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Archives for Health

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.

Working Together to End Stigma and Discrimination Against HIV/AIDS

An activist sets up a red ribbon during the commemoration of the World AIDS Day in San Salvador, on December 1, 2010. AFP PHOTO/ Jose CABEZAS

Stigma and discrimination are two factors that continue to drive the HIV/AIDS epidemic forward. Employees face discrimination at work, women and men are afraid to get tested and run the risk of being ostracized by family and friends, and children are turned away from schools.

Stigma and discrimination based on HIV status are wrong, and the U.S. government does not condone stigmatization or discrimination of HIV-positive persons. USAID takes stigma and discrimination seriously, and we work with our partner countries to make sure the effect of this type of thinking is understood.

Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. is proud to be making a historic commitment to combat HIV/AIDS. PEPFAR is driven by a partnership between the U.S. government and the nations where it works, along with other donors, multilateral organizations, nonprofit groups, faith-based organizations, and people living with HIV, to make smart investments to save lives.

With support from USAID, U.S. government country programs have been addressing stigma since the beginning of the epidemic and with increased intensity with the advent of PEPFAR in 2003. Reducing stigma and discrimination is a prominent goal of PEPFAR’s current Partnership Framework agreements. Through this mechanism, the U.S. government actively works in partnership with countries to end stigma and discrimination.

Centrally, the U.S. government funds activities that reduce stigma and discrimination, such as providing the tools necessary for networks of HIV-positive individuals to engage in evidence-based advocacy. USAID’s recently completed Health Policy Initiative (HPI) worked with partners to develop indicators to measure various aspects of stigma and discrimination. By participating in expert working groups, the program built consensus for common action and took the lead on a Health Facility and Provider Stigma Measurement Tool. HPI also increased private sector engagement and encouraged religious leaders to speak out against stigma and discrimination.

Now, through the Health Policy Project (HPP), USAID continues work globally to strengthen policy and advocacy support for the reduction of stigma and discrimination, especially as it relates to HIV prevention, care and treatment services.

All of us who work on global AIDS issues are aware of the negative impacts of stigma and discrimination, and are committed to creating equal access to quality care and services for those living with HIV worldwide.

World TB experts convene, work to blaze the trail to slow disease spread

As featured in Science Speaks by Meredith Mazzotta

“As you and I both know, people that dedicate their lives to global health are special,” said U.S. Agency of International Development (USAID) Administrator Dr. Rajiv Shah at the opening session of the Stop TB Partnership Coordinating Board Meeting, taking a moment to recognize the passing of his colleague, former USAID Tuberculosis (TB) Team Lead Susan Bacheller. He then asked for a moment of silence in her honor.

“She is deeply missed.”

Shah addressed an audience of physician-scientists, industry representatives, advocates and government officials that make up the Stop TB Partnership Coordinating Board, in addition to the ministers of health from Lesotho, Swaziland and South Africa. Shah commented on the current status of TB control efforts around the world, noting that, “we won’t meet the overall Millennium Development Goals (MDGs) unless we make some fundamental changes,” he said.

Part of the 6th MDG is to have halted by 2015 and begun to reverse the incidence of major infectious diseases including tuberculosis.

“We need to take some bold actions and risks and introduce new innovations, new technologies, new drug regimens and new ways of working to reach the outcomes that we all seek,” Shah said.

The changes he highlighted were the need for new technologies in diagnostics and treatment including for drug-resistant forms of TB. He noted that the development and deployment of the Gene Xpert rapid TB test is encouraging, but continues to be quite costly. He encouraged the audience to think about what types of strategies might exist to try to introduce these diagnostics to better understand their value and performance in the field, while looking for opportunities to reduce their cost.

The reality of treatment targets, Shah said, is our ability to reach them or not to reach them is not tied to our immediate budget, “but rather if we can continue on the path to reduce the cost per unit of treatment.  I hope we will greatly exceed these targets,” even in an environment where we are facing serious constraints on our ability to invest, here and abroad, he said. Using efficiency gains to achieve and exceed new targets, Shah said, could make a much stronger case for future investment in TB as a means of furthering overall global health targets.

Assistant U.S. Secretary for Health Dr. Howard Koh noted that even the U.S. still sees 11,000 cases of TB every year.  “We had a goal of eliminating TB in the U.S. by 2010 and we have not reached that goal,” he said, adding that the health of every nation affects the overall health of the globe.

During a question and answer session with an extended panel, Lesotho Minister of Health Dr. Mphu Ramatlapeng listed her thoughts on the three most important unmet needs inhibiting real progress against tuberculosis. First, she cited the need for diagnostic and other technologies that can be used across diseases. For example, “there is work underway with the Gene Xpert so that it also can be used to detect [sexually transmitted infections] and other diseases,” she said. Gene Xpert developer FIND announced in February that the company was investigating potential rapid HIV viral load measurement to be added to the current machine. Ramatlapeng also noted the need for fixed-dose combination drug regimens, “because they will make life very easy for all involved,” and better access to drugs as key to success in fighting TB.

When asked how the ministers were addressing the spread of TB among the mine workers in Lesotho and South Africa, Ramatlapeng said she is working with the World Bank to convene a meeting with the ministers responsible for natural resources and mining, as well as the ministers of finance to more holistically address how to move ahead.

Other future goals in TB control mentioned at the meeting included ensuring successful roll out of new technologies to those who need them most, access to health systems to ensure new cases are detected as early as possible, achieving the most value for investment, and making certain that TB is a party of primary health care that is universally accessible.

On World Health Day WHO takes on Drug Resistance

Featured on Science Speaks by Meredith Mazzotta

In honor of World Health Day 2011 (April 7), the World Health Organization (WHO) released a six-point policy package to combat the spread of antimicrobial resistance, a problem the organization says is not new but is becoming increasingly burdensome, dangerous and costly.

“The world is on the brink of losing these miracle cures,” said WHO Director-General Dr. Margaret Chan in a press release. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.” Chan authored a special statement in honor of World Health Day driving home the message that “no action today means no cure tomorrow.”

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World Health Day: Combating Drug-Resistant Tuberculosis

By: TB Alliance

MDR-TB can be transmitted through the air, and therefore patients like John are advised to wear masks at all times. Photo Credit: TB Alliance

John* can’t remember the names of all the medications he takes—there are just too many. In the morning, nurses watch him swallow 10 pills and give him an injection, and in the evening, they stop by with another two tablets. The regimen is tiresome, says John, but he is sick and has no other options. John is a multidrug-resistant tuberculosis (MDR-TB) patient at Kibo’ngoto National TB Hospital in Tanzania, one of few local facilities equipped to handle TB patients that have grown resistant two or more of the four drugs that comprise the standard treatment for TB.

John is only partially through his expected six-month stay at Kibo’ngoto, but even when he returns home, many more months of daily treatment await. John says it’s easy for patients to become depressed and despondent—and give up hope that they will ever get better.

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“No Action Today, No Cure Tomorrow”

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

USAID representatives joined the Afghanistan Ministry of Public Health, the World Health Organization (WHO), members of Parliament, health officials, and the international community on April 6, 2011, to celebrate World Health Day in Kabul. Under the theme “No Action Today, No Cure Tomorrow,” the event highlighted the growing threat of antimicrobial resistance and called attention to the need for policymakers, civil-society and patient groups, health practitioners and prescribers, pharmacists and dispensers, as well as the diagnostic and pharmaceutical community, to develop a comprehensive plan to minimize health risks from exposure to microbes.

Antimicrobial resistance, and its global spread, threatens the continued effectiveness of many medicines used today to treat infectious diseases. Antimicrobial resistance is not a new problem, but one that is becoming more dangerous. Urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.

For World Health Day 2011, the WHO is calling for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future generations. USAID Senior Deputy Mission Director Robert Hellyer said, “USAID is proud to be working in partnership with the Ministry of Public Health to strengthen pharmaceutical systems, and promote rational medicine use and good dispensing practices.”

Around Afghanistan, USAID is supporting national and provincial hospitals in developing drug and therapeutic committees, training pharmacists in modern pharmaceutical management practices, and raising public awareness of the importance of proper medicine use. This week, USAID’s Strengthening Pharmaceutical Systems project began regional training workshops on good dispensing practices for 112 pharmacists working at the Ministry of Public Health. Good dispensing practices include the delivery of the correct drug to the right patient, in the required dosage and quantities, in a package that maintains acceptable potency and quality, and with clear drug information. Training will take place in Balkh, Hirat, and Kabul provinces and will continue through the month of April.

For more than 20 years, the world has celebrated World Health Day on April 7. This day was chosen to commemorate the adoption of the WHO constitution on April 7, 1948. Around the globe, thousands of events mark the importance of good health for productive and happy lives.

From U.S. Aid Recipient to Donor Partner: The Republic of Korea’s Health Ministry Honors USAID

For nearly 50 years USAID has been in the business of providing assistance to individuals in need to alleviate suffering, save lives, and foster a brighter future for families around the world.

Our mission here at USAID is a unique one: to put ourselves out of business.  We seek to carry out development so effectively that people around the world no longer need the assistance we provide.  To achieve our mission, we partner with countries, at their request, to assist them in the process of developing national structures that ultimately can function independently, without foreign aid.

Today, on the behalf of USAID, I accepted an award from the Republic of Korea’s (South Korea) Health Minister Chin Soo-Hee to honor a history of partnership that helped transform a once-struggling nation into a donor partner.

The collaboration began in 1954, when the International Cooperation Association, the predecessor to USAID, coordinated an agreement between the University of Minnesota and Seoul National University that facilitated the post-war exchange of medical education and research at a critical period in Korean medical reconstruction.

In subsequent years, USAID continued to provide health assistance that promoted the ongoing development of the Korean medical system. Today, we recognize the Republic of Korea as one of our longest-standing partners and identify them as a world leader in medical research and technology.

Once a recipient of U.S. development assistance, the Republic of Korea is now a donor partner that itself provides assistance to help the world’s poorest and most vulnerable people.  Today, the country produces high-quality, affordably priced vaccines that have played an invaluable role in preventing disease and childhood death around the world.

In 2010, the Republic of Korea became the newest member of the OECD Development Assistance Committee, or the DAC.  Its DAC membership marks the only time since the OECD was established in 1961 that a country has joined the “advanced nations’ assistance club” after transitioning from an aid recipient to a donor.  To have made this transformation in just a few decades truly speaks to the Republic of Korea’s extraordinary economic rise, the compassion of its people, and its commitment to effective and coordinated assistance.

We are very proud of the role USAID played in helping the Republic of Korea achieve its development goals. Its remarkable transformation in such a short time span is an inspiration and a reminder. It reminds me that our mission is achievable.

An Ancient Disease, A Modern Day Development Challenge, A Child Who Deserves a Future

By: Clydette Powell, Medical Officer, Division of Infectious Diseases

We need a game changer that puts innovation for Tuberculosis diagnosis and treatment at the forefront of our global health agenda. Unsanitary and unhealthy realities bred by third world conditions provide the perfect opportunity for this ancient disease to continue to spread through vulnerable populations. There is one vulnerable population in particular that is greatly affected by this disease and often go unnoticed: children. We don’t have a good estimate of the disease burden in this population; we only know that the numbers of cases continue to increase, or go undiagnosed and untreated or improperly treated;

  • the current diagnostic test dates back to 1907 and is fraught with challenges;
  • newer laboratory diagnostic tests in the pipeline are largely not being tested in this vulnerable population;
  • the “preventive” vaccine we have been using is based on “technology” which is 90 years old;
  • that vaccine has limited efficacy and does not protect against the most common form of the disease;
  • the most recent drug to treat this population was developed in 1967;
  • a full course of treatment consists of up to 1,000 pills, and more if drug resistant;
  • this population continues to experience disability and death from complications of this disease;
  • those who have this disease often acquire it from household contacts, that is, those closest to them – those who are more likely to be diagnosed and treated; yet, few public health staff trace those contacts;
  • preventive measures, which are safe and available, are generally not applied to the vulnerable ones in those households with this disease. Is that fair and just?

So, what is this problem that cries out for a game change? It is childhood TB. Tuberculosis.
Yes, that neglected disease that has been around since 6000 BC. A disease that Moses described as the “fiery consumption” among the Israelites, that knocked downed Incans, Egyptian pharaohs, many in the world of the fine arts, and the wife of one 20th Century American president.

Ka-quarta, an eight year old Angolan boy who suffers from TB of the spine, with Clydette Powell, Medical Officer from USAID’s Division of Infectious Diseases. Photo Credit: USAID/Global Health.

Meet Ka-quarta. An eight year old Angolan boy, whose name loosely means “Wednesday’s child.” Do you recall the rhyme ”Wednesday’s child is full of woe”? Ka-quarta has TB of the spine. That makes him full of woeful TB. He lives away from his rural village family and stays at the local hospital where each day he receives many pills, injections and one meal a day. He will do this for up to one year. Yet, he is hardly full of woe in the other sense of the word.

Flashing a smile, he met me at the entrance to the hospital in Benguela Province, extending a hand from beyond the deformed spine that shortened him, slowed him down and made him an unwelcomed standout in the crowd. He offered me a hospital tour, beginning with the wards he knew best: the TB wards. It was in these wards that Ka-quarta lived, slept and ate with other adults. For one whole year. For 1,000 pills. He hoped for a cure, to someday stand taller than he was, now squatted by the gross deformity of his spine. He hoped to play soccer, to keep up with his friends, to be able to sit in a chair and lean back without his spine arriving much sooner than the rest of his thin frame.

Ka-quarta is the best advocate on two legs for fighting childhood TB. Without a single word, his body tells the community why we need to fight this disease in children. The next time I visited Angola, I sent Ka-quarta a little doctor’s kit, complete with a plastic stethoscope and a play X-Ray viewing box, that conveniently displayed an image of a set of lungs. I am rooting for Ka-quarta to be the local TB specialist, when he grows up in both years and stature, if not the authority on childhood TB for his country. Why not?

So what about you? How about that game change? How about taking some first steps towards eliminating childhood TB? Or would you like us to serve you up 1,000 pills starting today?

Making TB Personal: An Ancient Disease and the Need for Innovative Solutions

By: Christy Hanson, Chief of Infectious Disease Division, USAID

When I began my career working with Tuberculosis twenty years ago, the outlook for future progress against this biblical disease looked very different than it does today.  From 1990 to 2009, the TB community has made tremendous progress—TB related deaths have declined by more than one-third, and incidence is declining globally. The emergence of new diagnostic technologies has made it easier to quickly detect multi-drug resistant TB.

Today, the global incidence rate is falling slowly, and 5 of the 6 regions of the world are on track to meet the UN Millennium Development Goal target to halve TB prevalence and deaths by 2015. We are now looking beyond this goal and are focusing on providing universal access to TB care. This is an effort that will require engaging all providers in the public and private sector, people in communities, and TB patients themselves.

It gives me pause to think this is the same disease that has plagued mankind as far back as the ancient Roman civilization. To understand how this disease has survived for millennia, it is important to know how it works.

This is a disease that is inextricably linked to the socioeconomic realities of the impoverished. TB is activated when an individual’s immune system is weakened by any number of causal factors: old age, malnutrition, pregnancy, HIV, and other concomitant illness, such as diabetes. It is estimated that more than one-third of the population in the developing world who are exposed to these conditions are infected with the disease.

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