Posts in: Tuberculosis

 

August 20, 2009

A Promising Senate Initiative on Neglected Diseases

Posted by Tom Bollyky in Global Health Architecture and Governance, Health Product Innovation and Access, Health Systems, Services and Financing, Pharmaceuticals & Health Products, Tuberculosis, Vaccines

Early this month the U.S. Senate passed an amendment to pending legislation that has the potential to strengthen and streamline regulations governing the clinical testing of drugs for neglected diseases in the developing world. The targeted diseases include malaria and TB, which annually kill an estimated 2.5 million people in the developing world, plus scores of diseases you may have never heard of (such as Chagas disease and leishmaniasis), but that nonetheless exact a large and lethal toll, especially on children and poor people in developing countries.

Senator Sam Brownback, a Republican from Kansas, introduced the amendment to the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act of 2010. As Senator Brownback explained: Read More…

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September 23, 2008

When Domestic Meets Global: The U.S. Response to HIV at Home and Abroad

Posted by Nandini Oomman in HIV/AIDS & Infectious Diseases, News, Tuberculosis

This is a joint posting with Luke Easley

In August, CDC released updated estimates of HIV Infection in the U.S. showing that incidence for 2006 and over the previous decade was 40% higher than previously estimated. This was big news on the eve of the Mexico City AIDS Conference, but made more news on September 17th, when CDC officials “at a House Government Reform and Oversight Committee hearing said they would need an additional $4.8 billion dollars over the next five years to reduce the annual number of new HIV infections in the U.S.” The LA Times reports that:

The new numbers, published last month in the Journal of the American Medical Assn., were found through improved testing and were not an increase in new infections, which have remained relatively constant since the late 1990s. The higher estimates, however, served as a reminder that preventing transmission of the human immunodeficiency virus is still an issue in the United States, where the prevalence of HIV is greater than in Canada, Australia, Japan or any Western European country except Switzerland.

Sound familiar? Prevention of HIV transmission was NOT the strongest component of the United States’ fantastically generous PEPFAR program overseas (see my colleague David Wendt’s blog) AND it doesn’t seem to be doing the trick at home either. As the LA Times reports: “Young black gay men have been especially hard hit, representing 48% of new infections among gay and bisexual males ages 13 to 29. Yet only four of the CDC’s 49 recommended intervention programs specifically target gay men, and only one of them is designed to address gay men of color.”
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August 7, 2008

PEPFAR Reauthorization V: Science = Life

Posted by Ruth Levine in HIV/AIDS & Infectious Diseases, News, Tuberculosis Tags:

While AIDS activists in the 1980’s were surely right that Silence = Death, it was not voices and attention alone that brought the life-sustaining advances of AZT treatment and its successors. For all the flaws in process along the way, it was breakthroughs in biomedical science that yielded the therapies that literally raise people from their deathbeds to be productive and active members of their families and communities. Without the investments in the science behind the drugs, the conversation today at the XVII International AIDS Conference in Mexico City would be far different – or would not be occurring at all.

In sharp contrast to the biomedical and pharmacological advances, though, the science of implementation of large-scale programs is far less developed. We have relatively little solid evidence to go on to ensure that the billions of donor dollars on offer are going to bring about the greatest individual and social benefit, with the fewest costs to nations’ ability to deal with other health priorities. Instead of findings from systematic study, for the most part we are left with common sense, instinct and belief, shaped by the occasional compelling anecdote or observational study.

The early “emergency”-oriented nature of PEPFAR, which eschewed “the R word” (research), did little to fill the knowledge gaps. As the Institute of Medicine noted in its 2007 assessment of PEPFAR’s performance, “There are still more questions than answers about how to best provide ART” in low-income, high-burden countries. And the paucity of knowledge about the effects of PEPFAR’s HIV prevention efforts has been even more profound – and more lethal.
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March 17, 2008

Tearing Down the Barriers: Increasing Access in Emerging Pharmaceutical Markets

Posted by in Drug Resistance, HIV/AIDS & Infectious Diseases, Tuberculosis

Yesterday, the Financial Times reported GlaxoSmithKline’s exciting new strategy to expand markets and increase access to medicines in low- and middle-income countries. Through an internal policy known as “tearing down the barriers,” the company has established differential pricing schemes within and between India, South Africa and other developing countries, in hopes of shifting to a new low price, high volume business model. While similar initiatives have existed for AIDS antiretrovirals (in part through the work of the Clinton Foundation), the GSK strategy notably moves beyond the “Big Three” infectious diseases to tackle the growing challenge of diabetes and other noncommunicable diseases with a dual market among the rich and poor.

Although variants on this idea have been around for quite some time (for example, see related papers by Jenny Lanjouw or Patricia Danzon), GSK is the first company to implement such a policy openly and systematically across a broad range of products. But they almost certainly won’t be the last. Tiered pricing and the “middle markets” were prominent themes throughout last week’s Partnering for Global Health Forum, where biotechnology leaders came together with pharmaceutical manufacturers and global health funders to identify opportunities for collaboration in this new environment. Several biotech companies are seeking opportunities in emerging markets and are seeking novel business approaches that would serve the full spectrum of needs and abilities to pay in those countries. Here, too, the conversation frequently turned towards ways to price products to better serve the poor without eroding prices in their major markets. (Keep tabs on the Kaiser Family Foundation’s HealthCast, which should be broadcasting many of the sessions soon.)

Here at CGD, we hope to continue the dialogue over the next several months under the auspices of our new Global Health Frontiers project. It will be interesting to see whether the low-price high-volume approach taken by GSK can be sustainably extended to other companies and product areas, and whether there are other business models (such as joint ventures, in-country manufacturing, or voluntary licensing) that could profitably serve both those who can afford to pay a lot alongside those who can only afford to pay a little. It seems that some forward looking companies are willing to step into the new frontiers. This is a delicate time when the public health community can be either be supportive of these early efforts or send companies scurrying for less risky opportunities.

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July 3, 2007

Global Fund Grant Programs: An Analysis of Evaluation

Posted by Administrator in Global Fund, Global Health, Global Health Architecture and Governance, HIV/AIDS & Infectious Diseases, Tuberculosis

The Global Fund to Fight AIDS, Tuberculosis and Malaria has quickly become one of the world’s largest funders of health programs. Just five years after its founding, it has approved proposals worth $6.8 billion for 448 programs in 136 countries, and disbursed over $3 billion. In this article, originally published in The Lancet, Steve Radelet and Bilal Siddi analyze the first 140 program grants evaluated by the Global Fund and the association between the programs’ evaluation scores and various characteristics of the grants themselves (e.g., financial size, disease target, type of recipient), the health sector (e.g., physicians per capita, donor concentration) and the recipient country (e.g., income level, governance ratings).

Key findings include:

  • Programs implemented by civil society/private sector recipients receive higher scores than those implemented by the government.
  • AIDS and TB programs receive higher scores on average than malaria programs.
  • Smaller grants tend to receive higher scores than larger ones, as do grants that were rated more highly at the original proposal stage by the Global Fund’s Technical Review Panel perform better.
  • With respect to health sector characteristics, evaluations scores are higher in countries with more physicians per capita and high immunization rates, suggesting that capacity and institutional strength in the health sector have a strong influence on program success.
  • Scores are also higher where the health sector has fewer donors and where Global Fund grants are a larger share of donor funding.
  • Lower-income countries tend to have higher evaluation scores; countries with larger budget deficits tend to receive lower scores; and countries that currently have or have had socialist governments tend to receive higher scores.

    Acess the full article (pdf)

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May 31, 2007

PEPFAR(THER)*: Double the Money, Double the Impact?

Posted by Nandini Oomman in Drug Resistance, HIV/AIDS & Infectious Diseases, Health Systems, News, Tuberculosis

In anticipation of the G8 summit and its focus on commitments to international development in Germany next week, President Bush called on Congress a short while ago to double the funding for PEPFAR from 15 to 30 billion dollars when the current plan expires in 2008. The plan for PEPFAR 2, as described in a White House press release is a “continuation and expansion” of the initial PEPFAR program:

Continuation – HIV/AIDS treatment, prevention and care are life-long needs, and the American people will continue to support those served during PEPFAR’s first 5 years.

Expansion – PEPFAR will further expand efforts to strengthen health systems, and to leverage programs that address malaria, tuberculosis, child and maternal health, clean water, food and nutrition, education and other needs. The Plan will emphasize transitioning from an emergency to a sustainable response for treatment, prevention and care.

One can almost hear loud sighs of relief from our fellow citizens in the developing world as they get wind of this welcome news; continued treatment for a couple of million people on treatment and additional funding to treat another half a million will put many nervous political leaders and health officials at ease, at least partially, if they know that PEPFAR will not drop off this earth in 2008. But this is only part of the story about financing the AIDS response. Good economic sense and an understanding of the key drivers of the epidemic tell us that doubling the money for HIV/AIDS (especially if it is only for treatment) doesn’t necessarily double the impact.

The money will only have a significant impact if funding decisions are based on evidence, and program implementation can respond to specific country needs. PEPFAR has done a lot of good in getting people on treatment and in to care programs, but there are also a number of areas where the program could be further strengthened, including expanding evidence-based prevention efforts, removing funding restrictions and other measures outlined in a recent IOM evaluation report and described in a previous blog from the HIV/AIDS Monitor. Yesterday’s call from the President to take PEPFAR further emphasizes treatment, prevention and care as “life-long needs.” If PEPFAR is to be reborn, we hope that these words and money will turn in to policies and action that can more than double the impact of such generous resources from the U.S. in keeping people alive, but also preventing them from getting HIV in the first place. That will be a true victory.

* With acknowledgement to Dr. Robert Bollinger, Johns Hopkins University for the term “PEPFARTHER” to describe the next phase for PEPFAR.

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May 10, 2007

Child Health in Egypt and Iraq: Our Tax Dollars at Work

Posted by Ruth Levine in Demand Forecasting, HIV/AIDS & Infectious Diseases, Pharmaceuticals & Health Products, Tuberculosis

Iraqi children

A new report on child health from Save the Children presents perhaps the most striking contrast I have ever seen between the impact of “soft power” and the consequences of “hard power.” That contrast is manifested in the remarkable improvement in child well being in Egypt over 15 years, and in the devastating loss of young life in recent years in Iraq.

As Celia Dugger noted in the New York Times, the Save report ranks developing countries that have managed to dramatically improve child health and well being over the past 15 years — and the countries where the child death rate has skyrocketed during the same period because of conflict and the rampages of HIV/AIDS. On the top of the list of winners is Egypt, a country that for nearly 30 years has received a tremendous amount of support from the U.S., more than $800 million on average each year since 1979 through Economic Support Funds (ESF) (although much less in recent years). Much of that money, which was provided specifically because of Egypt’s geopolitical importance, has been channeled through USAID’s development programs, often ending up in child health and family planning programs. It supported the successful scale-up of oral rehydration programs, expansion of water and sanitation systems, and many other large-scale efforts to prevent and treat common diseases affecting the poor. Combined with the priority placed on child health by the Government of Egypt, those U.S. tax dollars contributed to a truly remarkable result: between 1990 and 2005 the child death rate declined by almost 70%, from 104 to 33 per 1,000. Compared to earlier generations, the Egyptian parents who are building their families today can be much more confident about their babies’ chances of thriving through childhood and beyond. A similar scenario has been played out in Nepal, Bangladesh and other countries that have benefited from significant, long-term U.S. development spending on child health.

If Egypt and other countries represent one way to spend U.S. tax dollars, Iraq, another country that because of geopolitical forces has drawn vast financial resources from the U.S., represents quite another. The years of sanctions and war have had corrosive effects on health and families, and Iraq has made its way to the top of Save’s list of losers. In 1990, the rate of death of children under 5 years old was 50 per 1,000; in 2005, it was estimated to be 150 per 1,000, with 122,000 Iraqi children dying in 2005.

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