receiveda $4 million grant from the Bill & Melinda Gates Foundation to support planning for a potential system wide UC School of Global Health.

The proposed school will be multicampus, incorporating “five or more” global health centers with faculty from diverse areas such as health and biological sciences, social sciences, law, business and engineering.

Officials said the two-year grant of nearly $3.99 million will fund final planning efforts for the proposed global health school, which is expected to officially enroll students in the summer of 2011.

The school will focus on, among other things, providing solutions to issues such as migration, climate change and emerging pandemics. 

To apply for UC’s existent masters of sciences in global health, click here.