Posts Tagged ‘Obama administration’

Ezekiel J. Emanuel, center, White House global health advisor

Ezekiel J. Emanuel, head of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist, is on extended detail as a special advisor for health policy to the director of the White House Office of Management and Budget.

But that doesn’t speak to his impact. He is one of the architects of the Obama administration’s Global Health Initiative, and he has been a lightning rod of criticism for activists who want a much more vigorous global AIDS response from the administration.

Emanuel spoke to John Donnelly on Saturday about how the Obama administration now needs better ideas for making global health programs more efficient, and how he won’t shy away from taking on AIDS activists. “I have two brothers and all we do is disagree,’’ he said.

Q: You haven’t been shy in pushing back on criticism from AIDS activists about the Obama administration’s smaller increases in the global AIDS budgets than under the Bush administration. What really upsets you?

A: We can have disagreements about the right policy, which way we are going forward, but we can’t have a disagreement about the facts – the facts of the budget. A number of advocates are saying we are cutting the PEPFAR budget. The fact is funding for HIV and our work on PEPFAR is going up – in 2009 2010 and 2011. That is matter of fact. You may not like the allocation we have made, or not like the pot we are putting it in, but (saying we are) cutting the budget is wrong.

The second thing is [the notion] that somehow I am `anti-HIV,’ or `anti-work-we-are-doing-on-HIV,’ is absolutely wrong. This development of the [Global Health Initiative (GHI)] is building on everything we have done, using what our work in HIV and malaria has shown us. One of the things that we have shown is that you can take complicated medical interventions, get them working in rural areas — including sophisticated techniques like measuring T cell and viral loads — and monitor people. A lot of what we have put into the GHI is built on the foundation of PEPFAR. We want to broaden it.

And (another thing) is that we have a moral obligation to the people we are trying to help that if we are spending money on things that are not efficient, we have to be more efficient. There is a moral obligation from the community (working in AIDS issues) not to just ask for more money, but to say, `We have this pot of money, how are we going to do the most with it?’

We’re not doing this because we are green-eyeshade, no-morals people. It’s because we want to save lives and spend money most efficiently.

Q: Still, Ambassador Eric Goosby told Science Speaks this week that even with efficiencies, there will be a `mismatch’ between funds and the need.


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This week, Dr. Peter Mugyenyi is visiting Washington from Uganda, where he directs the Joint Clinical Research Center, the largest PEPFAR implementer in East Africa. Dr. Mugyenyi was one of a half-dozen people in the room when PEPFAR was conceived back in 2003. As one of the program’s most eloquent supporters, Dr. Mugyenyi has recently begun voicing grave concern about the near flat-funding of PEPFAR’s budget. In this video interview, he talks about the on-the-ground consequences of a pullback from the fight against global AIDS. Dr. Mugyenyi will be testifying about this issue on Thursday at a hearing before a House Foreign Affairs subcommittee.

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An estimated 8 million tuberculosis-related deaths have been averted over the last 15 years through aggressive global efforts to combat this ancient and deadly epidemic, according to a new report released today by the World Health Organization.

Dr. Mario Raviglione, of the World Health Organization, highlights success in treating TB

 The epidemiological report, which provides more up-to-date figures than usual, says there were an estimated 9.4 million new cases of tuberculosis in 2008, a slight increase from the 9.3 million new cases in 2007. The disease claimed more than 1.8 million lives last year, including .5 million women.

Despite the continued global threat posed by TB, and reflected in the report’s new numbers, WHO officials said significant strides have been made in treating the disease. Over the last 15 years, an estimated 36 million patients have been cured of TB, Dr. Mario Raviglione, director of WHO’s Stop TB Department, said at a Congressional briefing to unveil the WHO report.

“We are now getting to the level of very high success rates,” Dr. Raviglione said of treatment under the DOTS strategy, or Directly Observed Therapy Short-Course. An estimated 87 percent of patients globally were successfully treated using DOTS, he said, marking the first time the global 85 percent treatment goal was surpassed since being set in 1991.

He noted that even in some countries with a high HIV burden, which fuels the TB epidemic, TB treatment has been successful. “That’s partly due to antiretrovirals being used abundantly in those countries,” he said. Still, in some parts of Africa, up to one percent of the population gets TB every year, “which is extraordinary,” Dr. Raviglione said.

Rep. Eliot Engel, D-N.Y., who also spoke at the briefing, said Congress must not falter in its commitment to fighting TB.

Rep. Eliot Engel, D-N.Y., called it "reprehensible that we allow over a half a million women to die each year of a preventable, treatable disease."


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Leading academic, scientific, and public health leaders from around the world sent a letter to President Obama last night, urging him to maintain robust scale up of AIDS services as part of his Global Health Initiative.

“It is imperative that we save lives, families and communities, as well as stabilize developing nations, through continued scale-up of HIV prevention and treatment services,” the letter says. “U.S. global health policy now has an opportunity to leverage the success of the AIDS response by using accelerated scale-up of HIV prevention and treatment as a platform on which to build broader and more sustainable healthcare capacity in low-and middle-income countries.”

The signatories on the letter include a broad array of leading medical and health experts—Jim Yong Kim, president of Dartmouth College; Martin Blaser, chair of the Department of Medicine at New York University, David M. Serwadda, dean of the School of Public Health at Makerere University, and Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard University, to name a few.

The missive to Obama comes as the Administration hones a new approach to global health. Top government officials are putting the finishing touches on a new global AIDS strategy, which is set to be released on Dec. 1—World AIDS Day. But right now, signals from the White House indicate lukewarm support for the US global AIDS program. Dr. Eric Goosby, Obama’s global AIDS coordinator, recently said the Administration would flat-fund PEPFAR for at least the next two years, possibly longer

The White House is also crafting details of its all-important Global Health Initiative, which could come out in the next few months. And there’s the nomination—finally—of Dr. Rajiv Shah to head USAID.

Given all that activity, the focus on AIDS could not come at a more crucial moment, particularly as the Administration appears to be shifting its attention to other health problems, such as child and maternal health, without an apparent acknowledgement of the link between AIDS and the health of mothers and children.

As the letter notes, HIV/AIDS is the No. 1 cause of death among women aged 15-44, the virus remains a leading cause of maternal mortality in sub-Saharan Africa. “Globally, only one-third of pregnant women have access to antiretroviral drugs that can virtually eliminate the risk of perinatal transmission,” the signers note. “Twelve million children have lost one or both parents to AIDS and the number of orphans continues to rise.”

The letter argues we cannot effectively address other health threats by pitting AIDS funding against other health needs, as some in Washington seem to be advocating.

“Today, some argue that we cannot increase the so-called “treatment mortgage” or that HIV resources should be shifted to other health care priorities,” the letter says. “We reject the notion that urgent health conditions should be pitted against one another. Narrow conceptions of cost–effectiveness, or the cost of a given intervention in isolation, cannot become the litmus test to compare interventions for different diseases or to prioritize U.S. global health funding.”

Click here to read the full text and see a complete list of signatories or below for a PDF.

Final_Letter to President on AIDS scale up 11 18 09 (2)

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Physician-scientists working on the frontlines of the HIV/AIDS epidemic today urged the White House to set bold new HIV treatment targets for PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief.

The Center for Global Health Policy joined with a coalition of other organizations—including HealthGAP, amfAR (the Foundation for AIDS Research), the Treatment Action Group, and The AIDS Institute—in calling for PEPFAR to reach 6 million people with antiretroviral drugs by 2013 and 7 million by 2014.

The Global Center and these other organizations, part of the Global AIDS Roundtable Treatment Working Group, detailed this HIV treatment imperative in a recent memo to US Global AIDS Coordinator Eric Goosby, MD.

The memo comes as the Administration crafts two related policy positions. First, the Administration is now preparing its Congressionally-mandated five-year global AIDS strategy, including treatment goals and funding levels for fiscal year 2011. And second, in the coming months, the White House is expected to release the details of its Global Health Initiative, which some fear will outline a shift away from AIDS toward other global health priorities.

HIV/AIDS experts say new attention to child and maternal health is welcome and necessary, but it cannot come at the expensive of continued scale up to combat the AIDS epidemic. For one thing, HIV/AIDS in inextricably linked to child and maternal health. In Sub‐Saharan Africa, antiretroviral drugs are critical to addressing maternal and child mortality, and robust scale-up of ARVs will mean millions of women’s lives saved from HIV and tuberculosis. It will mean fewer AIDS orphans and fewer HIV-positive babies.

“HIV remains the largest cause of maternal mortality in some countries and community‐wide coverage of ART is increasingly being shown to decrease non‐HIV infant mortality, poverty, and deaths from diseases like TB,” the memo to Dr. Goosby says. “It is also important to note that Lantos‐Hyde prioritizes scale‐up of PMTCT programs and expansion of ART treatment for HIV‐infected children—priorities that will not be realized in the absence of increased investment in ARV treatment and ambitious treatment targets.” (more…)

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This post is by Center Director Christine Lubinski: 

Dr. Jorge Sampaio, the UN Secretary-General’s Special Envoy to Stop TB and former President of Portugal, is in Washington this week to meet with key US government officials about the urgent need for enhanced U.S. leadership to battle global tuberculosis.

Dr. Sampaio invited a small group of global health advocates to brief him on the current climate in Washington and to offer advice about TB messages that might resonate with policymakers on Capitol Hill and in the Obama Administration.

Sampaio had just returned from a trip to Africa, where he met with a number of health ministers challenged by the high prevalence of tuberculosis in their countries. Those ministers were also worried about the economic downturn and its impact both on resources for health in their own countries and the potential impact on donor support. Of particular concern is the budget shortfall at the Global Fund to Fight AIDS, TB, and Malaria—the single largest source of funding for TB programs in developing nations.

Anxiety about the availability of adequate resources comes at a time when African nations are taking big steps forward in building the healthcare infrastructure essential to responding to TB and other infectious disease killers, according to Sampaio. Ethiopia’s efforts to train 40,000 community health workers are well underway. And Rwanda has made great progress in integrating HIV and TB services, but lacks the $500,000 necessary to bring its laboratory capacity up to the level necessary to deal with deadly drug-resistant TB. (more…)

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