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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: 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: Ukraine is once again at a potential turning point in its young history. It missed the opportunity at independence and during the Orange Revolution to make a decisive break with an authoritarian past and move decisively toward an open, market-oriented society. Yet Ukrainian civil society remained vibrant and late last year once again spoke out against the country's authoritarian and corrupt leaders. As a result of the protests from an enraged citizenry, then-President Viktor Yanukovych fled the country for Russia.
  • Topic: Security, Territorial Disputes, Governance, Reform
  • Political Geography: Russia, Europe, Ukraine
  • 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
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: In advance of the 2014 NATO Summit in Wales, United Kingdom, the Atlantic Council asked a select group of future leaders (ages twenty-five to thirty-five) in NATO member and partner countries about the role of the Alliance today. CEOs, elected officials, civil society leaders, PhD researchers, legislative staff, veterans, and active duty military officers were among the respondents.
  • Topic: NATO, Diplomacy, International Cooperation, Treaties and Agreements
  • Political Geography: Russia, United Kingdom, Europe
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: One of the greatest successes of our new century has been the progress made in unifying Europe. The accession of Central Europe's countries to the European Union (EU) has contributed to the end of division that wrought confrontations and conflicts. Yet this task is far from finished. Europe's economic woes, as well as new security challenges along the Union's eastern border add to the urgency of completing and consolidating the European integration project as part of our transatlantic vision of a Europe whole, free, and at peace.
  • Topic: Markets, Communications, Infrastructure
  • Political Geography: Europe
  • Author: Atlantic Council, CEEP
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: One of the greatest successes of our new century has been the progress made in unifying Europe. The accession of Central Europe's countries to the European Union (EU) has contributed to the end of division that wrought confrontations and conflicts. Yet this task is far from finished. Europe's economic woes, as well as new security challenges along the Union's eastern border add to the urgency of completing and consolidating the European integration project as part of our transatlantic vision of a Europe whole, free, and at peace.
  • Topic: Economics, Energy Policy, Science and Technology, Infrastructure
  • Political Geography: Europe, Central Europe
  • Publication Date: 05-2013
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: For too long, the United States and Europe have failed to embrace Latin America as a partner in a broader transatlantic community. Modern Latin America, like the United States, springs from a common European heritage and shares the historical, political, and philosophical roots that bind the West so closely together. The region is of growing strategic importance, with its expanding markets, energy resources, and global economic reach. But while Latin America is changing rapidly, the United States and Europe have been slow to sufficiently recognize and embrace this new world, missing crucial policy and business opportunities.
  • Topic: Economics, International Cooperation, International Trade and Finance
  • Political Geography: United States, Europe, Latin America
  • Publication Date: 05-2013
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: The analysis of the eurozone crisis is often limited to an assessment of its impact on the political and economic future of the European Union. Far less attention is given to how the crisis will shape Europe's role in the world and how other corners of the globe perceive Europe as a strategic actor. The economic crisis that began in 2008 has now become a multidimensional political crisis for both the northern and southern countries of Europe, and the trends do not all go in the same direction.
  • Topic: Economics, International Trade and Finance, Financial Crisis
  • Political Geography: Europe