These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

According to the Executive Director of the Global Fund Michel Kazatchkine:

“The story about the Global Fund is a story about how the world could actually come together and turn a hopeless situation into one of promise. This amazing film tells that story through the words of some of the people who were crucial in making this dramatic turnaround. It is fantastic to be reminded of how terrible the future looked for global health ten years ago, and how far we have come.”

The Bill & Melinda Gates Foundation recently renewed its commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria, giving $750 million through a promissory note. This innovative funding method gives the Global Fund the flexibility and authority to distribute funds efficiently based on immediate needs, leading to greater impact.

In what ways do you think that investments in females can have an impact?

The panel was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and included representatives from USAID and several global health R&D partners from the public and private sectors (representing Product Development Partnerships – or PDPs).

• Hugh Chang, Director of Special Initiatives, PATH
• Rick King, PhD, Vice President, Vaccine Design, IAVI
• Emily Moore, Vice President for Business Development, Temptime Corp.
• Wendy Taylor, Senior Advisor for Innovative Finance and Public Private Partnerships, Bureau of Global Health, USA

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

On Monday, Nov. 21^st 9:30am EST, Research!America will be webcasting a briefing on USAID and the agency’s impact on global health research and development.  The panel will be moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and will include representatives from USAID and several global health R&D partners from the public and private sectors (representing Product Development Partnerships – or PDPs).  Panelists include:

• Hugh Chang, Director of Special Initiatives, PATH
• Rick King, PhD, Vice President, Vaccine Design, IAVI
• Emily Moore, Vice President for Business Development, Temptime Corp.
• Wendy Taylor, Senior Advisor for Innovative Finance and Public Private Partnerships, Bureau of Global Health, USAI

The U.S. Agency for International Development (USAID) is marking its 50th anniversary as the main U.S. humanitarian relief and international development agency. This conversation regarding USAID and its global partenrs will shed insight into instrumental partnerships in global health work.

This important event will be webcast live at http://bit.ly/vWwx9o where you can also submit questions. You can also join the conversation on Twitter under the hashtag #GHPDP.

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

http://www.ted.com/talks/amy_lockwood_selling_condoms_in_the_congo.html

• The House State and Foreign Operations Appropriationsbill for Fiscal Year 2012;
• Movement on the Foreign Relations Authorizations Acts in the House and Senate; and
• A Government Accountability Office report on the President’s Emergency Plan for AIDS Relief (PEPFAR).

The Policy Tracker is a great feature of the Kaiser Family Foundation’s Global Health Gateway, an online source for information on the U.S. role in global health, with policy analysis, polling and other research; daily global news synthesis via the Kaiser Daily Global Health Policy Report; and country-level data through Kaiser’s Global Health Facts.

Two studies from the Johns Hopkins Bloomberg School of Public Health were recently published in Health Affairs‘ June issue on Strategies for the Decade of Vaccines. The studies examined the impact of expanding immunization against pneumococcal pneumonia; Haemophilus influenzae type b (Hib);  bacterial meningitis; diphtheria; pertussis; tetanus; measles; rotavirus and malaria to cover 90% of children in 72 countries. They found that increasing vaccine development and delivery over the next 10 years in these 72 countries could prevent 6.4 million children from dying with an economic savings of $231 billion in the value of statistical lives saved and over $151 billion saved through reduced treatment costs and increased productivity. The issue brief audiocasts offer more insight into these and other contents of the June issue.

From the Bill and Melinda Gates Foundation website

While this looks promising, another study from the GAVI Alliance suggests that developing nations will be challenged to pay for expanded vaccine delivery without substantial outside support. In order to procure the projected benefits of increased immunization efforts, creative vaccine financing strategies will be needed. One such effort comes from the Bill & Melinda Gates Foundation’s commitment over the current decade–the Decade of Vaccines–to promote childhood immunization in the developing world.

• Beth Tritter, Managing Director, The Glover Park Group; Former Legislative Director for Congresswoman Nita Lowey, Ranking Member of the House Appropriations Subcommittee on State and Foreign Operations.
• Todd Summers, Senior Advisor for Global Health, ONE Campaign.
• Allen Moore, Senior Advisor for Global Health Security Program, Stimson Center, and Adjunct Professor in Global Health, George Washington University; Former Deputy Chief of Staff and Policy Director for Former Senate Majority Leader Bill Frist.
• Jennifer Kates, Moderator, Vice President and Director, Global Health & HIV Policy, Kaiser Family Foundation.

They will examine the new legislative landscape of the 112th Congress and the ways in which recent changes will impact global health programs and foreign assistance.

You can watch the live studio webcast on kff.org. Viewers can also email questions before or during the live webcast at infocus@kff.org.

During a recent Duke Global Health Institute talk as part of Global Health Week 2011, Ugandan physician and HIV/AIDS pioneer Peter Mugyenyi gave a talk on the unresolved AIDS crisis in Africa. In his talk, Mugyenyi reiterated that, although progress has been made in the fight against HIV/AIDS, the epidemic is far from over. He emphasized that the implementation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have played large roles in saving the lives of millions around the globe. For example, Mugyenyi directs the Joint Clinical Research Center in Kampala, which receives funding from these organizations to bring life-saving antiretroviral therapy to hundreds of thousands of Ugandans. In the following video of Mugyenyi’s talk at Duke, he shares his thoughts on the role of universities in the fight against HIV/AIDS and his hopes and concerns for the future.

Peter Mugyenyi: The Unresolved AIDS Crisis in Africa

The following resources provide more information on the interactions between international trade and health:

• Is International Trade Impacting Health? Challenges for This Decade by Josh Ruxin. Virtual Mentor. 2010; 12:213-217.
• Trade and Health 101 from the Global Health Council.
• Understanding Private Sector Involvement in Health Systems Fact Sheet and Research Brief from the Global Health Council.
• Trade, foreign policy, diplomacy and health from the World Health Organization
• Counterfeit & Substandard Drugs in Low Income Countries fact sheet from the Global Health Council.
• The Impact of Tariff & Non-Tariff Barriers on Access to Essential Drugs for the Poorest People policy brief from the Global Health Council.
• World Trade Report from the World Trade Organization.
• AIDS, drug prices and generic drugs from AVERT.org.
• Global Trade and Public Health by Shaffer, E, Waitzkin, H, Brenner, J, Jasso-Aguilar, R. January 2005, Vol 95, No. 1 | American Journal of Public Health 23-34
• Foreign policy, trade and health: at the cutting edge of global health diplomacy by Drager, N and Fidler, D. Bull World Health Organ. 2007 March; 85(3): 162.

The 2010 UNAIDS report highlights updated information regarding the epidemic, including the growing number of people practicing safe sex, and gaining access to antiretrovirals in many parts of the world. Offering hope that progress is being made to quell the epidemic, UNAIDS reports that at least 56 countries have either stablized or achieved significant declines in rates of new HIV infections, with new HIV infections declining almost 20% in the last five years. At the same time that rates of new infections are declining overall worldwide, the number of new infections are increasing in areas like Eastern Europe and Central Asia, in large part due to injection drug use.

Highlights of the UNAIDS 2010 Report on the Global AIDS Epidemic

Kaiser Family Foundation recently held a webcast on “The Future of US Multilateral Engagement on Global Health“ as part of the Foundation’s US Global Health Policy: In Focus live webcast series. This question and answer format webcast featured an expert panel including Mark Abdoo the director for Global Health and Food Security, Natasha Bilimoria the president of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, and Jennifer Kates the vice president and director of Global Health Policy & HIV for the Kaiser Family Foundation, moderated by senior analyst Josh Michaud.

This discussion explores the approach taken by the United States to address Global Health funding historically and looking into the future. Discussions on global health funding often involve a division between bilateral approaches to funding versus multilateral funding engagement. Bilateral funding involves the provision of direct assistance from one government to, or for the benefit of, one or more other countries, with the donor having significant control over the target, approach and content of assistance. On the other hand, multilateral organizations such as the World Health Organization, the United Nations and the Global Fund, bring together global stakeholders to develop and collaborate on global health targets.

Historically, the US has commonly supported global health priorities via bilateral funding and programs but the focus on promoting multilateral organizations is growing. For example, the US was the first and is currently the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a key component of the Obama Administration’s Global Health Initiative includes a renewed and increased commitment to multilateral engagement. The shifting approach has led to questions regarding the appropriate focus for US global health engagement, the proper balance between multilateral and bilateral funding efforts and the appropriate role of the US government and other organizations in international treaties and other collaborative agreements.

Check out this and more global health-related webcasts and other valuable resources on global health policy at the http://www.kff.org/ website. A more detailed discussion on the US Government’s Global Health Policy Architecture is also available.

Yesterday, the international donor community pledged $11.7 billion over the next three years to fund The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. The fund had hoped to raise $20 billion. This shortfall in necessary funding will put at risk the 2015 goal to: eliminate HIV mother-to-child transmission worldwide, prevent the spread of multidrug resistant TB, and eradicate malaria as a public health issue.

A pressing question amongst global health advocates is how to finance global health in the midst of this global economic recession?

One solution proposed is the enactment of a financial speculation tax on the currency transactions market. The proceeds raised could fund global health initiatives such as the Global Fund and the President’s Emergency Plan for AIDS Relief (PEPFAR).

Sixty countries including France, Germany, Japan, Spain and the United Kingdom are publiclysupporting an international financial speculation tax on the $4 trillion dollar currency transactions market. In the United States, Congressman Pete Stark (D-CA), introduced H.R. 5783, the Investing in Our Future Act. Representative Stark proposes “a small tax — of five thousandths of one percent, or 0.005% — on currency transactions. Due to the extreme speculation that takes place, it would raise [at least] $28 billion a year and reduce currency speculation by 14 percent.”

Some may argue, as fiscal conservatives surely will, a tax on banks is ill advised at this time given the anemic state of our economy. However, David Stockman, director of the Office of Management and Budget under President Reagan, writes in the New York Times that “while supply-side catechism insists that lower taxes are a growth tonic, the theory also argues that if you want less of something, tax it more. The economy desperately needs less of our bloated, unproductive and increasingly parasitic banking system.” A proposed financial speculation tax — a financial “pinprick” for international banks — would be an important stream of revenue to fund domestic and global development initiatives as well as reduce the reckless financial speculation practices of international banks.

Global health is the moral litmus of our time. As Nelson Mandela once said “Sometimes it falls upon a generation to be great.” Fifty years from now, will we want to remember that we bailed-out AIG, Citibank, and Goldman Sachs? Or will we want to remember that we committed the necessary funds to end the scourge of AIDS, TB, and Malaria?

I urge President Obama and the United States Congress to support Congressman Stark’s Investing in Our Future Act. Together we can finance global health and protect Wall Street from the dangerous speculation practices that contribute to global economic instability.

Check out the webcast from the recent “The Future We Make” meeting on the Bill and Melinda Gates Foundation website for an engaging and insightful discussion of issues related to the Millennium Development Goals such as child mortality rates, birth rates, literacy, HIV/AIDS and more on a global level.

TEDxChange Webcast

• End Poverty and Hunger
• Universal Education
• Gender Equality
• Child Health
• Maternal Health
• Combat HIV/AIDS
• Environmental Sustainability
• Global Partnership

The Millennium Development Goals Report 2010 summarizes the progress which has been made thus far while striving to meet these goals as well as potential actions, strategies and policies which could be implemented to continue positive progress.

This global discussion series began this past May with a debate entitled “Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?” which looked at testing and treating strategies with a focus on their role in Africa.

In June, a debate on “Behavior Change in HIV Prevention” took place looking at dynamics involved in behavior change approaches and their past ineffectiveness.

Check out these past debates and the ones still to come including theis week’s August 26th debate on “Discordant Couples and HIV Transmission” and continue to follow this debate series for future conversations.

With the highest recorded global population growth rate and the most enormous demographic shift ever between the more developed and less developed regions, the century from 1950 to 2050 saw dramatic changes in global development. It is still unforeseen whether this pattern of human development will remain sustainable. This paper explores the ways in which policy could respond to unmet human needs, many of which have arisen from human choices rather than biophysical necessities.

In a recent article on Huffington Post, Dr. Ezekiel J. Emanuel, special advisor for health policy in the OMB, defends the Obama Administration’s decision to shift some of the funding away from successful AIDS treatment efforts:

This comprehensive and integrated approach is what the President’s Global Health Initiative is all about. It recognizes that we can’t treat our way out of the HIV-AIDS epidemic. The key to ending it is to reduce the number of those who become HIV-positive in the long-term – and that takes improving their overall health and the health systems around them. After all, patients don’t come to doctors with one disease or condition, and our response shouldn’t focus on one as well.

Dr. Emanuel writes in response to widespread criticism of the Obama Administration during the International AIDS Conference in Vienna, as well as to the July 20^th New York Times op-ed by Archbishop Desmond Tutu, who writes:

During my life, I’ve witnessed amazing advances in medical science. New treatments turn H.I.V. infection from a death sentence to a manageable illness. The cost of treating it is a small fraction of what it was 10 years ago. Meanwhile, more and more African nations have invested in the public health infrastructure needed to distribute AIDS drugs. I appreciate that tough financial times require the United States government to cut spending. But scaling back America’s financial commitments to AIDS programs could wipe away decades of progress in Africa.

Anand Reddi responds on Huffington Post and specifically counters the argument that “we can’t treat our way out” of the epidemic:

Results by Dr. Julio Montaner published in The Lancet demonstrated that provision of antiretroviral therapy in British Columbia halved the rate of new infections. The Economist writes the study by Montaner is “the strongest confirmation yet that treatment and prevention are two sides of the same coin.”  Treating our way out is indeed possible.  In our recent article in AIDS, Sarah Leeper and I demonstrated the unique dynamic-reciprocal relationship that HIV/AIDS, TB, and Malaria have on maternal and child health and vice-versa in the resource limited setting. I salute Dr. Emanuel for forwarding the dialogue on global health and advocating for comprehensive, integrated, cost-effective models of care that advance not just HIV/AIDS but other important health priorities including maternal and child health. Given that the provision of antiretroviral treatment can actually lead to prevention, eradication of new HIV infections is possible if the world community remains fully committed to funding cost-effective antiretroviral treatment initiatives.

Further reading:

• Anand Reddi’s previous article about AIDS funding on Huffington Post.
• The CID journal article by Rochelle Walensky and Daniel Kuritzkes, from the Center for AIDS Research at Harvard Medical School, that Archbishop Tutu references in his letter.