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PUBLIC POLICY UPDATE Dec.

9, 2011 WASHINGTON UPDATE Final negotiations continue on FY2012 maxi-bus Appropriators are planning to spend the weekend on the last tough issues as they push for agreements on the nine remaining FY2012 appropriations bills. With the current continuing resolution (CR) expiring on Dec. 16, the hope is to have the final text of all bills in the maxi-bus package ready by next Monday or Tuesday, Dec. 12 or 13. House rules require 48 hours between bill text being available and a vote, so publishing the final text on Monday would set up a Wednesday vote in the House. The bill would then go to the Senate for passage, then to the White House for signature. The outstanding issues appeared to be primarily related to policy provisions that would restrict spending for particular purposes, and House Republican leadership who will probably need significant Democratic support to pass the bill were working to find the sweet spot that would include enough of the provisions to keep Republicans on board without alienating Democrats enough that they would vote against the bill. While earlier in the week there was some concern that the fear of controversy over policy provisions in the State, Foreign Operations (SFOps) bill might cause it to be left out of the package, recent reports have raised that fear for the Labor-HHS, Financial Services, and InteriorEnvironment bills, without mentioning SFOps. Bills left out of the package would be funded with a new CR that would be attached. UPCOMING HEARINGS Hearing: Governance in the Democratic Republic of Congo Committee: Senate Foreign Relations Committee African Affairs Subcommittee Witnesses:

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When: Dec. 15, 11 a.m. Where: 419 Dirksen Senate Office Building Contact: 202-224-4651 http://foreign.senate.gov

HEARING SUMMARIES Senate Foreign Relations Committee Ambassadorial Nominees Confirmation Hearing Senate Foreign Relations Committee, Full Committee Dec .08, 2011 Nominees: Tara Sonenshine, nominated under secretary for public diplomacy and public affairs Anne Richard, nominated assistant secretary for Bureau of Population, Refugees and Migration 1

Robert Whitehead, nominated ambassador to the Togolese Republic Earl Gast, nominated USAID assistant administrator

Opening statements: Earl Gast Nowhere does development show more promise yet pose such a challenge than it does today in sub-Saharan Africa. Look forward to working with talented colleagues at USAID, our partners throughout the U.S. government, the private sector, multilateral and nongovernmental organizations (NGOs), and our counterparts in Africa to address critical development and humanitarian needs on the continent. Africas future is bright. o Our investments in its future are paying off. o Administration has plotted a path for our long-term support, capitalizing on regions emerging opportunities. Remarkable progress of Africa is often overlooked. o Ghana and Tanzania are stable democracies, leading their own development plans that we contribute to but do not dictate. o Kenya, recovering from post-election violence, has created a coalition government working to reconcile differences that stretch back decades before 2007. o Liberia and Sierra Leone quietly reaping the dividends of peace after their brutal civil wars, building sustainable institutions to provide their people with social services. Anne Richard Our helping hand offered to refugees, victims of conflict, the uprooted and the stateless expresses our highest American values and demonstrates our global leadership. Secretary Clinton has consistently demonstrated that meeting the worlds humanitarian challenges is a State Department priority. PRM supports protection measures which seek to maintain safe places of refuge, address gender-based violence, ensure that refugees have appropriate documentation of their status, and that their newborn children are registered. If confirmed, would place special emphasis on three key PRM responsibilities: o Continue to engage in humanitarian diplomacy that holds governments accountable for fulfilling their international obligations and emphasizes the fact that humanitarian emergencies ultimately require political solutions; particularly true in the Horn of Africa. o Work with other parts of U.S. government to ensure that our country sustains a vibrant refugee admissions program while carrying out effective security screening. o Need to protect vulnerable populations, particularly women and girls. Tara Sonenshine Public diplomacy is a shared means to a shared goal of extending Americas reach and security by influencing how individuals around the world come to know and understand us. For public diplomacy to succeed, it must be: strategic in how it engages stakeholders, tactical in the use of new tools, and aligned with foreign policy goals and priorities. There is no doubt that public diplomacy, like every facet of American government and American life, will have to do its work in ways that save costs.

Shifting base resources to higher priority countries and issues as well as monitoring and evaluation of public diplomacy to make sure we can show results. I will help to further a youth and democracy Public Diplomacy Initiative getting more young people positively engaged as the youth bulge around the world continues to challenge us.

Robert Whitehead The Togolese Republic lies in the middle of a region that is important to U.S. energy security, and with which the U.S. has longstanding cultural ties. Principal U.S. concerns around Togo are: o the welfare of Americans located there o the promotion of democracy and good governance o the improvement of basic health services o maritime security in the Gulf of Guinea o human rights o the advancement of prosperity. Will encourage and support expanded Togolese participation in UN peacekeeping missions in Africa through the Africa Contingency Operations Training Assistance program. Questioning Sen. Ben Cardin (D-MD) 1. How will each of you make the advancement of human rights a priority in your respective offices? Sonenshine: o Will advance democracy and human rights agenda in three ways: Weaving human rights into tapestry of all our messaging overseas. Continue support for indigenous media on the ground training of local press for an open society. We can make virtual embassy in nonpermissive environments like Iran, where we can leverage technology to get around the curtain drawn around the people. Gast: o Supporting human rights has been a critical element of our development programs, as emphasized by President Obama, Secretary Clinton, and Administrator Shah. Support civil society organizations throughout Africa. Continue support for indigenous media on the ground training of local press for an open society. Global Health Initiative. Support womens rights. Richard: o PRMs mission is about the provision of supplies, but also protection of rights. Both refugee rights, but also fundamental human rights. Whitehead: o Since change of head of Togolese state in 2005, encouraging reforms taking place in a number of areas.

Of most urgency are democratic selection of government, freedom of the press and child labor. 2. What should we be doing in the Horn of Africa? How can we be a responsible international player? Gast: o Close to 13 million people in dire need of emergency food assistance. Without U.S. government actions more than a year ago to stockpile supplies in surrounding region, it could have been much worse than it currently is. Success of resiliency strategies in Ethiopia enabled 7.5 million people previously dependent on emergency assistance who no longer require it. Situation in Somalia very dire; we dont know when al-Shabab will allow emergency food in. 3. Women are comparatively vulnerable in a humanitarian crisis, with abuse more prevalent and food shortages hitting them hardest. How do we take that into consideration? Richard: o Displaced women and children is an absolute top priority. Problem has been very well articulated, but we need to follow through in the field and make sure operations live up to best practices. Working very closely with our partners, such as UNHCR and International Committee of the Red Cross, to make sure best intentions are followed through with. Gast: o Clear that we need separate strategies for assisting women. In Darfur, providing more fuel-efficient stoves was an innovative way of reducing the need for women to go out seeking fire wood, opening themselves up to potential abuse. In DRC, training Security Forces to deal with womens issues and are assisting the government to bring trained female officers into the police and armed forces. Importance of public education and public information. Fighting Malaria: Progress and Challenges House Committee on Foreign Affairs Subcommittee on Africa, Global Health, and Human Rights Dec. 5, 2011 Witnesses: Mark Green, U.S. Global Leadership Coalition Dennis Schmatz, Medicines for Malaria Venture North America, Inc. Regina Rabinovich, Global Health Program, Bill and Melinda Gates Foundation Roger Bate, American Enterprise Institute David Bowen, Malaria No More Richard W. Steketee, Malaria Control Program, Program for Appropriate Technology in Health

Opening Statements

Chair Chris Smith (R-NJ) Malaria is the fifth leading infectious disease worldwide, and it particularly affects Africa: o 781,000 people died from malaria in 2009, and 225 million have suffered from infection. o 90 percent of disease-related deaths in Sub-Saharan Africa are caused by malaria. o Every 45 seconds, malaria claims the life of an African child. Malaria is preventable and treatable, and the international community already has the tools to do so. However, malaria can resurge when treatment becomes ineffective through drug resistance. o With U.S. leadership, the international community must continue to support research and development programs for a new drug before resistance makes current drugs inefficient. Ranking Member Donald Payne (D-NJ) The global fight against malaria is daunting, but winnable. In a time of difficult discussion on foreign assistance reform, it is important that malaria control and prevention commitments represent some of the strongest returns on investment on assistance dollars. The tremendous anti-malarial progress the world has made would not have been possible without U.S. leadership. However, the successes achieved are currently at risk, as some Congress members have rallied to cut back on foreign assistance programs. Mark Green The international community is making real and sustainable progress in the fight against malaria. The emergence of African leadership has been crucial to the success stories in defeating the disease. o The African Leaders Malaria Alliance (ALMA) which includes 41 African heads of state, as well as membership by the African Union itself is a particularly exciting and important development in African leadership. Influential faith-based networks, Christian and Muslim together, have also played a significant role in carrying out malaria prevention messages to villages cut off from infrastructure. The successes are measurable, verifiable, and predictable. Dennis Schmatz With U.S. in the lead, the international community continues to discover, develop and deliver effective and affordable medicines to the most vulnerable populations. However, there are still unmet medical needs, including a lack of new drugs at the ready to combat the developing resistance to existing drugs. Todays drugs, too, are imperfect, either because they take too long to work or they are too costly for those who need it most. Without continuous supply of innovative medicines, defeating malaria will not be possible. Regina Rabinovich Malaria has a disproportionate impact on the most vulnerable populations, many of them children. Though the impact of anti-malarial tools available now is very real, malaria has a history of adapting to drugs and insecticides. 5

Thus, significant work is still needed in researching and developing new drugs, and the U.S. government will continue to play an important role in supporting these efforts. The world has now reached an inflection point: forge ahead in the eradication of malaria, or slide back and risk losing ground already gained.

Roger Bate Challenges remain in the elimination of malaria, such as procurement problems and drug resistance. Resistance is being noticed in South East Asia, and is likely to increase for two reasons: o The proliferation of fake, substandard and inferior quality anti-malarial drugs, roughly half of which contain chemicals that directly contribute to resistance. o The sale of monotherapies, as opposed to ACTs. David Bowen Malaria cases have been halved in over 40 countries due to global efforts just in the past decade. Through the Presidents Malaria Initiative (PMI), established in 2005, and U.S. contributions to the Global Fund, the U.S. is helping to win the battle against malaria. Though investment of less than 1 percent of the budget, the U.S. saves and improves millions of lives, helps build current and future trading partners across the world, and bolsters national security. o Disease, death, and poverty have a positive correlation to failed statedom, which is a refuge and breeding ground for extremism. Richard W. Steketee Through remarkable partnerships across many nations, progress against malaria has shown incredible speed of change and innovation. o In the last decade, the funding dedicated to anti-malarial tools increased from $100 million in 2000 to $1.6 billion in 2009-2010. If the world lets its guard down now and stops the resource flow, the speed of reversion will be in our face. Questioning Chair Chris Smith (R-NJ) 4. How much U.S. funding is needed in the immediate term, this fiscal year and in the near term to ensure that there is no speed of reversion? Green: o The world knows precisely what to do to combat malaria; it is a question of whether or not to keep the U.S. will stay engaged and invest in necessary resources. Bowen: o Congress should strongly support the presidents request of $691 million for PMI and $1.3 billion for the Global Fund. o The math of cutting back is grim, but inescapable: For every $50 million cut under 2011 levels, 1 million fewer bed nets will be distributed and 2.5 million fewer combination therapies. Bate: o U.S. funding of the Global Fund should go under serious review.

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Because of poor management within the Global Fund, 28 percent of drugs were stolen and diverted from the public sector in certain parts of Africa. o The U.S. should pressure the Global Fund as hard as it can to look into and enact transparency and management recommendations, and potentially restrict funding from the U.S. government if recommendations are not met. Can the panel elaborate on the role of faith-based collaboration in the fight against malaria? Green: o The advantages of faith-based collaboration, Muslim and Christian, are twofold: In terms of being able to deliver product, faith leaders are wellestablished in the most remote of villages, and have a traditional, built-in distribution network and infrastructure by which they can move product very quickly; Faith leaders are able to pierce through lack of education about malaria, which in some ways is the most daunting challenge in preventing malarial outbreaks. What can be done about those manufacturing countries, including China, that produce poor quality drugs and distribute them against World Health Organization (WHO) regulations? Bate: o One immediate action to take against those companies that are not adhering to WHO policy is to in every sense limit donor support for any manufacturer that is selling monotherapy, even if it is also selling ACT. Schmatz: o By already existing law, countries cannot buy drugs that are not qualified by WHO. o This is an important standard to stick with and ramp up, even if it is impossible to enforce everywhere. Green: o The prevalence of monotherapy is a problem on even another level: Poor African families that see monotherapies as a much cheaper way to treat malaria even if it leads to resistance later will find it very difficult to refuse. What recommendation does the panel have for increasing support of malaria coverage for pregnant women? Steketee: o The problem is the fact that the issue has been off the radar. o Treatment is relatively inexpensive and relatively easily solved, but more attention needs to be given. How possible is it that a new malarial vaccine will be available by 2015? Rabinovich: o Preliminary results about a vaccine that has been tested in Africa were published in October. Full results will be available by 2014. o Early tests indicate that it is not a perfect vaccine: evidence shows that it is about 50-55 percent efficacious at preventing malaria and preventing clinical illness from malaria. How quickly will the best anti-malarial treatment the world has available now, the ACTs, become obsolete due to resistance? 7

Rabinovich: o Resistance has not come to Africa, but there is concern that it will move there. o Historically, resistance has begun in South East Asia, spread to India, and then jumped over to Africa. The hope is to try to contain the resistance to Cambodia and Thailand as much and long as possible as we develop a new drug. 10. BBC recently ran a program about releasing genetically-modified mosquitoes with less than normal sperm production to decrease mosquito reproduction rates. How viable is this as a method of controlling the mosquito population itself? Rabinovich: o It is important to consider innovation in drugs, treatments, etc., but it is equally important to invest in ways to control mosquito populations. Bed nets and indoor residual spraying are undoubtedly at the core of our impact in Africa today. o The approach you mentioned is one idea that is indeed being tested as a way to control mosquito numbers. Bate: o Only 4 percent of funding goes towards developing insecticides. o The fight against malaria cannot be successful without the development of better insecticides, an area that in the short run needs to be ramped up. Ranking Member Donald M. Payne (D-NJ) 1. How are organizations and governments keeping count of insecticide-treated nets to be replaced after several years of use? Steketee: o Systems that deal with replacing nets have become categorically better and better organized. In Zambia, for example, there exists a district-by-district assessment of inventory on a regular basis, and then reports are submitted to the government. o However, one challenge is the ups and downs of funding, which determines if the insecticide nets come to the country i.e., if a country cannot afford the nets, it holds off. Funding must be more consistent so countries have supplies when needed. Bowen: o Like with anti-malarial drugs, mosquitoes develop resistance to insecticides, and insecticide-infused nets. o Bed nets also become inefficient through normal wear and tear. o Thus, producing and distributing bed nets is not a one-and-done thing. We need ongoing funding to continue to develop insecticides and replace bed nets. 2. How rife is the sale of counterfeited, adulterated, or poor quality drugs? Bate: o We do not have a good handle on the size of the problem. o Data collected is not easily comparable: are we dealing with products that are intentionally there to mislead, or drugs that have been made legally but are not up to standards?

o However, most studies see at least 10 percent failing quality control, and in some markets considerably higher. ARTICLES AND REPORTS BBC Dec 7: Kenyan troops join AU forces in Somalia The Kenyan parliament has approved integrating its troops in Somalia into the AU forces. The governments of Djibouti and Sierra Leone have each also promised to send 1,500 extra troops to support the effort. AU commanders estimate that they require 20,000 troops to hold on to territory captured from al-Shabab. Dec. 9: South Sudan and Sudan on 'brink of war' Nhial Deng Nhial, the foreign minister of South Sudan, has warned that war is imminent between the governments in Juba and Khartoum. Citing the example of Sudanese forces invading the South Sudanese town of Jau, Nhial urged the international community to intervene in order to avoid full-scale hostilities. The Independent Dec. 5: Gbagbo appears before the International Criminal Court Laurent Gbagbo, the former Ivory Coast president, became the first former head of state to face judges at the worlds first permanent war crimes court. He faces charges that his supporters were guilty of committing rape and murder during the civil war following his electoral loss to President Alassane Ouattara. Gbagbo denies all charges. Los Angeles Times Dec. 9: Kabila declared Congo election winner Following the internationally-criticized elections in the DRC on Nov. 28, where ballot-rigging and intimidation are believed to have been widespread, President Joseph Kabila has proclaimed himself the winner, earning another five-year term. Support for Kabila is believed to be waning, particularly in the capital of Kinshasa, where violent opposition protests are feared. New York Times Dec. 7: Yemeni opposition leader to be sworn in Consistent with the power-transfer plans agreed last month, the General Peoples Congress led by former president Ali Abdullah Saleh will divide cabinet posts with the main opposition party in a coalition government. Former opposition leader Mohammed Basindwa is scheduled to be sworn into office as president on Saturday, Dec. 10. Dec. 8: Israeli Planes Attack Gaza Targets Israeli airstrikes continued in Gaza, killing one Palestinian, and militants responded with rocket fire into southern Israel. Seven other Palestinians were wounded, including two women and several children. The Israeli military had previously announced that the primary target of the attack was Essam al-Batsh, a leader of the Al-Aksa Martyrs Brigades. Disclaimer: Articles linked in the Update are intended to provide a dashboard view of newsworthy and topical issues from popular news outlets that will be of interest to readers of the Update. The articles are an information sharing vehicle rather than an advocacy tool. They are in no way representative of the views of InterAction or the U.S. NGO community as a whole.