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41. The U.S. Department of Defense’s Role in Health Security

Author:
Tom Cullison and J. Stephen Morrison
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
Protecting the homeland against biological threats begins with preventing those threats from reaching our shores. The Department of Defense (DOD) contributes to overall U.S. health security through programs specifically aimed at countering biological threats from all sources—through public health activities coordinated with civilian counterparts at home and abroad and through research and development of medical countermeasures aimed at protecting U.S. Forces against health risks throughout the world. Civilian and military scientists, public health experts, and disaster planners are somewhat familiar with DOD’s health security capabilities, yet most lack a clear understanding of the breadth, depth, and limitations of DOD’s capacities. A solid and consistent U.S. policy framework has steadily evolved over the past few decades that identifies health as a national security issue and calls for a broad-based, inclusive national response to addressing the issue of health security. Now is the time to more fully integrate DOD’s unique expertise and capabilities in a more cohesive and efficient manner. This paper provides a broad overview of DOD health security activities and capabilities and also offers select concrete recommendations for strengthening the coherence and integration of DOD activities, with a special emphasis on leadership, novel diseases and new dangerous forms of resistance, surveillance, building host country capacities, and expanded exercises.
Topic:
Security, Defense Policy, Health, and Civil-Military Relations
Political Geography:
North America and United States of America

42. Federal Funding for Biosafety Research Is Critically Needed

Author:
Rocco Casagrande
Publication Date:
08-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
The advent of powerful new tools in biotechnology promises to open a new era in the battle against infectious disease. This research will undoubtedly lead to better capability to predict and prevent global outbreaks, and will support the development of new vaccines and treatments to reduce the burden of outbreaks we cannot prevent. The benefits afforded by these powerful tools are not without attendant risks. The threat of biological laboratory accidents is not commonly understood to be a serious health security concern similar in significance to the threats of emerging infectious diseases and biological attacks. However, scientists are just now creating viruses that exceed the transmissibility or pathogenicity of naturally occurring strains. Also contributing to the rising risk of accidents is the entry into the life sciences of scientists from other fields and hobbyists, who may be accustomed to weaker accountability measures, enjoy less training and weaker knowledge of safety and consequences of accidents, and yet are drawn to the tools of biology because of the expansive power they afford. Unlike accidents in transportation, chemical production, or even nuclear power, biosafety accidents can result in the unforeseen and uncontrolled infection of lab personnel or their local communities, the release of a pathogen into the environment, or even the initiation of a global pandemic that could reach millions. There is abundant concern among health security experts and U.S. policymakers over the threat of pathogens being deliberately released into communities by malevolent actors and terrorist attacks. While these concerns are valid, we are not paying enough attention to the costly and real risks of biological laboratory accidents that threaten similarly dangerous outcomes. The United States is underinvesting in the science of biosafety. The resulting lack of data and active research in the field leaves the biosafety community with little understanding of how accidents are likely to occur and impedes the identification of cost- effective measures to prevent accidents. This gap in knowledge could be addressed with a modest budget of $10 million per year given to the National Institute of Occupational Safety and Health to fund a dedicated U.S. biosafety research program. The funding is modest because the first step is to develop a research community that focuses on these issues; currently, the lack of funding has prevented focused attention on research in biosafety. With adequate funding, this research will lead to the development of cost-effective training programs to reduce human error in the laboratory, the redesign of risky experiments to prevent outbreaks before they occur, and the identification of cost-effective investments in laboratory safety equipment, which could make the conduct of life sciences research more efficient.
Topic:
Health, Science and Technology, Biosecurity, and Medicine
Political Geography:
North America and United States of America

43. Putin and Global Health: Friend or Foe?

Author:
J. Stephen Morrison and Judyth L. Twigg
Publication Date:
09-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
Over the course of this decade, Russia has consciously enlarged its engagement and commitments, at home and in the wider world, in battling both tuberculosis (TB) and non-communicable diseases (NCDs). Despite these positive steps, Russia remains a serious global health security threat. There is a live risk of uncontrolled HIV/AIDS and drug-resistant tuberculosis (DR-TB) epidemics within Russia itself, as well as ongoing risk of export to neighbors in Eastern Europe and Central Asia, whose deep interdependence with Russia, including extensive migrant traffic, creates acute vulnerabilities. Beyond Eurasia, Russia stands out as one of several flashpoints in the world that could contribute to a resurgent HIV/AIDS and DR-TB epidemic that reverses the global gains of the past 15 years. Russia’s social media practices deliberately spread confusion and distrust surrounding a wide range of preventive health measures, ranging from vaccines to harm reduction. This analysis weighs Russia’s positive contributions against its multiple destructive actions in global health, examines what the overall pattern of Russian behavior means for U.S. policy, and concludes with a proposal for an expanded U.S. health security alliance with Eastern Europe and Central Asia. It argues that the United States should welcome Russian contributions and collaborate with serious Russian partners in the service of broader shared health goals. At the end of the day, however, Russia will only earn a legitimate global health leadership seat through progressive, evidence-based policies and actions, which can never be wholly segregated from the noise created by its geopolitically destabilizing actions.
Topic:
Health, International Cooperation, Public Health, and Pandemic
Political Geography:
Russia, Europe, North America, and United States of America

44. Testing the Validity of the Single Interrupted Time Series Design

Author:
Katherine Baicker and Theodore Svoronos
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
Given the complex relationships between patients’ demographics, underlying health needs, and outcomes, establishing the causal effects of health policy and delivery interventions on health outcomes is often empirically challenging. The single interrupted time series (SITS) design has become a popular evaluation method in contexts where a randomized controlled trial is not feasible. In this paper, we formalize the structure and assumptions underlying the single ITS design and show that it is significantly more vulnerable to confounding than is often acknowledged and, as a result, can produce misleading results. We illustrate this empirically using the Oregon Health Insurance Experiment, showing that an evaluation using a single interrupted time series design instead of the randomized controlled trial would have produced large and statistically significant results of the wrong sign. We discuss the pitfalls of the SITS design, and suggest circumstances in which it is and is not likely to be reliable.
Topic:
Health, Governance, and Health Care Policy
Political Geography:
North America and United States of America

45. Reporting on the Spread of HIV in China

Author:
David Cowhig
Publication Date:
11-2019
Content Type:
Journal Article
Journal:
American Diplomacy
Institution:
American Diplomacy
Abstract:
Chinese physician Dr. Wang Shuping predicted the HIV epidemic among Henan peasant blood sellers and eventually raised the alarm all the way to Beijing when local and provincial authorities ignored the rapid spread of HIV among the sellers. This heroic and far-sighted woman became my most important informant on the HIV epidemic when I worked in the Environment, Science and Technology Section of U.S. Embassy Beijing 1996 – 2001.
Topic:
Diplomacy, Health, Public Policy, and Memoir
Political Geography:
China, Beijing, North America, and United States of America

46. Six Global Health Challenges Facing Russia and the US

Author:
Pietro A. Shakarian and Lusine Gigoyan
Publication Date:
02-2018
Content Type:
Commentary and Analysis
Institution:
Rethinking Russia
Abstract:
U.S.-Russia relations are in a deep crisis. However, the current state of these relations should not prevent the two powers from cooperating on resolving global problems. Rethinking Russia assesses six global health challenges, which can bring Moscow and Washington together.
Topic:
Health, International Cooperation, Bilateral Relations, Trafficking, and Crisis Management
Political Geography:
Russia, Eurasia, North America, and United States of America

47. Using Your Genome and Big Data to Manage Your Health

Author:
Michael Snyder
Publication Date:
11-2017
Content Type:
Video
Institution:
Clarke Forum for Contemporary Issues
Abstract:
New technologies that determine DNA sequencing means we can now profile people over time to better predict and diagnose disease. Michael Snyder shares his work in these new technologies and the power they hold to transform how we manage human health.
Topic:
Health and Science and Technology
Political Geography:
North America and United States of America

48. The US-Saudi coalition’s impact on Yemen’s health – a series on Yemen, part 2

Author:
Shireen Al-Adeim
Publication Date:
01-2017
Content Type:
Journal Article
Journal:
Harvard Journal of Middle Eastern Politics and Policy
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
This is the second of a three-part series of essays on Yemen highlighting the magnitude and impact of the civil war on Yemenis. Starting in March 2015, Saudi Arabia led a coalition of several Arab countries in bombing Yemen, its neighbor to the south. The coalition’s indiscriminate bombing has targeted countless homes, schools, markets, and even hospitals. Yemenis have become accustomed to double-tap and triple-tap strikes that target rescuers after an attack. One notable case was a double-tap strike that killed at least 140 mourners at a large funeral home in Sana’a, Yemen’s capital. The number of deaths resulting from US/Saudi airstrikes and fighting between Saudi-allied and Saleh/Houthi-allied forces has been conservatively estimated at 10,000 deaths and 40,000 injuries. The hidden costs of war, however, are much greater.
Topic:
Health, Poverty, War, and International Affairs
Political Geography:
Middle East, Yemen, Saudi Arabia, North America, United States of America, and Gulf Nations

49. Water for Security

Author:
Peter Engelke
Publication Date:
07-2017
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
In February 2017, California’s Oroville Dam threatened to collapse due to an unprecedented level of water in its reservoir. Faced with the possibility of calamity (Oroville Dam is the nation’s tallest at 770 feet), state officials evacuated 200,000 people from downstream areas.[1] The Oroville incident followed another high-profile water tragedy in the United States. In December 2015, Flint, Michigan Mayor Karen Weaver declared a state of emergency because lead contamination from Flint’s ancient water pipes poisoned the city’s water supply, making it unsafe to drink.[2] Michigan’s governor, Rick Snyder, and President Obama both followed with similar declarations. Flint sadly became a national symbol of incompetence, to some even proof of deliberate malfeasance by public officials. Despite remedies to fix the problem, Flint’s water remains unsafe, and the city’s residents continue to go about their lives drinking bottled water. These cases are more than just poignant demonstrations of the truism that water is life. They show that even in advanced societies, there is a fine line between water security and insecurity, between having and not having on-demand clean water in exactly the right quantities at precisely the right moment. In the United States, we are the beneficiaries of past investments in water infrastructure that have removed water insecurity from our lives. We believe that simply turning a tap provides clean, drinkable water as a free good of nature, as readily available to everyone as it is to us. Unfortunately, this assumption is not only untrue, it is dangerous to boot. A great many societies around the world are water insecure, meaning their inhabitants do not enjoy what Americans take as a given. As water is fundamental to public health, economic activity, energy and agricultural production, and countless other uses, the poor supply of water or disruption in that supply is a serious threat to domestic and international security...
Topic:
Security, Environment, Health, Water, and Infrastructure
Political Geography:
North America and United States of America

50. Epidemiological Insurgency: Polio Persistence on the Afghanistan-Pakistan Border

Author:
Rand Quinn
Publication Date:
07-2017
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
Despite a profound global impact over the first half of the twentieth century, polio is largely an afterthought throughout the developed world. Vaccines engineered in the late 1950s paved the way for a precipitous drop in global disease burden with the onset of the World Health Organization-led (WHO) Global Polio Eradication Initiative (GPEI) starting in 1988. Recent indicators of the program’s success include a declaration of eradication in India[1] and a teeteringly low infection rate in Nigeria;[2] two of the disease’s last bastions. This progress, however, has been notably stifled by the steady persistence of a wild poliovirus reservoir centered in northern Pakistan along the Afghanistan-Pakistan (Af-Pak) border. Throughout significant portions of recorded history this region’s volatility has been well-documented, including a currently sustained network for the training of terrorist fighters dating back to the period of the 1979 Afghan-Soviet War.[3] These networks serve to both attract fledgling radical jihadist recruits and supply fighters globally, markedly providing many of the transnational fighters taking part in the Syrian Civil War. Their movement in and out of the Af-Pak region has provided a major disease vector for poliovirus. The location of a terrorist network transit hub in by far the world’s largest remaining reservoir of wild poliovirus poses a major challenge for policymakers. Due to several factors, including a decline in healthcare infrastructure throughout the western world, the situation presents a legitimate epidemiological threat. However, the issue is more importantly an exemplar of the morphing nature of multidimensional threats, which are likely to become more prevalent in an era of globalization, failed states, and an inability to effectively address social issues amidst the threat of kinetic warfare...
Topic:
Security, Environment, Health, Terrorism, World Health Organization, Infectious Diseases, and Borders
Political Geography:
Pakistan, Afghanistan, South Asia, Middle East, and United States of America