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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
  • 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: Jason Marczak, Peter Schechter
  • Publication Date: 02-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Why is now the right moment to commission a poll on the US public's views toward Cuba and US-Cuba relations? Why is a new, nonpartisan Latin America center reaching out to grab the third rail of Latin American foreign policy in the United States? Both good questions. Sometimes in foreign policy, structural impediments or stark policy differences will stymie progress in a certain area. Relations with China could not proceed until the United States recognized a “one China” policy that forever downgraded US relations with Taiwan. An activist foreign policy with Africa was impossible until the United States denounced apartheid.
  • Topic: International Relations, Foreign Policy, Reform
  • Political Geography: Africa, United States, China, Cuba, Latin America
  • Author: Nicholas Dungan
  • Publication Date: 01-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Competitiveness encompasses all the factors that will serve to make a society, an economy, and a country successful in the globalized world of the twenty-first century. France and the United States rank among the most competitive countries overall, but both have seen their position decline in recent years in key attributes of competitiveness.
  • Topic: Economics, International Cooperation, Bilateral Relations
  • Political Geography: United States, Europe, France
  • Author: Blythe Lyons
  • Publication Date: 05-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: US national security is enhanced by energy security. The United States is enjoying a unique opportunity to bolster its energy security by increasing domestic production of oil and gas resources. The recent explosion in domestic unconventional production will allow an expanded bandwidth of US responses to the turmoil in the Middle East and Europe. If further exploited, the move toward energy self-sufficiency also gives the United States a cushion to reassess its global strategic policies. Expanding the domestic resource base further provides the United States with an industrial advantage in global commerce.
  • Topic: Energy Policy, International Trade and Finance, National Security, Oil
  • Political Geography: United States, Europe, Middle East
  • Publication Date: 07-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: To deal effectively with long-range global trends and near-term security challenges, the United States requires a broader application of all elements of national power or risks continued disjointed efforts in US global engagement. A transformed interagency balance is a hedge against uncertainty in a dramatically changing world.
  • Topic: Diplomacy, National Security, International Security, Military Strategy
  • Political Geography: United States
  • Author: Garrett Workman
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: With Transatlantic Trade and Investment Partnership (TTIP) negotiations underway, there is an increasing focus on the prospective economic benefits and potential policy changes resulting from an ambitious agreement. While modernizing trade rules will benefit businesses of all sizes on both sides of the Atlantic, TTIP will be especially critical for small and medium-sized enterprises (SMEs) that often struggle with the numerous administrative, legal, and regulatory barriers to exporting that slow down trade and hinder innovation. Given their limited financial and human resources, small businesses stand to gain exponentially from a transatlantic agreement that streamlines regulatory and customs processes.
  • Political Geography: United States, America, Europe
  • Author: Robert A. Manning
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: The shale revolution, the combination of computer-aided horizontal drilling and hydraulic fracturing known as “fracking,” already has had a profound multidimensional impact. After the breakthroughs in information technology (IT) and biotechnology, shale may be the most transformational technological change so far in the twenty-first century. This report argues that shale gas and tight oil has: begun to radically shift global energy markets and redraw the global energy map, forty years after the Arab oil embargo; dramatically shifted the outlook for US energy security and our national strategic calculus; altered geopolitics, making the Western Hemisphere—Canada, the United States, Mexico, Brazil—the new center of gravity for oil and gas production; turned the future of oil debate on its head; debate about whether or not “peak oil” has been reached is over. Now the issue is whether or not we are approaching “peak demand;” has altered market economics to slow the deployment of wind, solar, and nuclear energy and a transition to a post-petroleum economy; yet also reduced US greenhouse gas (GHG) emissions by displacing coal as a source of electricity; strengthened the US economy with cheap gas prices triggering a resurgence in US manufacturing and; potentially repositioned the United States vis-à-vis the Middle East and Asia.
  • Political Geography: United States, Middle East, Canada, Asia, Brazil, Mexico
  • Author: Peter Haynes
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: In a world of near-infinite computing power, ubiquitous connectivity, cloud-based services, and big data, the fact that the vast majority of countries holds elections using paper ballots appears an anomaly.
  • Topic: Government, Science and Technology, Reform
  • Political Geography: United States
  • Author: Robert A. Manning
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: US extended deterrence in Asia, involving the full spectrum from nuclear to conventional capabilities, faces an array of new challenges. Indeed, a dynamic, volatile, and more complex security landscape in the Asia-Pacific and globally has heightened regional security concerns and given deterrence and strategic stability a renewed importance in the period extending to 2025.
  • Topic: Conflict Prevention, Nuclear Weapons, International Security, Military Strategy
  • Political Geography: United States, Asia, Asia-Pacific