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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: Mariana Magaldi de Sousa
  • Publication Date: 03-2015
  • Content Type: Working Paper
  • Institution: Centre for International Governance Innovation
  • Abstract: Expanding the access of financial services to low-income households and other disadvantaged groups has become an important public policy goal in the past decade. Many developing economies have encouraged the introduction of a variety of programs, services and branchless banking instruments ranging from automatic teller machines to cell phones to reach people for whom traditional, branch-based structures, had not. After the 2008 global financial crisis, the leaders of the Group of Twenty (G20) recognized the need to further promote these initiatives as key components in the development of healthy, vibrant and stable financial systems that contribute to sustainable economic growth and lower levels of income inequality. As a result, financial inclusion has become one of the new areas of international financial regulation coordination, alongside shadow banking, resolution regimes and new capital requirements.
  • Topic: Development, Economics, Health
  • Author: Vijaya Ramachandran, Benjamin Leo, Robert Morello
  • Publication Date: 02-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The need for infrastructure improvements is a top-tier economic, political, and social issue in nearly every African country. Although the academic and policy literature is extensive in terms of estimating the impact of infrastructure deficits on economic and social indicators, very few studies have examined citizen demands for infrastructure. In this paper, we draw upon survey data to move beyond topline estimates of national infrastructure access rates towards a more nuanced understanding of service availability and citizen demands at the regional, national, and sub-national level. We find a predictable pattern of infrastructure services across income levels—lower income countries have fewer services. The survey data also allows us to observe the sequencing of infrastructure services. On the demand side, survey respondents are most concerned with jobs and income-related issues, as well as with the availability of infrastructure: specifically transportation and sanitation. These priorities transcend demographic factors, including gender and location (urban/rural).
  • Topic: Health
  • Political Geography: Africa
  • Author: Jacopo Bonan, Philippe LeMay-Boucher, Douglas Scott, Michel Tenikue
  • Publication Date: 05-2015
  • Content Type: Working Paper
  • Institution: Kellogg Institute for International Studies
  • Abstract: This paper studies the effects of information about malaria and of bednet distribution strategies on the demand for anti-malaria bednets, using a randomized experiment in the city of Thiès in Senegal. We offer two orthogonal treatments to a random sample of households. The first is a sale treatment and consists of 1) an offer to purchase on the spot a bednet at a subsidized price or 2) an offer to purchase a bednet at the same subsidized price with a voucher valid for seven days. The second is an information treatment that consists of a ten-minute information session on malaria-related issues. We find that information has no significant effect on the demand for bednets and that receiving a voucher increases purchasing by 20%. Our results suggest that selling bednets at a subsidized price and allowing for some flexibility with a short period of seven days increases purchase compared to the on-the-spot sale approach.
  • Topic: Health, Human Welfare, Humanitarian Aid, Health Care Policy
  • Political Geography: Africa
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: International Crisis Group
  • Abstract: The accelerating deterioration of Venezuela’s political crisis is cause for growing concern. The collapse in 2014 of an incipient dialogue between government and opposition ushered in growing political instability. With legislative elections due in December, there are fears of renewed violence. But there is a less widely appreciated side of the drama. A sharp fall in real incomes, major shortages of essential foods, medicines and other basic goods and breakdown of the health service are elements of a looming social crisis. If not tackled decisively and soon, it will become a humanitarian disaster with a seismic impact on domestic politics and society, and on Venezuela’s neighbours. This situation results from poor policy choices, incompetence and corruption; however, its gravest consequences can still be avoided. This will not happen unless the political deadlock is overcome and a fresh consensus forged, which in turn requires strong engagement of foreign governments and multilateral bodies.
  • Topic: Democratization, Development, Health, Food, Financial Crisis
  • Political Geography: Latin America
  • Author: Nellie Bristol
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Center for Strategic and International Studies
  • Abstract: The Global Polio Eradication Initiative (GPEI) in April 2013 unveiled an ambitious six-year strategy aimed at finally ending polio worldwide. The four-pronged approach called for stopping transmission in the remaining polio endemic countries while also eliminating rare but paralyzing vaccine-related polio. It outlined plans to ensure proper laboratory and health facility containment of poliovirus as eradication neared. Lastly, the Polio Eradication & Endgame Strategic Plan 2013–2018 urged countries, donors, and international partners to begin planning for the transition of polio program resources to country heath systems and other health initiatives. The drive to eradicate polio is at a pivotal point. The number of cases is down globally compared to last year. Polio programs in both Nigeria and Pakistan are moving in a positive direction while progress in Afghanistan is holding steady. A successful move to bivalent OPV would greatly reduce the number of polio cases caused by vaccine viruses and set the stage for an eventual worldwide switch to IPV. But extraordinary efforts still are required to reach the endgame strategy’s goals.
  • Topic: Health, Infectious Diseases, Health Care Policy
  • Author: Richard Downie, Sahil Angelo
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Center for Strategic and International Studies
  • Abstract: South Africa’s health system is approaching a make or break moment. Can it complete a set of complex organizational reforms and place itself on a sustainable financial footing that will enable it to deliver first-rate health care services to patients? Or will a stalled political process, economic stagnation, and the country’s daunting—and expanding—health burden torpedo the reform effort and cause the system to grind to a halt, with dire consequences for the nation’s health? CSIS explored these questions on a recent research trip to South Africa. This report summarizes the findings
  • Topic: Health, Health Care Policy
  • Political Geography: South Africa
  • Author: Katharina Hauck, Peter C. Smith
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrheal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption? We use economic models of public choice, supported by examples, to explain how powerful interests groups, politicians or bureaucrats who pursue their own objectives, or voting and institutional arrangements in countries have shaped health priority setting. We show that it may be perfectly rational for policy makers to accommodate these constraints in their decisions, even if it implies departing from welfare maximizing solutions.
  • Topic: Health, Political Economy, Health Care Policy
  • Author: Carol Graham, Shaojie Zhou, Junyi Zhang
  • Publication Date: 06-2015
  • Content Type: Working Paper
  • Institution: The Brookings Institution
  • Abstract: The past two decades in China brought unprecedented rates of economic growth, development, and poverty reduction. Indeed, much of the reduction in the world’s extreme poverty rates during that time can be explained by the millions of people in China who exited poverty. GDP per capita and household consumption increased fourfold between the years 1990 and 2005.1 China jumped 10 places forward on the Human Development Index from 2008 until 2013, moving up to 93 of 187 countries, and life expectancy climbed to 75.3 years, compared to 67 years in 1980.
  • Topic: Development, Economics, Health, Human Welfare
  • Political Geography: China
  • Author: Philip Saure
  • Publication Date: 07-2015
  • Content Type: Working Paper
  • Institution: Peterson Institute for International Economics
  • Abstract: With its cost- and time-intensive research and development, the pharmaceutical sector can generate large trade imbalances. These imbalances may arise because investment and output occur in different years; they are sizable if pharmaceuticals account for a large and growing share of exports. Switzerland's recent trade surplus results from this effect, which also explains why the Swiss trade surplus is exceptionally resilient. The Swiss trade surplus is, therefore, a poor indicator for exchange rate assessments.
  • Topic: Foreign Exchange, Health, International Trade and Finance, Markets
  • Political Geography: Switzerland