Global Health and Foreign Policy Blog

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 called for malaria to be eradicated.

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.

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.

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.

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.

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, Why Cooperate?, the eradication of smallpox is probably the best single public investment the world has ever made.

However, smallpox may yet prove the exception. Other eradication efforts, including an earlier effort to eradicate malaria, all failed.

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.”

More national security and science than global health and foreign policy, but Rick Atkinson’s four-part “Left of Boom” 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 Iraq. IEDs have proven to be a low-tech and deadly way to attack U.S. troops as they travel the roadways of Iraq. U.S. 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. 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?”)

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. Retired General Montgomery C. Meigs who directs the Pentagon’s Joint IED Defeat Organization, provides a key observation:

“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… 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.”

In other words the artillery shells are not being fired at vehicles by a traditional army, but are coming at U.S. forces through a social network of insurgent financers, bomb-makers and low-level persons paid to place IEDs. Dealing with this social network is low-tech, requiring deep understanding of language, culture and insurgent social networks. 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.

Two photos from a friend witnessing the Saffron Revolution in Burma. Good information has been difficult to come by as the junta attempts to enforce a media blackout. Official (and by that I mean the military junta) data reports 9 deaths, while a recent high-level defector reports thousands of deaths. Here is our friend’s interview with a monk about events at the Eastern Gate of Shwedagon Pagoda:

“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.

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.”

“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.”

“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.”

“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.”

Burma has long been a terrible example of how violation of human rights contributes to worsening public health (warning, large pdf file). 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. Here’s hoping the Saffron Revolution succeeds for the health and political freedom of the Burmese.