TASK DEFINITION: Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
PROBLEM: Dr. Nelson Teich, an oncologist and health care consultant, took the job April 17 faced with the task of aligning the ministry’s actions with the president’s view that Brazil’s economy must not be destroyed by restrictions to control spread of the virus. Teich’s predecessor, Luiz Henrique Mandetta, also had rejected the use of chloroquine, which also had been touted by U.S. President Donald Trump as a treatment. Four government ministers who spoke after Teich’s resignation defended the idea of patients being allowed to use the drug if they want to, including Economy Minister Paulo Guedes and the Cabinet chief of staff, Gen. Walter Braga Netto. Officials say almost 15,000 people have died in Brazil from COVID-19, the disease caused by the coronavirus, though some experts say the figure is significantly higher due to insufficient testing. The peak of the crisis has yet to hit Latin America’s largest nation, experts say. Gen. Eduardo Pazuello, who had no health experience until he became the Health Ministry’s No. 2 official in April, will be the interim minister until Bolsonaro chooses a replacement. Brazilian media have said that Teich’s ability to do his job had been weakened by the appointment of dozens of military personnel to jobs in the ministry. “Life is made up of choices and today I decided to leave,” Teich told journalists in capital Brasilia. He did not explain why he left the job and refused to answer questions. Braga Netto, the Cabinet chief, said Teich left the job “for personal reasons.” Bolsonaro did not comment. Teich’s resignation came one day after Bolsonaro told business leaders in a videoconference he would ease rules for using chloroquine to treat people infected with the coronavirus. Teich has frequently called use of the drug “an uncertainty,” and this week warned of its side effects. The Health Ministry previously allowed chloroquine to be used in coronavirus cases only for patients hospitalized in serious condition. At Bolsonaro’s urging, the country’s Army Chemical and Pharmaceutical Laboratory boosted chloroquine production in late March. Researchers last month reported no benefit in a large analysis of the drug or a related substance, hydroxychloroquine, in U.S. hospitals for veterans. Last month, scientists in Brazil stopped part of a study of chloroquine after heart rhythm problems developed in one quarter of people given the higher of two doses being tested. Governors who have recommended quarantine measures and refrained from touting the drug’s unproven potential said Teich’s resignation reflects Bolsonaro’s failure to manage the pandemic. Rio de Janeiro Gov. Wilson Witzel, a former ally of Bolsonaro, said “no one can do serious work with interference in ministries.” “That is why governors and mayors need to lead the pandemic crisis, and not you, Mr. President,” Witzel said on Twitter. The governor of Ceara, one of Brazil’s most hard-hit states, said Teich’s exit “brings enormous insecurity and concern.” “It is unacceptable that in the face of this serious health crisis, the focus of the government is still on political and ideological discussions. That is an affront to the nation,” Camilo Santana said. On April 16, Bolsonaro fired Teich’s predecessor, Mandetta, who had become the embodiment of challenges to the president’s opposition to governors’ quarantine recommendations and restrictions on businesses. Bolsonaro was eager to resume economic activity and warned failure to do so would cause Brazil to descend into “chaos”. Teich took office pledging to balance health care concerns and the president’s economic worries. He did not openly challenge the president’s views, but did defend stay-at-home measures. Miguel Lago, executive director of Brazil’s non-profit Institute for Health Policy Studies, which advises public health officials, said Teich wasn’t able to build his own team, didn’t have Mandetta’s political strength and wasn’t willing to violate the scientific recommendations. “He clearly had limitations,” Lago said. “He would not challenge what has been consensus among the scientific community. He would never accept the chloroquine thing that Bolsonaro wanted him to do, to recommend publicly that chloroquine was a remedy to be used in the public health system.”  Hours after Teich left the job, the Health Ministry began listing figures on chloroquine distribution as part of its main charts about government initiatives against the pandemic, alongside intensive care unit beds, personal protection equipment, tests and flu vaccines. Risk consultancy Eurasia Group analyst Filipe Gruppelli Carvalho said that the Health Ministry’s capacity for ”an effective coordinating role looks to have dropped with Mandetta’s exit,” . “Ultimately, Teich’s dismissal reinforces our view of increasing risks from the government’s poor response to the pandemic, which could contribute to a weaker presidency and decline in support for Bolsonaro in the post-pandemic phase,” he said. The newspaper Folha de S.Paulo published an editorial after Teich’s exit saying Bolsonaro is trying to “put his own survival above state policies and national interest.” “The resignation of another health minister — in less than a month and during the most serious sanitary emergency of contemporary history — exposes the downfall of a president that doesnt’t even pretend to govern the country,” the newspaper said. “As if the economic and sanitary calamities were not enough, he turned himself into a crisis to be faced.” After Teich’s resignation was announced, pot-banging protests were heard in different regions of Sao Paulo and Rio de Janeiro. _____ Associated Press writers David Biller and Diane Jeantet in Rio de Janeiro contributed to this report.

SOLUTION: Brazil’s health minister resigns after one month on the job.

PROBLEM: Questions about whether the NHS can survive in its present form are the subject of a long-running British debate, given an aging population and increased costs due to advances in medicine and surgery. Following is a timeline of key events spanning its history. Health minister Aneurin Bevan launches the tax-funded NHS to bring medical services together and provide free healthcare to all. Polio and diphtheria vaccines become available to children under 15, leading to a major fall of cases in both diseases. The Mental Health Act recognizes for the first time that patients with mental health issues should be treated the same as those with other types of illnesses. Kick-starting the “Swinging Sixties”, the contraceptive pill is made widely available amid a major movement for women’s liberation. The number of women on the pill rises from around 50,000 in 1962 to 1 million in 1969. The Abortion Act becomes law, apart from in Northern Ireland, making termination legal up to 28 weeks if it is deemed to be in the best physical and mental interests of the patient. The world’s first test-tube baby, a girl called Louise Brown, is born on July 25 thanks to in vitro fertilization. The first advertising campaign in the fight against AIDS uses slogans such as “Don’t die of ignorance” to raise awareness. The world’s first heart, liver and lung transplant is  conducted in Cambridge. Free mammograms are offered in a bid to reduce breast cancer deaths among women over 50. The NHS Organ Donor Register is set up. More than 12 million people register by 2005, according to the NHS. A four-hour target for waiting times in hospital Accident and Emergency departments is made into an operational standard. The Care Quality Commission, a new regulator which will  monitor health services, is launched. Junior doctors in England go on their first all-out strike, protesting at government plans for a new employment contract.

SOLUTION: Timeline: Britain's National Health Service turns 70.

PROBLEM: Tuberculosis is North Korea’s biggest public health problem. With this American-made machine, his lab would be able to complete a TB test in just two hours, instead of two months. It took years, but Dr. O got the machines, only to discover that GeneXpert needs cartridges he can’t replace. It’s not entirely clear what about the cartridges would violate international sanctions. For a long time, the producer refused to disclose what agents were inside because that was patented information. But it doesn’t really matter. No one, it seems, is willing to help him procure them from abroad and run the risk of angering Washington. Despite a budding mood of detente on the Korean Peninsula since the summit between President Donald Trump and North Korean leader Kim Jong Un last month in Singapore, ongoing sanctions championed by the U.S. and Trump’s “maximum pressure” policy continue to generate an atmosphere of hesitation and the fear of even unintentional violations. And that is keeping lifesaving medicines and supplies from thousands of North Korean tuberculosis patients. Dr. O’s laboratory, built with help from Stanford University and Christian Friends of Korea aid group, has essentially been running on empty since April. But the idle GeneXperts may soon be the least of his troubles. ___ Tuberculosis kills more than 1.6 million people a year. When left untreated it will be fatal in half of those it infects. It’s the world’s most deadly infectious disease and is so contagious that each case can be expected to lead to 10 to 20 more. In developed countries, it has largely been brought under control. There’s a vaccine that prevents it and a cocktail of drugs that can be used to treat, and often cure, it in a matter of months. But it’s a major scourge in less affluent places, including North Korea and sub-Saharan Africa. To help North Korea control its tuberculosis problem, a Geneva-based international aid organization called the Global Fund to Fight AIDS, Tuberculosis and Malaria has dispersed more than $100 million in grants since 2010. Last year it supported the treatment of about 190,000 North Korean TB patients. But, two weeks ago, Global Fund ended all of its North Korea-related grants, saying it could no longer accept the North’s “unique operating conditions.” Spokesman Seth Faison said the fund informed Pyongyang in February so it would have time to look for alternative funding sources. He said Global Fund is providing buffer stocks of medicines and health products to help support the treatment of tuberculosis patients through June next year. Faison said Global Fund welcomes the “positive diplomatic efforts underway” between Pyongyang and its neighbors. But the fund’s position stands. The decision shocked the doctors at the Pyongyang tuberculosis lab, who praised Global Fund for the work it had done but accused it of bowing to political pressure from the United States and Trump’s vow to keep the pressure on and not ease sanctions until the North makes major steps toward denuclearization. The United States government, which has pledged $1.4 billion this year, is one of Global Fund’s biggest donors. The fund’s retreat sparked outrage outside of North Korea as well. In an open letter published in the medical journal Lancet, Harvard physician Kee Park, director of North Korea programs for the Korean American Association, warned the fund’s withdrawal could create a “humanitarian and public health crisis” and called the move “a cataclysmic betrayal of the people of the DPRK.” Whatever the reason, its departure is valid cause for concern. When tuberculosis patients reduce or go off their medications prematurely, or begin taking lower quality ones, the bacteria that causes their disease can develop a resistance to the two most powerful anti-TB drugs, making the condition harder and much more expensive to treat. This kind of multi-drug resistant TB is most often found in China, India and Russia. And it’s a big problem in North Korea. ___ North Korea’s health system is fragile and strapped for resources. But in keeping with Kim’s directives to lift the nation’s standard of living, officials are looking for ways to improve. “We have been waging a vigorous struggle with a highly ambitious plan to increase the average life expectancy of the population and bring other health indices in line with those of the world’s most advanced countries,” explained Ri Jong Chang, who is the director of the Central Tuberculosis Prevention Institute and has worked with TB patients for the past 25 years. Ri explained that at the most basic level, the country maintains a network of about 7,000 clinics and a system initiated decades ago that focuses on “household doctors.” Each doctor is responsible for the care of 150 households within their administrative area. Along with primary care, they keep their patients informed and educated about health issues and conduct activities to prevent diseases. If a suspected case of tuberculosis is found, the patient is sent to a county-level hospital for testing. Aware of its needs and vulnerabilities, North Korea, which is generally secretive and deeply suspicious of anything that smacks of foreign “meddling,” has demonstrated a surprising willingness to accept help, allow access and share information with United Nations’ agencies and foreign aid organizations. Along with Global Fund, the most established group treating TB patients in the North is the Eugene Bell Foundation, which supports the treatment of more than 1,000 patients at 12 centers across the country. Unlike Global Fund, since 2008 the Eugene Bell Foundation has been solely focused on fighting multi drug-resistant tuberculosis, which typically takes about 18 months to treat and costs nearly $5,000 per patient. Stephen Linton, who founded the group in 1995, has a grim assessment of the situation. “We are probably only covering about one-tenth of the MDR-TB patients in the country right now,” he told The Associated Press. He said about half of his patients are in Pyongyang, a city of 3 million and the place where most of the North’s elites reside. The reason is straightforward — MDR-TB develops after exposure to medications that failed. In rural areas, fewer people have access to those medicines to begin with. “If you are living in the countryside in North Korea, you are much less likely to get MDR-TB than if you live in Pyongyang. It’s horrendous,” he said. “We can’t get to the bottom of it, even though we focus a lot of resources there.” What really worries him, and the North Korean government, is what will happen if the patients who relied on Global Fund support run out of medications, stop getting help or turn to cheaper, less effective treatments. Many will die. But not before infecting many others. “This is an airborne infection,” he said. “Every time you are in a closed space with a TB patient, you are at risk. So for all the people that travel to North Korea, all the tourists, all the diplomats — they are a risk to everyone who comes near them.” ___ This was supposed to be the year Eugene Bell began to really up its game in North Korea, tripling to 3,000 the number of patients it treats. Many of the sanatoria where TB patients are treated in the North were built 30 or 40 years ago. They have poor insulation, are overcrowded and are often fire hazards. To address those problems and the sort of transparency issues Global Fund was concerned about, Eugene Bell has developed pre-fabricated wards tailor-made to meet the North’s conditions. They are simple, single-story duplexes. Each can be put up quickly by three or four people, meaning the entire process can be monitored while Linton and other Eugene Bell people are in the country on their bi-annual medical team visits. The wards are already paid for when they are shipped from China, so the money isn’t going into the pockets of government officials or funding Kim Jong Un’s missile programs. The idea was to begin putting up 80-100 wards to create large centers in each of North Korea’s nine provinces. A pilot project with 10 wards is now operating on the outskirts of Pyongyang, not far from the airport. Linton said everything was going well until last December. “Then we ran into this sanctions problem,” he said. “It’s officially approved. The design is approved. And it’s not that we can’t send anything in. But these buildings have a metal roof — a panel that has metal in it, aluminum — and that’s the issue.” Linton said Eugene Bell has a quarter of a million dollars’ worth of them “rotting in monsoon weather” in a dockyard outside of Seoul. He believes that until Washington makes it clear it is not against humanitarian aid, other countries and aid organizations will be reluctant to act — or even approve the shipment of items like Dr. O’s GeneXpert cartridges or Eugene Bell’s patient wards that are clearly intended for humanitarian use. As an American, Linton says, he is concerned the U.S. will be held responsible for whatever bad happens with TB in North Korea since no country is as seen as “owning” the sanctions as much as America. “Unless something is done and done soon, this medical emergency will become known in Korea as the ‘Sanctions TB Epidemic,’” he said. “And it will haunt the peninsula for generations.” ___ Talmadge is the AP’s Pyongyang bureau chief. Follow him on Instagram and Twitter: @EricTalmadge

SOLUTION:
Despite detente, sanctions on North Korea fan TB epidemic.