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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en-US"> <head profile="http://gmpg.org/xfn/11"><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://globalhealth.sais-jhu.edu:80/?","20090905150505","https://web.archive.org/","web","/_static/", "1252163105"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/> <title>Global Health and Foreign Policy Blog </title> <meta name="generator" content="WordPress 2.6.1"/>  <link rel="stylesheet" href="https://web.archive.org/web/20090905150505cs_/http://globalhealth.sais-jhu.edu/wp-content/themes/sais/style.css" type="text/css" media="screen"/> <link rel="alternate" type="application/rss+xml" title="Global Health and Foreign Policy Blog RSS Feed" href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/feed/"/> <link rel="pingback" href="http://globalhealth.sais-jhu.edu/xmlrpc.php"/> <link rel="EditURI" type="application/rsd+xml" title="RSD" href="http://globalhealth.sais-jhu.edu/xmlrpc.php?rsd"/> <link rel="wlwmanifest" type="application/wlwmanifest+xml" href="http://globalhealth.sais-jhu.edu/wp-includes/wlwmanifest.xml"/> <meta name="generator" content="WordPress 2.6.1"/> </head> <body>    <div id="wrapper"> <div class="header"> <div class="header-text"> <h1><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/">Global Health and Foreign Policy Blog</a></h1> <h2>Blogging on the overlap between principle and power.</h2> </div> </div> <table width="752" border="0" cellspacing="0" cellpadding="0" id="wrapper_table"> <tr> <td width="500" align="left" valign="top"> <div id="content"> <div class="post" id="post-"> <div class="dateheader">December 2, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/12/?y%/update-on-pharmaceuticals-and-war/" rel="bookmark" title="Permanent Link to Update on pharmaceuticals and war">Update on pharmaceuticals and war</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:39 pm</em></div> <div class="post_body"> <p>Sad to have this relevant update to the pharmaceuticals and war post, but the terrorists behind the recent Mumbai attacks were found to be using cocaine, LSD, steroids and possibly other stimulants during the fighting. “This explains why they managed to battle the commandos for over 50 hours with no food or sleep.” Full story from the Telegraph is <a href="https://web.archive.org/web/20090905150505/http://www.telegraph.co.uk/news/worldnews/asia/india/3540964/Mumbai-attacks-Terrorists-took-cocaine-to-stay-awake-during-assault.html" target="_blank">here</a>. Thanks to Chris Albon from <a href="https://web.archive.org/web/20090905150505/http://warandhealth.com/" target="_blank">warandhealth.com</a> for the tip.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/12/?y%/update-on-pharmaceuticals-and-war/#respond" title="Comment on Update on pharmaceuticals and war">Comments (0)</a> </div> </div> <div class="dateheader">June 24, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/06/?y%/pharmaceuticals-and-war/" rel="bookmark" title="Permanent Link to Pharmaceuticals and War">Pharmaceuticals and War</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 10:53 am</em></div> <div class="post_body"> <p>This is a rather light <a href="https://web.archive.org/web/20090905150505/http://www.time.com/time/nation/article/0,8599,1811858,00.html" target="_blank">treatment</a> of the subject in Time Magazine, covering the seemingly increasing numbers of US Army soldiers who are prescribed antidepressants to “calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan,” fight PTSD and keep needed soldiers on the front lines. There is a long history of the use of drugs during warfare, from antidepressants in current wars, to amphetamines in Somalia (Khat), Vietnam and WWII, to alcohol from time immemorial. I heard chilling first-hand stories of Serb soldiers drunk on schlivovitz from Bosnian refugees after the war. I’m surprised Time didn’t dig a little deeper and describe the current use of amphetamines or “<a href="https://web.archive.org/web/20090905150505/http://www.stripes.com/article.asp?section=104&article=12710&archive=true" target="_blank">go pills</a>,” antidepressants and sleep aids “<a href="https://web.archive.org/web/20090905150505/http://www.stripes.com/article.asp?section=104&article=18001&archive=true" target="_blank">no go pills</a>” to improve Air Force pilot performance during long missions. And not just the US Air Force, most countries “<a href="https://web.archive.org/web/20090905150505/http://blog.wired.com/defense/2008/02/israel-mulls-vi.html" target="_blank">drug their pilots, to keep ‘em alert.</a>” A touchy political subject? Sure. An old issue that might deserve a well-researched and reasoned debate in a news magazine? I guess that’s pushing it.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/06/?y%/pharmaceuticals-and-war/#respond" title="Comment on Pharmaceuticals and War">Comments (0)</a> </div> </div> <div class="dateheader">March 4, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/03/?y%/interrogating-zimbabwes-declining-hiv-prevalence/" rel="bookmark" title="Permanent Link to Interrogating Zimbabwe’s declining HIV prevalence">Interrogating Zimbabwe’s declining HIV prevalence</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:57 pm</em></div> <div class="post_body"> <p>The Washington Post had a pretty good <a href="https://web.archive.org/web/20090905150505/http://www.washingtonpost.com/wp-dyn/content/story/2008/02/20/ST2008022000118.html" target="_blank">review</a> of PEPFAR last week. Unfortunately, it concluded with the misleading point that Zimbabwe has seen the largest declines in HIV prevalence in Southern Africa, while its PEPFAR-funded neighbors “lag behind.” SAIS International Health Policy student Ilaria Regondi sets the record straight in this <a href="https://web.archive.org/web/20090905150505/http://www.washingtonpost.com/wp-dyn/content/article/2008/02/29/AR2008022903244.html" target="_blank">letter</a> to the Washington Post, reprinted below. The Post called her letter “Zimbabwe’s Lethal HIV Solution,” but I think her original title, “Is State Failure an Antidote to AIDS?” gets the point across better.</p> <p>“Regarding the Feb. 20 article “African AIDS Crisis Outlives $15 Billion Bush Initiative”: According to the article, “economic collapse has coincided with fundamental social change” to decrease the rate of HIV infection in Zimbabwe.</p> <p>Nevertheless, it is rising mortality — resulting from hardship and poverty — that has been instrumental in effecting change. As mortality rates increase, the pool of infected people and the risk of new infections shrink, and — statistically speaking — this decreases HIV rates.</p> <p>Death, then, acts as a powerful incentive for behavioral change, but it can hardly be prescribed as the ideal antidote to AIDS. While the health benefits of embracing monogamy are obvious, the cause of this shift (poverty) should also be a cause for widespread concern.</p> <p>Skyrocketing unemployment and social disruption have also played a part, at once reducing mobility and increasing migration. While the former lessens the risk of infection, the latter inflates other countries’ HIV rates while letting Zimbabwe benefit.</p> <p>When a country with 150,000 percent inflation and a despotic ruler flaunts achievements that no one else can claim, perhaps a little more caution is in order.”</p> <p>Ilaria Regondi</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2008/03/?y%/interrogating-zimbabwes-declining-hiv-prevalence/#comments" title="Comment on Interrogating Zimbabwe’s declining HIV prevalence">Comments (1)</a> </div> </div> <div class="dateheader">December 18, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/12/?y%/climate-change-and-infectious-disease-keep-it-in-perspective/" rel="bookmark" title="Permanent Link to Climate Change and Infectious Disease: Keep it in Perspective">Climate Change and Infectious Disease: Keep it in Perspective</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 4:27 pm</em></div> <div class="post_body"> <p>During the first week of December (coincident with the opening of the United Nations <a href="https://web.archive.org/web/20090905150505/http://unfccc.int/2860.php">Climate Change Conference</a> in Bali) the Institute of Medicine’s <a href="https://web.archive.org/web/20090905150505/http://www.iom.edu/?id=19170">Forum on Microbial Threats</a> convened an expert meeting to explore the links between climate change and infectious disease. The event brought together a diverse group of experts from fields such as medicine, public health, ecology, plant science, remote sensing, agriculture, entomology, demography, and public policy to grapple with an important, but somewhat controversial, question within the overall climate change debate: will a changing climate lead to more infectious disease?</p> <p>In seeking an answer to the general question, presenters tackled multiple perplexing sub-questions, such as: What are the mechanisms by which climate change leads to shifts in disease? How do human social factors interact with the ecological processes leading to shifts in disease? Which countries will be most affected and which will be spared? How potent are the tools that we currently have at predicting, identifying and ameliorating future changes in disease incidence? After two full days of rigorous discussion, it seems fair to say that participants found that clear, convincing answers to these questions were often hard to come by.</p> <p>There is solid scientific evidence that increasing temperatures can lead to increased transmission of disease, through direct action on infectious agents (e.g. malaria parasites develop in the mosquito more rapidly in higher temperatures), effects on vectors (e.g. greater geographic range and longer active season for mosquitoes, ticks, etc), or changes in host behavior (e.g. shifts in migratory bird patterns). Rainfall and humidity also have proven biological effects. Not all the effects are negative – e.g. influenza virus transmission is reduced in humid, warm environments. In addition, the bulk of the negative effects will be concentrated at the “disease margins” – areas on the border of endemic regions are much more vulnerable to climate change.</p> <p>While these biological effects can be proven, what is increasingly clear is that such changes will be dwarfed by the interacting variables of future human behavior in reaction to climate changes (urbanization, migration, and agricultural practices), and the pre-existing and future capacity of public health systems. A poor country with a weak health system and a large infectious disease burden will likely have a hard time adapting (or even identifying) relevant changes in disease incidence in the future, leaving it vulnerable to the effects of climate change. In contrast, a rich country with an effective, existing public health system is likely to respond well. Whatever the temperature is in Atlanta in the future, we are unlikely to ever again see endemic malaria there.</p> <p>Putting yet another layer of perspective on it, one can note that the additional cases of disease likely attributable to climate change as predicted by our best forecasting models represent only a small fraction of the current global infectious disease burden. Why are we worked up about possible climate change-induced disease when we have totally unacceptable levels of disease right now? This viewpoint was captured beautifully by Dr. Donald Burke, the keynote speaker and main author of the National Research Council’s comprehensive 2001 report on climate and infectious disease <a href="https://web.archive.org/web/20090905150505/http://www.cdc.gov/ncidod/eid/vol7no3_supp/geller.htm">Under the Weather</a>, when he answered an audience member’s question about what guidance he would suggest for ministers of health in countries at risk for climate-aggravated vector-borne disease problems. Burke responded that countries could reduce and even eliminate vector-borne diseases with existing tools and knowledge, all it would take is adequate financial resources and political will. Thailand could end its dengue problem now, he said, and never have to worry about whether or not climate change will increase dengue in the future.</p> <p>The point is that with or without climate-change induced changes to disease, we still need to focus on the fundamentals – good health systems, adequate surveillance, predictive capacity, health prevention, laboratory capability, transparency, and effective vector control. Concerns about climate change could raise awareness about weaknesses in these areas and could lead to corrective actions (which would be a welcome development), but a changing climate is will not be a principal determinant of the future global distribution infectious diseases in general. Poverty, lack of adaptive capacity, and human social factors (including trade and travel practices) will play a much bigger role and should be placed at the center of all these discussions of the health effects associated with climate.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/12/?y%/climate-change-and-infectious-disease-keep-it-in-perspective/#respond" title="Comment on Climate Change and Infectious Disease: Keep it in Perspective">Comments (0)</a> </div> </div> <div class="dateheader">November 7, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/11/?y%/what-does-health-mean-to-the-department-of-defense/" rel="bookmark" title="Permanent Link to What does health mean to the Department of Defense?">What does health mean to the Department of Defense?</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:05 pm</em></div> <div class="post_body"> <p>For militaries, health has always meant the preservation of the health of armed forces. This is with good reason. Throughout history disease has decimated militaries, altered or cancelled military operations, and (particularly before the 1930’s) caused more deaths in wartime than combat. <a href="https://web.archive.org/web/20090905150505/http://www.amazon.ca/Rats-Lice-History-Hans-Zinsser/dp/1412806720/ref=sr_1_6/701-0428724-3160316?ie=UTF8&s=books&qid=1194468081&sr=1-6" target="_blank">Zinnser</a> writing in the 1930s went so far as to argue that “Soldiers have rarely won wars. They more often mop up after the barrage of epidemics.” So it is not surprising that a huge part of the Department of Defense’s (DoD) interest in health is in maintaining the health of its forces and their dependents during peacetime, predicting and preventing illness during deployment, and in combat care during war. (For a recent high tech example, see the <a href="https://web.archive.org/web/20090905150505/http://www.darpa.mil/dso/thrusts/bio/mainhuman/predhealth/index.htm" target="_blank">Defense Advanced Research Projects Agency’s</a> research into predicting illness in U.S. forces <em>before symptoms are apparent</em>. The rational is of course to minimize or even eliminate the impact of disease on U.S. military operations.)</p> <p>DoD is also interested in the health of foreign militaries. You might think this would be because DoD wants to know if a threatening military may be weakened by disease, but more often it is to ensure that foreign militaries do not collapse due to HIV/AIDS. Since 2001, the <a href="https://web.archive.org/web/20090905150505/http://www.nhrc.navy.mil/programs/dhapp/index.html" target="_blank">Department of Defense HIV/AIDS Prevention Program</a> (DHAPP) has been training foreign militaries, starting in Sub-Saharan Africa but now in 70 countries, to prevent, treat and cope with the impact of HIV/AIDS. DHAPP does this to 1) prevent HIV/AIDS from causing instability in foreign militaries that could lead to state instability and calls for U.S. military or humanitarian intervention; 2) ensure that foreign militaries can continue to contribute troops to peacekeeping operations and therefore eliminate the need for U.S. participation in peacekeeping; 3) build relationships through cooperation on HIV/AIDS that enables greater cooperation with the U.S. in the long war on terrorism. These programs are in DoD’s enlightened self-interest to pursue.</p> <p>DoD’s third interest in health is in using health as a tool to pursue U.S. strategic goals. The rationale for this is competitive. The example I hear repeatedly is the case of Hezbollah running hospitals, and providing public health and social services, then going on to win significant representation in Lebanese elections. The Cuban training and exporting of medical personnel across Latin America since 1960 is another often cited example. As one Air Force Colonel at DoD says; “the competition uses health diplomacy.”</p> <p>Unfortunately, DoD’s efforts to use health diplomacy seem neither as well targeted as Hezbollah’s nor as long-term as Cuba’s. One example is the recent 4 month, 12 nation <a href="https://web.archive.org/web/20090905150505/http://www.miamiherald.com/multimedia/news/usnscomfort/index.html" target="_blank">USS Comfort</a> mission to Latin America to counter Castro’s long-standing health diplomacy program. Supporters argue that the Comfort is on a “<a href="https://web.archive.org/web/20090905150505/http://www.miamiherald.com/multimedia/news/usnscomfort/index.html" target="_blank">voyage of healing</a>” that will win hearts and minds across the region. Detractors point out that the Comfort screens patients because they only treat problems they can fix within their 72 hour docking time, that the supertanker-based ship can only dock at 30% of the world’s ports, and that there is no telling when or if the Comfort will ever return. This hardly demonstrates a long-term commitment to health and development, and will likely only win a few hearts and minds for the $18 million dollar cost.</p> <p>Another example is the use of medical civil-assistance programs (MEDCAPs) in Iraq, which are essentially temporary health clinics set up to treat as many patients as possible in a few hours before closing down. Supporters argue that a few hours of world class medical care can help win support of local populations, gather intelligence, and reward communities for cooperation with the U.S. Describing MEDCAPs as “<a href="https://web.archive.org/web/20090905150505/http://usacac.leavenworth.army.mil/CAC/milreview/English/SepOct07/bakerengseptoct07.pdf" target="_blank">tailgate medicine</a>,” Major Jay Baker argues that MEDCAPs actually undermine local health systems while failing to build Iraqi health capacity. In the end he argues, they weaken the ability of the Iraqi government to provide health services and therefore undermine U.S. strategic goals. It seems that DoD still has a lot to learn about basic global health principles such as sustainability, building capacity, and low-tech interventions that save the most lives including clean water and maternal healthcare.</p> <p>A final uncomfortable note for those in global health is provided by David Kilcullen, currently advising General Petraeus in Iraq, in his fascinating <a href="https://web.archive.org/web/20090905150505/http://www.d-n-i.net/fcs/pdf/kilcullen_28_articles.pdf" target="_blank"><em>Twenty-Eight Articles</em></a> of conducting counterinsurgency. Those in global health who hope to use health as a bridge between fighting populations to create peace, take note: “There is no such thing as impartial humanitarian assistance or civil affairs in counterinsurgency. Every time you help someone, you hurt someone else - not least the insurgents.”</p> </div> <div class="post_footer"> <div class="comments_etc"> <span>Comments Off</span> </div> </div> <div class="dateheader">October 19, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/10/?y%/malaria-eradication/" rel="bookmark" title="Permanent Link to Malaria Eradication?">Malaria Eradication?</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 3:13 pm</em></div> <div class="post_body"> <p>Bill and Melinda Gates (their foundation, I should declare, funds our Global Health and Foreign Policy Initiative) are not lacking in ambition for global health. On October 17th, they <a href="https://web.archive.org/web/20090905150505/http://www.cbsnews.com/stories/2007/10/17/ap/health/main3378687.shtml" target="_blank">called</a> for malaria to be eradicated.</p> <p>As the Gates’s acknowledged, the goal of eradicating malaria is nothing less than audacious. But is it practicable? The answer is no, given current technology. But that’s their point: to eradicate malaria, new technologies are needed. The Gates’s are saying that innovation in this area should be developed with eradication, and not only control, in mind.</p> <p>The drive to eradicate polio, which began in 1988 and which was to have finished by 2000 but is still ongoing, demonstrates the importance of technology. Should we succeed in eradicating the wild polioviruses (more on this below), we will only face a new challenge. The vaccine being used to eradicate the wild viruses contains live viruses that can mutate and evolve to resemble the wild viruses. Stopping use of this vaccine thus creates risks. The alternative vaccine does not have this problem but it is much more expensive; it will not be used by the poorest countries. In short, the vaccines we have today are ideal for controlling polio but not for eradicating polio. Had we to do over again, the world might have wanted to undertake R&D for new tools before embarking on the quest to eradicate polio.</p> <p>Technology, however, is only a necessary condition for eradication to succeed; it is not sufficient. A program to eradicate guinea worm has been underway since 1981. The technology for doing so is very simple. Education and water filters alone can do the job. However, civil war in Sudan has blocked progress. That’s the problem with eradication: its success depends on the weakest link in the chain, not the sum total of the effort. For eradication, the weakest link is often a failed state.</p> <p>Polio suffers the same problem. It is still endemic in the border region between Pakistan and Afghanistan. Even with the right tools, it may not be possible to interrupt transmission in these areas.</p> <p>Eradication not only rids the world of a disease; it also saves money in the long run. This is because, once a disease has been eradicated, control of the disease can be stopped. Eradication is thus the ultimate form of sustainable development. Indeed, as I explain in my new book, <a href="https://web.archive.org/web/20090905150505/http://www.oup.com/us/catalog/general/subject/Economics/International/?view=usa&ci=9780199211890" target="_blank">Why Cooperate?</a>, the eradication of smallpox is probably the best single public investment the world has ever made.</p> <p>However, smallpox may yet prove the exception. Other eradication efforts, including an earlier effort to eradicate malaria, all failed.</p> <p>The challenge in moving forward is thus to develop technologies and institutions—including institutions that can address the challenge of failed states—that yield real benefits in the near term while at the same time creating opportunities for achieving even more in the future. As Melinda Gates said, malaria eradication “is a long term goal; it won’t come soon.”</p> </div> <div class="post_footer"> <div class="comments_etc"> <span>Comments Off</span> </div> </div> <div class="dateheader">October 3, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/10/?y%/moving-left-of-boom/" rel="bookmark" title="Permanent Link to Moving Left of Boom">Moving Left of Boom</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 3:38 pm</em></div> <div class="post_body"> <p class="MsoNormal">More national security and science than global health and foreign policy, but Rick Atkinson’s four-part “<a href="https://web.archive.org/web/20090905150505/http://www.washingtonpost.com/wp-srv/world/specials/leftofboom/index.html">Left of Boom</a>” series in the Washington Post is a sobering look at the military’s attempts to use science to innovate away the devastating problem of IEDs (improvised explosive devices) in <st1:place w:st="on"><st1:country-region w:st="on">Iraq</st1:country-region></st1:place>.<span> </span>IEDs have proven to be a low-tech and deadly way to attack <st1:country-region w:st="on">U.S.</st1:country-region> troops as they travel the roadways of <st1:country-region w:st="on"><st1:place w:st="on">Iraq</st1:place></st1:country-region>.<span> </span><st1:place w:st="on"><st1:country-region w:st="on">U.S.</st1:country-region></st1:place> countermeasures have proliferated, only to see insurgent bomb-makers quickly innovate new approaches using widely available commercial products such as key fobs and radio controlled cars.<span> </span>The Pentagon’s broken procurement process plays a role in the story, as do inane and impractical projects like harnessed bomb sniffing bees ($2 million invested in those bees until Brig. Gen. Joseph L. Votel asked “How does, say, 1st Platoon manage their bees?”)<span> </span></p> <p class="MsoNormal">Just as interesting is what the articles say about the nature of this war and why high-tech solutions to the IED problem may only be half-measures.<span> </span>Retired General <a href="https://web.archive.org/web/20090905150505/https://www.jieddo.dod.mil/JIEDDOLEADERSHIP/LEADDIR.ASPX" target="_blank">Montgomery C. Meigs</a> who directs the Pentagon’s <a href="https://web.archive.org/web/20090905150505/https://www.jieddo.dod.mil/" target="_blank">Joint IED Defeat Organization</a>, provides a key observation:</p> <p class="MsoNormal"><em>“The IED is the enemy’s artillery system. It’s simply a way of putting chemical and kinetic energy on top of our soldiers and Marines, or underneath them…<span> </span>What’s different is the trajectory. Three 152mm rounds underneath a tank, which will blow a hole in it, are artillery rounds. But they didn’t come through three-dimensional space in a parabolic trajectory. They came through a social trajectory and a social network in the community.”<o:p></o:p></em></p> <p class="MsoNormal">In other words the artillery shells are not being fired at vehicles by a traditional army, but are coming at <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> forces through a social network of insurgent financers, bomb-makers and low-level persons paid to place IEDs.<span> </span>Dealing with this social network is low-tech, requiring deep understanding of language, culture and insurgent social networks.<span> </span>The Pentagon’s high-tech efforts to protect troops against IEDs have had some success, but low-tech, on the ground intelligence may be the only way to stop IEDs before they explode under our troops, ie. to move left of boom.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/10/?y%/moving-left-of-boom/#respond" title="Comment on Moving Left of Boom">Comments (0)</a> </div> </div> <div class="dateheader">October 2, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/10/?y%/the-saffron-revolution/" rel="bookmark" title="Permanent Link to The Saffron Revolution">The Saffron Revolution</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 3:32 pm</em></div> <div class="post_body"> <p><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/burmese-monks.jpg" title="Burmese monks"><img src="https://web.archive.org/web/20090905150505im_/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/burmese-monks.jpg" alt="Burmese monks"/></a><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/soldiers.jpg" title="Soldiers"><img src="https://web.archive.org/web/20090905150505im_/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/soldiers.jpg" alt="Soldiers"/></a></p> <p class="MsoNormal"> </p> <p class="MsoNormal">Two photos from a friend witnessing the Saffron Revolution in <st1:place w:st="on"><st1:country-region w:st="on">Burma</st1:country-region></st1:place>.<span> </span>Good information has been difficult to come by as the junta attempts to enforce a media blackout.<span> </span>Official (and by that I mean the military junta) data reports 9 deaths, while a recent high-level defector <a href="https://web.archive.org/web/20090905150505/http://www.dailymail.co.uk/pages/live/articles/news/worldnews.html?in_article_id=484903&in_page_id=1811&ct=5" target="_blank">reports</a> thousands of deaths.<span> </span>Here is our friend’s interview with a monk about events at the Eastern Gate of Shwedagon Pagoda:</p> <p class="MsoNormal"><em>“On Thursday we were praying at the Kyethune Phaya. There were 30 of us. It was around noon. Then we heard the sound of the soldiers coming. Banging their sticks on their shields. Without warning they entered the pagoda and started to beat us with their sticks. Some had swords on the end of their guns. They beat a young monk, only 15 years old. He fell down, bleeding on the head.” The young monk ran and escaped. He learned later that some of his companions had been killed, most of them beaten and taken away in the “J” car – the black van with bars on the windows, a sight now common near the scene of any demonstration. <o:p></o:p></em></p> <p class="MsoNormal"><em>The elderly monk then went on to explain, “They (the Government) are afraid. They know this is different from ’88. The Sangha (religious authority) did not lead the strikes in ’88. They (the soldiers) are going to the monasteries at night. Pretending to be lay people. Entering the monastery, beating and taking away the monks. Even the young boys. They raided Waizayandar on Thursday. On Friday they cleaned the monastery and replaced the monks. With men who are not real monks or with monks who side with the government.” <o:p></o:p></em></p> <p class="MsoNormal"><em>“They have taken 3000 monks. They do not put them in prison. They take them to the many military camps around the country. The monks are refusing the small bowl of rice being offered to them by the soldiers. The soldiers offer it to them after 1pm to make them break their vows. No one is allowed to see them. We are worried.”<o:p></o:p></em></p> <p class="MsoNormal"><em>“But we know. We knew what would happen. We see the situation in the country. We go around and we beg for our food. We see the rich and the poor. We see that a very few people are very rich. They are all the families and relations of the Generals. We see that the people are getting poorer. They cannot even feed themselves. We see this. We cannot ignore it.” <o:p></o:p></em></p> <p class="MsoNormal"><em>“We don’t know how long it will take. One month. One year. But too many of us have died already. We cannot go back.”<o:p></o:p></em></p> <p class="MsoNormal"><st1:country-region w:st="on"><st1:place w:st="on">Burma</st1:place></st1:country-region> has long been a terrible example of how violation of <a href="https://web.archive.org/web/20090905150505/http://www.jhsph.edu/humanrights/images/GatheringStorm_BurmaReport_2007.pdf" target="_blank">human rights contributes to worsening public health</a> (warning, large pdf file).<span> </span>The country is suffering under one of the highest rates of tuberculosis in the world, extensive malaria and HIV/AIDS, along with rising drug-resistance due to counterfeit drugs.<span> </span>Here’s hoping the Saffron Revolution succeeds for the health and political freedom of the Burmese.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/10/?y%/the-saffron-revolution/#respond" title="Comment on The Saffron Revolution">Comments (0)</a> </div> </div> <div class="dateheader">September 4, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/09/?y%/us-lawmakers%e2%80%99-efforts-to-support-global-disease-surveillance-are-not-contagious%e2%80%a6yet/" rel="bookmark" title="Permanent Link to US lawmakers’ efforts to support global disease surveillance are not contagious…yet">US lawmakers’ efforts to support global disease surveillance are not contagious…yet</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 11:21 am</em></div> <div class="post_body"> <p>An outside observer might get the idea that the US Congress is ignoring the international disease threat. Federal agencies have <a href="https://web.archive.org/web/20090905150505/http://www.dni.gov/nic/special_globalinfectious.html" target="_blank">clearly indicated</a> that these diseases pose a health threat and an economic and security risk to the country, but there is little evidence of a widespread push for better global disease surveillance around the world aside from the emergency earmarking of funds for (mostly domestic) influenza surveillance and the reshuffling of bureaucratic priorities within the government’s health-related agencies. In an effort to take the government’s commitment to a higher level (albeit still not commensurate with the threat), some lawmakers have introduced legislation aimed at improving disease surveillance around the world.</p> <p>Senator Joe Biden (democrat from Delaware, and current aspirant for the democratic presidential nomination) along with co-sponsors Sen. Robert P. Casey, Jr. [PA], Sen. Chuck Hagel [NE], and Sen. Edward Kennedy [MA], introduced a bill titled “The Global Pathogen Surveillance Act” (<a href="https://web.archive.org/web/20090905150505/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:s1687is.txt.pdf" target="_blank">S. 1687</a>) to the Senate on June 25, 2007. The bill essentially requires that the United States provide funding and other support to bolster the infectious disease surveillance capacity in developing countries through: 1) direct monetary support of the World Health Organization’s efforts in the area, 2) earmarking scholarship support for foreign nationals to study in graduate programs in public health surveillance, laboratory science, and other related programs, 3) purchasing communication equipment for use by developing countries in support of disease surveillance, and 4) expand the programs and outreach of the already existing US HHS/CDC and DoD programs in other nations. The bill has been introduced in three separate congressional sessions—the first two times it failed to be introduced in the House of Representatives after being approved by the Senate Committee on Foreign Relations. See the original press release on the bill from Sen. Biden’s office <a href="https://web.archive.org/web/20090905150505/http://biden.senate.gov/newsroom/details.cfm?id=188531" target="_blank">here</a> and the Congressional Budget Office’s (CBO) cost estimate for implementing the bill <a href="https://web.archive.org/web/20090905150505/http://www.cbo.gov/ftpdocs/83xx/doc8344/s1687.pdf" target="_blank">here</a>.</p> <p>Another bill (which tangentially overlaps the other bill) is the “Wildlife GAINS act” (<a href="https://web.archive.org/web/20090905150505/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:s1246is.txt.pdf" target="_blank">S. 1246</a>, <a href="https://web.archive.org/web/20090905150505/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1405ih.txt.pdf" target="_blank">H.R. 1405</a>) introduced in the Senate in March of this year by Joe Lieberman, Sen. Daniel Akaka [D-HI], Sen. Jeff Bingaman [D-NM], and Sen. Samuel Brownback [R-KS] and introduced in the House by Rep. Rosa DeLauro [D-CT]. The bill seeks to “establish and maintain a wildlife global animal information network for surveillance internationally to combat the growing threat of emerging diseases that involve wild animals, such as bird flu.” Currently the bill is sitting with the House Subcommittee on Horticulture and Organic Agriculture and the Senate Committee on Health, Education, Labor, and Pensions without having been voted on. This bill is itself a re-working of a previous proposal (“The Global Network for Avian Influenza Surveillance Act”) that failed to get a full House vote during the previous congressional session. The CBO cost estimate for Wildlife GAINS can be seen <a href="https://web.archive.org/web/20090905150505/http://www.govtrack.us/data/us/110/bills.cbo/h1405.pdf" target="_blank">here</a>.</p> <p>Making law is cumbersome and time-consuming, and many factors can determine success and failure. Still, the main culprit behind the inability to turn these bills into law can be probably attributed to a lack of popular understanding of their importance to protect US public health. As with so many other preventative, “global good” measures, investing in a longer-term solution comes at the expense of immediate political pressures. Probably it will take a serious health emergency to shock the public out of complacency, but hopefully these bills (or something like them) will be move beyond the subcommittee rooms of the capital and into become law before that occurs.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/09/?y%/us-lawmakers%e2%80%99-efforts-to-support-global-disease-surveillance-are-not-contagious%e2%80%a6yet/#respond" title="Comment on US lawmakers’ efforts to support global disease surveillance are not contagious…yet">Comments (0)</a> </div> </div> <div class="dateheader">August 2, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/08/?y%/the-politics-of-bird-flu-science-when-countries%e2%80%99-self-interest-intellectual-property-and-global-health-collide/" rel="bookmark" title="Permanent Link to The politics of bird flu science: when countries’ self-interest, intellectual property, and global health collide">The politics of bird flu science: when countries’ self-interest, intellectual property, and global health collide</a></div> <div class="post_subhead"><em>Posted by Harley Feldbaum at 4:36 pm</em></div> <div class="post_body"> <p class="MsoNormal" style="margin: 5pt 0in">The world’s ability to prevent a devastating pandemic of influenza depends in large part on the willingness and ability of countries to share information, including virus samples, openly and quickly.<span> </span>A delay in detecting and reacting to an outbreak of human-to-human transmission caused by self-interested hoarding of samples or information could lead to thousands, if not millions, of otherwise avoidable deaths.<span> </span>That is why the pressure is on for the World Health Organization (WHO) to help countries iron out a possible impasse on bird flu sample sharing. <span> </span></p> <p class="MsoNormal" style="margin: 5pt 0in">The tension originally arose from a group of countries, led by <st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region>, <a href="https://web.archive.org/web/20090905150505/http://www.nytimes.com/2007/02/07/world/asia/07birdflu.html?_r=3&oref=slogin&oref=slogin&oref=slogin" target="_blank">claiming intellectual property rights over flu virus samples</a> originating inside their borders. <span> </span>For the last half-century, countries had freely shared influenza samples with the WHO, which then worked with various laboratories (including the US-based Centers for Disease Control and Britain’s Health Protection Agency) to isolate and study them.<span> </span>In some cases, the virus samples were used to generate “seed strains”, which would then be handed over to pharmaceutical companies so they could manufacture and sell influenza vaccines back to countries.<span> </span>Indonesia, which has recorded the highest death toll due H5N1 (avian) influenza, stopped sharing samples earlier this year saying that it required assurances that it would have access to any products developed using its samples.<span> </span>Other countries quickly joined the call for access to life-saving interventions generated using samples coming from their territory.<span> </span></p> <p class="MsoNormal" style="margin: 5pt 0in">In response to the growing stalemate, the <a href="https://web.archive.org/web/20090905150505/http://ca.news.yahoo.com/s/capress/070731/health/health_bird_flu_virus_sharing" target="_blank">WHO convened a special working group meeting</a> of 24 countries on July 31, 2007, whose goal is to generate recommendations flu virus sample sharing. <span> </span>While the task at hand is limited to flu samples, the repercussions of any guidelines could include other infectious diseases of international concern.<span> </span>Governments, pharmaceutical companies, intellectual property rights supporters, and public health representatives all have large, and somewhat opposing, stakes in the outcome of these discussions.</p> <p class="MsoNormal" style="margin: 5pt 0in">The developing nations’ concerns are legitimate.<span> </span>It would not be hard to imagine, especially in the face of an actual pandemic, that vaccines generated from Indonesian virus samples might be hoarded by rich countries where the manufacturing capabilities lie, or perhaps priced too high for poor countries to purchase enough to adequately protect their populations.<span> </span>On the other hand, any restrictions on virus sharing could hinder tracking the virus and developing necessary vaccines.<span> </span>If countries are allowed to share only on a limited basis, gaps in knowledge will result and the march of scientific progress will be slowed.<span> </span></p> <p class="MsoNormal" style="margin: 5pt 0in">The WHO can be commended for taking rapid action on this complicated issue.<span> </span>The solution should fall heavily on the side of maintaining a robust scientific exchange on disease, because the cost (in lives and dollars) of a slow pandemic response far outweighs the potential loss of economic returns on a product.<span> </span>It will take skillful diplomacy to make sure that all stakeholders are working together to face the world’s biggest disease threat. <span> </span></p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/2007/08/?y%/the-politics-of-bird-flu-science-when-countries%e2%80%99-self-interest-intellectual-property-and-global-health-collide/#respond" title="Comment on The politics of bird flu science: when countries’ self-interest, intellectual property, and global health collide">Comments (0)</a> </div> </div> <a href="https://web.archive.org/web/20090905150505/http://globalhealth.sais-jhu.edu/page/2/">Next Page »</a> <div class="copyright_footer"> <p>Copyright © 2007, all rights reserved. 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