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World AIDS Vaccine Day: Igniting the prevention revolution

By: Seth Berkley, President and CEO of the International AIDS Vaccine Initiative

Crossposted from The Hill

There’s one bromide any decent physician endorses — the one about an ounce of prevention being worth a pound of cure. When it comes to ending the AIDS pandemic, U.S. policymakers from both sides of the aisle have embraced this notion as well, providing unwavering, bipartisan support for the global effort to end AIDS, which has already claimed nearly 30 million lives and left another 33 million infected.

U.S. government support for research into HIV prevention — most notably an AIDS vaccine — has been crucial to seeding what scientists are calling a prevention revolution. Without it, we would not be where we are today: The sheer risk of taking on AIDS vaccine development is a significant disincentive to private sector investment. This has resulted in a classic market failure that can only be surmounted with government support. World AIDS Vaccine Day provides an opportunity to consider why this support is also smart long-term policy — why it makes sense not just in medical terms, but in financial ones as well.

Indonesian volunteers light candles during a ceremony to mark World AIDS Day in Jakarta. Photo Credit: Adek Berry/AFP

Because there is no cure for AIDS, over the next few decades this merciless disease will continue to dismantle the familial networks that sustain and stabilize human society in many poor nations and, in some of them, sow the seeds of lasting political instability. As we have all learned in the past decade, such instability has a way of reaching around the world. Today some 5 million of the most vulnerable people in such places have access to HIV drugs today, thanks mainly to the President’s Emergency Plan for AIDS Relief launched by George W. Bush, and the U.S.-funded Global Fund to Fight AIDS, Tuberculosis and Malaria.

Still, every day, an additional 7,100 people become HIV positive, and for each person put on antiretroviral drugs, two are newly infected by the virus. While indispensible, the provision of HIV treatment cannot keep pace with this modern plague.

Even in the U.S., there are 56,000 new HIV infections each year, and the government spends $16.7 billion domestically on treatment and care for AIDS. The only medically and fiscally sane option we have is to find an efficient way to reverse the tide of new infections. Vaccines provide that option. As illustrated by recent efforts of the International AIDS Vaccine Initiative (IAVI) — which is led by the author of this piece — when done right, support for such research has the added benefit of spurring innovation in American industry.

Fortunately researchers have, with government support, made significant headway to that end. In 2009, a clinical trial in Thailand, conducted by U.S. military and Thai researchers, demonstrated for the first time that vaccines can in fact prevent HIV.

Meanwhile, researchers at and affiliated with IAVI have over the past two years isolated fifteen antibodies capable of neutralizing a broad spectrum of globally circulating HIV variants; others, at the National Institutes of Health, have independently found similarly powerful antibodies. Each of these discoveries holds valuable clues to the design of more effective HIV vaccine candidates.

But to harness them, we must find ways to bypass the market failure that discourages industry involvement. As a nonprofit public-private product development partnership, IAVI, with the support of its donors — most notably USAID — picks up much of the risk associated with developing promising AIDS vaccine concepts, and so draws industry into such efforts.

Second, the organization identifies and actively cultivates promising but neglected avenues of related research. As part of that effort, IAVI has in partnership with the Bill & Melinda Gates Foundation launched an Innovation Fund that seeks out biotech companies working on a variety of biomedical problems and supports the application their technology to solve the major problems of AIDS vaccine development.

It was from this fund that IAVI provided Theraclone Sciences, a small Seattle-based biotechnology firm seed funding to apply its technology to help isolate neutralizing antibodies. The success of this joint effort wasn’t just good for the field of HIV prevention. It was also good for Theraclone. Partly on the strength of its work with IAVI, the start-up won an agreement with a Japanese drug company to develop therapies and vaccines against influenza and, more recently, established an exclusive partnership with Pfizer for cancer and infectious disease therapies that could eventually be worth more than $600 million.

Just as the U.S. space program generated countless engineering innovations, solving the AIDS vaccine problem will have a lasting impact on one of the greatest growth industries of the future: biological therapies and vaccines, especially those relevant to emerging markets around the world.
We are today at a tipping point in our journey toward an AIDS vaccine. In these economically tough times, we must not forget the long term cost-savings promise of AIDS vaccines — and keep doing all we can to make that promise a reality.

Seth Berkley is the president and CEO of the International AIDS Vaccine Initiative.

USAID’s Frontlines – April/May 2011

Frontlines Banner Graphic

Read the latest edition of FrontLines to learn about the Agency’s work in global health and in Iraq, including these stories:

This photo of a woman administering a polio vaccine took second place in the latest FrontLines photo contest. Photo credit: Alain Mukeba, USAID/Democratic Republic of Congo

  • An exclusive interview with U.S. Lt. Gen. John Allen on how the United States’ military and civilian arms found common ground in Iraq. Allen is President Obama’s new nominee to lead U.S. and NATO forces in Afghanistan
  • How the new Global Health Initiative is building on a foundation of partnerships as key to healthier families, communities and countries
  • How the historic Food for Peace program has proven to be an extremely versatile development tool in rural Mozambique. Listen to FrontLines’ first ever podcast.

Get these stories and more in the new issue of FrontLines. If you would like to receive a reminder about the latest FrontLines, you can subscribe here.

Working Together for Healthy Communities in Senegal

Lois Quam is the Executive Director of the Global Health Initiative.

In the Senegalese village of Nianing, I joined a group of elderly ladies in a circle of plastic chairs as they sang a simple song, a drum keeping time with their claps.  Despite their years, each stood up one by one to dance a few steps.  But this “grandmothers’ group” does more than dance – they counsel young wives of the village to limit childbearing from 18 and 35 years of age and space births two years apart.

Executive Director of the Global Health Initiative Lois Quam Visits Senegal. Photo Credit: GHI

I met lots of other people in the village who cared about the good health of their community too:  political and religious leaders, volunteer health workers, and the counterpart to the grandmothers, a newlyweds association.  Their focal point is a “health hut,” which USAID supports through equipment and training of volunteer community mobilizers and health practitioners.

The health hut belongs to the village and you can see the difference it makes.  It’s been four months since they’ve had a positive malaria test, and in March nearly 40 women have come in to receive family planning services.  At the district health post down the road, we learned that they hadn’t lost a mother since the renovation of its maternity ward, thanks to safe, delivery services provided by qualified personnel – including a young, dynamic midwife named Felicity, who had been recruited by the district health post health committee.

As they opened their records for me, I could see their pride in the statistics they shared, which testified to the fact that practically everyone is engaged in the good health of the community. It moved me to see the way village leaders and extended families work together on a daily basis to develop and operate the health care services that they really need.

During my trip, I also met with religious, civil society, and implementation partners in a lovely reception at the Ambassador’s residence.  A highlight of this evening was meeting the Senegalese military leaders engaged in combating HIV/AIDS.

You can see that they have been built up over time with the long term support of the American people.   The health hut – and their good health – belongs to them.  I am really proud of the work that the United States government, through USAID, the Peace Corps, the Department of Defense, PEPFAR and Centers for Disease Control have done to help make that possible. And I am so proud of how effectively our team works together.  To learn more about health huts in Senegal, click here.

PEPFAR Support for a Country-Owned Continuum of Response to HIV/AIDS

Also posted at DipNote, the U.S. Department of State Official Blog

Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.

During today’s opening of the PEPFAR annual meeting, we focused on PEPFAR’s role in supporting countries to establish a “continuum of response.” Through this continuum, countries can provide a comprehensive system of care and support to meets their health needs to their people. As our Global Health Initiative (GHI) recognizes, the continuum is needed not only for particular diseases such as HIV, but for the whole range of public health issues.

At the individual level, a continuum of response means that the government orchestrates a health system that identifies populations at risk and follows them, addressing through all their needs through their lifespan — for prevention, and then for care and treatment if they become infected. And it means following them through all their non-HIV needs as well.

The continuum of response is anchored in the principle of country ownership. PEPFAR is working to support governments in orchestrating national efforts to address the health needs of their citizens, and enabling the strong participation of civil society in those efforts. Deputy Secretary of State Tom Nides affirmed the importance of country ownership in the U.S. foreign policy portfolio. And I was fortunate enough to join discussion on global health diplomacy and leadership with CDC Director Tom Frieden, USAID Administrator Raj Shah, and GHI Executive Director Lois Quam to focus on different dimensions of U.S. global health strategic priorities.

Thanks in part to the mechanism of PEPFAR Partnership Frameworks, I believe we are at the precipice of real country ownership of the fight against HIV/AIDS in a growing number of countries. Partnership Frameworks provide a 5-year joint strategic framework for cooperation among the U.S. Government, the partner government, and others to combat HIV/AIDS in the partner country. With our support, countries are putting structures in place that position them to meet not only HIV/AIDS needs, but whatever future public health challenges they face. To date, U.S. Chiefs of Mission and 21 partner governments have signed Frameworks, with more to follow. Today, we were welcomed by the South Africa Minister of Health, Dr. Aaron Motsoaledi, whose government recently signed a Framework with the United States. Turning a decisive page, the South African Government has assumed increasing leadership, including a dramatically heightened financial contribution and an intention to approach full financial responsibility for its program by 2016.

A continuum of response requires both commitment and capacity on the part of the government. And today, I was pleased to have the opportunity to affirm the leadership role of the U.S. Ambassador in working with our partnership governments. Our Chiefs of Mission are leading their teams to make sure that Partnership Framework commitments are fleshed out in Implementation Plans, which enable real accountability. In terms of the capacity required to establish ownership, tomorrow we will hear from field teams about their hard work to develop capacity at the country level. The locally employed staff of PEPFAR is at the forefront of our efforts on country ownership, focusing on building the technical and managerial capacity of partner nations. This capacity is a key contribution to our effort to foster country ownership and create a continuum of response. All of this is critical to saving lives.

New Partnership to Strengthen Mobile Health Programs for Moms

Appeared in the White House Science & Technology Policy Blog

By: Aneesh Chopra, U.S. Chief Technology Officer

Kudos to Secretary of State Hillary Clinton, USAID Administrator Raj Shah, Johnson & Johnson CEO William Weldon, and their colleagues at the United Nations Foundation, the mHealth Alliance, and BabyCenter on the launch of the Mobile Alliance for Maternal Action, a new public-private partnership to improve maternal and child health by harnessing the power of mobile technology to deliver vital health information to expectant and new mothers.

Many women around the world have limited or no access to basic health information necessary for safe pregnancies and healthy babies.  These women typically live in resource-constrained settings that lack the first-line providers of such information — nurses, midwives, and trained birth attendants.

Enter technological innovation, which has the potential to be a force multiplier – enabling us to reach more people, more efficiently and at lower cost.  Technologies like the mobile phone, for example, can unlock novel and transformative solutions to longstanding development challenges if we utilize them effectively.  We need to make sure that people have access to new technologies, which is happening at a rapid pace with cell phones around the world (more than 1 billion women in low- and middle-income countries own a mobile phone).  In fact, global smartphone sales exceeded PCs for the first in the fourth quarter of 2010, ahead of market predictions.  That said, we need to understand how technology can make a difference.

What’s exciting about the Mobile Alliance for Maternal Action is that it acts both locally and globally to achieve scale and impact. Over the next three years, it will work across an initial set of three countries, Bangladesh, South Africa and India, to help coordinate and increase the impact of existing mobile health programs, provide resources and technical assistance to developers of promising new business models, and build the evidence base on the effective application of mobile technology to improve maternal health. Lessons learned from these and other initiatives will be shared globally in a coordinated exchange of information. The partnership will foster collaboration among similar initiatives in other countries to accelerate efforts to reach millions of women with mobile phone access around the world with critical health information.

We have had some experience with mobile health programs for moms here in the US.  Last February, I had the pleasure of announcing the domestic text4baby program that has now reached nearly 170,000 moms.  And early this March, our colleagues in Russia announced that they are creating a similar program, which will bring mobile health information to moms in Russia as well. Moreover, the Administration’s FY12 budget establishes a Wireless Innovation (WIN) Fund to spur innovation through investments in research and development of wireless technologies and applications.  In particular, the WIN Fund proposes a $100 million investment over five years to CMS for emerging wireless technologies in the health care sector in order to spur applications that educate consumers, offers new tools to assist in patient care, and reduces health care costs.

Measuring results and using evaluation data – lessons learned from mobile health information programs in the United States, Russia, Bangladesh, India, South Africa, and many others — to develop best practices and improve our understanding of what works and why will be a critical part of the MAMA partnership.  As we strengthen the global knowledge base and share best practices around effective ways to provide these services, designers of new and existing programs will be able to learn from tap into each other’s experiences to increase their impact, sustainability, and scale.

Most importantly, information initiatives such as the MAMA partnership empower women, which is important in its own right and is also essential to improving the health of families and communities.   Access to a mobile phone can mean access to information about pregnancy, childbirth and the first year of life that enables women to make healthy decisions for themselves and their families.

Congratulations again to all the partners.

Mobilizing Against Malaria in Africa

USAID and the Peace Corps celebrated World Malaria Day by announcing a collaboration to help reduce the burden of malaria in Africa.  Here’s a rundown of the event from guest blogger Ben Brophy of the Malaria Policy Center.

Dr. Rajiv Shah, USAID Administrator, Aaron S. Williams, Peace Corps Director, and Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator, gathered today to announce the partnership of the President’s Malaria Initiative (PMI) and the Peace Corps as a component of broader USAID and Peace Corps collaboration in global health and to talk about the progress made against malaria so far.

Mr. Williams opened the event discussing the problem of malaria and the new partnership, named ‘Stomp Out Malaria’ between PMI and the Peace Corps. He lauded both Dr. Shah and Admiral Ziemer for their tireless efforts against malaria.

Dr. Shah gave a great overview of the amazing progress that has been made against malaria so far. He pointed to the fact that PMI is reducing overall childhood mortality and for this reason it is one of the best investments we can make. However, Shah also cautioned that “If we step back now we will see a rapid uptick in malaria and unnecessary child deaths.”

Admiral Ziemer echoed this message of success and talked about the emerging partnership between PMI and the Peace Corps. Essentially, PMI and organizations like Malaria No More, VOICES for a Malaria Free Future and WorldVision will train Peace Corps volunteers on malaria interventions and then those volunteers can take that knowledge with them to instruct their local villages and communities.

Washington Post columnist Michael Gerson hosted a panel of several speakers to talk about the malaria fight in more detail. Gerson also discussed his recent trip to Senegal with the Malaria Policy Center where he saw U.S. investments in malaria in action. Gerson came away from that experience saying ”This is how aid should be done.”

Ambassador Mark Green, Matt McLaughlin of the Peace Corps Malaria Initiative for Africa, Professor Awa Marie Coll-Seck of the Roll Back Malaria Partnership, and Andrea Gough, of the Nothing but Nets campaign were all on hand to talk about various aspects of the world’s efforts against the disease. The most notable quote came from Ambassador Green “Development dollars are being stretched thin and partnerships like this one between PMI and the Peace Corps are squeezing out every penny and producing great results.”

Ultimately, the partnership between PMI and the Peace Corps is producing yet another new tool to help end malaria deaths by 2015. It is these types of integrated partnerships that are uniting our efforts and amplifying our resources.

Polio Immunization Efforts Showing Positive Results in Southern Sudan

USAID, the United Nations, the Government of Southern Sudan (GOSS), and other international partners launched a polio immunization campaign March 28 in southern Sudan, where the crippling disease re-emerged in 2008.

“Due to the efforts of the GOSS, development partners, and people of southern Sudan, the outbreak that re-emerged in South Sudan in 2008 has been halted,” USAID/Sudan Mission Director William Hammink explained at the Juba Nyakuron Cultural Center, where the three-day campaign was launched. “Since 2005, USAID has committed over $8 million to support polio immunization and eradication as well as routine immunization activities across the region,” he added.

GOSS Minister of Health Dr. Luka Tombekana Monoja and Minister of Information Dr. Barnaba Marial Benjamin GOSS said it is time to “kick it and keep it out” when referring to polio and other preventable diseases. The ministers expressed their commitment to continue campaigns that vaccinate against preventable diseases, including polio. Along with international organizations such as USAID and Rotary, the GOSS pledged to reach those in need throughout southern Sudan, particularly children in remote areas.

Mothers attending the event were invited to have their young children vaccinated with ‘just two drops’ of the polio-preventing vaccine.

USAID assisted with the last polio immunization campaign in November 2010, which reached more than 3 million children under age 5 in southern Sudan with the vaccine, achieving polio immunization coverage of 99 percent.

In Ethiopia, supply chains are a smart investment for public health

A pharmacist by training, Yodit Assefa will complete her Master Degree in Public Health this year. Her long-term goal is to contribute to the vision of an HIV-free generation in Ethiopia.

As a procurement specialist with PEPFAR’s SCMS project, I am one of a growing number of women working in supply chain management in Ethiopia.  I manage procurements of HIV/AIDS commodities – including the complex procurement of specialized medical equipment used to treat HIV/AIDS – as well as the vehicles that distribute those commodities.

Well planned, strategic procurement is a smart investment.  Our team helps save money by minimizing costly unplanned and emergency procurements and buying low-value and bulky products locally.

Yodit Assefa (center) and procurement colleagues from PEPFAR’s Supply Chain Management System (SCMS) Photo credit: SCMS

I use my skills to help scale-up Ethiopia’s aggressive HIV/AIDS program.  In just two short years, the number of people on treatment has tripled from 50,000 to over 167,000 and the number of clinics has increased more than fourfold from 170 to 843.

This type of scale-up requires a similar scale-up of supply chain systems.  A little over a year ago, we joined USAID and local partners in a public ceremony to celebrate the arrival of equipment to strengthen warehousing and distribution for public health commodities.  We now have 29 delivery vehicles, seven generators, 10 forklift trucks, 150 refrigerators, nine deep freezers, a 824-cubic meter cold room, racking for 5,400 pallets and 1,320 adjustable shelves for 12 warehouses, including six temporary warehouses leased through SCMS.

A typical day for me starts before sunrise.  I get two kids ready for school – the youngest ready for her nanny – check the car and head for work. We have lots of problems with internet connections in a developing country like Ethiopia, so I am at my desk by 6:30 a.m. to get the best available connection before the lines get busy.  I take information from the client management teams and create quotation requests to send to potential vendors.  I analyze quotations to decide which meet our specifications and offer us the best value.  Best value does not just mean lowest price – I also take into account things like product quality and timeframe for delivery.  On-time delivery is one of our key performance indicators.

After choosing the supplier, I go through a complex process to ensure my purchase orders meet all necessary US government regulations and comply with Ethiopian law.  Finally, I manage the supplier, making sure the products are delivered on time and in the right quantity.  This may not sound like a lot, but remember, each procurement specialist manages around 50 different orders at a time.

Our procurement team is the first SCMS field office to “graduate” to do international procurement—in additional to local procurement—of commodities without any supervision from the SCMS headquarters procurement office.  I’m proud of our graduation, but my greatest satisfaction comes from knowing our work contributes to restoring health to people living with HIV/AIDS. I have seen formerly bedridden patients return to work after receiving antiretroviral drugs. This is what inspired me to join SCMS. I believe helping one person really helps 5.4 people, the average family size in Ethiopia.

PEPFAR’s impact goes beyond saving lives and improving quality of life. It helps national development and economic growth by preventing people in the workforce from dying of AIDS.

World Malaria Day: Celebrating Progress Against a Preventable and Curable Disease

By Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator

Over the past four years I have had the privilege of serving as Coordinator of the President’s Malaria Initiative. The initiative is led by USAID and implemented together with the Centers for Disease Control and Prevention.  Our goal is to reduce malaria illnesses and death by half for 70 percent of at-risk populations in sub Saharan Africa, and to remove the disease as a major public health threat by 2015.

Children in Ghana carry home their insecticide-treated nets, which can protect them against the dangers of malaria. Credit: Esther Hsu/ TAMTAM

I also oversee two regional malaria programs outside of Africa. The Amazon Malaria Initiative covers 7 countries making up the Amazon Basin of South America, and the Mekong Malaria Program covers 5 countries in the Greater Mekong Sub-Region of Southeast Asia.  In both of these areas, multi-drug resistance is a major problem.

I am fortunate to work with a talented group of technical staff and public health experts who implement U.S. global malaria programs.  The incredible progress we have made against malaria is due in large part to effective partnerships with host governments, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank Booster Program for Malaria Control, the Bill and Melinda Gates Foundation and the U.N. Office of the Special Envoy for Malaria, as well as other non-governmental and private organizations too numerous to count.    Now, five years into the Initiative, we are seeing substantial reductions in deaths in children under the age of five years, and we are seeing improvements in malaria-specific indicators in all PMI-supported countries where baseline and follow-up nationwide household surveys were conducted. These reductions are due in large part to a dramatic scale-up of malaria prevention and treatment measures since 2005, thanks to the collective efforts of national governments, other international donors; and multilateral and nongovernmental organizations.

PMI relies on a four-pronged, proven approach to prevent and treat malaria:  the correct use of insecticide-treated mosquito nets above sleeping spaces; indoor spraying with insecticides; intermittent preventive treatment for pregnant women; and timely use of artemisinin-based combination therapies for those who have been diagnosed with malaria.  Malaria is one of today’s best investments in global health; globally, these interventions are saving the lives of 485 children each day.

Each year, World Malaria Day is observed on April 25 to call attention to the disease and to mobilize action to combat it. It’s heartening to see the progress that has been made in delivering malaria prevention tools to those at risk of malaria and providing treatment to those with confirmed malaria. Progress against malaria is one of development’s most impressive stories.  On this occasion, PMI releases its fifth annual report, which describes the role and contributions of the U.S. Government in the effort to reduce the burden of malaria in Africa.

Despite considerable progress, malaria remains a major public health problem on the African continent, with about 80 percent of malaria deaths occurring in African children under five years of age.  However, over the past 50 years the U.S Government has been a major player in coordinated global efforts to beat back major killers like smallpox, polio and measles.  So, with sufficient and sustained international commitment, we can continue to achieve sustainable progress in our fight against malaria.

To learn more about PMI, visit http://www.pmi.gov/

Rear Admiral Tim Ziemer is the U.S. Global Malaria Coordinator. He grew up in Asia, attended the missionary boarding school in Dalat, Vietnam, graduated from Wheaton College, served as a Naval aviator with the U.S. Navy, and was Executive Director of World Relief prior to being asked to lead the President’s Malaria Initiative.

White House Easter Prayer Breakfast

By: Ari Alexander, Director, Center for Faith-based & Community Initiatives and Senior Advisor to the Administrator for NGO Partnerships and Global Engagement

Yesterday President Obama hosted a prayer breakfast observing the Christian holiday of Easter in the East Room of the White House.  In only its second year, President Obama is the first President to host such an event for Easter, and was honored to be joined by pastors and leaders from around the nation.  USAID Administrator Rajiv Shah attended the morning prayer breakfast and was recognized for his extraordinary leadership in the President’s remarks.

“Before I begin, I want to acknowledge one particular member of my administration who I’m extraordinarily proud of and does not get much credit, and that is USAID Administrator, Dr. Raj Shah, who is doing great work with faith leaders.  […]  Raj is doing great work with faith leaders on our Feed the Future global hunger program, as well as on a host of other issues.  We could not be prouder of the work that he’s doing.”

Following the breakfast,  attendees gathered for a series of policy briefings from various U.S. government agencies.  The discussion included topics on: energy and climate change; immigration; fatherhood and healthy families; human trafficking; and international development.  Gayle Smith, Special Assistant to the President and Senior Director on the National Security Council, spoke eloquently about development, calling the gathered faith leaders “champions of dignity” for those often forgotten.  She highlighted the importance of the Presidential Policy Directive on Development as well as the role of USAID and Administrator Shah in leading the Feed the Future initiative.  The gathering was a unique opportunity to gather religious leaders from around the nation for a moment of reflection during Holy Week and to dialogue about ways to partner together in caring for the most vulnerable.

You can view the full transcript or video of the President’s remarks.

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