Biomedical Research Facility At Gitmo Aka Hotez

BIOMED RESEARCH FACILITY AT GITMO NEG The Case: They found a great article that says exactly what it should- that Gitmo can be transformed into a biomedical research facility that yields productive research. What it doesn't say is that this facility would be a US/Cuban joint venture. Rather, the author (Hotez) just wants an international research facility. Whether Cuba is involved or not is entirely inconsequential to case. Hence, the strat-

The Strat: 1. Topicality: Plan is untopical because it imposes no condition on Cuba, nor is Cuba the target of conditions. Essentially, plan is untopical because it's not exclusive to Cuba. 2. Vagueness: It's uncertain how case is implemented. Do its mandates only involve Cuba? If they don't, you win Topicality. If they do, the CP will solve best. No matter what, though, case claims a lot of solvency for things that are nowhere in plan text. Like vaccine distribution, policy reformation from research, etc. Vagueness is needed to shut them down from accessing this stuff. 3. Counterplan: Do the Hotez plan WITHOUT Cuba, and specify mandates that solve better. Hotez says you can do plan with any number of countries. There's a solvency PMN on gendered research that CP uniquely solves, plus CP provides policy recommendations and vaccine distribution that case doesn't. PULL THE GROUND STANDARD ON TOPICALITY TO GAIN LEGITIMACY FOR RUNNING THIS POSITION. 4. Case press: If you run everything else here, cover case with some quick points. You'll spread them out of the round. There's no way they can cover all of this without dropping at least one advantage cold. a. Inherency: Their author couldn't speak in more glowing terms about our current research. He calls this "A New Rennaissance in tropical disease research." Moreover, Cuba is already awesome at all this stuff. They don't need US coop. b. Solvency: Press the stuff brought up in the Vagueness position and in the CP solvency. Plan doesn't have the mandates to solve, but CP does. c. Advantages: Just spew some points. They'll apply.

NOTE: Watch for cards they might label "Cuba wants plan" or "Cuba's research would benefit the US." None of these cards are talking about their plan. Additionally, the CP's solvency ev explicitly says it would function with other countries instead of Cuba. Good luck!

Topicality ______________________________________________________________1 Vagueness _____________________________________________________________2 Counterplan ____________________________________________________________3-5 Solvency ______________________________________________________________6 Advantage Blips ________________________________________________________7 Inherency _____________________________________________________________8-

A. Interpretation 1. CE Crocker 89 [Chester A. Crocker, Former Assistant Secretary for African Affairs at the Department of State, Fall 1989, Foreign Affairs, p. 144, “Southern Africa: Eight Years Later”] Regarding South Africa, constructive engagement was by definition a conditional concept: in exchange for Pretoria's cooperation on achieving Namibia's independence, we would work to restructure the independence settlement to address our shared interest in reversing the Soviet-Cuban adventure in Angola; in exchange for reduced rhetorical flagellation and minor adjustments in certain bilateral fields (e.g., civilian export controls), we would hold Pretoria to its self-proclaimed commitment to domestic reform. There would be a change of tone toward reciprocity and even-handedness. But there would be no change in basic policy parameters on such matters as the U.S. opposition to South African apartheid laws and institutions or bilateral security ties -- no "rewriting of the past 20 years of U.S. diplomacy," as the 1980 article put it -- in the absence of fundamental internal change. 2. With The phrase "with Cuba" immediately follows our resolutional wording, signifying it as the target of conditions.

B. Violation The affirmative's plan does not come with conditions, nor is its exclusive target Cuba, making it a failed interpretation of "constructive engagement with Cuba." C. Standards 1. Etymological Precision - My evidence comes directly from the author who coined the phrase. Any other interpretations are either copy cats or bastardization of the true meaning of the phrase.

2. Framers Intent – When selecting the wording of the resolution the framers deliberately choose the term constructive engagement. If the framers had intended for us to debate unconditional engagement then they wouldn't have selected a word that was invented to describe the exact opposite. They could have easily selected an alternative phrase without the history of unconditional engagement.

3. Ground- By not targetting Cuba, the Aff case forces Negatives into ground that deals only with issues of global or regional implementation.

4. Exclusion Test- Plan's actionable mandates ought only operate with Cuba's consideration. If plan's actionable mandates can function without Cuba, then plan relies on nonresolutional advocacy. D. Voters Topicality is a prima facia burden. It serves to test the resolutional sufficiency of the aff as a precondition of whether it is evaluable via an affirmative ballot.

Vagueness A. Plan text uses a multinational research facility as its agent of enforcement. Details of its composition, charter of standards, paradigm of study, agenda-setting measures of preferred research, technological supply, methods of presenting results or translating them into tangible policy or product, and dispute resolution processes among researchers are all wholly absent from plan text.

B. This is uniquely bad for a multitude of reasons: 1. Solvency cannot be resolved- If questions to solvency are answered by allusion to amorphous mandates that aren't in text, we can never confirm that case actually addresses these issues. 2. Jurisdictional reasons require details- If plan lacks information required to formulate a policy, plan is simply unpassable as a policy. In a policy debate, we look to standards of passable policies. The exeplained particulars above have actual policy implications that are never resolved and that will be pressed, AND UNANSWERED, later on the flow. 3. Fiat abuse- Cases can't simply say, "We pass plan through what is assumed the easiest, least politically volatile, and most scientifically rigorous means." We can only fiat passage of plan texts.

4. Advocacy shift is an instand Decision ruling- If my opponent deviates from the written plan text, this is uniquely abusive as my entire 1NC is predicated upon the advocay of the 1AC's plan text. 5. Prima Facia Delinquency is time abuse- They will insist that vagueness is checked by my ability to try and figure out what they intend for their plan to be composed of. This sets a denagerous precedent for the duties of affirmatives and makes it my burden to ask them what plan is in my speech time and in CX.

CP In light of the advocacy problems already explained in case, I propose the following counterplan to test the Aff plan's advocacy. Text: The USFG shall establish a multinational biomedical research facility at Guantanamo Bay without the inclusion of Cuba. Research conducted shall operate with focus on NTD transmission, preventative approaches, and policy advisory methods. This research shall incorporate gender perspective in methodology and technique according to the Kitts and Roberts checklist.

A. CP is non-Topical: It is explicity NOT engagement with Cuba, exemplifying resolutional tension of the Aff's own evidence.

B. CP is mutually exclusive: A facility can't both engage and not-engage Cuba.

C. CP is net beneficial: It avoids all of the theoretical implications mentioned elsewhere while giving the most effective solvency.

THE HOTEZ CENTER COULD COLLABORATE WITH ARGENTINA, BRAZIL, AND MEXICO TO SOLVE Hotez, 2008. "Reinventing Guantanamo: From Detainee Facility to Center for Research on Neglected Diseases of Poverty in the Americas." http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000201 The neglected tropical diseases represent some of the most important poverty-promoting disease conditions [13]. By establishing a center of excellence on the diseases of poor, at Guantanamo, the United States Government would directly address poverty and health disparities in the worst-off

nations in Central and South America and the Caribbean. Such a center could conduct translational research to develop new drugs and vaccines for neglected diseases, possibly in collaboration with research institutes and public sector pharmaceutical manufacturers in some of Latin America's so-called innovative developing countries, such as Argentina, Brazil, Cuba, and Mexico [14]. It could also promote clinical research and take on the control of some of the more pressing public health threats in the Caribbean region, including vector-borne diseases such as dengue [9]. It would serve as a vital resource for training physicians, scientists, and public health experts, and meet an important demand for training in applying appropriate technology to global public health practice [15].

CONDUCTING RESEARCH WITH GENDER PERSPECTIVE IN TROPICAL DISEASES IS INTEGRAL TO PROVIDING FULLEST RESEARCH THAT TRANSLATES EFFECTIVE HEALTH PROGRAMS AND POLICY. IF THIS IS NOT A PART OF THE INITIAL RESEARCH PROTOCOL, MASCULINE PERSPECTIVES DOMINATE WITHOUT EFFECTIVE RESEARCH EMERGING. JENNIFER KITTS AND JANET ROBERTS. "The Health Gap." IDRC International Development Research Centre. 2003. [Jennifer Kitts is currently completing a Master of Laws degree in the prestigious international and comparative law program at the University of Brussels. As a past consultant to IDRC, the World Health Organization, and other institutions, her expertise is in the health, legal, ethical, and socioeconomic issues affecting the lives of women. Janet Hatcher Roberts is a health-policy specialist in the Program Branch of IDRC. Formerly the Deputy Director of Research and Evaluation at the Canadian Royal Commission on New Reproductive Technologies, her main interests involve creating and ensuring links between research and strategic policy development. ]

http://www.idrc.ca/en/ev-27486-201-1-DO_TOPIC.html Various obstacles hinder the adoption of a gender perspective in health research. There is sometimes a lack of institutional and financial support for gender and health research, and many researchers lack the necessary research tools. In some cases, recent publications, good research, and bibliographies are difficult to access. In Latin America, researchers have difficulty obtaining resources in the Spanish language. The dearth of health research that incorporates a gender perspective, for example, in tropical disease research and the study of occupational health and safety, represents another barrier to research. There is also a need for in-depth training with regard to methodologies, techniques, and specific instruments for studying gender dimensions and for some form of a "checklist" that could be followed to ensure that research is gender-sensitive. Beyond these barriers, it can take great efforts to overcome a "masculine-oriented perspective" (Lange et al. 1994). For example, Ilta Lange, in her research on health monitors in Santiago, Chile, found that masculine language dominated the research process. The Spanish word "monitores" was always used, instead of "monitoras," the feminine version of the word. Although all the health monitors studied were women, Lange said researchers persisted in using the masculine form of the word. Finally, community resistance to certain types of research can also be an obstacle. Pino et al. (1994) reported that parents and teachers in Santiago, Chile, tried to prevent research that involved the study of adolescents and early sexual behaviour. Such barriers must be overcome. Research in this area is needed to help design sound programs and policies aimed at reducing the number of unwanted pregnancies and the incidence of sexually transmitted diseases, including AIDS, among adolescents.

A gender perspective cannot simply be added to a study as an afterthought. It must be fully integrated into the research protocol as it is conceived, carried out, analyzed, and disseminated. A gender perspective also involves much more than sex disaggregation. At the very least, however, "sex should be a variable taken into account in ... studies, even where understanding sex differences as such are not inherent to the study objectives" (Vlassoff 1994, p. 1256). The existing lack of sex-disaggregated data

and information hinders the ability of decision-makers to develop effective women's health programs and policies. In addition to providing information on the sex of respondents and why they were selected, studies should furnish information "on the social structural and cultural context in the society under investigation" (Vlassoff 1994, p. 1257). Ideally, health research should address differential female and male roles; responsibilities; knowledge bases; positions and status within society; attitudes and perception; access to and use of resources and information; and participation in decision-making; as well as social codes and attitudes governing female and male behaviour. Because women and men often have different roles and responsibilities, their "environmental life spaces" within and outside the home can be quite different. The impact of these differing environments on health should be addressed. Interdisciplinary research teams, which, for example, include researchers with medical backgrounds and social scientists, may facilitate the adoption of a gender perspective. It is impossible for any single discipline or type of specialist to "have the requisite expertise to identify the critical socio-biomedical factors determining women's health risks and needs" (Paolisso and Leslie 1995, p. 55). However, interdisciplinary teams are not always feasible because of insufficient resources. Because of this constraint, cross-disciplinary training, for example, highlighting social science issues and techniques in the medical school curriculum, and vice versa, is increasingly being carried out. However, researchers with scientific and medical backgrounds, even without social science training, can learn to look at their data from a new perspective. As human beings, medical researchers can uncover the human dimension and carry out social science research.

The challenge is to find ways of ensuring that health studies are designed to take into account all the determinants of health and disease in any society so that gender differentials become visible to policymakers. Where does a man or a woman, a girl or a boy, a female baby or a male baby, stand 24 hours of the day? Men's and women's life spaces are different and this may lead to differential exposure to diseases and illnesses, including tropical diseases. This is tied to the gender division of labour. For example, who does the animal herding? Who picks up the cow dung? Who slaughters the animals? Who cleans the clothes and utensils in the river? Researchers could look at how many hours members of the population being studied spend each day at the office, in the field, at home, and so on. How often is the population exposed to certain hazards? If the community lives near a toxic waste dump, which community members -- men, women, or children -- are at home all day and most exposed to the dump? Having a gender perspective means being aware of, and accounting for, the plethora of gender-related factors that may affect the collection of research data. Researchers should be aware, for example, that women may have different notions of health and illness than men. Women, and in particular, poor women, may take a certain amount of aches and pain for granted. They may not report backaches as a health problem because they have a high threshold of pain, and view them as normal. "Women tend to suffer in silence ... the threshold of illness recognized by the society on the illness-health continuum is so high for women that they endure so much in order not to disrupt household organization" (Okojie 1994, p. 1237). GENDER PERSPECTIVES IN RESEARCH ARE NEEDED TO INTEGRATE RESEARCH INTO ACTUAL HEALTH INTERVENTIONS. RESEARCH WITHOUT THEM FAILS. JENNIFER KITTS AND JANET ROBERTS. "The Health Gap." IDRC International Development Research Centre. 2003. [Jennifer Kitts is currently completing a Master of Laws degree in the prestigious international and comparative law program at the University of Brussels. As a past consultant to IDRC, the World Health Organization, and other institutions, her expertise is in the health, legal, ethical, and socioeconomic issues affecting the lives of women. Janet Hatcher Roberts is a health-policy specialist in the Program Branch of IDRC. Formerly the Deputy Director of Research and Evaluation at the Canadian Royal Commission on New Reproductive Technologies, her main interests involve creating and ensuring links between research and strategic policy development. ]

http://www.idrc.ca/en/ev-27486-201-1-DO_TOPIC.html State-of-the-art research data on women's health issues is often not integrated into public policy and health interventions. Atai-Okei (1994, pp. 205-206), for example, expressed frustration concerning the extent to which health research has failed to reach the local populations that it is meant to serve. Results from research are often not "put into practice in ... hospitals or in rural medical clinics." Information obtained as a result of research must serve to empower women, and the communities to which the research applies, to foster the process of change (AbouZahr 1994, p. 6). All research on women's perceptions and needs in health should be designed and implemented with the express objective of developing interventions arising from the analysis of research results. Such interventions should be applied to extend health-care services into the community, improve the quality of health care available to women, and have an impact on women's health status. Although there have been a number of health conferences, seminars, and workshops organized in the name of women's health in Uganda, little has been accomplished to date in terms of measurable improvement in the status of women's health or in the accessibility of health care to women. SolvencyAT THE TOP OF THE SOLVENCY FLOW- DRAW A BOX- WRITE "WATCH FOR NEW MANDATES" I want you to be looking for new mandates or new clarifications of mandates that are articulated in new speeches to explain the workability of plan.

1. Plan provides no mechanism for vaccine distribution

2. No evidence that collaboration with Cuba yields new research

3. No evidence Cuba will collaborate

4. No evidence that new research will yield new policy

5. X-Apply Kitts and Roberts- Research without gender data prevents effective disease prevention methods from arising.

DiseaseAlt cause- water quality Alt cause- poverty. Threshold Answered on solvency Disease is inevitable- foreign sources outside of cuba CP Solves best

PovertyAlt cause- authoritarian structure Alt cause- hurricane devastation Alt cause- embargo Threshold Can't claim structural solvency. poverty is a structural problem. Poverty is inevitable- capitalism assures. THE FUNDING BIND: Either A. Cuba pays to participate--- These funds further drive them into debt and perpetuate poverty or B. Cuba doesn't participate--- In which case plan doesn't solve. CP solves best InherencyWE'VE ENTERED A NEW ERA OF TROPICAL DISEASE RESEARCH WITH COMPLIMENTARY VACCINE INITIATIVES. THEIR SOURCE CALLS THIS A "NEW RENAISSANCE IN TROPICAL MEDICINE RESEARCH!" Peter J. Hotez, 2001.

"Vaccines as instruments of foreign policy:The new vaccines for tropical infectious diseases may have unanticipated uses beyond fighting diseases." [Peter J. Hotez is Professor and Chair of the Department of Microbiology and Tropical Medicine at the George Washington University and Senior Fellow of the Sabin Vaccine Institute, Washington, DC, where he is Principal Investigator of the Human Hookworm Vaccine Initiative. E-mail: [email protected].]

EMBO Rep. 2001 October 15; 2(10): 862–868. doi: 10.1093/embo-reports/kve215. Nearly a century ago, in 1913, the International Health Board of the Rockefeller Foundation in New York City almost single-handedly created American tropical medicine research. Through a focused programme of philanthropic support for research on the treatment and prevention of infections such as malaria, yellow fever and hookworm, they initiated efforts to fight those diseases that affect the world’s poorest nations. Simultaneous funding for The Rockefeller Institute for Medical Research, new institutions of public health at Johns Hopkins and Harvard University, and overseas research and educational institutions in Brazil and China further created an infrastructure by which American tropical disease research and development was supported and sustained.

The development of the yellow fever vaccine and the eradication of malaria in many parts of the world are among the many achievements that resulted from the Rockefeller initiative. But the last two decades have witnessed a decrease in clinical and laboratory tropical disease research. During this period, the Rockefeller Foundation gradually moved away from funding biomedical research and left this task to organisations without experience in tropical disease research, such as the MacArthur Foundation. Unfortunately, these foundations were not prepared or committed to support work in this difficult field in the long term. Moreover, both the Tropical Disease Research programme of the World Health Organization (WHO) and the international programmes of the US National Institutes of Health (NIH) suffered from chronic under-funding. Thus, during the late 1980s and early 1990s, American scientists began leaving research on tropical diseases at an alarming rate. This scientific exodus occurred at a time when 2 million children were dying each year from malaria, when children’s hospital wards in Southeast Asia and Central America regularly filled with cases of dengue haemorrhagic fever, and when soil-transmitted helminthiases were the most prevalent infections on Earth. The dwindling resources for developing world health in the context of a booming stock market and unprecedented economic growth and prosperity in the USA threatened to tarnish the 1990s as a decade of moral outrage. Former Secretary of State Henry Kissinger labels this period as a paradox: ‘On the one hand, the United States is sufficiently powerful to be able to insist on its view and to carry the day often enough to evoke charges of American hegemony. At the same time, American prescriptions for the rest of the world often reflect either domestic pressures or a reiteration of maxims drawn from the experience of the Cold War. The result is that the country’s preeminence is coupled with the serious potential of becoming irrelevant to many of the currents affecting and ultimately transforming the global order […] At the apogee of its power, the United States finds itself in an ironic position. In the face of perhaps the most profound and widespread upheavals the world has ever seen, it has failed to develop concepts relevant to the emerging realities.’ (Kissinger, 2001).

The concept of ‘universal humanitarian intervention’ finally took hold in the second half of the 1990s (Kissinger, 2001) when military operations by the United States, Western Europe and Australia in Haiti, Somalia, Kosovo, East Timor and Sierra Leone became the ‘poster children’ for this new world order. This period also heralded a resurgence in funding for the treatment and prevention of tropical diseases. Indeed, the new millennium is the harbinger of a renaissance in tropical disease research that resembles the Rockefeller philanthropy at the turn of the last century. In an extraordinary two-year burst of activity, vast amounts of new private and federal funds were infused into what the late Kenneth Warren of the Rockefeller Foundation often referred to as ‘the great neglected diseases of mankind’. Funds from the Bill and Melinda Gates Foundation (www.gatesfoundation.org) and Ted Turner received the greatest attention, but the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH and nascent foundations like the Burroughs Wellcome Fund and Ellison Medical Foundation are also helping to revive a moribund US tropical disease research effort. The Rockfeller Foundation also renewed their commitment to funding biomedical research through financing the International AIDS vaccine initiative. As shown in Table I, the funding is targetted to new or improved vaccines for the great scourges of the tropics such as malaria, HIV/AIDS, tuberculosis, measles, meningococcal meningitis, enteric bacteria, hookworm and leishmaniasis. Overall, funds will exceed US$ 1 billion and an almost

the magnitude of the Gates funding for vaccine R&D dwarfs all previous funding from the Rockefeller Foundation, WHO or any single national government. equal amount has been set aside to improve the delivery of existing vaccines. Here,

CUBA IS ON TOP OF ITS GAME- IT HAS INTEGRATED RESEARCH AND IS ENGAGING IN VACCINE INITIATIVES. PARTICIPATION IN TRANSNATIONAL LABS WILL ONLY HINDER THEIR EFFORTS BY UPPING THEIR COSTS Patricia Grogg, IPS, Havana, 1 December 2006 "Cuba: Conquering vaccines - and their markets." TWN Info Service on Health Issues (December 06/06) 12 December 2006 http://www.twnside.org.sg/title2/health.info/twninfohealth058.htm Deliberately putting human health before economic considerations, according to local experts, Cuba has launched full-tilt into the vaccine industry to compete on the international market with its products, some of which are unique. Cuban scientists are devoting themselves to investigating therapeutic products against cancer, malaria and cholera, diseases that ravage the people of poor nations. However, the first destination of every new pharmaceutical is the Cuban market and the national hospital network. Medical sources indicated that eight of the 13 vaccines included in the national immunisation programme are produced locally. "Half of our research projects deal with vaccines, which are financially unattractive to the big pharmaceutical companies," Carlos Borroto, deputy director of the Genetic Engineering and Biotechnology Research Centre (CIGB), told IPS. In the early 1980s, the Fidel Castro administration made biotechnology a priority area for the country's social and economic development. The financial support granted to the sector was maintained even during the crisis of the 1990s, triggered by the break-up of the Soviet Union, Cuba's main trading partner. Spokespersons for the Pan American Health Organisation (PAHO) reported that Cuba, together with Mexico and Brazil, are among the countries which made significant investments in installations and capacity-building for producing vaccines and other medicines between 1980 and 2000.

Cuba devotes 1.7% of its gross domestic product (GDP) to science and technological innovation, a proportion that is higher than that of Latin America as a whole, which invests an average of 0.7% of GDP, according to the Ministry of Science, Technology and the Environment. This Caribbean island nation possesses 222 scientific research centres, employing 31,000 people, although only the six main institutes conduct the complete cycle: research, production and marketing.

The "West Havana Scientific Pole" is made up of the CIGB, the Finlay Institute for Serum and Vaccines, the Centre of Molecular Immunology, the National Centre for Scientific Research and the National Bio-preparations Centre. Instead of competing with each other, as might be supposed, the Pole institutions work on the basis of cooperation, and each project usually involves more than one unit. "Nearly all the products are a result of integration, which is something that gives us an advantage over other countries," CIGB's director of Regulatory Affairs and Clinical Trials, Pedro Lopez-Saura, told IPS. CIGB was the first institute to link up with a marketing company, Hebert Biotec, founded in 1991, which was seen as a milestone in its development. At present, each of the units is associated with a company that handles export sales, although they are all financed by the state.

CIGB, the leading institute in Cuban scientific development, has just celebrated the 20th anniversary of its foundation. Its laboratories were responsible for producing an effective vaccine against hepatitis B, a liver disease that causes 520,000 deaths a year worldwide, according to the World Health Organisation (WHO). Heberbiovac HB, the first vaccine obtained in Cuba using molecular biology techniques, is now exported to some 20 countries, and has contributed to a considerable reduction in the incidence of the disease among Cuba's 11.2 million people. Hepatitis B cases have fallen from over 2,000 a year before vaccination began in 1992, to less than 50 a year at present. Medical sources reported that the decline is continuing, and that the disease is likely to be eliminated. But in Latin America, the most widely-used Cuban vaccine is VAMENGOC-BC, the only vaccine in the world against meningitis caused by serotype B bacteria, which is the predominant strain in the region. The Finlay Institute is currently developing a vaccine against cholera bacteria, based on a Cuban attenuated strain (Tor 638) which has been genetically engineered in a novel way. The strain has been modified so that it is still capable of generating a protective immune response, but not of causing the disease itself. The new product is administered orally in a single dose, and is now at the clinical trial stage in healthy volunteers, for safety evaluation. Two other cholera vaccines are being developed in the Finlay Institute. One is based on inactivated strains, and the other on sub-fractions of the cholera bacterium, applying innovative molecular biology techniques. The second project is in the research and process development phase. Other Cuban biotechnology research projects include producing vaccines against the viruses that cause hepatitis A, dengue and AIDS, the parasites causing malaria, and leptospirosis bacteria.

Exchange agreements with various countries channel the transfer of technology for producing vaccines like Heberbiovac HB and VAMENGOC-BC, thus avoiding the high prices charged by transnational laboratories. For example, cooperation with Brazil will enable Cuba to export meningitis vaccine for mass immunisation in Africa "at competitive prices," Marcel Biato, minister counsellor of the Brazilian embassy in Havana, told IPS. One of the latest trends in the vaccine industry, in Cuba and worldwide, is formulating combined products for immunisation. Here, the active principles of two or more vaccines already available on the market are mixed into one preparation, so that fewer injections are needed for prevention of multiple diseases. The Finlay Institute and CIGB took up the challenge and achieved a combined vaccine against diphtheria, tetanus, whooping cough and hepatitis B, which has been introduced with good results in the National Vaccination Programme. Since September, Cuban children have been receiving pentavalent vaccine, which protects against the four diseases named above, plus a type of bacterial meningitis caused by Haemophilus influenzae type B. According to experts, this is the second vaccine of its kind in the world after one developed in France, and its safety has been demonstrated in trials involving 500 infants aged between six and 10 weeks. Meanwhile, the Molecular Immunology Centre is working on eight projects to produce therapeutic agents against different types of cancer. Three of the projects are undergoing phase III clinical trials. Phase III trials are carried out after establishing that a product has a reasonable probability of effectiveness, and the aim is to glean additional information about its effectiveness for specific indications, and more detailed knowledge of the adverse reactions associated with its use.

INH - CUBA COLLABORATING WITH SINGAPORE, YIELDING TRANSNATIONAL DEVELOPMENTS ON NTD RESEARCH. THE ONLY EVIDENCE FOR CUBA OFFERING COOPERATIVE BIOMEDICAL RESEARCH IS THIS SCENARIO WITH SINGAPORE, AND NOT WITH A CAPITALIST EMPIRE Nationional Environment Agency of Singapore. "NEA ANNOUNCES NEW RESEARCH TIE-UP WITH CUBA." Sep 14, 2007.

NEWS RELEASE NO: 43/2007 http://app.nea.gov.sg/cms/htdocs/article.asp?pid=2961 At an inaugural Singapore-Cuba Dengue Seminar today, Mr Lee Yuen Hee, CEO of National Environment Agency (NEA) and Professor Gustavo Kouri, Director-General of Institute of Pedro Kouri of Cuba signed a Memorandum of Understanding (MOU) for cooperation on infectious disease research. Singapore and Cuba have often been cited by dengue experts as the two countries with the most successful dengue control policy and measures. Witnessed by Dr Yaacob Ibrahim, Minister for the Environment and Water Resources, the signing of the MOU and subsequent collaboration is a demonstration of the two organsations commitment and desire to bring dengue control to an improved level. Collaborating with Cuba on dengue is a new initiative in NEA's strategy to engage and learn from other countries beyond the region. It is part of a strategy which saw NEA hosting a World Health Organisation meeting in Singapore early this year aimed at developing a strategic framework to support efforts to combat and control dengue in the Asia-Pacific region. This is in recognition that dengue is not just a local problem, but a regional and international one as well. The collaboration will commence with three projects. The first will review the dengue situation in Cuba and Singapore, identifying relevant data and parameters for comparison of the dengue situation in both countries. The review will help to identify questions, differences, similarities, research and operational issues on dengue control and surveillance. The second project on mosquito virus interaction focuses on determining if there are any differences in the Cuba and Singapore Aedes Aegypti species that could result in different competence in transmitting different type of dengue viruses. Understanding the replication rate of different virus types in the different mosquito strains in Cuba and Singapore will help us in risk assessment to better deal with epidemics that could be caused by introduction of possible new strains of the dengue virus. The third project will analyse and compare the dengue viruses from the two countries. Each Dengue serotype (DEN-1, DEN-2, DEN-3 and DEN-4) consists of various genotypes, which can be determined by gene sequencing. Each of these types of dengue viruses possesses different properties like potential for causing varying degree of illness, or various size of outbreaks. Understanding the viruses and their properties is thus imperative in understanding the disease epidemiology. In this collaboration, which involves IPK, NEA and one of A*STAR's Institutes - Genome Institute of Singapore (GIS), high throughput sequencing will be conducted, to obtain information on the property of the circulating viruses in both countries.

Singapore and Cuba have been working hard to fight dengue in the last few decades. Major differences between the two states are evident. For example, Singapore's human density is at a high of 6500 people per square kilometer, while Cuba's is about 100 people per square kilometer. These differences have posed different challenges to each country. Yet, these different experiences and operational strategies provide an opportunity for technical exchanges and collaboration, allowing both sides to learn from each other. For example, Singapore and Cuba could share with each other experiences in sustaining community efforts in dengue control, and in leveraging on technology for planning and monitoring anti-dengue operations. The MOU will facilitate exchange of information and expertise as well as joint research, allowing both organizations to develop better strategies to tackle the disease. Cuba is renowned for its achievements in dengue control, and its experience in biomedical research and industry in infectious diseases. Interaction with Cuba's Institute of Pedro Kouri, its main government institute for research and surveillance on infectious diseases will thus facilitate exchange of knowledge and experience in biomedical research. Local institutes and agencies like GIS, Singapore Immunology Network , Novartis Institute of Tropical Diseases, National University Of Singapore, Communicable Diseases Centre, Changi Hospital and National University Hospital have expressed an interest towards this objective.

Nurses are key to hospital success and hospitals account for a huge portion of the economy OCIS (Office of the Citizenship and Immigration Services Ombudsman) Dec 5, 2008 “improving the processing of “schedule a” nurse visas”

RNs have a variety of employers, including public health facilities, long-term care facilities, and hospitals. They provide invaluable services to an aging U.S. population. The American Hospital Association (AHA) reported on the impact that hospitals alone have on the United States’ health care and economy: there are over 35 million people admitted, nearly 118 million people treated in emergency rooms, over 4 million babies delivered, and over 481 million outpatients treated each year.6

, hospitals are one of the largest private sector employers, employing more than five million people, and stimulating economic productivity.7 According to the report, “[w]hen also accounting for hospital purchases of goods and services from other businesses, hospitals support one of every 10 jobs in the [United States] and $1.9 trillion dollars of economic activity.”8 RNs9 are a significant factor in the success of hospitals and the health care industry. The Bureau of Labor Statistics reported that RNs held approximately 2.5 million jobs in 200610 with the majority of RN positions Furthermore

filled in hospitals.11

RN SUPPLY IS LIMITED BECAUSE OF A LACK OF FACULTY American Association of Colleges of Nursing September 2008 “Nursing Shortage Fact Sheet”

According to AACN's report on 2007-2008 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 40,285 qualified applicants from baccalaureate and graduate nursing programs in 2007 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost three quarters (71.4%) of the nursing schools responding to the 2007 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level nursing programs.

TURN - THIS FURTHER FEEDS IN THE IMPACT BECAUSE THE SHORTAGE CAUSES NURSES TO LEAVE THE PROFESSION American Association of Colleges of Nursing September 2008 “Nursing Shortage Fact Sheet”

75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%). In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than

TURN ON TB ADVANTAGE - Nursing shortage kills hospital’s ability to expand during emergency situations OCIS (Office of the Citizenship and Immigration Services Ombudsman) Dec 5, 2008 “improving the processing of “schedule a” nurse visas”

The shortage also makes it difficult for facilities to expand services or prepare for an emergency response.19 One hospital representative reported to the CIS Ombudsman that hospitals have been forced to close beds and wings to their hospitals due to the shortage.20 In a public teleconference held by the CIS Ombudsman on May 30, 2008, a nurse recruiter commented that every time the vacancy rate for RNs goes up one percent, a hospital may lose as much as $300,000.21

TURN ON TB ADVANTAGE - Nurses are at risk when they are treating TB Huey-Ming Tzeng. Department of Nursing, I-Shou University, Kaohsiung, Taiwan. Journal of Nursing Care. October/December 2005. “Promoting a Safer Practice Environment as Related to Occupational Tuberculosis: A Nursing Care Quality Issue in Taiwan” Quality:Volume 20(4) p 356-363 As a result of a recent cluster of tuberculosis (TB) transmission among healthcare providers in a regional teaching hospital in Taipei, Taiwan, there has been growing concern about occupational health hazards, especially of communicable diseases, faced by our nurses in practice. Tuberculosis is an invisible killer of nurses in the process of nursing care delivery. This descriptive article briefly reviews the epidemiology of TB in Taiwan, discusses the recent cluster of TB transmission in Taipei, and reviews relevant studies of occupational hazards. This article also focuses nurses' attention on relevant legislation and hospital policies related to occupational hazards in Taiwan. Suggestions and practice implications are discussed.

HOSPITALS AND UNIVERSITIES ARE COMBINING TO INCREASE NURSING ENROLLMENT, ADDRESSING A ROOT CAUSE OF THE NURSING SHORTAGE American Association of Colleges of Nursing September 2008 “Nursing Shortage Fact Sheet”

Nursing colleges and universities are also forming strategic partnerships and seeking private support to help expand student capacity and strengthen the nursing workforce. For example, Blue Cross and Blue Shield of Florida donated $600,000 in funding to both the University of North Florida and the University of Florida in an effort to address critical issues in nursing education. The State of Florida matched each gift at $420,000. In September 2005, the Osteopathic Heritage Society awarded almost $1 million in funding to five Columbus, Ohio area schools of nursing to recruit more faculty and equip more training facilities. In June 2005, Georgia Baptist College of Nursing is partnering with Piedmont Healthcare in Atlanta to help recruit, educate and ultimately place more nurses in the health system and the community at large

EVEN THOUGH THERE WERE SOME INCREASES IN NURSES, THERE IS STILL A SHORTAGE American Association of Colleges of Nursing September 2008 “Nursing Shortage Fact Sheet”

Dr. Peter Buerhaus and colleagues found that "despite the increase in employment of nearly 185,000 hospital RNs since 2001, there is no empirical evidence that the nursing shortage has ended. To the contrary, national surveys of RNs and physicians conducted in 2004 found that a clear majority of RNs (82%) and doctors (81%) perceived shortages where they worked According to a report published in November 2004 as a Web exclusive of Health Affairs,

BRINK – THERE ARE 100,000 VACANCIES RIGHT NOW IN STATUS QUO American Association of Colleges of Nursing September 2008 “Nursing Shortage Fact Sheet” According to a report released by the American Hospital Association in July 2007, U.S.

hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report, titled The 2007 State of America's Hospitals - Taking the Pulse, also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005.

UNIQUENESS - The nursing shortage is at its worst state in 50 years because of the lack of nurses being trained and the baby boomer generation Laura Marquez. ABC News. Jan. 21, 2006. “Nursing Shortage: How It May Affect You” http://abcnews.go.com/WNT/Health/story?id=1529546

Nursing care in America's hospitals has reached a critical shortage -- the worst in 50 years, according to Peter Buerhaus, the assistant dean of Vanderbilt School of Nursing, who has studied the problem. To make matters worse, just as there are fewer nurses, the population is aging and in need of more medical care. Hartman said she didn't sue for the money. "I wanted them, as I wheeled my mother into that courtroom, to see what their decision to run the hospital shorthanded cost somebody," she said. So far, it is the only successful malpractice lawsuit against a hospital citing inadequate nursing. But amid an ongoing staffing shortage, it may not be the last.

LINK - SHIFTING NURSES AROUND THE WORLD EXACERBATES THE NURSING SHORTAGE PROBLEM John Daly. Council of Deans of Nursing and Midwifery. International Journal of Nursing Studies. August 2008. “The Global Alliance for Nursing Education and Scholarship: Delivering a vision for nursing education” 45 (2008) 1115–1117

Nursing shortages and the need to meet health needs of populations worldwide is high on many government agendas. However, these shortages cannot be addressed unless there are sufficient appropriate nurse education programs in place. Global migration of nurses around the world is not solving the nursing shortage (McElmurray et al., 2006). On the contrary, it is exacerbating the problem and increasing the unequal distribution (Cowan and Wilson-Barnett, 2006; Lu et al., 2005; WHO, 2006). Importantly, many health issues are global and no longer isolated to individual countries (e.g. SARS, pandemic flu, HIV/AIDS, tuberculosis) creating the need to establish common nursing educational approaches. These approaches need to be respectful of both unique cultural needs within a country, and preparing nurses to provide care across multi-cultural groups (Davidson et al., 2003)

BRINK - IMPACT – LACK OF NURSING FACULTY KILLS ANY ATTEMPTS TO INCREASE THE NUMBER OF NURSES, AND THE NURSING SHORTAGE CAUSES 6700 DEATHS EACH YEAR Laura Marquez. ABC News. Jan. 21, 2006. “Nursing Shortage: How It May Affect You” http://abcnews.go.com/WNT/Health/story?id=1529546

Hospitals are under pressure to keep control of their bottom lines, and nurses account for a large part of their budgets. But a recent study published in the Health Affairs medical journal found hiring more nurses could actually save a hospital money in the long run. The study found 6,700

patient deaths and 4 million days of hospital care could be avoided each year by increasing staff of registered nurses. However, training new nurses is the problem. Last year, nursing schools had to turn away 125,000 applicants because they didn't have enough faculty to teach them. Many nursing professors are retiring just when they're needed most.

"Our current work force will get older and older and retire in large numbers in the next decade just as we see the aging of baby boomers, all 80 million of them, beginning to turn 65 and consuming more health care." "Today, we have a cruel and unfortunate development, said Buerhaus, who co-authored the Health Affairs study.