Polio and the CIA

Posted on by Laurie Garrett

It may long be debated just how much the CIA’s use of a vaccination ruse to identify Osama bin Laden’s children contributed, but on May 5, 2014 the World Health Organization declared polio a Public Health Emergency of International Concern. The WHO noted that by the end of 2011 only three countries still had endemic polio (Pakistan, Afghanistan and Nigeria), but by the end of April 2014 that number had soared to 10 nations. The world had been on the edge of polio eradication: It is now witnessing expansion of the virus’ territory and caseload.

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Why Japan Has Made Worldwide Access to Healthcare Coverage a Critical Element of Its Foreign Policy

Posted on by Laurie Garrett

From Thanksgiving to December 7, I was in Japan, a guest of the Ministry of Foreign Affairs, marking my third visit to the country in 2013. The chief reason for multiple treks to Tokyo, and elsewhere in Japan, is Prime Minister Abe’s staunch support of universal health coverage (UHC) as the primary post-2015 aspirational target for global health. As Abe explained in the Lancet in September, “Global health is standing at a crossroads,” between more than a decade of powerful disease-specific achievements, and the dawn of a far broader, all-health approach, worldwide. Earlier this year, Abe launched his strategy on global health diplomacy, naming worldwide creation of UHC its primary feature.

Abe’s UHC gambit is part of an overall, marked shift in Japanese foreign policy that is at once far to the right of the country’s position eighteen months ago, under Prime Minister Yoshihiko Noda, and significantly more engaged in world affairs

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A word about the H7N9 influenza

Posted on by Laurie Garrett

Ten months ago, this new form of bird flu, which appears to represent a recombination of four forms of influenza that have circulated in China for a few years, surfaced in people in Shanghai. By March, the virus seemed to be in widespread circulation across a densely populated swath of Eastern China, surrounding Shanghai and Jiangsu. At the time I wrote a piece for Foreign Policy asking, “Are we watching a pandemic being born?”

Chinese authorities responded to the outbreak with obvious frustration, as the human cases – in some instances spreading between people – had no obvious source. After two months of hard sleuthing, amid a mounting human death toll, Chinese researchers determined that people were getting H7N9 from live poultry, sold in animal markets all over the region. Shutting down those markets stopped the H7N9 outbreak, with human cases slowing to isolated, sporadic ones by late May. Despite the clear evidence that live animal markets were a crucial piece of the puzzle, and calls from Hong Kong scientists for permanent closure of the poultry vending points, Chinese authorities were stumped. After more than six months of research scientists found some animal market workers last spring had mild, unreported ailments due to their exposures to H7N9. The epidemiology pointed to the animal markets, but the birds were not ailing or dying, and no single species seemed to be clearly linked to any human case. Meanwhile, H7N9 seemed significantly more virulent in humans than any other flu, save H5N1 avian influenza that has been in circulation since the mid-1990s. About one third of H7N9 patients have died from the infection.

(Courtesy Reuters/Jason Lee)

With seasonal warming, H7N9 disappeared, and health authorities around the world crossed their finders, hoping they’d seen the last of the virus. But H7N9 resurfaced in October, on the other side of China: Guangdong province and, from there, Hong Kong. As was the case ten months ago, authorities cannot find clear connections between infected birds and humans, there is some evidence of human-to-human transmission, and closure of live animal markets seems advisable. China’s neighbors are now getting nervous, and recently, the U.S. Centers for Disease Control and Prevention issued a level two travel advisory for China. (Shanghai health authorities announced that from January 31 to April 1, 2014, all its animal markets will be shut down. We were left to wonder why they are waiting until late January, given H7N9 is already in circulation; why the closure isn’t extending across a broader Chinese geography; and where people will find chickens, ducks, geese, and pigeons to eat. It is not common practice in China to sell poultry that is butchered, wrapped in cellophane, and sold from refrigerated supermarket cases, as is the case in the West. If Chinese people can manage to find poultry to eat during a live market shutdown, why not now make the transition to safer market sales of bird meat?)

Recent surveys find distribution of influenza across China is a mosaic of the older H5N1 virus, H7N9, and several other bird flus, creating real headaches for the country’s surveillance team. Finding flu in a bird doesn’t mean it’s the right flu. In October, researchers reported the H7N9 virus has an unusual dual capacity, genetically, to infect mammalian respiratory tract cells while retaining avian infection capacity. This week, researchers from the Mount Sinai School of Medicine in New York revealed that genetic studies of H7N9 show more disturbing facets of the virus. It is completely resistant to the primary anti-flu drug Tamiflu (oseltimivir) and its chemical kin, and partially resistant to the only other class of anti-influenza drugs. Despite having the capacity to withstand anti-viral treatment, H7N9 remains virulent and transmissible. One set of mutations imparting resistance has not forced a predicted diminution in other powers of the virus.

We will be watching H7N9 closely as winter unfolds in Asia.

A $12 Billion Turnaround: Thoughts from the Global Fund Fourth Replenishment

Posted on by Gabriella Meltzer

After two days of meetings in Washington, DC, for its fourth replenishment session, the Global Fund for AIDS, Tuberculosis and Malaria announced that donors committed $12 billion over the next three-year cycle. Although this number falls short of the stated $15 billion target, this is the Fund’s most successful replenishment to date, and the largest amount ever committed to fighting AIDS, tuberculosis (TB), and malaria.

This week’s successful replenishment is all the more surprising considering the last two year’s turbulence at the Global Fund. In January 2011, the Fund was mired in a corruption scandal, causing several major donors to pull funding. This forced a massive restructuring of the organization, beginning in September 2011, which included the creation of a new funding model for grant-making, and the appointment of a new executive director, Mark Dybul, who took the reins in January 2013.

For a while, the Global Fund seemed to be on its last legs, but the response from donors this week—in the form of pledges and this record-breaking commitment—demonstrates that the Fund has not only been successful in its restructuring, but has also been able to rebuild a crucial trust within its partnerships. There were several forces at play, encouraging this dramatic turnaround and ultimately inspiring donors to so generously open their wallets.

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Loss and Redemption

Posted on by Laurie Garrett

I was stunned this week to learn on PBS NewsHour that Velvet Underground’s first album sold fewer than 5,000 copies. That was a footnote to a TV obituary for Lou Reed.

The astonishment came in two parts. First that so few people recognized in 1966 how important, however raw it might have been, that album was in the arc of rock ‘n roll history. And second, that I, a mere Tween at the time, was one of the fewer than 5,000 purchasers. News of Lou Reed’s passing brought back memories of swaying back and forth, huge headphones firmly in place, humming along with “Heroin” and “Waitin’ for My Man” while dutifully completing homework algebra assignments. Reed’s notion of the “wild side” and Frank Zappa’s attitudes about “normal people” kept me plowing through many a dull math and science assignment in high school.

A couple of years ago I saw Laurie Anderson in concert at Lincoln Center when she brought her husband out for a surprise encore. Reed appeared dazed, dissipated, hardly aware of his surroundings, and painfully out of touch with the music he was supposedly playing with Anderson. She propped him up, tried to get him on key, and appeared melancholic at his side. The writing was on the wall.

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The "New Normal" is a Tight Belt

Posted on by Laurie Garrett

This morning, NPR aired a report asserting that sequestration has become the “new normal” in Washington, and the Republican political leadership plans to block any attempts to cease sequestering funds not only for the remainder of FY2013, but for the coming decade. It is an analysis shared by POLITICO, which asserts $1.2 trillion will be cut from the federal budget in slow, painful slices annually, up to 2023. Every nook and cranny of the federal budget will share the pain, but three areas of concern to global health are already shouting, “Uncle!”

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