Global Health Policy Update

August 22, 2011

We would like to update you on some important policy discussions and decisions happening in Washington.

As we indicated in our last policy update, the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs (SFOPS) released its FY2012 appropriations bill last week. This budget contains a majority of global health program funding and overall funding levels for USAID and the State Department. The bill also includes “Overseas Contingency Operations” (OCO) funding, which finances supplemental programs in Afghanistan, Pakistan, and Iraq. The Subcommittee marked up the bill on July 27th, and the full Committee is expected to consider the legislation on August 3rd.

The total budget approved by the Committee is $39.6 billion—$8.6 billion (18%) below the enacted FY2011 budget. As expected, there were deep cuts in development programs, with global health programs hit particularly hard. The bill cuts overall global health funding by 9% compared to FY2011 levels and 18% below the President’s request. In comparison, security assistance programs and OCO funding received little or no cuts.

Several policy provisions were also included in the bill that will significantly impact global health programs:

  • Statutory reinstatement of the Global Gag Rule, which prohibits US funds going to organizations that “promote or perform abortion, except in cases of rape or incest or when the life of the mother would be endangered if the fetus were carried to term.”
  • Prohibition on funding for the United Nations Population Fund (UNFPA).
  • Prohibition on funding in FY2012 or prior fiscal years to “carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug.”
  • Withholding of 20% of funds for the Global Fund until the Secretary of State makes certain certifications about the independence and transparency of the work of the Fund’s Inspector General.

Unlike previous years, the bill provides an overall funding level for global health but does not specify funding for specific programs, thereby giving broad discretion to the Administration to determine funding levels. However, the bill does contain language, albeit non-binding, that gives the Administration guidance on Congress’s priorities. Among this year’s priorities are maternal and child health programs, which the Committee indicates should not receive less than FY2011 funding levels. The Committee also indicated support for programs targeting malaria, tuberculosis, and neglected tropical diseases – although no funding levels were specified.

The bill includes several provisions to increase oversight of taxpayer dollars and places specific restrictions on the Administration in areas such as direct government assistance, UN funding, and multi-year funding commitments. It also increases oversight by funding Inspectors General, reduces the period of availability of funds, and requires more accurate reporting of how and when funds are spent.

House Appropriations Chairman Hal Rogers (R-KY) praised the bill, claiming, “This bill provides essential support to secure and stabilize some of the most critical areas of the world—including Iraq and Afghanistan.” Echoing Rogers’ support for the bill, SFOPS Chairwoman Kay Granger (R-TX) stated, “This bill reforms and refocuses the way we spend our foreign aid… In this difficult geopolitical and economic climate, the American people deserve policies that are based on our principles.”

House Democrats, meanwhile, voiced strong disappointment with the bill’s steep funding cuts. Congresswoman Nita Lowey (D-NY), the ranking Democrat on the SFOPS Subcommittee, issued a statement criticizing the inclusion of “divisive and partisan policy riders that are counter-productive to effective diplomacy and development,” and claimed that inadequate funding levels threaten the government’s leadership in areas such as global health, development, and disaster relief. Her statement also made specific reference to the Global Gag Rule, claiming that it “prohibits recipients of U.S. health assistance from providing the most truthful and comprehensive health care possible to women in need” and that cutting funding for family planning and UNFPA denies critical health care to millions of women worldwide. House Appropriations Committee Ranking Democratic member Norm Dicks (D-WA) voiced similar disapproval, calling the subcommittee allocation “irresponsibly low” and claiming that the bill is “loaded down with short-sighted and ideologically driven riders.”

The full Appropriations Committee is scheduled to mark up the bill on Wednesday, August 3rd, but that mark-up may be postponed until the fall when Congress returns from its August recess. And despite an outcry from State Department officials and relief agencies, there is speculation that some Republican members may offer amendments during full committee consideration to further reduce funding levels in the bill.

Global Health and Development Assistance Funding, FY2012 House Subcommittee Mark
($US, millions)

  FY2010
Enacted
FY2011 Enacted FY2012 Request FY2012 House
Global Health/Child Survival $7,783 $7,845 $8,716 $7,114
USAID $2,424 $2,500 $3,074
Department of State $5,359 $5,345 $5,642

Sources:

http://appropriations.house.gov/UploadedFiles/FY12-SFOPS-07-25_xml.pdf

http://www.washingtonpost.com/blogs/checkpoint-washington/post/house-subcommittee-approves-foreign-aid-cuts/2011/07/27/gIQAtD6WdI_blog.html

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Global Health Policy Update

January 27, 2011

Global health was a hot topic in Washington, D.C. this past year starting out with lots of excitement and ending with much uncertainty. In this policy update we have highlighted the major events in global health in 2010 including the Obama Administration’s Global Health Initiative, the Presidential Policy Directive, and the Quadrennial Diplomacy and Development Review. Given the strong interest and concern with cost cutting in our government today, global health promises to be on the agenda again in 2011. To keep our membership informed of policy changes that present both challenges and opportunities for global health programs, we are launching a global health policy update to which you can subscribe.

  • 2010 started with a bang when President Obama requested huge increases in funding for global health programs as part of the Administration’s Global Health Initiative (GHI). While it’s a difficult time to increase spending, the Administration made global health one of their top funding priorities. The GHI ushered in a new way of thinking about global health – shifting away from the disease-specific emergency response policy of the past Administration and towards a more sustainable approach geared towards women and girls, strengthening country capacity, and improving health outcomes.
  • The GHI was the first in a number of new Administration initiatives and reviews geared towards strengthening our foreign assistance. The Presidential Policy Directive on Global Development (PPD), released in September, and the long-awaited Quadrennial Diplomacy and Development Review (QDDR), rolled out in December; both highlighted the need for a more streamlined approach to foreign assistance. The Administration also announced the Feed the Future initiative, the U.S. government’s global hunger and food security initiative that renews its commitment to invest in sustainably reducing hunger and poverty.
  • On Capitol Hill, the debate over foreign assistance took place largely in the Appropriations Committee. While no legislation is needed for the GHI, funding to carry out the President’s goals certainly is a necessity. Democrats and Republicans debated the merits of increased funding for global health when considering the 2011 Fiscal Year Budget. One could call the debate a draw as Congress passed a Continuing Resolution – funding the government at FY’10 levels through March 4, 2011.
  • The House and Senate Foreign Affairs/Relations Committees also took steps towards enacting legislation that would reform foreign aid – a high priority for the Administration and former Chairman Howard Berman and Chairman John Kerry. However, with the 2010 election and the elevation of Congresswoman Ileana Ros-Lehtinen to Chair of the House Foreign Affairs Committee, that legislation may well have seen its last day, as her legislative priorities are elsewhere.

Sources: Glover Park Group, www.whitehouse.gov, www.state.gov, www.senate.gov, www.house.gov


Living in a Post-SARS World: What happens when another outbreak occurs?

September 27, 2010

In this day and age of global travel, you can get anywhere in the world during the incubation period of a new pathogen.  In the case of SARS, it took 61 days for a global pandemic.

Timothy Brewer of McGill University in Canada, speaking on the panel: “One Health: Detection and Control of Emerging and Endemic  Zoonotic Pathogens” noted that in the Guandong Province in China, people were walking around with masks, hospitals were shut down, and people were buying white vinegar to disinfect their homes long before most of the world knew what was happening.  He said the outbreak became widely known in November 2002, but it wasn’t until March 2003 that the Chinese government acknowledged it.

In 2005, WHO passed the Revised International Health Regulations, which requires mandatory reporting of outbreaks on international concern. The regulations went into effect June 15, 2007, and although there is no police force backing the regulations, Brewer said it adds more pressure to countries to come forward.

So has outbreak recognition improved over time?

In an analysis of the 398 reported outbreaks by WHO between 1996-2009, Brewer said there has been a slow improvement in outbreak discovery and reporting.

“SARS was the real impetus for outbreak discovery,” he said.

Panelist Jonna Mazet of University of California, Davis, an expert on surveillance, said researchers now have a cell phone network in place in many communities with an application to notify people when people see a sick animal.

But the gaps in zoonotic surveillance are still pretty big.

“Detecting a new respiratory pathogen is tricky unless you get lucky,” Brewer said.  Many of the new pathogens like H1N1 look like other  infections, so unless a pathogen creates unusual symptoms, he said it will be hard to detect especially with a lack of lab capacity.

“Even in 2010, you cannot access the WHO database unless you are with the Ministry of Health,” he said.

Panelist Hector Garcia with the Universidad Peruana Cayetano Heredia Institute of Neurological Sciences in Lima and an expert on cysticercosis (a disease from pigs) and Mazet of University of California, Davis,  said capacity building is a huge need.

Garcia said capacity building needs to happen with organizations and among collaborations. And Mazet said there is a huge need to fix the brain drain and to create a proactive approach. Her experience has been that when hunters in the Congo died of hemorraghic fever and the lab determined the pathogen wasn’t ebola, no one was interested in doing more investigation.

All three of these panelists also discussed the political pressure to keep outbreaks quiet because of the enormous economic consequences. 

For example, Garcia said during a continent-wide cholera outbreak in Peru in 1991 when many people got sick after eating fish, the health minister announced it was unsafe to eat ceviche but Peruvian President Fujimori, fearing a huge impact to the seafood industry, went to the media and said it was OK to eat ceviche.

Prepared by Bobbi Nodell,  Communications Specialist, University of Washington


The Role of Universities in Global Health-Redefining the Paradigm

September 24, 2010

The opening session of the CUGH conference provided a platform for dialog revolving around the various roles academics, researchers, and the universities  that they are linked can play in the emerging field of Global health. The distinguished speakers provided a linear progression of how the field of global health evolved over time and how the role of universities changed to keep up with the evolution of global health.

Some of the topics discussed included, but was not limited to global peace and security, emerging infectious disease, health inequalities, global brain drain, and the necessity for collaborations between universities and other stakeholders in the global health milieu.

An emerging theme that I believe is commonplace in the discourse of the future of global health is the emphasis on collaborations between industry and global health. Susan Hellman, a distinguished professor and chancellor of University of California, San Francisco provided perspective as an individual who worked in both academia and private industry and stressed how important this collaboration can be to the future of global health.

Overall, the opening session set the stage for further discourse on global health services, education, research and collaborative partnerships between academia and industry.  Hopefully the information disseminated over the course of the conference will provide the data that various stakeholders in the global health milieu will need to advance health worldwide.

Prepared by Wendell Jones


Stephen Morrison: US Global Health Initiative

September 23, 2010

Stephen Morrison, CSIS

Missed Stephen Morrison’s excellent presentation on the Global Health Initiative and USG global health policy?  Read his remarks here.  Morrison is director of CSIS Commission on Smart Global Health Policy.

http://www.smartglobalhealth.org/blog/entry/remarks-to-the-consortium-of-universities-for-global-health-on-the-u.s/


The Wellcome Trust Approach to Capacity Building

September 22, 2010

Val Snewin opened the session describing The Wellcome Trust, a global charity based in the UK dedicated to achieving extraordinary improvements in human and animal health, and how they fund different programs around the world to help build up health services workers, especially researchers. The Wellcome Trust funded seven consortia involving 70 institutes, of which the session highlighted funded work that impacts India, Kenya and Africa. Speakers from each country explained about how their programs are structured and their learnings – the speakers all agreed that the consortia need to focus on the long-term success like career paths in order to establish the right supporting programs, especially mentorship, that ultimately build up capacity and maintain it.

Andrew Haines from the London School of Hygiene and Tropical Medicine said the priorities of the consortia in Africa are developing mentorship, MSc training, supporting PhD students, professional development and career planning, and establishing research support centers in the region. They face many challenges though in making the consortia successful – money, Internet bandwidth, expectations and the government’s visa restrictions are all hurdles. Haines said there is no real financial reward for the staff’s time in research from universities so they actually have a net loss. With limited bandwidth in Africa, it makes distance learning a serious problem. They’ve implemented several approaches to try to address the challenges including sharing resources like research methods add staff development in region, they are doing more courses taught by LSHTM staff based in the country, and they are licensing distance learning courses.

For India, Srinath Reddy of the Public Health Foundation of India, spoke about the foundation’s focus on improving health outcomes through education;  research, policy and advocacy; training; and public health practice. PHFI is in partnership with the Wellcome Trust for capacity building – they began doing annual meetings in 2007, in which seven institutions participated – these groups had never previously collaborated. In 2008, that number has grown to 12. Its proposal to the Wellcome Trust is nurturing young faculty, fostering research, and active sharing of resources.

 Sam Kinyanjui of the Kenya Medical Research Institute walked through how they’ve managed to implement a program that has shown a strong track record of its students in the program going on to get PhDs or to Masters tracks – many of those in the Masters tracks have even submitted and were chosen for fellowships from the Wellcome Trust. The KEMRI does demographic and epidemiological surveillance for 240,000 people, clinical surveillance and investigation, and utilizes high quality labs and data centers. Kinyanjui showed a startling image of the KEMRI first research facility, a dilapidated small shed where they squeezed 20 members in, located in the middle of overgrown grass. Now, 20 years later, the research capacity is s large, high quality building with multiple spaces for training and which houses 750 staff.

 Prepared by Erika Bitzer


Global Health Policy and Diplomacy

September 22, 2010

The world currently faces a plethora of challenges that transcend national borders: economic upheaval, the spread of emerging pathogens like H1N1 influenza, the increasing global migration of people and goods, climate change, and the ever-widening gap between wealthy and vulnerable populations. Each of these impacts human health, and the speakers in this session each started with the premise that it is time to draw on the art of diplomacy to build coalitions to address these issues.

Sara Curran introduced the session by asking the question “Why do we need health diplomacy?” She was followed by Kelly Lee, from the London School of Hygiene and Tropical Medicine, who offered a historical perspective on the art of diplomacy and the emergency of what she calls “New Diplomacy.” She argues that there is a shift in the actors, agendas, and technologies in modern diplomacy, and a rise in the influence of human rights and social justice. “Maybe in the future,” she reflects, “ “Might makes Right’ will be replaced with ‘Right makes Might.’ ” She hopes that through the framework of global health diplomacy, people working in separate disciplines can start to work together in harmony.

Peter Lamptey, from Family Health International, added to the discussion with his arguments for why global health is in America’s interest. In addition to providing economic opportunities and promoting U.S. leadership and values broad, he stated that a global health framework is important to protect people from issues such as food safety, counterfeit pharmaceuticals, and biological terrorism that transcend national boundaries. He points out the successes that have already occurred as a result of U.S. funding of global health, but admits that there are many challenges ahead, including shrinking economic resources, the need for improved coordination and agenda-setting, and the need to better match funding to better reflect the global burden of disease. 

A representative spoke on behalf of Margaret Hamburg on the role that the FDA plays in the global sphere. In its vast mandate to oversee all imported food, drugs, cosmetics, and medical devices to the U.S., she feels that the FDA is able to help promote stronger international collaborations, scientific partnerships, and regulatory networks.

Lawrence Gostin pointed out the problems of the current donor-led approach to global health.  He feels that it undermines states’ responsibilities for the health of their own people, replacing national policy with a dizzying array of separate, uncoordinated, donor-led programs. “You may think that your own program has been a success,” he says, “but when you talk to health ministers in low income countries, you find out that they are in despair, because they are unable to know what is going on in their own country.” He proposes turning the traditional approach to global health on its head, and to begin by asking “What does each state owe to its own citizens?” He discussed the Joint Learning Initiative on National and Global Responsibilities, which calls for a bottom-up approach to global health led by the global South.

Prepared by David Roesel


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