The Global Pulse Journal Blog

For the past seven years, the United States has supported and expanded its program to fight HIV/AIDS in developing nations, underwriting almost half of the world’s AIDS relief. But some are concerned by recent setbacks in the global campaign to fight disease in the developing world. At a time when the numbers of people infected with HIV is beginning to increase after stabilizing in countries like Uganda and the number of people in need of treatment is rapidly expanding, the US funding has not kept pace. With updated World Health Organization guidelines, the number of HIV-infected people eligible for treatment has expanded to 14 million, a large increase from the only 4 million people current in treatment.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

On October 30, 2009 President Obama announced the end of a 22-year ban on travel to the United States by people infected with the HIV virus. The President made good on an earlier promise, acting to eliminate a restriction he said was “rooted in fear rather than fact.” The new rule will take effect after a routine 60-day waiting period, ending the US’s position as one of only about a dozen countries that bar people who are infected with HIV. Read the rest of this entry →

This past Tuesday, May 5, 2009, President Obama announced a $63 billion global health initiative as part of his 2010 fiscal year budget which begins October 1, 2009. Reflecting the President’s belief that, “We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health,” Obama proposed a six-year health initiative dedicating $63 billion to support programs in the world’s poorest nations. The initiative is targeted at some of the world’s largest global health challenges such as AIDS, TB and maternal health according to Deputy Secretary of State Jack Lew.

The President’s Emergency Plan for AIDS Relief (PEPFAR), a national program initiated during the Bush administration, would receive $51 billion over the six years of the initiative, aimed at AIDS, tuberculosis and malaria. Obama’s plan aims to reach beyond AIDS and dedicate the remaining $12 billion to target other tropical diseases, improve pre- and post-natal care and support child health initiatives. The President’s budget calls to increase the $366 million spent on malaria, AIDS and tuberculosis in 2009 to $7.4 billion in 2010.

The President’s proposal has drawn criticism from many activists who feel that Obama’s plan fails to fulfill his campaign promise to expand PEPFAR by $1 billion a year over the next five years (not six) with a $50 billion pledge towards HIV/AIDS worldwide by 2013. Reflecting this sentiment, the Infectious Diseases Society of America called the proposal a meager increase which would impact the health care cuts already in place by impoverished countries in light of the worldwide economic crisis. Dr. Paul Zeitz of the Washington-based Global AIDS Alliance agreed that the proposal was a betrayal of trust with its lack of increased overall funding and Christine Lubinski of the Global Health Policy Center stated that the proposal is “worse than we had feared.” On the other hand, musician Bono, representing his advocacy group ONE, praised the funding increase stating that President Obama’s “strategic leadership on these issues is protecting the long-term interests of the people in his own country as well as saving vulnerable lives overseas.”

Stay tuned, as the White House plans to release a more detailed budget proposal on Thursday, May 7, 2009. For details on the proposed global health funding for 2009 to 2014 see the White House Statement by the President on the Global Health Initiative.

As we all come down from last week’s frenzy surrounding the (now renamed for lesser offensiveness to pork-marketing sensibilities) Swine-Origin Influenza Virus (S-OIV) H1N1 , is it possible that there is a hint of disappointment in the air?  Perhaps a whiff of anti-climactic letdown after the threat of feverish, lung-rending apocalypse?  Are we seeing a lucky escape from a close brush with global pandemic, at mercy of mutation and chance?  The product of a genuine, coordinated worldwide epidemic response?  Or merely the end of one news cycle and the beginning of the next?

While you ponder those questions, I bring you what could be one of the last updates before S-OIV H1N1 becomes terminally uncool.  As of Monday, April 4, the World Health Organization registered 1,085 laboratory-confirmed cases in 21 countries.¹ Mexico has begun to step down its safety measures, with restaurants and other venues for public activity set to re-open on Wednesday, and U.S. public health officials will be allowing schools to remain open in spite of the continuing spread of the virus, as most new cases appear to be mild.  In the business of assuaging fears, it has been confirmed by the WHO that eating pork is safe (so long as you cook it to 70°C/160°F first), and in the business of fanning fears of a different kind, U.S. conservatives are wasting no time in casting President Obama’s “overreaction” to the crisis as big-government encroachment.

For the fun flu facts reading selection this time,  I introduce another global health resource: the University of Pittsburgh’s Supercourse online series on epidemiology and global health.  Click on the Swine Influenza A link (or on the image below), pick your language of choice (including Spanish, Russian, Farsi, Vietnamese, and Hebrew), and click “Start” for a refresher on hemagglutinins, neuraminidases, and case definitions.

For a cool overview of influenza virus genetics, check out this article by Carl Zimmer in the New York Times:

Scientists first isolated flu viruses from pigs in 1930, and their genetic sequence suggests that they descend from the Spanish flu of 1918. Once pigs picked up the flu from humans, that so-called classic strain was the only one found in pigs for decades. But in the 1970s a swine flu strain emerged in Europe that had some genes from a bird flu strain. A different pig-bird mix arose in the United States.

In the late 1990s, American scientists discovered a triple reassortant that mixed genes from classic swine flu with genes from bird viruses and human viruses. All three viruses — the triple reassortant, and the American and European pig-bird blends — contributed genes to the latest strain.

And for possibly the best selection of flu-tracking maps you’re likely to find, this one is brought to you by Google and Rhiza Labs:

¹ For the epidemiologically-minded, with a lab-confirmed death toll of 26, this makes for a Case Fatality Ratio of 2.4% and falling with every new case of lab-confirmed disease in the absence of further deaths.  For comparison, your annual, garden-variety flu has a CFR of less than 0.1% in the general population, with a bimodal distribution of mortality (mostly limited to the very young and the very old).  Past flu pandemics have had CFRs in the 0.1%-2.5% range, while the dreaded H5N1 avian flu virus tracked in Asia in recent years showed a CFR of 14%-60% by various estimates (Li et al., J Epidemiol Community Health. 2008 Jun;62(6):555-9 ).  One previously reported CFR for zoonotically-acquired swine influenza was 14% (Myers et al., Clin Infect Dis. 2007 Apr 15;44(8):1084-8 ).  As you may suspect, flu CFRs are notoriously difficult to calculate, due to the wide incidence and under-reporting of mild cases.

Ask your senators, via email and phone, to include the option of public health insurance in the Health Care Reform Bill. This would offer more choice, as the public plan would not cross off existing private insurers. Read Mary-Carol’s legislative action statement below:

Dear AMSA,  

The Senate just returned from recess on Monday and square on the agenda is a big Health Care Reform bill that has yet to be fully written.  One of the more important aspects of this reform process is over the inclusion of a “public health insurance option”.  This is what it says, a plan run by the federal government (much like Medicare), that people have the option of buying much as they would buy a private insurance plan.   

This public plan would, as our Legislators are describing it, exist alongside the private plans like Aetna and Blue Cross/Blue Shield.  The legislation is on the Congressional drawing board right now and the public plan option is the contentious issue - many opponents are saying it should be on the Congressional chopping block.  AMSA supports the creation of a single, country-wide risk pool of patients, funded from one budget, but right now, we’re not going to have any say at all unless we weigh in as this Nation’s future physician workforce with our support of the public insurance option at a minimum.We need your help to let your Senators know that you want your future patients to have the choice of a public health insurance option. Join AMSA members across the country today, Thursday April 23, to contact both of your Senators.

- Mary Carol

Will the public health insurance option take us a step closer to single payer? Perhaps so. But, the first thing congress and people at large must agree upon is the underlying principle that health is a human right. Without agreeing on this unshakeable foundation, health will still remain a commodity. 

SUPPORT SYRINGE EXCHANGE! In case you didn’t know already, the globe is interconnected.  What happens here at home, affects those abroad, and vice versa. Support this domestic issue now! Call your representative and the White House to make it loud and clear to them that: 1) They must support the Community AIDS and Hepatitis Prevention Act H.R. 179 and 2) President Obama must keep campaign promises to end the ban on Federal Funding from his Fiscal Year 2010 budget.  See below for links and a letter from Mary Carol-Jennings and the AMSA AIDS Advocacy Network Steering Committee…  

Today, April 2, as part of the final budget wrap-up, we need to take a stand on domestic issues - please take just 2 minutes to call the White House and your Representative to advocate for domestic harm reduction programs.Call your Representative and the White House to ask our Nation’s leaders to support Syringe Exchange Programs and End the Federal Funding Ban!1. Urge Your Representative to Support the Community AIDS and HepatitisPrevention Act, H.R.179, introduced by Representative Serranoand2. Urge President Obama to keep his campaign promises to end the ban on Federal Funding from his Fiscal Year 2010 budgetWe made huge strides last year when Congress lifted the ban against Washington DC using its local tax dollars to support syringe exchange.Unfortunately, since 1988, there has been a Congressional ban on the use of federal funds for Syringe Exchange Programs nationwide. By allowing federal dollars to fund Syringe Exchange Programs, the Community AIDS and Hepatitis Prevention (CAHP) Act of 2009 will save thousands of lives and help reduce high-risk behavior. As future physicians and public health advocates, we must pass the Community AIDS and Hepatitis Prevention Act, H.R.179. Again, Take Action here. In solidarity, Mary Carol, your Jack Rutledge Legislative Director, and Merrian Brooks, the AMSA AIDS Advocacy Network Steering Committee   

CALL NOW! Thanks!  

NO JOKE!! Today, the Senate passed the Kerry-Lugar amendment by unanimous consent! YES for all your calls, because our individual actions do make a difference! A loud sigh of relief, since we can rest assured $4 billion is secured for HIV treatment, malaria bed-nets and vaccinations for our fellow global citizens. Below is an excerpt from Senator John Kerry’s remarks regarding the Kerry-Lugar Amendment: 

…Returning diplomacy and development to their rightful place cannot be achieved through words alone:  It takes money to drive civilian foreign policy—and if it keeps us safer, as I believe it will, then that is money well spent.    

Full funding of the President’s international affairs budget is a vital step toward greater civilian capacity, and I urge my colleagues to support it. That’s why, along with Senators Lugar, Leahy, Voinovich, Durbin, Kaufman, Menendez, Dodd, Feinstein, Brown, Sanders, Lieberman, Casey, and Corker, I ask for approval of this amendment to restore $4 billion worth of funding to the President’s FY 2010 international affairs budget request for the Function 150 Account.  The offset here will come from the Function 920 Account…

Surveying the wide range of commitments and aspirations this budget addresses, it is clear that our challenge is immense. And yet, even as we confront a crisis here at home, we cannot afford to delay the task of restoring our leadership, returning to our best traditions of civilian outreach, and restoring our influence and authority.  We cannot afford to come up short on our promises to allies, to vulnerable populations, and to the world.    We cannot try to be a world leader on the cheap.  If we fail to do our part to solve the world’s problems, those problems will eventually find us here at home. 

From pandemics to climate change to failed states, this century’s security challenges demand that a new level of commitment to diplomacy and development.  With this relatively small investment, we are making significant strides toward restoring America’s leadership role in the world. It will make the world safer, and it will make us safer.  And so I urge my colleagues to join me in supporting the President’s budget request. 

To read the full statement from Senator John Kerry on the Kerry-Lugar Amendment to Restore Full Funding to President Obama’s International Affairs Budget, click here. 

Ain’t No Joke: If You Act, It makes a difference! Please call your senator TODAY (before the vote on the Hill tomorrow April 2nd), and ask that the USA continue to provide essential vaccinations and HIV & malaria meds for patients around the world. This will take less than 5 minutes!   below is a letter from Mary Carol-Jennings. Please read and ACT!!

Dear AMSA,Is the Senate playing an April Fools’ joke on millions of patients around the globe? They’ve threatened to cut President Obama’s request for foreign aid spending by $4 billion. In a time of global economic crisis, the Senate is saying that the poorest people in the world should be punished, while Wall Street executives swim in our tax dollars. They must be joking!Take Action NOW!Thankfully, Senators Kerry (D-MA) and Lugar (R-IN) aren’t falling for any April Fools’ Day pranks. They have introduced a Budget Resolution amendment to restore the $4 billion to the foreign aid budget. This money translates to life-saving HIV treatment, malaria bed-nets, and vaccinations for those who need it most. As physicians-in-training we need to speak up for our future patients before the vote on Thursday!  Today, during AMSA’s Global Health Week of Action, we need you to call your Senators and urge them to vote on Thursday for this critical amendment to the Senate Budget Resolution which would restore the $4 billion the President requested. Now is not the time to scale back on foreign aid and jeopardize the health of patients. Last year, with your help, Congress reauthorized the US Global AIDS Plan, and tripled its size and scope. Without additional funding for foreign aid, the US will not be able to meet the bold targets set by the Plan. Moreover, the budget funds critical global health programs like PEPFAR and supports humanitarian aid to Darfur, as well as other essential development world-wide.Will you call your Senators and ask them to vote for this critical amendment? Take Action NOW!  In solidarity, Mary Carol and AMSA’s Committee on Global Health     

It’s easy. Click on link, type in your zip, call and read! Magnify your voice and be the advocate for the millions of our brothers and sisters in need!