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101. Re-thinking Biological Arms Control for the 21st Century

Author:
Filippa Lentzos
Publication Date:
07-2019
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
International treaties prohibit the development and use of biological weapons. Yet concerns about these weapons have endured and are now escalating. It is high time to take a hard look at technical and political developments and consider how the international security policy community should respond. ​ A major source of the growing concern about future bioweapons threats stem from scientific and technical advances. Innovations in biotechnology are expanding the toolbox to modify genes and organisms at a staggering pace, making it easier to produce increasingly dangerous pathogens. Disease-causing organisms can now be modified to increase their virulence, expand their host range, increase their transmissibility, or enhance their resistance to therapeutic interventions.[1] Scientific advances are also making it theoretically possible to create entirely novel biological weapons,[2] by synthetically creating known or extinct pathogens or entirely new pathogens.[3] Scientists could potentially enlarge the target of bioweapons from the immune system to the nervous system,[4] genome, or microbiome,[5] or they could weaponize ‘gene drives’ that would rapidly and cheaply spread harmful genes through animal and plant populations.[6] ​ Concurrent developments in other emerging technologies are also impacting potential future biological weapons threats. Developments in artificial intelligence and machine learning could speed up identification of harmful genes or DNA sequences. Artificial intelligence and machine learning could also potentially enable much more targeted biological weapons that would harm specific individuals or groups of individuals based on their genes, prior exposure to vaccines, or known vulnerabilities in their immune system.[7] Big Data and ‘cloud labs’ (completely robotized laboratories for hire) facilitate this process by enabling massively scaled-up experimentation and testing, significantly shortening ‘design-test-build’ timeframes and improving the likelihood of obtaining specificity or producing desired biological functionality.[8] Other developments provide new or easier ways to deliver pathogens or biological systems. Nanotechnology could potentially create aerosolized nanobots dispersing lethal synthetic microbes or chem-bio hybrids through the air,[9] or in vivo nanobots releasing damaging payloads inside human bodies.[10] Aerosol or spraying devices attached to swarms of small unmanned aerial vehicles, or drones, could be another potential means to disperse biological agents. Additive manufacturing, or 3D printing, could circumvent barriers imposed by national export control systems on controlled laboratory equipment or dispersal devices. ​
Topic:
Security, Health, Science and Technology, Treaties and Agreements, Biosecurity, and Weapons
Political Geography:
Global Focus

102. Social Protection as a Tool to Address Slow Onset Climate Events: Emerging Issues for Research and Policy

Author:
Mariya Aleksandrova
Publication Date:
01-2019
Content Type:
Special Report
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
This discussion paper aims to further awareness of opportunities to address loss and damage caused by climate change-related slow onset events (SOEs) through social protection. The analysis is based on a review of interdisciplinary theoretical and empirical literature. The findings suggest that designing comprehensive, climate-responsive social protection strategies can strongly support proactive measures to avoid, minimise and address the complex, long-term impacts of SOEs on human health, livelihoods, poverty and inequality. This entails improving the effectiveness and extending the coverage of existing social protection systems; mainstreaming climate concerns, including risks associated with SOEs, into national social protection frameworks; integrating social protection with broader climate and development policies and strategies; and developing innovative and transformational approaches to social protection. To this end, several issues for research and policy are discussed. Overall, the paper attempts to set the groundwork for an advanced research and policy agenda on social protection and climate change as well as emphasise the need for wider consideration of social protection in global climate change debates. In addition, the study aims to inform the future work of the Executive Committee of the Warsaw International Mechanism for Loss and Damage associated with Climate Change Impacts in the working areas of SOEs and comprehensive risk management approaches.
Topic:
Climate Change, Health, Poverty, Inequality, and Social Services
Political Geography:
Global Focus

103. Why Uncertainty in Global Health Interventions Matters—and What We Can Do About It

Author:
Kalipso Chalkidou, Anupama Dathan, and Francis Ruiz
Publication Date:
09-2019
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Global health interventions, like many public policies, are rife with uncertainty. Will a program, such as a malaria prevention strategy that looks strong on paper, work as intended? Will a new technology, such as a specific drug or device that appears effective in clinical trial settings, work in practice and provide good value-for-money? In the case of programs made up of a complex interaction of multiple interventions, implementers often create a theory of change and then meticulously track whether it is being followed every step of the way, from each input translating into the prespecified activity, and the activities yielding the right outputs and the expected outcomes. When observational data is available that permits quantitative analysis (evaluation), it may also be possible to estimate causal impact in a given setting by applying experimental methods (such as a randomized controlled trial) or quasi-experimental techniques (such as difference-in-difference analysis). Such program evaluations generally consider outputs (e.g. the number of bed nets distributed) and relatively short-term outcomes (e.g. malaria infections following bed net distribution). Many eval- uations also collect data years after the program to identify longer-term impacts. Cost-effectiveness calculations are sometimes conducted after ascertaining the cost and impact of the program, but such analyses aren’t necessarily considered when determining whether to implement a certain program or technology—especially when politics and other concerns get in the way. Discrete clinical interventions and technologies (which are defined as including clinical interven- tions, drugs, diagnostics and even public health programs) are usually the subject of health technolo- gy assessment (HTA) to inform coverage decisions in many contexts. The underpinning evidence base for HTA typically involves a synthesis of randomized trial data, designed to reduce bias in estimating causal inference and relative effectiveness. Trial data is then combined with information from other sources and study designs to develop models of the technology’s long-term health and cost impact in a given context. A key feature of both programs and technologies is uncertainty.
Topic:
Health, International Cooperation, Science and Technology, Humanitarian Intervention, and Pharmaceuticals
Political Geography:
Global Focus

104. Development Impact Bonds Targeting Health Outcomes

Author:
Lorcan Clarke, Kalipso Chalkidou, and Cassandra Nemzoff
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
As of December 2018, seven development impact bonds (DIBs) have been launched across seven countries with nearly US$55million in cumulative outcome funding. DIBs fund public services through contracts where private investors provide upfront flexible funding to service providers and outcome funders repay these investors based on the outcomes achieved by people receiving services. Three DIBs specifically target health outcomes: the Humanitarian Impact Bond, the Utkrisht Impact Bond, and the Cameroon Cataract Bond. The three “health DIBs” involve US$26.5 million in upfront investment, US$38.1 million in outcome funding and aim to impact the health of at least 31,600 people. Using publicly available information, we describe all seven DIBs, and evaluate the three “health DIBs” in more detail, comparing their stakeholders, implementation, and outcome structures. Building on a scoping review of relevant literature, we outline health DIBs in the pipeline and note that the potential of DIBs as a funding structure is hindered by the lack of publicly available information on their estimated impact and value for money. We offer three recommendations to improve evaluation and inform development of DIBs in the future: (1) publish plans and evaluations, (2) create and use consistent reporting guidelines, and (3) allocate funding to evaluate impact and value for money.
Topic:
Development, Health, and Humanitarian Intervention
Political Geography:
Global Focus

105. How Individuals’ Birth Weight and Later Risk Factors Interact to Determine Their Risk of Cardiovascular Disease: A Longitudinal Study in the Philippines

Author:
Marjorie Pajaron
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016). This paper examines these risk factors with a focus on the fetal environment and its interaction with adult body mass index (BMI), using longitudinal data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). Using a Cox proportional hazards model to estimate hazard ratios adjusted for age and risk factors in adulthood, such as cigarette smoking, the results suggest that there is a positive association between birth weight and heart disease. In addition, when birth weight is interacted with BMI, raised blood pressure is found to be higher among those who were bigger infants at birth and grew to be lighter adults, suggesting centile crossing. Probit models are also used for sensitivity analysis, and the results are consistent with those of the hazards model. Other factors such as adult obesity and a smoking habit are also positively associated with hypertension and CVD.
Topic:
Health, Medicine, Risk Factors, and Birthing
Political Geography:
Global Focus

106. Regulation: The Responsible Control of Drugs

Author:
Global Commission On Drug Policy
Publication Date:
03-2018
Content Type:
Special Report
Institution:
Global Commission On Drug Policy
Abstract:
This new report provides a practical roadmap that tackles the real implications and recognizes the difficulties of transitioning from illegal to legally regulated drug markets. It offers concrete answers regarding the organizational capacity of state institutions to regulate and control a legal market of potentially dangerous products. It highlights the challenges facing impoverished populations that constitute the “working class” of the illegal drug markets. It offers possible ways forward to deal with the risks inherent to the resilience of organized crime. Finally, this report calls for a reform of the prohibition-based international drug control system, which is compromising a universal and holistic approach to the “drug problem.”
Topic:
Crime, Health, War on Drugs, Drugs, and Public Health
Political Geography:
Global Focus

107. What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?

Author:
Sara R. Collins, Shanoor Seervai, Roosa Tikkanen, and Munira Z. Gunja
Publication Date:
12-2018
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Women in the United States have long lagged behind their counterparts in other high-income countries in terms of access to health care and health status. This brief compares U.S. women’s health status, affordability of health plans, and ability to access and utilize care with women in 10 other high-income countries by using international data.
Topic:
Health, Health Care Policy, Women, and Reproductive Health
Political Geography:
United States and Global Focus

108. Safeguarding Medical Care and Humanitarian Action in the UN Counterterrorism Framework

Author:
Alice Debarre
Publication Date:
09-2018
Content Type:
Policy Brief
Institution:
International Peace Institute (IPI)
Abstract:
In the past decade, counterterrorism measures have had an increasingly adverse impact on the provision of medical care and the conduct of principled humanitarian action in armed conflict settings. Whether inadvertently or not, they have impeded, and at times prevented, the provision of essential and lifesaving aid, often in violation of international humanitarian law (IHL). This paper aims to assist the Security Council, relevant UN organs, UN member states, and other stakeholders in upholding their obligations under IHL. It maps the UN counterterrorism framework and looks into the extent to which it guides states in complying with these obligations. In doing so, it offers several recommendations for the way forward: All UN resolutions and other UN and national policies that pertain to counterterrorism should contain an exemption for humanitarian activities. Every relevant UN counterterrorism measure should continue to reiterate that counterterrorism efforts need to comply with international law. Humanitarian actors should engage with UN counterterrorism structures more actively, strategically, and systematically. UN bodies that engage in counterterrorism should systematically include humanitarian actors in relevant conversations. The UN Counter-Terrorism Committee’s Executive Directorate and Office of Counter-Terrorism should better integrate IHL considerations into their work. Member states, UN entities, humanitarian actors, counterterrorism and sanctions experts, and other stakeholders should step up efforts to start a wide political discussion on tensions between counterterrorism and humanitarian action.
Topic:
Health, Humanitarian Aid, United Nations, Violent Extremism, and Counter-terrorism
Political Geography:
Global Focus

109. Hard to Reach: Providing Healthcare in Armed Conflict

Author:
Alice Debarre
Publication Date:
12-2018
Content Type:
Policy Brief
Institution:
International Peace Institute (IPI)
Abstract:
Armed conflict is a global health issue. Long-lasting and protracted conflicts in particular have consequences not only for the war-wounded but also for the health of entire communities. Over the years, global health actors and humanitarian health actors have developed health policies, guidelines, frameworks, and structures to improve delivery of health services in emergencies or humanitarian crises. Despite these advancements, however, the international health response in conflict-affected settings still faces gaps and challenges. Some policies and frameworks need to be rethought or redesigned, while others need to be better implemented. This paper explores challenges to healthcare provision in conflict-affected settings. These challenges are broadly broken down into three categories: constraints related to the health system and damaged health infrastructure, difficulty for health workers to access populations in need, and restrictions to healthcare provision intentionally or accidentally placed by donors or states engaged on humanitarian and health issues (e.g., through the securitization of healthcare). Tackling these challenges will have a direct impact on the lives of people in conflict-affected settings. However, doing so requires a radical shift in mindsets and the incentives that guide the actions of international health actors. Even so, more incremental changes can also be beneficial. To that end, this report puts forth the following recommendations: Improve coordination between and among humanitarian, development, and global health actors; Respond to context-specific needs; Hold health actors accountable to affected populations for their performance, and; Make responses sustainable. This work is based on a combination of desk research, interviews with more than seventy key informants, and an expert meeting bringing together key stakeholders and experts on global and humanitarian health.
Topic:
Health, Humanitarian Aid, and Conflict
Political Geography:
Global Focus

110. Enhancing Public Health Outcomes in Developing Countries: From Good Policies and Best Practices to Better Implementation

Author:
Michael Woolcock
Publication Date:
02-2018
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
In rich and poor countries alike, a core challenge is building the state’s capability for policy implementation. Delivering high-quality public health and health care – affordably, reliably, at scale, for all – exemplifies this challenge, since doing so requires deftly integrating refined technical skills (surgery), broad logistics management (supply chains, facilities maintenance), adaptive problem solving (curative care) and resolving ideological differences (who pays? who provides?), even as the prevailing health problems themselves only become more diverse, complex and expensive as countries become more prosperous. The current state of state capability in developing countries, however, is demonstrably alarming, with the strains and demands only likely to intensify in the coming decades. Prevailing ‘best practice’ strategies for building implementation capability – copying and scaling putative successes from abroad – are too often part of the problem, while individual training (‘capacity building’) and technological upgrades (e.g., new management information systems) remain necessary but deeply insufficient. An alternative approach is outlined, one centered on building implementation capability by working iteratively to solve problems nominated and prioritized by local actors.
Topic:
Health, Developing World, State, Public Policy, and Policy Implementation
Political Geography:
Global Focus