The CSIS Global Health Policy Center

The CSIS Global Health Policy Center publishes a range of timely materials of interest to readers in the policy, government, business, and academic communities. These publications include reports and books from CSIS experts; newsletters; commentaries and Critical Questions on current global health issues issues.

Published Reports

Russia’s Emerging Global Health Leadership

After nearly a decade of dipping its toes in the waters of international development assistance (IDA), Russia appears ready in 2012 to reconfigure its institutional apparatus for global aid—perhaps as a prelude to emergence as a more serious presence and partner on the IDA landscape. Russia must address its own substantial health challenges, as well as its growing political instability—there is a good chance that, in the near term, IDA will be of secondary importance to Russian decisionmakers who are preoccupied with managing and quelling public dissatisfaction over recent electoral processes. But there are serious motivations, with the potential for significant payoff to Russia, for engaging in international assistance in the area of health. Such a program, however, should be selective and focused. The major immediate goal should be not to impress the international community or to score international diplomatic points, but instead to learn important lessons as the potential for future development programs is nurtured. Read More >

The International AIDS Conference Returns to the United States

This report examines the political history of the international AIDS conferences from 1985 to the present. It is less a survey of major public health achievements in the fight against HIV/AIDS than an examination of the politics of the conferences themselves. It provides insights into the ways the conferences have contributed to the mobilization of funding, research, and advocacy focused on ending the epidemic. At the same time, it both aims to identify the key attributes that have characterized the most “successful” conferences for participants, organizers, and the broader AIDS community and to offer considerations for future conference planning and decisionmaking. Read More >

Injection Drug Use in Ukraine

Ukraine has been experiencing what has now become Europe’s most severe HIV epidemic. As of 2009, people who inject drugs (PWID) represented about 60 percent of all HIV-infected people in Ukraine, and nearly 50 percent of new HIV infections registered in 2010 were among PWID. However Ukraine is poised for progress. If the outstanding major administrative and structural challenges can be addressed and the political will mobilized and sustained, the availability and eventual full implementation of Ukraine’s Round 10 Global Fund grant will provide the country and its institutions with both adequate resources and with an excellent opportunity over the next several years. The U.S. government, through its political leadership and through the effective implementation of the bilateral Partnership Framework agreement, can play a critical role in keeping this process on track. Read More >

U.S. Global Health Policy in Palestinian Hands?

Palestinians, Israelis, Americans and others are engaged in high-stakes brinkmanship over recognition of a Palestinian state at the United Nations. For the Palestinian leadership, pursuing UN statehood and membership in UN bodies holds out the prospect of greater international recognition and rare diplomatic leverage over both the United States and Israel. Membership may bring a visible political victory at a time when Palestinian victories are scarce. Yet, the consequences could reach beyond the Israeli-Palestinian conflict if the Palestinians seek membership in specialized UN agencies— including, specifically, the World Health Organization (WHO). Read More >

Righting the Global Fund

Over the course of 2011, the Geneva-based Global Fund to Fight AIDS, Tuberculosis, and Malaria experienced unprecedented adversity. Media accounts and internal reports drew attention to instances of corruption involving grantees: $34 million of probable fraud in four African countries triggered a suspension of assistance by Germany and two other European donors. External reviews detailed the Fund’s deficient managerial practices, weak oversight of investments, and ineffectual board governance. An alarming, $2-billion-plus financial shortfall, revealed suddenly at year’s end, reflected a worsening global economy, overly optimistic forecasting by the Fund secretariat, and flagging donor trust and confidence in the Fund itself. Suddenly, the Fund faced painful existential questions: might it soon actually fail to meet the baseline needs of the millions of people whose lives were dependent on it? Or would it be able to regain its footing and return as a dynamic, expansive funding instrument focused on three of the world’s most deadly epidemics? Read More >

Gaza’s Health Sector under Hamas

In less than three decades Hamas health care activities have transformed dramatically. This transformation in health care has mirrored Hamas’s own evolution, albeit incomplete, from a militant organization to a de facto government. In the process the Islamic movement has gone from coordinating dozens of medical clinics and charities in the West Bank and Gaza to managing a multimillion dollar health ministry with thousands of employees and hundreds of thousands of beneficiaries. Once seen as a religious duty and a practical recruiting tool, Hamas’s health care agenda is now one of practical governance and political survival. This paper traces the evolution of Hamas’s health care services from the movement’s origins to its current role as the de facto government of Gaza. Read More >

Polio in Nigeria

Since 1988, the Global Polio Eradication Initiative (GPEI)—an international partnership of government and private institutions—has reduced the number of reported polio cases worldwide by more than 99 percent, successfully eliminating polio from much of the globe. Yet Nigeria remains one of the most entrenched reservoirs of poliovirus in the world. Continued transmission in 7 of Nigeria’s northern states has led to reintroduction of the virus in at least 12 African countries previously declared polio free, repeatedly dashing hopes that global targets for eradication—first in 2000, then in 2005—could be met. The Nigerian experience has underscored the complexity of the eradication endeavor and vividly demonstrates the fragility and reversibility of gains made to date. Now, with a new target date for global eradication set for the end of 2012, the stakes are extremely high. Concern that this new target may be missed has spurred an urgent “now or never” push by GPEI members to apply the lessons of the last decade and ensure that Nigeria will be polio free by 2013. Read More >

Egypt and U.S. Health Assistance

Few countries have been as successful as Egypt in parlaying its strategic position into an economic asset. At the nexus of two continents, astride the Suez Canal, and with one-quarter of the Arab world’s entire population, Egypt has made itself an object of interest, and often an object of concern, among the world’s great powers for more than a half-century. The health sector is a valuable prism through which to examine these phenomena shaping the overall U.S.-Egypt economic aid relationship. Over more than three decades, the United States invested more than $1 billion in health projects in Egypt, and the period of U.S. assistance corresponded to a period of dramatic improvements in Egyptians’ health. Bilharzia was largely eliminated from the rural population, the rate of infant and child death from diarrheal diseases plummeted, and population growth flattened considerably. USAID efforts played a significant role in supporting each of these trends. Read More >

The Private Sector Role in Public Health

In recent decades, there has been a decided evolution in perspectives on the roles and responsibilities of business in society. The classic position was Milton Friedman’s 1970 pronouncement that the only responsibility a business has is to return a profit to its shareholders. That view has largely been replaced by a more nuanced understanding of the ways in which businesses can enhance their competitiveness and economic returns by addressing the needs and challenges of the communities in which they operate. Corporate responsibility is no longer an oxymoron, as skeptics claim, but rather an emerging approach designed to create shared value for businesses and their shareholders—having positive social impact while also generating the return on investment expected by shareholders. There is still wide variation in corporate responsibility practices. Read More >

Protection of Health Care in Armed and Civil Conflict

During recent uprisings in Bahrain, Syria, and Libya, security forces obstructed access to health facilities; harassed, arrested, and prosecuted medical personnel; and even assaulted patients within hospitals. Assaults like these have long been part of the landscape of armed and civil conflict. They jeopardize the lives and well-being not only of those directly attacked but of others who may never be able to access the health care they need. Yet, for decades, a paucity of regular reporting on the frequency, dynamics, and impacts of these assaults; lack of attention to strategies to prevent attacks; and absence of accountability mechanisms for those who perpetrate assaults has allowed these assaults to continue with impunity. Read More >

Polio Eradication in India

There is a good chance that India’s polio eradication campaign will tell a more inspiring story. If this milestone endures, it will be the result of a persistent and focused effort and unprecedented collaboration among Indian scientists, administrators, and their international counterparts. The campaign has combined cutting-edge research on vaccines, old-fashioned door-to-door follow-up, public and private outreach, political drive, and relentless surveillance. It has had to overcome what the program’s Indian and international leaders regard as a unique combination of biologic and epidemiologic challenges, as well as classic speed bumps in navigating India’s bureaucracy. The effort’s ultimate legacy—beyond the unquestioned benefit of reducing or eliminating paralytic polio—will depend on how India’s health leaders consolidate their victory, and how they embed the institutional sources of their apparent success into the country’s remarkably diverse health system. Read More >

Terra Nova: How to Achieve a Successful PEPFAR Transition in South Africa

Seven years ago, the President’s Emergency Plan for AIDS Relief (PEPFAR) made its first investments in South Africa, the heart of the global HIV/AIDS pandemic. These historic investments quickly grew to become the largest single bilateral health account in the world. The resulting story of U.S. engagement in South Africa is one of strategic choice, sustained commitment, and significant human impact. In the past three years, it has also been the story of increased South African ownership and action, as its government has brought unprecedented levels of money and political will to the battle against HIV/AIDS. Today, South Africa is home to a profoundly important transition in U.S. foreign assistance. The United States and South Africa are negotiating a complex, multiyear handoff that will shift financial and managerial responsibilities for HIV/AIDS to the South African government and move the United States away from direct service delivery and into technical assistance. This report outlines five key steps the United States, in close partnership with South Africa, can take to build on recent gains, manage the risks and tensions associated with the transition, and raise the prospects of success. Read More >

Role(s) of Vaccines and Immunization Programs in Global Disease Control

Much of the substantial progress seen in global health over the past several decades can be ascribed to the beneficial impacts of various vaccines and immunization programs on the control of serious disease among both individuals and populations. In only the first decade of the twenty-first century, an estimated 2.5 million deaths of children younger than five were prevented worldwide by vaccines. Given the relative successes of the GAVI Alliance (formerly, the Global Alliance for Vaccines and Immunisation) and the recent call by the World Health Assembly for a global vaccine action plan to guide the world for the next 10 years, the world is focusing much attention, justifiably, on various aspects of macropolicy and planning for the progressive expansion of global vaccine efforts. This brief report focuses on the “nuts and bolts” of the complex biological, epidemiologic, and risk management concepts that are the foundations of global and national “expert group” recommendations for specific target groups for currently available childhood vaccines and others. Using examples of specific vaccine successes and disease challenges, this report highlights the ongoing attention to detail required for the success of local, national, and global immunization efforts. Read More >

The Future of Global Immunization

In January 2010 at the World Economic Forum, the Bill and Melinda Gates Foundation launched the Decade of Vaccines by pledging $10 billion over the next 10 years to support worldwide efforts to develop and deliver vaccines to the world’s poorest countries. The foundation also challenged other global partners to demonstrate their continuing commitment and, in so doing, to dramatically reduce child mortality by the end of the decade. This is a tremendous opportunity for transforming global health and could have significant consequences for child survival while expanding the impact of vaccines across the lifespan, but there is no easy formula for success. How a number of challenges are addressed will be critical to success or failure in the next decade and to the most effective use of available resources. This report outlines 10 important issues facing the global vaccine and immunization agenda. Read More >

China’s Emerging Global Health and Foreign Aid Engagement in Africa

This volume is a compilation of papers that were written for the Conference on China’s Emerging Global Health and Foreign Aid Engagement, sponsored by the Center for Strategic and International Studies (CSIS) and the China Institute of International Studies (CIIS), in Beijing on May 24, 2011, as part of a larger CSIS initiative to examine the global health engagement of the BRIC countries (Brazil, Russia, India, and China). Focusing specifically on China’s health and foreign aid engagement in Africa, the volume includes contributions by U.S. and Chinese experts. Read More >

Implementing Health Care Reform Policies in China

China’s health system has spanned the antipodes of potential health system models, ranging from a pure government delivery model to one radically driven by profit incentives, and now China is seeking a hybrid to suit its hybrid economy. After an extensive and remarkably public debate that featured clashes between the “government approach faction” and the “market approach faction,” China has settled on a mixed vision that guarantees a level of basic universal health security while permitting market space to meet additional demands. To realize this vision, the government along with the Central Committee of the Communist Party announced a major comprehensive health reform effort in April 2010, committing RMB 850 billion over three years to the project, even amid a major economic recession. In this report, American and Chinese experts examine how health reform is being implemented in China, as well as the challenges and opportunity reform is facing. Read More >

The Global Health Initiative in Malawi

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative's (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs. The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President's Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi's weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI's ability to achieve sustainable results. The value and impact of GHI's new business model may ultimately be evaluated based on its outcomes for women and girls, given the prominence of the women, girls, and gender equality principle in GHI and the importance of cross-sectoral approaches to address their health and non-health needs. Read More >

Scaling Up Prevention of Mother-to-Child Transmission of HIV

Prevention of mother-to-child transmission of HIV (PMTCT) is an essential tool in the fight against HIV. A comprehensive PMTCT approach includes four components: primary prevention of HIV among women of childbearing age; preventing unintended pregnancies among women living with HIV; preventing HIV transmission from women living with HIV to their infants; and providing appropriate treatment, care, and support to women living with HIV and their children and families. It is estimated that PMTCT, when done exceptionally well, can reduce the rate of transmission of HIV in pregnancy, at birth, and while breastfeeding, from 25-45 percent to less than 2 percent. Mother-to-child transmission accounted for over 90 percent of the estimated 370,000 new HIV infections among children in 2009. Better PMTCT programs have the promise of significantly reducing this number. The United States has an opportunity to make rapid progress on PMTCT in the 14 countries where PEPFAR is already partnering with governments to implement PMTCT Acceleration Plans. To facilitate progress more broadly, the United States should use its leadership role and influence in global health to encourage other donors, partner organizations, and institutions such as the Global Fund to do more to lower the incidence of mother-to-child transmission. Through its own programming and diplomatic partnerships, the United States can do better by addressing more aggressively stigma and gender inequity, integrating programs, and strategically targeting investments to address persistent obstacles. Read More >

Improving Women’s Health in South Africa

A period of major change is unfolding in health and HIV services in South Africa, carrying opportunities and risks for delivering effective, integrated health services that improve health outcomes and save lives. South Africa is decentralizing HIV services to the primary health care level, paving the way for greater integration to address women’s health and to reduce maternal mortality. The United States can find feasible, flexible ways to support this process, even though its health program through the President’s Emergency Plan for AIDS Relief (PEPFAR) is scaling down. As PEPFAR transitions from an emergency to a more sustainable response, this is a crucial moment to demonstrate that it can address HIV-related goals by linking to more comprehensive services for women—notably linking HIV with family planning (FP), reproductive health (RH), and maternal child health (MCH). The stakes are high for PEPFAR and for the Global Health Initiative (GHI) to show results and, most importantly, for the women and children most at risk. Read More >

Making Progress on Global Water, Sanitation, and Hygiene (WASH) Challenges

This report presents conclusions and recommendations offered at a World Water Day Learning Forum, “Making Progress on Global Water, Sanitation, and Hygiene (WASH) Challenges,” held at CSIS on March 21, 2011. Sessions focused on the role of the private sector in water supply; achieving operational sustainability; the relevance of climate change adaptation programs for the WASH sector; and how to promote transparency and accountability within WASH programs. The report highlights the importance of community engagement, private sector involvement, and a commitment to the monitoring and evaluation of projects as critical factors in promoting WASH program sustainability. Read More >

The Defense Department’s Enduring Contributions to Global Health

In the spring of 2010, CSIS launched a year-long, independent examination of the U.S. Army and Navy overseas medical research laboratories. The impetus was an awareness that despite the laboratories’ impressive scientific accomplishments and contributions to U.S. national interests and global health, they are not well understood outside of research circles and consequently find themselves undervalued in today’s environment of fiscal austerity. They stand at the intersection of health and security, a topic of increased importance to U.S. approaches to global health. The CSIS project aimed to assess the laboratories’ contributions and achievements; examine the factors that constrain their performance; and propose reforms that will put them on the best course to continued success. It included considerable background research, three formal meetings of experts, travel to five overseas laboratories, and interviews with dozens of laboratory researchers and collaborators. This report lays out the project’s research, conclusions, and recommendations. Read More >

GAVI’s Future: Steps to Build Strategic Leadership, Financial Sustainability, & Better Partnerships

On June 13, the GAVI Alliance will ask donors to commit $3.7 billion to immunize an additional 250 million children by 2015. Now, as GAVI prepares for its next decade of progress under new leadership, is an opportune moment to examine critical challenges and how they can be addressed to ensure continued success. This policy brief, developed collaboratively by the CSIS Global Health Policy Center and the Center for Global Development provides analysis and recommendations to GAVI leadership in three vital issue areas: GAVI’s mandate and business model; its financing strategy; and the GAVI Secretariat and partners’ capacities. Read More >

Leveraging the World Health Organization’s Core Strengths

The World Health Organization (WHO) was formed in 1948 to act globally as the “directing and coordinating authority on public health” to promote the “attainment by all peoples of the highest possible level of health.” Under this broad mandate, WHO has contributed to historic public health advancements, such as the eradication of smallpox, achieved in 1979, and galvanizing its members around the Framework Convention on Tobacco Control, which entered into force in February 2005. At present, there is a U.S. government interagency review under way on policy approaches to WHO, along with calls from independent critics to reform the body’s governing charter. On the question of whether WHO has value to U.S. global health policy and U.S. national interests, the answer, in the opinion of the authors of this paper, is decidedly yes—provided that WHO narrows its focus strategically to those activities for which it is best suited and for which it has the greatest prospects of delivering substantial value. Read More >

HIV Prevention among Injection Drug Users in Kenya and Tanzania

While overall growth in numbers of new HIV infections has slowed in most regions of the world, infections linked to injection drug use (IDU) continue to grow. This trend has been most pronounced in Eastern Europe and Central Asia; however, new infections related to injection drug use also appear to be growing in East Africa. A team from the CSIS Global Health Policy Center recently visited Kenya and Tanzania to better understand the dimensions of the IDU-driven HIV epidemic in those two countries and to look at how U.S.-supported programs through PEPFAR are helping shape a response. The team concluded that recent changes in U.S. policy are playing an important role in helping to improve HIV prevention and IDU treatment policies in both countries and recommended a number of additional measures to ensure that these programs achieve maximum impact. Read More >

On the Ground with GHI in Kenya

In December 2010, the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) organized a trip to Kenya to examine progress in implementing the U.S. government’s Global Health Initiative (GHI). This trip followed an earlier mission to Kenya in August 2009 that had helped inform the recommendations of the CSIS Commission on Smart Global Health Policy. The December trip grew from a strong sense of the importance of examining how GHI was evolving on the ground in key partner countries, especially as debate sharpens in Washington around whether and how to preserve U.S. gains in global health, expand on them, and win continued support across partisan lines, from congressional and executive decisionmakers and from American citizens. These questions have intensified in the midst of a protracted U.S. economic downturn, acute budget pressures, and following the November 2010 elections, split power in government. It was our view that a close analysis of GHI’s evolution since 2009, through the prism of how it is unfolding in Kenya, would be highly valuable and timely to broader discussions in Washington on GHI’s future in this era of austerity. Read More >

Lessons from Kenya for the Global Health Initiative

The Obama administration’s Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR. As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government’s health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries, the emphasis on program integration in those U.S. government programs is especially relevant. Read More >

Getting the Politics Right for the September 2011 UN High-Level Meeting on Noncommunicable Diseases

The UN General Assembly’s decision to convene a “high-level meeting on the prevention and control of noncommunicable diseases (NCDs) worldwide” in September 2011 creates a major, timely opportunity to elevate chronic diseases onto the global stage. Just as the 2001 UN General Assembly Special Session on HIV/AIDS was a pivotal moment in the global response to AIDS, there is hope that the September session on NCDs can become a historic rallying point. But we need to be realistic. Time to prepare adequately is short. NCDs do not enjoy many of the advantages that helped propel AIDS to become a global priority. High-level leadership is thus far missing, and the odds are long that the September meeting will have a transformative impact. Important gains are indeed possible in September but only with disciplined pragmatism and urgent, focused action taken to seize the moment. Read More >

Linkages Between Gender, AIDS, and Development

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference entitled “Linkages between Gender, AIDS, and Development: Implications for U.S. Policy” on June 11, 2010. This is an unprecedented opportunity to develop strategies and implement programs that make a difference in the lives of women and girls and to address head on the complexities that program linkages and multisectoral programming present. The report recommends that, to be successful, the U.S. government should: systematically hold implementing government agencies accountable to promote multisectoral linkages; put in place better measurement tools to track progress in addressing women’s health outcomes and achieving structural change and identify intermediate steps to capture impact; and set out long-range plans to build sustainability, encourage innovation, and ensure U.S. global leadership. Read More >

Beyond Ratification: The Future of U.S. Engagement on International Tobacco Control

Tobacco use is arguably the greatest threat to global health. Tobacco use and secondhand smoke kill more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, an expanding pandemic of tobacco-related diseases promises to disable and kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming health care budgets, robbing families of their primary wage earners, and hindering economic development. Tobacco use is also one of the most preventable threats to global health. Many arguing for increased U.S. engagement on global tobacco control have focused on the need for the United States to ratify the FCTC. Given the poor near-term prospects for ratification and the lack of momentum behind FCTC implementation, a new approach is warranted. Although the United States should ratify the FCTC, it should not wait to do so before increasing its support for low- and middle-income countries’ FCTC implementation. This approach would accomplish the same objective—to meaningfully demonstrate U.S. commitment and leadership—and do more to advance global tobacco control. Read More >

Key Players in Global Health: How the BRICS are Influencing the Game

This report represents the first step in an 18-month CSIS initiative focused on how the BRIC (Brazil, Russia, India, and China) countries and South Africa are influencing activities, practices, and strategies in the area of global health diplomacy. Over the next year and a half the CSIS Global Health Policy Center, along with the CSIS programs on China Russia, South Asia, Africa and the Americas, will develop partnerships with institutions in each country to support shared research projects, to organize international discussions, and to disseminate policy analysis and recommendations intended to encourage greater understanding of the ways in which approaches to global health policy and cooperation are changing. Read More >

African Perspectives on Genetically Modified Crops

By Jennifer G. Cooke, Richard Downie. -- The authors gauge the current status of the debate on biotechnology in Africa with a snapshot of three countries at different stages along the spectrum of opinion on genetically modified crops (GMOs): Zambia, where a strong emphasis on the precautionary principle remains very much in place; Kenya, where recent legislation has opened the door to eventual commercialization of GM crops; and South Africa, where GM food crops are widespread and where elaborate regulatory capacities are fully established. The authors look at what practical steps countries are taking to settle the question and examine the wider issue of what debates around GM technology say about the role of science in Africa. The research is based on interviews conducted with policymakers, scientists, farmers’ groups, anti-GMO campaigners, and other interest groups in all three countries in October through December 2009. This report supplements the work of the CSIS Task Force on Global Food Security, chaired by Senators Richard Lugar and Robert Casey. Its final report, Cultivating Global Food Security, published in April 2010, calls on the U.S. government to pursue a multifaceted response to food insecurity, driven by strong White House leadership, focused on specific country needs, and drawing on the strengths of the research community and the private sector. The role of GM technology in enhancing food security does not feature prominently in the work of the task force, but because the issue arises frequently in U.S. discussions on boosting agricultural productivity, it is worthwhile to examine how African opinions are evolving. This report does not take a position either for or against GM technology. Instead, it seeks to highlight current thinking on GM crops in three sample countries; identify the drivers of these discussions; and offer thoughts on how the debate about GMOs might play out in the future. Read More >

Strengthening Global Health Preparedness: Recommendations for Expanding U.S. Engagement and Leadersh

The world has entered an era in which the numbers of new and reemerging global health threats argue for a longer-term, more strategic, and more coherent U.S. approach to global health preparedness. The ongoing threat from emerging infections such as SARS, extensively drug-resistant tuberculosis (XDR-TB), H5N1 (avian) influenza, and most recently, H1N1 influenza has raised awareness within the U.S. government and other partner states and multilateral institutions of the global interdependence of human security and global commerce. This awareness has spurred more systematic efforts to identify and respond to sudden global public health emergencies stemming from infectious diseases, natural disasters, and other public health emergencies. Recent experience has also illustrated the potential damage that can result from unresolved controversies over the global sharing of biological specimens, as well as the closely related and equally sensitive imperative to mitigate stark inequities experienced by poor countries unable to obtain medicines, vaccines, and other commodities in timely, affordable volumes to meet public health crises. Read More >

Building U.S. Diplomatic Capacity for Global Health

By Harley Feldbaum - As U.S. funding for global health has increased, U.S. diplomatic capacity for supporting and leveraging our global health funding remains stagnant and fragmented. This lack of capacity to manage the political aspects of global health is dangerous, because the politics of global health have never been more divisive, and the opportunities for improving health and controlling disease epidemics never more extraordinary. -- U.S. diplomatic capacity for global health represents the organization, staffing, and direction necessary to engage, not only on the charitable, technical, and scientific aspects of global health, but on the political and diplomatic aspects as well. The current lack of diplomatic capacity for global health at the Departments of State, Defense (DOD), Health and Human Services (HHS), the U.S. Agency for International Development (USAID), and the National Security Council (NSC) results in continually missed opportunities to support global health efforts and to leverage U.S. global health funding to support foreign policy objectives, and this imperils the success of U.S. global health aid. In a small number of cases, this lack of capacity threatens U.S. national security by undermining negotiations on influenza virus sharing and global health security. -- Numerous reports have outlined the goals the Obama administration should pursue in global health. This brief does not seek to add to those or to propose detailed policy solutions to the cases discussed. Instead it seeks to demonstrate that U.S. global health policy has global political ramifications that cannot be ignored and that demand permanent capabilities within the U.S. government. It describes the need for improved U.S. diplomatic capacity on global health, outlines the currently fractured architecture of the U.S. government on this issue, and issues recommendations for building diplomatic capacity for global health. Read More >

From Conflict to Pandemics: Three Papers from the CSIS Global Health and Security Working Group

The CSIS Global Health Policy Center formed a working group in the spring of 2009 to examine the nexus of security and global health, with a special focus on the missions and programs of the U.S. Department of Defense (DOD). Specifically, the group concentrated on: The role of the U.S. Department of Defense in preparing for global pandemics - Leveraging military-to-military cooperation to support global health - Preserving and improving civilian health in conflict-affected nations. An additional appendix examines the respective roles of civilian institutions and the military in promoting health in conflicted settings. The CSIS Global Health and Security Working Group, cochaired by recently retired Colonel Eugene Bonventre, M.D., and former Secretary of Veterans Affairs James B. Peake, M.D., convened health and security experts from U.S. government agencies, humanitarian organizations, academia, the private sector, and foundations. Over the course of 10 months, the 40-member group held four formal meetings, hosted multiple guest lecturers, and had numerous side discussions. Out of this emerged a realistic strategy, detailed in the three papers contained herein, for the United States to concurrently improve global health and security. This report represents the majority opinion of working group members, not a unanimous consensus on every last issue. The opinions expressed in the report are those of the cochairs. Within this report are actionable recommendations for how the Obama administration can better use its military health programs to overcome knowledge gaps between the often segregated global health and national security objectives and improve interagency and civil-military communication. Recommendations focus on increasing global public health capacity, improving access to health care for host-nation civilians, and increasing security and stability abroad. Read More >

A Healthier, Safer, and More Prosperous World

As the United States applies smart power to advance U.S. interests around the world, it is time to leverage the essential role that U.S. global health policy can play. Americans have long understood that promoting global health advances our basic humanitarian values in saving and enhancing lives. In recent years, support for global health has also proven its broader value in bolstering U.S. national security and building constructive new partnerships. A smart, strategic, long-term global health policy will advance America�s core interests, building on remarkable recent successes, making better use of the influence and special capabilities of the United States, motivating others to do more, and creating lasting collaborations that could save and lift the lives of millions worldwide. It will usher in a new era in which partner countries take ownership of goals and programs; in which evaluation, cost effectiveness, and accountability assume vital roles; and in which a focus on the health of girls and women becomes a strategic means to bring lasting changes. And it will enhance America�s influence, credibility, and reservoir of global goodwill. Read More >

Innovative Financing for Global Health: A Moment for Expanded U.S. Engagement?

By Robert Hecht, Amrita Palriwala, and Aarthi Rao -- Mar 16, 2010 -- In this paper, the authors assess some of the most promising new financing mechanisms for global health, describing their current status, actual and potential benefits, and limitations. They also examine the prospects for increased U.S. involvement in innovative financing for global health, discuss some of the barriers that have hampered U.S. support in this area, and point to actions that could be taken to address these barriers. --Their conclusion is that new forms of financing are important, and that furthermore, the United States should become a more engaged participant in shaping and backing efforts in this area. Doing so could yield important health and economic benefits for millions of people in the world�s poorest countries and also generate important political and economic gains for the United States. Read More >

Kenya Trip Report: CSIS/CARE Joint Delegation to Kenya

Members of the CSIS Commission on Smart Global Health Policy traveled to Kenya from August 8�12 to get a snapshot of multiple U.S. health investments on the ground and gather perspectives on the core questions of impact, measurement, integration, and sustainability of current efforts. Read More >

Prevention of New HIV Infections: Priorities for U.S. Action

Building on its work of the last several years, the CSIS HIV Prevention Working Group organized in the summer of 2009 a consultation on �Revisiting U.S. Approaches to HIV Prevention�. The discussion brought together more than twenty HIV prevention experts to review the concrete priority steps the U.S. could take to enhance the effectiveness of HIV prevention programs during the next fi ve years of the President�s Emergency Plan for AIDS Relief (PEPFAR). Participants were drawn from academia, research institutions, foundations, civil society, government and service delivery organizations. Each brought to the table significant professional expertise,operational experience and personal commitment. We are grateful to them for their valuable contributions. Read More >

Making Gender a Global Health Priority

The world faces enormous challenges in the global health arena, many of which have a disproportionate impact on women and girls. Many key global health priorities revolve in fundamental ways around the gender-related barriers that women and girls face in accessing health-related information, services, and resources, all of which increase their vulnerability to ill health. For success and sustainability, the United States should anchor its global health strategy in a firm commitment to address the gender disparities that affect global health outcomes. Read More >

The European Approach to Global Health: Identifying Common Ground for a U.S.-EU Agenda

The European Approach to Global Health - By Gaudenz Silberschmidt - Nov 13, 2009 - The advent of the Obama administration offers an important opportunity to launch a serious dialogue on strengthening transatlantic collaboration on global health issues. This dialogue will require high-level commitment and engagement from both Europe and the United States. And it will naturally emanate from each side�s internal processes and strategic approach to global health. his paper, based on a series of interviews with senior European health leaders, seeks to shed light on European approaches to global health; the interactions among the European Union (EU), the European Commission (EC), and member states; and, finally, European perceptions of U.S. global health policies. All of those interviewed strongly support the need for a more consistent and reciprocal dialogue between the United States and Europe, although there were varying opinions on what the initial focus of such a dialogue should be. The paper concludes with suggestions for enhancing U.S.-EU engagement to better identify partnership opportunities in improving global public health in the long term. Read More >

Global Health Interventions for U.S. Food and Drug Safety

By Thomas J. Bollyky - Nov 13, 2009 - In 2007, a series of high-profile scandals involving contaminated blood thinner, toxic toothpaste, and melamine-laced pet food demonstrated the threat that unsafe food and drug imports pose to U.S. public health and international trade. Contaminated and adulterated products have sickened and killed U.S. consumers, fueled protectionism, raised business costs, and destabilized markets. A 2008 public opinion poll found that 67 percent of Americans are worried about food safety, ranking it higher than concerns about pandemic flu or natural disasters. Food and drug safety also has the attention of U.S. policymakers. In 2007, the Bush administration convened an Import Safety Working Group that called for an increased focus on prevention, more resources and greater mandates for the Food and Drug Administration (FDA) and other U.S. regulators, and increased engagement with trading partners and industry. President Obama appointed a cabinet-level Food Safety Working Group and requested the largest-ever budget increase for FDA food programs. The House of Representatives recently passed food safety legislation to modernize the authorities of the FDA and improve the ability of the FDA to trace and register facilities that import food, issue mandatory food recalls, and conduct border surveillance and enforcement. The Senate is scheduled to take up the food safety legislation in the coming weeks. Drug safety bills, pending in the House and Senate, would increase the mandate and resources for the FDA to conduct inspections of foreign drug suppliers. Increasing the resources and mandate of U.S. regulators to conduct border and foreign risk-based inspections are positive and necessary steps, but insufficient. There are legal and practical limits to the ability of U.S. regulatory authorities to conduct inspections of foreign food and drug producers and suppliers. The scale and complexity of the global trade in food and drugs overwhelm traditional methods of border control and inspection at ports of entry. Ensuring the safety of U.S. food and drug imports requires new approaches as well as new resources for traditional interventions. Read More >

China�s Health amidst the Global Economic Crisis

Potential Effects and Challenges -- By Charles Freeman, Xiaoqing Lu Boynton -- Oct 19, 2009 -- The current economic crisis has hit China hard. China's high savings rate is a significant deterrent to boosting domestic consumption, and with little sign of a resumption of global demand for Chinese exports, the leadership recognized early in the crisis that it needed to take aggressive action to ensure growth from alternative sources. Hence, Beijing leapt into the fray with a massive $586-billion fiscal stimulus package in November 2008. As China moves to restructure its economy, a major overhaul of its health care system has become one of its top priorities. In April 2009, after over two years of intense debate and repeated revisions, Beijing unveiled its blueprint for health care as part of its economic stimulus package�a much-anticipated reform to fix the ailing medical system and ensure fair and affordable health services for all 1.3 billion citizens. The reform plan anticipates improving public confidence in China's health care system and thus creating a multiplier effect through the economy in response to the global economic downturn. Despite these aspirations, however, Beijing's objectives might not be achieved without proper implementation of the plan. Read More >

International Family Planning

A Common-Ground Approach to an Expanded U.S. Role -- By Janet Fleischman, Allen Moore -- Jul 23, 2009 -- The election of Barack Obama has fundamentally changed the landscape for the debates around U.S. support for international family planning (FP) programs. The personal engagement of top government officials, combined with policy and budgetary announcements that make averting unintended pregnancies a priority issue, clearly signal the administration's intention to promote family planning as part of a comprehensive approach to global health. Despite the polarization that often surrounds the debates on these issues in the United States, largely over their perceived linkage to the highly charged issue of abortion, an unprecedented opportunity now exists to significantly expand international FP programs based on a �common-ground� approach. The core element of this approach is the need to move toward universal access to FP services�defined throughout this paper as education, counseling, and contraceptive commodities�provided on a voluntary basis to females and couples. The common ground does not include abortion, which is prohibited by U.S. laws governing foreign assistance. In most developed countries, a wide array of contraceptive options are available so people can plan whether and when to have children. It is precisely that acceptance and availability of FP services in the developed world that forms the basis for a common-ground policy toward international FP services. Read More >

Enhancing U.S. Leadership on Drinking Water and Sanitation

Opportunities within Global Health Programs, By Katherine Bliss - Sep 24, 2009 - In the United States, domestic support for greater investments in projects dedicated to improving global health through addressing water, sanitation, and hygiene issues has gathered momentum in recent years. In 2005 President George W. Bush signed into law the Senator Paul Simon Water for the Poor Act, making water, sanitation, and hygiene (WSH) activities a strategic focus of United States foreign assistance. In FY 2008 and FY 2009, Congress appropriated $300 million to support international WSH activities for the poorest and most vulnerable populations. During a period of economic crisis in which some U.S. citizens have questioned the utility of overseas assistance programs and believe the government should focus more attention on domestic concerns, a poll released in May 2009 showed that 61 percent put improving access to safe drinking water at the top of a list of issues Americans believe should be global health priorities for the U.S. government. With the Obama administration's announcement of a new Global Health Initiative, the time is right for U.S. agencies to assert political leadership in addressing the persistent and significant global health challenges related to water and sanitation. This report focuses on the links among water, sanitation, and the health sector and identifies opportunities for greater U.S. engagement on water and sanitation as global health challenges. Read More >

Using Measurement to Drive Results

We are in the midst of a major transition in the core U.S. goals for global health. During the period 2003�2008, the predominant goal was to respond to a health emergency, through large-scale, dramatic, single-disease initiatives: the President's Emergency Plan for AIDS Relief (PEPFAR) and subsequently the President's Malaria Initiative (PMI). Increasingly now, the overriding goal is to help create in partner countries sustainable, long-term programs that will decrease mortality and morbidity in most at-risk populations while strengthening health systems. That will involve building on the success of the HIV/AIDS and malaria platforms, while broadening approaches to put a new emphasis on maternal and child health, family planning, and prevention of high-burden, high-risk conditions. In this new phase, there is a corresponding paradigm shift with respect to measurement: from a focus on inputs and process to a higher priority on ensuring that U.S. investments are leading to the greatest health impacts possible. The ability to link new goals with concrete results is contingent on this new paradigm of measurement. Read More >

A Call for a Strategic U.S. Approach to the Global Food Crisis

In May 2008, in response to the growing global food crisis, the Center for Strategic and International Studies (CSIS) launched a task force to assess the rising humanitarian, security, developmental, and market impacts of rising food costs and shortages. Its cochairs, Senators Richard G. Lugar (R-IN) and Robert P. Casey (D-PA) charged the task force with identifying, by late July 2008, a feasible but bold plan of action that the Bush administration, the presidential campaigns, Congress, and the next administration could embrace on a bipartisan basis. The result, outlined in the following report, is an argument for modernizing and doubling emergency assistance, elevating rural development and agricultural productivity to be new foreign policy priorities, revising the U.S. approach to biofuels so that fuel and food security objectives are effectively de-conflicted, acting on an urgent basis to conclude the Doha Development Round, and creating a strategic U.S. approach to global food security that interlinks approaches to relief, development, energy, and trade and that is backed by new robust organizational capacities. Read More >

Health in Latin American and the Caribbean

The United States' geographic proximity to Latin America and the Caribbean, as well as its extensive trade, migration, and border relationships with countries in the hemisphere, make addressing health issues in the Americas a matter of national interest. Challenges include the persistence of high maternal and infant mortality rates; diarrheal and respiratory diseases; and vaccine-preventable infections in some countries, along with the emergence of noncommunicable chronic diseases as an increasing cause of disability and death among aging populations across the region. Drug resistant infectious agents; an inadequate food and drug safety system; and the emigration of health personnel undermine the region's efforts to promote disease surveillance and prepare for emergencies. By updating its foreign assistance health priorities for Latin America and the Caribbean; expanding technical cooperation activities; and working with host countries, nongovernmental organizations (NGOs), and other partners to reach underserved communities, the United States can better promote health, security, development, and good will in the region. Read More >

The Dramatic Expansion of University Engagement in Global Health

Global health is experiencing an unprecedented and palpable surge of attention and growth on universities campuses across the United States. Curricula, programs, centers, departments, and institutes of global health are being established as either free-standing entities or within schools of medicine and public health at major universities. In direct response to this growth and the need for academic stewardship, the Consortium of Universities for Global Health (CUGH) was formed in 2008 to promote, facilitate and enhance the growth of global health as an academic field of study. This country-wide growth creates a new constituency and voice for global health in this country and for the new Obama administration. Read More >

U.S. National Security and Global Health

Despite a broadening consensus that global health care efforts have an impact on national and global security, the U.S. national security community's efforts to address global health are weak and uncoordinated. The 2006 National Security Strategy states that "development reinforces diplomacy and defense, reducing long-term threats to our national security by helping to build stable, prosperous, and peaceful societies." While the U.S. government struggles to find the right balance among the "three Ds" of defense, diplomacy, and development, the U.S. military has increased its involvement in global health where it perceives the diplomacy and development to be underresourced--or to achieve its own specific objectives. As efforts to renew the capabilities of civilian agencies proceed, it is an appropriate time to step back and consider the role that the U.S. Department of Defense (DoD) currently plays in global health, the impact of its health activities on national and regional security, and the role it could play to support a newly balanced U.S. foreign policy. Read More >

Public Health in Africa

Nowhere are global public health challenges more acute than in sub-Saharan Africa. With just 13 percent of the world's population, this region carries 24 percent of the global burden of disease. The continent's immense disease burden and frail health systems are embedded in a broader context of poverty, underdevelopment, conflict, and weak or ill-managed government institutions. These complex, interrelated challenges will ultimately demand sustained, patient, and integrated responses. This report examines these challenges and makes recommendations for a strategic U.S. response by the Obama administration. Read More >

Policies and Practices to Advance global Health Technologies

Innovation in global health technologies has been a hallmark of the past century. Often advanced through U.S. leadership, these new technologies have contributed to enormous progress in the battle against some of the world's greatest public health challenges. Significant barriers remain, however, and the world lacks many important tools to address existing and emerging health threats. Continued support for the development and delivery of global health technologies is critical to ensuring better health for all. Read More >

U.S. Global Health and National Security Policy

The emergence of HIV/AIDS, SARS, extensively drug-resistant tuberculosis, and avian influenza, as well as the Aum Shinrikyo sarin gas attack and anthrax letters, have demonstrated the threat that certain global health issues pose to U.S. national security. The related threats of infectious disease epidemics and bioterrorism are being driven by trends related to globalization. Increased travel, trade, development, and land use are creating new infectious disease threats, and the rise of nonstate actors and the global dissemination of advances in biology and technology are facilitating the potential use of biological weapons. Underlying both threats is a growing acceptance of global interdependence on health issues. U.S. policymaking to address global health threats is complicated by a rising dependence of U.S. security on health conditions in other countries as well as weak health knowledge among foreign policy and national security decisionmakers. Overall, the U.S. response to infectious diseases and bioterrorism has overemphasized defensive medical countermeasures and treatment while underinvesting in prevention, strengthening of public health systems, and the surveillance and response capacities of developing countries. This paper recommends an increased focus on global surveillance and response capacity, heightened attention to the World Health Organization's International Health Regulations, and putting a high priority on meeting the health needs of developing countries as core elements of a U.S. strategy to address the national security threats of emerging infectious diseases and bioterrorism. Read More >

U.S. Policy Options for Strengthening Coordination between Global HIV/AIDS and TB Programs

Over the past two decades, the relentless spread of human immunodeficiency virus (HIV) has amplified the global tuberculosis (TB) pandemic, which had previously been coming under increasing control. Currently, approximately onethird of those living with HIV around the world are coinfected with TB Worldwide, active TB is the most common infection heralding the onset of acquired immune deficiency syndrome (AIDS), as well as the leading cause of death among people living with AIDS. TB kills about 1.6 million people annually, including an estimated 195,000 people who are also infected by HIV. Of the 10 countries with the highest TB incidence rates among HIV-infected people, 7 are focus countries of the President's Emergency Plan for AIDS Relief (PEPFAR), illustrating the importance of coinfection as an issue in places where the United States is concentrating its HIV/AIDS programs and investments. Read More >

Combating the Twin Epidemics of HIV/AIDS and Drug Addiction

This report examines on 12 countries in Asia, Africa, and eastern Europe that have experienced significant increases in reports of injection drug use, injection-related HIV, or both during the past decade. These countries receive significant aid from the United States either directly through the President's Emergency Plan for AIDS Relief (PEPFAR) or through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The report focuses on a particular intervention--medication-assisted maintenance treatment for drug dependence--an area in which the United States has considerable experience and strength and that offers an opportunity to expand engagement in global HIV efforts. U.S. efforts should be coordinated with those of recipient governments and other donors in an integrated, comprehensive approach that ultimately will be the most effective strategy to curb the rapid growth of injection-driven HIV epidemics. Read More >