Global Pulse Blog

USAID has released its new Climate Change and Development Strategy for 2012-2016, a strategic framework for approaching the barriers and opportunities presented by global climate change. The strategy strives to “enable countries to accelerate their transition to climate resilient, low emissions development to promote sustainable economic growth.”

3 strategic objectives are incorporated in USAID’s strategy:

1. Enhance the transition to low emission development via investments in clean energy and sustainable landscapes for climate change mitigation;
2. Grow resilience of people, places, and livelihoods through investments in climate change adaptation; and
3. Strengthen development outcomes through the integration of climate change in USAID programming, learning, policy dialogues, and operations.

“…the threat from climate change is serious, it is urgent, and it is growing. Our generation’s response to this challenge will be judged by history, for if we fail to meet it—boldly, swiftly, and together—we risk consigning future generations to an irreversible catastrophe.”

President Obama, United Nations Summit on Climate Change, September 22, 2009

As mentioned recently on the Global Pulse Blog, Research!America held a webcast briefing November 21st on USAID.  If you missed it, you can check out the panel discussion on the agency’s impact on global health research and development and partnerships in the global arena by clicking on the image below.

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

With World AIDS Day coming up on December 1st, I had the opportunity to join in a call with Stefano Bertozzi Director of HIV and TB at the Bill & Melinda Gates Foundation.

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.

As promised, today we bring you another commentary inspired by Secretary Clinton’s recent speech calling for an AIDS free generation by Matthew Basilico, Nworah Ayogu, and Arjun Suri of Harvard Medical School.

As students immersed in the study of biological sciences, and as future physicians anxious to provide care and improve lives, we can be frustrated when public health policy seems based on interests neither scientific nor beneficent. United States programs that fight global AIDS have accomplished tremendous good over the past eight years; however, recent stewardship by President Obama has been disappointing both scientifically and morally. Last fall, many of us at Harvard Medical School protested President Obama because we believed his failure to keep his promises to scale-up the fight against HIV/AIDS was proof that he was ignoring the science and neglecting his ethical obligation to save millions of lives around the world. However, on Tuesday, Secretary of State Hillary Clinton delivered an inspiring address that is at once evidence-based and morally laudable.

When we began our protests last fall, there was a growing body of research indicating that treating HIV also prevents its spread. Evidence from a localized study South Africa indicated that when people with HIV received antiretroviral treatment (ART), their partners were 92% less likely to contract the virus. [1] Initial modeling used this information to theorize that, with universal access to treatment, infections could plummet within 10 years. [2] With this growing evidence (as well as other studies), the phrase “treatment as prevention”—long used by health professionals working at the front lines of AIDS care—resonated in scientific communities. Not only does treatment save lives, but these recent studies show that treatment could dramatically reduce new infections, slowing or even halting the epidemic in the future. It was not until this year, however, that this could be said with such certainty. A multi-site, large-N, randomized control trial showed that ART reduces new infections by 96%. [3]

We have also been encouraged by the growing literature showing that investments in HIV treatment programs improve health systems and eases delivery of other life-saving interventions.[4,5]  Dr. Paul Farmer, co-founder of Partners In Health, described HIV treatment as the “battle horse” to drive the necessary expansion in infrastructure and political will for addressing other global health priorities.

The evidence is clear: now, more than ever, we know that investing in AIDS treatment will save millions of lives and reduce new infections. Yet in the first years of his administration, President Obama fell dreadfully short on campaign promises to significantly improve resources for AIDS funding.  Many fellow classmates from Harvard Medical School, as well as from colleges and medical schools across the east coast, joined in protests encouraging the administration to uphold its promises.  It is impossible to forget the numbers—a year of AIDS treatment costs less than $100, and the treatment program makes up far less than 0.2% of the federal budget.  Yet while hundreds of billions of dollars went to bank bailouts, no new money was found for the meager $1 billion dollar annual rise that was promised during the election cycle.

Secretary Clinton’s speech on November 8^th, therefore, was encouraging.  She declared that for the first time, it will be United States government policy to create “an AIDS-free generation.”  She emphasized prioritizing high impact interventions—prevention of mother-to-child transmission, circumcision, and treatment.  And she lauded the vital role of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been an innovative and transparent engine for delivering resources where they are needed most.  Secretary Clinton’s speech had much of what is needed, except for the numbers.

To transform the Secretary’s vision into a reality, we will need bold treatment targets and solid commitments to increase funding.  Six million patients on treatment by the end of 2013 would be an appropriate goal for the United States government, which is on track to have four million on treatment by the end of this year.  Congress and the administration have responsibility for the 2012 budget, while the Super Committee debates 2013 and beyond.  We eagerly await President Obama’s address on World AIDS Day (December 1^st).  Lawmakers have the opportunity to transform one of the greatest human scourges of our generation, or to be held accountable for inaction by patients, activists and history books.  As medical students, we have the ability to hold lawmakers accountable by calling and writing our elected officials, and communicating publically the cost of inaction.

-Matthew Basilico, Nworah Ayogu, Arjun Suri; Harvard Medical School

References

1. Deborah Donnell, Jared M Baeten, James Kiarie, Katherine K Thomas, Wendy Stevens, Craig R Cohen, James McIntyre, Jairam R Lingappa, Connie Celum, “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet 2010;375:2092-2098.

2. Reuben Granich, Siobhan Crowley, Marco Vitoria, Ying-Ru Lo, Yves Souteyrand, Christopher Dye, Charlie Gilks, Teguest Guerma, Kevin M De Cock, and Brian Williams “Highly active antiretroviral treatment for the prevention of HIV transmission,” Journal of International AIDS Society 2010; 13:1

3. Cohen MS, Chen YQ, McCauley M, et al. “Prevention of HIV-1 infection with early antiretroviral therapy.” New England Journal of Medicine 2011;365:493-505.

4. David Walton, Paul Farmer, Wesler Lambert, F. Léandre, Serena Koenig and Joia Mukherjee, “Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti,” Journal of Public Health Policy 2004:137-158.

5. World Health Organization, “An Assessment of Interactions Between Global Health Initiatives and Country Health Systems,” Lancet 2009;393:2137-2169.

With Secretary Clinton’s recent speech calling for an AIDS-free generation, one important question revolves around funding for this bold and enthusiastic plan. Pertinently, Funders Concerned About AIDS (FCAA), with support from Joint United Nations Programme on HIV/AIDS (UNAIDS), has released a report which shows that both the number of private U.S. funders and amount of funding has decreased this past year. The U.S. Philanthropic Support to Address HIV/AIDS in 2010 report shows which philanthropic organizations have been, and continue to be, leaders in the HIV/AIDS field.

Today’s guest blog post by Anand Reddi was originally published yesterday in The Huffington Post. Anand Reddi was a Fulbright Scholar in 2005, assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine. Here, he reflects on Secretary Clinton’s speech earlier this week and the importance and potential of a Global Health Service Corp.

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.

Recently, we shared with you Partner’s In Health’s Program Management Guide. This resource stresses the value of partnerships between NGOs and the public health sector. Related to this idea, PIH is hosting an online discussion on  Strengthening Health Systems: The Role of NGOs taking place from November 7-11. This Expert Panel to continue the conversation with participants online and address the ways in which NGOs can best support governments to strengthen local health systems.

Hosted by GHDonline in collaboration with PIH, the panelists include:

• Dr. Agnes Binagwaho, Minister of Health of Rwanda
• Ted Constan, Chief Operating Officer, Partners In Health
• Dr. Felix Kayigamba, Access Project Country Director
• Christina Bethke, Program Coordinator, Tiyatien Health
• James Pfieffer, NGO Code of Conduct author and Director of Mozambique Operations, Health Alliance International

To join the discussion, please sign up today!

Bill Gates and Rotarians make the “This Close” gesture on the steps of the U.S. Capitol in Washington, D.C. on World Polio Day, October 24, 2011, to promote Rotary’s End Polio Now campaign and show how close the world community is to eradicating the scourge of polio

Learn more about World Polio Day and global efforts to eradicate this disease which has been decreased thus far by 99% thanks to efforts including vaccination campaigns.

On September 19-20 the High-Level Meeting at the UN General Assembly was held to discuss the possibility that non-communicable disorders (NCDs) could become a new global health priority. While many hoped that the conference would generate increased action to target chronic diseases like diabetes, cancer, lung disease and heart disease as well as common underlying risk factors including tobacco, alcohol, poor diet, and inactivity, outcomes were mixed, influenced by strong economic and political factors. The meeting accomplished an elevation of attention for such diseases and laid forth a political declaration calling for national plans by 2013 to address such issues.

For more reflections on the event, tune into the Kaiser Family Foundation event - What Happened at the UN High-Level Meeting on Noncommunicable Diseases? Diverse Perspectives on the Meeting’s Outcomes and Next Steps tomorrow Thursday, September 29, 2011 from 12:30-2:30pm EST. You may RSVP at: http://smartglobalhealth.org/outcomesUNHLM

The Director of the Office of Global Health Affairs at the U.S. Department of Health and Human Services, Dr. Nils Daulaire, will introduce the event with a keynote address on the major achievements and outcomes of the high-level meeting, areas of unresolved tension and disagreement, and critical follow on steps over the next two years. This will be followed by a panel of diverse commentators, including:

Ambassador Ebrahim Rasool, South African Ambassador to the United States
Dr. Trevor Gunn, Senior Director of International Relations at Medtronic
Dr. Peter Lamptey, President of Public Health Programs, FHI 360

WHO Photo

Phots from the UN website

The Kaiser Family Foundation’s Global Health Policy Tracker provides brief overviews of key congressional, administrative, and budgetary actions, including the status of legislation, policies and programs, and government reports and hearings. This online tool is newly updated and allows users to quickly find and track the latest developments on U.S. global health policy issues such as:

• 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.