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  • Author: Maxine Builder
  • Publication Date: 01-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
  • Topic: Health, National Security, Infectious Diseases, Health Care Policy
  • Political Geography: United States, China, United Kingdom, America, Europe
  • Author: Elizabeth Pond
  • Publication Date: 01-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: In the Ukraine crisis, soft economic power last month trumped hard military power for the first time. The threatened meltdown of the Russian economy could push Russian President Vladimir Putin to dial down his undeclared war on Ukraine in return for some easing of Western financial sanctions. Still, that is not assured.
  • Topic: Economics, Bilateral Relations
  • Political Geography: Russia, Ukraine
  • Publication Date: 02-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: We face a critical juncture in Ukraine. There is no real ceasefire; indeed, there was a significant increase in fighting along the line of contact in eastern Ukraine in mid-January, with Russian/separatist forces launching attacks on the Donetsk airport and other areas. Instead of a political settlement, Moscow currently seeks to create a frozen conflict in eastern Ukraine as a means to pressure and destabilize the Ukrainian government. Russians continue to be present in the Donetsk and Luhansk oblasts in substantial numbers and have introduced significant amounts of heavy weapons. This could be preparation for another major Russian/ separatist offensive.
  • Topic: NATO, Government
  • Political Geography: Russia, United States, Ukraine, Moscow
  • Author: Andrii Klymenko
  • Publication Date: 08-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: The “green men” who fanned out across Crimea in early 2014, establishing control over key infrastructure and clearing the way for once-marginal political actors to seize the reins of power, were the vanguard of a forced political change that has led to grave human rights abuses across the Crimean peninsula. Firmly in control of the executive and law enforcement bodies, the so-called Crimean authorities ostensibly implemented the law of the Russian Federation but in reality created a hybrid system where Russian law is subsidiary to the whims of “selfdefense forces” and “republican authorities.” Those forces derive their power from their weapons rather than from the support of the local population. In an environment where brute force rules the day, the international community has lost access to basic information about political, economic, and social developments on the Crimean peninsula. As a result, human rights abuses, now a regular part of life in Crimea, are left unreported or poorly understood. Freedom House and the Atlantic Council’s Dinu Patriciu Eurasia Center are proud to present Andrii Klymenko’s report, Human Rights Abuses in Russian-Occupied Crimea. His work makes an important contribution to our understanding of what has happened in Crimea since the Kremlin forcibly seized the peninsula in February 2014, setting off a crisis that is transforming security calculations in Europe and Eurasia.
  • Author: Senator Lisa Murkowski, Senator Mark Warner, Bud Coote, David L. Goldwyn
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Senator Lisa Murkowski (R-AK), Chairwoman of the Senate Energy and Natural Resource Committee, and Senator Mark Warner (D-VA), co-chaired the Atlantic Council Global Energy Center's US Energy Boom and National Security task force, which convened foreign policy, defense, and energy experts. The experts assessed how the United States can strengthen American leadership, advance international security, and promote global prosperity by leveraging necessary hydrocarbon export policies and deploying US prowess in energy innovation and technology to others. The task force report, Empowering America: How Energy Abundance Can Strengthen US Global Leadership, makes the case for a more robust energy strategy that capitalizes on US energy resources to advance our foreign policy and economic interests. It calls on US policymakers to repeal the crude oil export ban, ease the process of licensing for LNG exports, sustain research and investment in clean energy technology, support energy diplomacy and technical assistance abroad, advance North American energy integration efforts, and more. The report unequivocally concludes that, if properly utilized, American energy abundance will be an extremely valuable tool that favorably impacts global energy security, trade, and US foreign policy.
  • Author: Pavel Vidal, Scott Brown
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Cuba's Economic Reintegration: Begin with the International Financial Institutions is the first major policy publication on Cuba's role in the global economic community since the December announcement of new policies toward Cuba. The team of authors include Cuban economist Pavel Vidal and former Senior IMF Economist Scott Brown, a former mission chief for Albania. Beyond examining conditions in Cuba, the report also looks to the successful reintegration of previously isolated economies such as Vietnam and Albania as possible models for Cuba. It calls on the United States to put aside longstanding objections to Cuban membership to the IFIs and for Cuban authorities to re-evaluate why this may be the moment to take steps toward engaging the international organizations. Joining the IFIs could provide necessary technical assistance to transition the economy, spur economic growth, assist with infrastructure development, and improve the lives of everyday Cubans.
  • Author: Maksymilian Czuperski, John Herbst, Eliot Higgins, Alina Polyakova, Damon Wilson
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Russia is at war with Ukraine. Russian citizens and soldiers are fighting and dying in a war of their government's own making. Russian President Vladimir Putin continues to deny Russian involvement in the fighting, but the evidence is overwhelming and indisputable. Drawing upon open source information, Hiding in Plain Sight: Putin's War in Ukraine provides irrefutable evidence of direct Russian military involvement in eastern Ukraine.
  • Author: Magnus Nordenman
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: For more than a decade, NATO has been engaged in expeditionary ground-centric operations that have shaped the strategic thinking, capabilities, and planning of the Alliance and its members. But moving forward, NATO must also consider its role in the global maritime domain as it relates to transatlantic security and interests, as well as NATO operations. The maritime domain is increasingly competitive and contested, and the return of geopolitical competition has important maritime dimensions. Russian aggression to the east and Mediterranean turbulence to the south present unique maritime challenges for European security.
  • Author: John Roberts
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Russia has proposed building a major new pipeline intended to carry gas to customers in both Turkey and the European Union. The project, dubbed Turkish Stream, is controversial for two interconnected reasons. Firstly, it is intended to help Gazprom fulfil its stated intention of terminating gas exports to Europe via Ukraine by the end of 2019. Secondly, it is far from clear that customers in the European Union would accept delivery of gas at Turkey's border with Greece in place of current deliveries to locations in Central Europe.
  • Author: Bilal Y. Saab
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Securing the Middle East after an Iran nuclear deal is the next big challenge for both the region and the international community. The United States and its allies have engaged in tireless diplomacy with Iran over the past few years to produce an agreement that would limit Tehran's nuclear program for the next decade and a half. However, the hard work does not stop here; in fact, it may have just begun. To protect the deal (assuming one is finalized) and take full advantage of its potential benefits, which include the drastic reduction of the risk of nuclear weapons proliferating in the region, the United States needs a comprehensive strategy for regional security in the Middle East. A potential nuclear deal with Iran—as strategically significant as it is—is only one piece of the Middle East security puzzle