On the ballot: global health policy

The ideas and innovators shaping health care

Nov 04, 2024 View in browser   By Carmen Paun, Daniel Payne, Erin Schumaker and Ruth Reader WORLD VIEW Abortion politics could roil PEPFAR reauthorization next year. | Rodney Muhumuza/AP Photo The election’s stakes are high for U.S. policy positions on global health,  from pandemic preparedness to abortion rights to public health funding. Carmen compared Vice President Kamala Harris’ and former President Donald Trump’s approaches to global health. On the pandemic agreement:  The World Health Organization aims to complete negotiations on a pandemic deal that could oblige pharmaceutical companies, including U.S.-based ones, to share vaccines and drugs with the developing world. President Joe Biden has resisted firm commitments, but he’s stayed in the talks, and Harris figures to keep negotiating, too. Trump will almost certainly pull U.S. diplomats out and may quit the WHO altogether, as he moved to do when he was president in 2020, accusing it of protecting China during the Covid pandemic. On the President’s Emergency Plan for AIDS Relief: PEPFAR, launched by President George W. Bush in 2003 to combat HIV and AIDS in the developing world, long enjoyed bipartisan backing. But many Republicans in Congress made their support conditional during President Joe Biden’s term on barring funding for international public health groups that support abortion rights. For the first time, Congress granted the program an extension of only one year, which ends on March 25. Congress had granted five-year extensions. Democrats opposed the anti-abortion language. Expect the fight to continue. On abortion rights broadly:  As a U.S. senator from California, Harris co-sponsored legislation to permanently repeal the Mexico City Policy, a Reagan-era rule that bars U.S. funding of international groups that provide or promote abortion. The Senate never took it up. Republican presidents, including Trump, have followed the policy since Ronald Reagan, while Democratic presidents have rescinded it. During his time in office, Trump also expanded the policy to require the vast majority of groups receiving U.S. global health assistance to certify that they don’t provide or promote abortion, even with money they received from other donors. On global health funding: America is the top global health donor at more than $12 billion a year. The U.S. provides about a quarter of the WHO’s core annual budget and often gives more — with the figure ranging from $163 million to $816 million in recent years, according to health policy think tank KFF. The U.S. is also the principal funder — to the tune of millions of dollars — of other U.N. agencies and global campaigns to combat disease, such as the World Bank-hosted Pandemic Fund; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Gavi: The Vaccine Alliance. Harris will likely seek to maintain or increase the support provided during the Biden years. Trump, especially if paired with a Republican Congress, will seek to hold flat or reduce those levels, public health advocates expect. WELCOME TO FUTURE PULSE Tarrytown, N.Y. | Eli Reyes/POLITICO This is where we explore the ideas and innovators shaping health care.  Don’t mess with crows. The big-brained birds can hold multi-generational grudges, lasting upward of 17 years, The New York Times reports. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com, or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.  POLICY PUZZLE You're less likely to encounter a problem in Canada, a new study says. | AP Drug shortages due to supply-chain problems are 40 percent more likely to occur in the U.S. than in Canada , despite the two countries having similar regulatory standards and manufacturing inspection rules, a new study suggests. How so? The JAMA study authors, from the University of Toronto, the University of Pittsburgh and other schools and health organizations, analyzed drug supply-chain data from IQVIA, a U.S. health information technology firm, examining shortages between 2017 and 2021. Of 104 supply-chain reports that involved drugs: — 49 percent were associated with shortages in the U.S., compared with 34 percent in Canada, a finding that held true both before and after the Covid-19 pandemic snarled global supply chains — 1 in 12 drugs purchased in the two countries had at least one supply-chain issue reported during the study period   Split-screen: Canada’s better shortage stats might be thanks to cooperation between its regulatory agencies and provincial public payers, the researchers write, noting that those payers make up 42 percent of outpatient drug spending and fund all hospitals. That cooperation allows for coordinated talks with drug wholesalers, synchronized drug pricing and expedited reviews of drugs in shortage. And it contrasts with America’s more split system of public and private payers. The U.S. and Canada also have different types of national drug stockpiles. Health Canada’s national stockpile maintains supplies of commonly used drugs likely to be affected by pandemic-related supply-chain problems; the U.S. Strategic National Stockpile is meant for acute threats, like mass casualties or terrorism. SAFETY CHECK ERs are often not well equipped to treat kids, a study found. | Jack Taylor/Getty Images More than 2,000 children could be saved from dying each year if more emergency departments across the country were better prepared to care for them, says a new study funded by the National Institutes of Health. Researchers from the Oregon Health & Science University, Stanford and others found that only around 17 percent of emergency departments across the country had high pediatric readiness. How so? Pediatric readiness is defined as having physicians, nurses and other health care providers who are evaluated periodically for their handling of children and for having the right policies and procedures in place for them, among other things. Some states had better prepared emergency departments to care for children than others: Just below 3 percent in Arkansas were well prepared compared with 100 percent in Delaware, according to the study, published Friday in JAMA Network Open. The cost to get all emergency departments able to properly care for children is around $207 million a year, the study says, a relative pittance in a country that spends more than $4 trillion on health care. Why it matters: The results provide policymakers, states, and others with the information to potentially save thousands of children’s lives each year and to address inequities in access to high quality emergency services for children, the study authors say. “When our results are combined with the known decreases in pediatric inpatient services over the past decade and large regions without immediate access to pediatric trauma care, it is clear that there are large health care deserts across the U.S. where children lack access to high-quality acute pediatric care,” they wrote. Increasing the number of emergency departments with high pediatric readiness would partly reduce the number and size of these deserts, they argue. What’s next? The funding to improve emergency departments’ capacity to care for children should ideally come from the federal level to avoid “the uneven patchwork of health care services that already exists across states,” the study authors wrote.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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