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Global Health Group H

Global Health Group H. Foronda, Fortune, Gerlach, Gicca, Gomez. What is Global Health? .

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Global Health Group H

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  1. Global Health Group H Foronda, Fortune, Gerlach, Gicca, Gomez

  2. What is Global Health? • The Institute of Medicine refers to global health as "health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions."

  3. Beginnings of Global Health and the United States • United States involvement begins with the Malaria Control in War Areas (MCWA) in 1942 • Established to control malaria on military bases. Also, protecting civilian populations from malaria from returning soldiers. • Training of state and local health officials in malaria control. • Later renamed Centers for Disease Control and Prevention

  4. Beginnings of Global Health and the United States • 1948 – Member states of United Nations create the World Health Organization • Spurred by a cholera epidemic in Egypt that took 20,000 lives • Headquartered in Geneva, Switzerland • Mission - “is the attainment by all peoples of the highest possible level of health”

  5. Beginnings of Global Health and the United States • Beginning in 1967, the WHO and international health communities decided to take on Smallpox • By 1979 WHO declared that the disease had been eradicated. The first disease in history to be eliminated by deliberate human design. • Nearing success in developing vaccines against malaria and “snail fever”

  6. Disease Specific Approach Has been used effectively in the past E.g. Successful campaign to eradicate smallpox Broad Approach across several Disciplines Feel that it’s needed to make lasting progress in public health E.g.. Emphasize the need to establish primary health care clinics--that treat as well as immunize against the routine diseases of childhood, provide maternal health care, and family planning Different Views of Global Health

  7. Brain Drain….Fact or Fiction? • The migration of health workers from poor countries to richer countries. • The current global situation reveals a significant shortage of healthcare in much of the world – the most severe cases occurring in sub-Saharan Africa. • WHO estimates that sub-Saharan Africa is suffering a shortage of more than 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers. • This translates into a mere 3% of the world’s health workers struggling to combat 24% of the global disease burden.

  8. What’s Being Done? • World Health Organization: • Objective is the attainment of the highest level of health by all the world’s populations. Millennium Development Goals: 1) poverty; 2) primary education; 3) gender equity; 4) child mortality; 5) maternal health; 6) HIV/AIDS, malaria and other diseases; 7) environmental sustainability; and 8) global partnerships for development. • Health Volunteers Overseas: • An organization that works to increase health care access and sustainability in developing countries through clinical training and education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education and burn management.

  9. Global Health Initiatives • Nutrition • HIV/AIDS • Children’s Health • Sanitation • Vaccination • Malaria • Women’s Health • Infectious Diseases

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  15. U.S. Government Agencies and Global Health • The Department of State is the lead institution for the conduct of U.S. diplomacy. • The U.S. Agency for International Development is an independent federal agency responsible for U.S. foreign assistance; the agency takes overall foreign policy guidance from the Secretary of State. • Some of the other U.S. Government agencies that are working in specific areas of health globally include the Department of Health and Human Services, the Peace Corps, the Department of Defense, and the Department of Agriculture.

  16. Office of Global Health Affairs (OGHA) • Mission Statement: To promote the health of the people of the world by advancing the Department of Health and Human Services‘ global strategies and partnerships, thus serving the health and well-being of the people of the United States.

  17. OGHA cont. • Represents the Department to other governments, other Federal Departments and agencies, international organizations, and the private sector on international and refugee health issues. • Develops U.S. policy and strategy positions related to health issues and facilitating involvement of the Public Health Service in support of these positions and in collaboration with other agencies and organizations • Provides leadership and coordination for bilateral programs with selected countries, such as the U.S-Russian and U.S. South Africa Health Committee, in support of Presidential and Vice Presidential initiatives

  18. How Much Is Spent on Global Health Initiatives? • Health and Human Services: $272.3 million in FY 1999 • CDC: $226.8 million in FY 2001 • U.S. Agency for International Development: $1.494 billion for FY 2001 • President's budget for FY 2002 includes an additional $212 million over the $480 already committed for HIV/AIDS, tuberculosis, and malaria alone. **Even with these large commitments, the United States spends only 0.1% of its gross national product (GNP) on foreign assistance, a relatively low percentage compared with other developed countries**

  19. Other Organizations at Work • World Health Organization • Pan American Health Organization • World Bank • UNICEF • UN High Commissioner for Refugees • UN Foundation • Bill and Melinda Gates Foundation • CARE International • Global Health Council

  20. Current WHO Initiatives • Focus on health workers • Shortage of 4.3 Million doctors, nurses, and support services • Preparing the workforce that is in place • Limiting exits from the workforce • Formulating national health workforce strategies • Working together, across nations

  21. Current WHO Initiatives • Water Sanitation and Health • Lack of basic sanitation education is one of the leading causes of death. Typhoid and chronic dysentery can be drastically reduced with safe access to clean water • PHASE • Personal Hygiene and Sanitation Education

  22. New Traditions in Global Health • Bill and Melinda Gates Foundation • Access to existing vaccines, drugs, and other tools to fight diseases common in developing countries • Research to develop health solutions that are effective, affordable, and practical • Large focus on HIV an TB in developing countries • TB is leading cause of death for people with HIV

  23. New Traditions in Global Health • International AIDS conference • “Battle against AIDS cannot be won unless we also fight TB” –Nelson Mandela • International Labor Organization • UN specialized agency which seeks social justice and internationally recognized human rights • Health Volunteers Overseas • Works to increase healthcare access in developing

  24. New Traditions in Global Health • Physicians for Human Rights • Investigate and expose violations of human rights worldwide and educate the health professionals • International Center of Equal Healthcare Access • Allows healthcare professionals to teach their expertise on HIV care and other infectious disease through clinical mentoring

  25. Key Issues and Efforts by Republicans for Global Health • Foreign Operations, Export Financing, and Related Programs Appropriations Act, 2007 • Fiscal appropriations for foreign operations and the Department of State • Has been enacted • Global Pathogen Surveillance Act of 2005 • Global pathogen surveillance and response • Bill Frist Jr. – Part of Frist family that owns Hospital Corporation of America (HCA) • Not yet enacted

  26. Key Issues and Efforts by Republicans for Global Health • Microbicide Development Act of 2005 • Intended to facilitate the development of microbicides for the prevention of HIV and other diseases through the establishment of a Microbicide Research and Development Unit and through the concurrent strengthening of microbicide activity at CDC. • Not yet enacted

  27. Key Issues and Efforts by Republicans for Global Health • Global Health Corps Act of 2005 • Would mobilize U.S. health care workers abroad • Send doctors as federal employees and private-sector professionals as volunteers to developing countries • Not yet enacted

  28. Key Issues and Efforts by Democrats for Global Health • Rep. Juanita Millender-McDonald (D-CA) • H.R. 164 – International Pediatric HIV/AIDS Network Act of 2005 • To amend the Foreign Assistance Act of 1961 to provide for the establishment of a network of pediatric centers in certain developing countries to provide treatment and care for children with HIV/AIDS, and for other purposes • Fiscal Implications • For fiscal years 2006 through 2010 – no less than $10,000,000 annually • This bill never became law

  29. Key Issues and Efforts by Democrats for Global Health • Rep. Barbara Lee (D-CA) • H.R. 945 – New Partnership for Haiti Act of 2005 • To provide assistance to combat infectious diseases in Haiti and to establish a comprehensive health infrastructure in Haiti, and for other purposes • Fiscal Implications • Such sums as may be necessary for each of the fiscal years 2006 and 2007 • Authorized to remain available until expended • This bill never became law

  30. Global Health Issues - Democrats • Rep. Carolyn Maloney (D-NY) • H.R. 1011 – Women, Children and Infant Tsunami Victim Relief Act of 2005 • To provide financial assistance to the United Nations Population Fund to provide urgent medical and health care to tsunami victims in Indonesia, the Maldives, and Sri Lanka • Fiscal Implications • $3,000,000 to provide assistance • This bill never became law

  31. Global Health Issues - Democrats • Sen. Jon Corzine (D-NJ) • S. 674 – A bill to provide assistance to combat HIV/AIDS in India, and for other purposes • Rep. Barbara Lee (D-CA) • H.R. 1408 – A bill to provide assistance to combat HIV/AIDS in India, and for other purposes • Amends the State Department Basic Authorities Act of 1956 to provide assistance to combat HIV/AIDS in India • Fiscal Implications • Any amounts otherwise available for such purpose • Such sums as may be necessary for fiscal years 2006 through 2008 to provide assistance pursuant to the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 • This bill never became law

  32. Global Health Issues - Democrats • Sen. John Kerry (D-MA) • S. 1698 – Vaccines for the New Millennium Act of 2005 • Rep. Peter Visclosky (D-IN) • H.R. 3781 – Vaccines for the New Millennium Act of 2005 • A bill to accelerate efforts to develop vaccines for diseases primarily affecting developing countries and for other purposes • Fiscal Implications • The Secretary determines that a vaccine to combat a neglected disease is available for purchase • For each fiscal year – any funds in the Treasury not otherwise appropriated as may be necessary • Amounts shall remain available until expended without fiscal year limitation • This bill never became law

  33. Global Health Issues - Democrats • Rep. Betty McCollum (D-MN) • H.R. 4188 – Focus on Family Health Worldwide Act of 2005 • To Amend the Foreign Assistance Act of 1961 to improve voluntary family planning programs in developing countries, and for other purposes • Fiscal Implications • $600,000,000 for fiscal year 2007; $700,000,000 for fiscal year 2008; $800,000,000 for fiscal year 2009; $900,000,000 for fiscal year 2010; and $1,000,000,000 for fiscal year 2011 • This bill never became law

  34. Global Health Issues - Democrats • Sen. Barbara Boxer (D-CA) • S. 2564 – Stop Tuberculosis (TB) Now Act of 2006 • Rep. Sherrod Brown, (D-OH) • H.R. 5022 – Stop Tuberculosis (TB) Now Act of 2006 • To amend the Foreign Assistance Act of 1961 to provide increased assistance for the prevention, treatment, and control of tuberculosis • Fiscal Implications • Assistance to combat TB • Not less than $225,000,000 for fiscal year 2007 and $260,000,000 for fiscal year 2008 to carry out the Foreign Assistance Act of 1961 • Global TB activities though the Centers for Disease Control and Prevention • $30,000,000 for fiscal year 2007 and such sums as may be necessary for fiscal year 2008. • Amounts shall remain available until expended • This bill never became law

  35. Global Health Issues - Democrats • Sen. Christopher Dodd (D-CT) • S. 2765 – Child Health Investment for Long-term Development (CHILD and Newborn) Act of 2006 • Rep. Betty McCollum (D-MN) • H.R. 4222 – Child Health Investment for Long-term Development (CHILD and Newborn) Act of 2006 • To provide assistance to improve the health of newborns, children, and mothers in developing countries • Fiscal Implications • $660,000,000 for fiscal year 2007 and $1,200,000,000 for each of the fiscal years 2008 through 2011 • Amounts are authorized to remain available until expended • This bill never became law

  36. Global Health Issues - Democrats • Rep. Barbara Lee (D-CA) • H.R. 5674 – Protection Against Transmission of HIV for Women and Youth Act of 2006 • To require the President and the Office of the Global AIDS Coordinator to establish a comprehensive and integrated HIV prevention strategy to address the vulnerabilities of women and girls in countries for which the United States provides assistance to combat HIV/AIDS • Fiscal Implications • Provide flexibility to support the implementation of culturally appropriate HIV prevention programs • Ensure onerous requirements are not imposed with respect to how funds can be obligated and expended • Prevent unnecessary reduction in funding for effective HIV programs in order to meet such onerous requirements • This bill never became law

  37. Global Health Issues - Democrats • Democratic Presidential Candidate – John Edwards • Proposed the U.S. spend $5 billion annually to lead a worldwide effort to end global poverty through education and health care initiatives • Fiscal Implications • Commit $600 million for overseas health-related initiatives • Programs for clean water • “If, and I'm not saying at this moment I'm going to do it, but if there has to be another revenue source, it can't come from middle or low-income taxpayers.” • Create a new Cabinet post to oversee efforts to fight global poverty • Currently – more than 50 separate agencies working on foreign assistance • Convene a worldwide summit on "low-cost investment in clean drinking water and sanitation" and support preventive health care John Distaso, Senior Political Reporter, The New Hampshire Union Leader, 3/16/2007

  38. HIV/AIDS Around the World

  39. Proposed Legislation: Pharmaceutical Incentive for HIV/AIDS Vaccine 2007 • Establish economic incentives that would increase the participation of pharmaceutical companies in the Research and Development of an HIV/AIDS vaccine • A recurring grant in the amount of $125 million dollars to be used in the R&D division towards the creation of a vaccine • Tax credit for any costs associated with any phase of the development of the vaccine • Establish affiliations and partnerships with Universities/Organizations to increase efforts in the development of a vaccine

  40. Rationale • Approximately 40 million individuals are living with HIV/AIDS and 5 million are infected with the virus each year • The prevalence levels for this virus will continue to rise globally • High mortality and morbidity rates associated with HIV/AIDS • High economic costs in lost productivity and pensions resulting from absenteeism, sickness, and deaths from AIDS

  41. Rationale Cont. • Immunization is an inexpensive and effective public health intervention that has had a profound life-saving impact around the world. • The devastating impact of neglected diseases in developing countries threatens the political and economic stability of these countries and constitutes a threat to the United States economic and security interests. • Despite the devastating impact that AIDS and other diseases have on developing countries, it is estimated that only 10 percent of the world’s research and development on health is targeted on diseases affecting 90 percent of the world’s population.

  42. Target Groups • Pharmaceutical Companies • Individuals at high risk of becoming infected with HIV/AIDS • Institutions such as Universities and teaching hospitals as well as IAVI (International AIDS Vaccine Initiative) and NIH to assist in our efforts to the development of a vaccine in order to reach our target population

  43. Pharmaceutical Companies • Lack of funding (financial support) to private and public sector organizations to development of the vaccine • Because the developing country market is small and unpredictable, there is an insufficient private sector investment in research for vaccines for neglected diseases that disproportionately affect populations in developing countries • Of more than $100,000,000,000 spent on health research and development across the world, only $6,000,000,000 is spent each year on diseases that are specific to developing countries, most of which is from public and philanthropic sources.

  44. Partnerships • Partnerships between governments and private sector are playing a critical role in the area of global health, particularly in the fight against neglected diseases, including HIV/AIDS. • These public-private partnerships improve the delivery of health services in developing countries and accelerate research and development of vaccines and other preventive medical technologies essential to combating infectious diseases that disproportionately kill people in developing countries. • These public-private partnerships maximize the unique capabilities of each sector while combining financial and other resources, scientific knowledge, and expertise toward common goals which cannot be achieved by either sector alone

  45. Partnerships Cont. • Public-private partnerships serve as incentives to the research and development of vaccines for the neglected diseases by providing biotechnology companies, which often have no experience in developing countries, with technical assistance and on the ground support for clinical trials of the vaccine through the various stages of development. • Sustaining existing public-private partnerships and building new ones where needed essential to the success of the efforts by the United States and others in the international community to find a cure for these and other neglected diseases

  46. Mechanism • Interested pharmaceutical companies would apply for the grant and the IAVI and the OGHA would be responsible in selecting the recipient • Recipient selection based on quality of proposals submitted and grading criteria will be established (i.e. advance laboratory technology, past HIV/AIDS research conducted, etc.) • One (1) Pharmaceutical Company will be selected to receive the grant each year • Company must submit quarterly reports on status of vaccine development

  47. IAVI Mission Statement • To ensure the development of safe, effective, accessible, preventive HIV vaccines for use throughout the world. IAVI is a global not-for-profit, public-private partnership working to accelerate the development of a vaccine to prevent HIV infection and AIDS. Founded in 1996, IAVI researches and develops vaccine candidates, conducts policy analyses, and serves as an advocate for the field with offices in Africa, India, and Europe. IAVI supports a comprehensive approach to HIV and AIDS that balances the expansion and strengthening of existing HIV prevention and treatment programs with targeted investments in new AIDS prevention technologies. As the world’s only organization focused solely on the development of an AIDS vaccine, IAVI also works to ensure a future vaccine will be accessible to all who need it.

  48. Mechanism Cont. • Establish partnerships with the Pharmaceutical company selected and Universities through providing fellowships/internships to students interested in R&D of HIV/AIDS vaccine • Intellectual property belongs to pharmaceutical company but US government will get discounted/bulk price on vaccines to distribute to individuals at risk • Funds must primarily be used in the R&D of an HIV/AIDS vaccine (including clinical trials to ensure safety and efficacy)

  49. Financing • Up to $125 million in Categorical Grant • $25 million per year • Life of grant will be a maximum of 5 years • Each year the grant would be renewable based on the progression in the development of the vaccine

  50. Financing Cont. Tracking Funding for Preventive HIV Vaccine R&D, June 2005 [IAVI]

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