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1. Supporting Water Programming in the Sahel

Author:
Conor M. Savoy and Alexandra Norris
Publication Date:
09-2022
Content Type:
Special Report
Institution:
Center for Strategic and International Studies
Abstract:
The Sahel region of Africa is one of the most climate-affected regions in the world. Temperatures are rising 1.5 percent faster than the global average rate. Increasing temperatures and irregular rainfall have resulted in regular droughts and floods that disrupt traditional agropastoral patterns and contribute to broader instability and fragility. Lake Chad, a crucial water and livelihood source for 30 million people in the Sahel, has shrunk by 90 percent since 1960, displacing 2.3 million people and creating a humanitarian crisis. Periods of prolonged and intense drought and improper land use have degraded much of the soil in the Sahel. In Burkina Faso, over one-third of farmland is degraded, meaning some land cannot sustain agriculture even when there is enough rainfall. A rapidly increasing population, coupled with the impact of climate change, means more people are competing for diminishing water resources. This results in a vicious cycle of population growth, land degradation, and food instability. The greater the population, the greater the demand for food and the greater the use of unsustainable farming practices, exacerbating food scarcity and demand for additional farmland. As the U.S. Agency for International Development (USAID) updates its water strategy, it is important to examine the interplay of economic and conflict fragility, irregular migration, climate change, and water availability in the Sahel to identify interventions for greater resilience. In a region like the Sahel, water is critical to resilience and adaptation to the effects of climate change. While water strategy is not a cure-all, it can improve outcomes for other challenges. The Biden administration recently announced the new Partnership for Global Infrastructure and Investment (PGII), an initiative to mobilize private capital investment in infrastructure. The four pillars of this initiative—climate and energy security, digital connectivity, health and health security, and gender equality and equity—could support additional investments in water infrastructure.
Topic:
Climate Change, Environment, Health, Water, and Infrastructure
Political Geography:
Africa and Sahel

2. The Ending the HIV Epidemic in the U.S. Initiative: An Interim Assessment and Policy Recommendations

Author:
Jeffrey L. Sturchio, Mackenzie Burke, and Maclane Speer
Publication Date:
10-2022
Content Type:
Special Report
Institution:
Center for Strategic and International Studies
Abstract:
The Ending the HIV Epidemic in the U.S. (EHE) initiative is a promising federal program launched by the U.S. Department of Health and Human Services (HHS) in February 2019 with the aim of reducing new HIV infections by 75 percent by 2025 and 90 percent by 2030 (from a baseline of more than 38,000 new diagnoses in 2017). While the EHE initiative set ambitious targets for ending the HIV epidemic in the United States in the context of a sound and sensible plan, it is at present off track. Now, three years in—at the midpoint of the first EHE phase, which has a target of reducing new HIV infections to 9,250 people or fewer by 2025—is an opportune moment to assess its status and the challenges it faces. After a review of progress to date, this report examines the collision between the logical plan behind the EHE initiative and the complicated patchwork of programs that provide HIV prevention, care, and treatment to the diverse communities affected across all EHE jurisdictions. The analysis is informed by several roundtable discussions convened by CSIS with the participation of a representative group of people living with HIV/AIDS (PLWHA), community advocates, physicians, service providers, researchers, and policymakers who are implementing the EHE initiative around the country. The report concludes with policy recommendations in four areas: (1) meet people where they are by building programs that are centered on the needs of populations directly affected by the HIV epidemic; (2) address flexibility in design and implementation; (3) improve data, metrics, and accountability; and (4) heighten political advocacy to ensure future funding of the EHE initiative. A strong theme that runs throughout the report is that lessons from the global HIV response—the importance of building interventions from the ground up, of engaging with affected communities, and of taking an integrated approach across a spectrum of biomedical, clinical, social, behavioral, economic, and political dimensions—can inform and strengthen the U.S. domestic response to HIV/AIDS.
Topic:
HIV/AIDS, Health, Medicine, and Epidemic
Political Geography:
North America and United States of America

3. Transforming Health Crises with Pandemic Therapies Image

Author:
Katherine E. Bliss and J. Stephen Morrison
Publication Date:
11-2022
Content Type:
Special Report
Institution:
Center for Strategic and International Studies
Abstract:
The CSIS Commission on Strengthening America’s Health Security convened a working group on Covid-19 therapies in the fall of 2021 to develop policy recommendations aimed at strengthening U.S. leadership and global action to ensure development of, access to, and uptake of Covid-19 therapies worldwide. Drawing on insights gleaned through private meetings and roundtable discussions with pharmaceutical manufacturers, government officials, representatives of multilateral organizations, and nongovernmental organizations, and building on points raised in an interim report published in July 2022.
Topic:
Health, Pandemic, COVID-19, and Health Crisis
Political Geography:
Global Focus

4. The U.S. Department of Defense’s Role in Health Security

Author:
Tom Cullison and J. Stephen Morrison
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Protecting the homeland against biological threats begins with preventing those threats from reaching our shores. The Department of Defense (DOD) contributes to overall U.S. health security through programs specifically aimed at countering biological threats from all sources—through public health activities coordinated with civilian counterparts at home and abroad and through research and development of medical countermeasures aimed at protecting U.S. Forces against health risks throughout the world. Civilian and military scientists, public health experts, and disaster planners are somewhat familiar with DOD’s health security capabilities, yet most lack a clear understanding of the breadth, depth, and limitations of DOD’s capacities. A solid and consistent U.S. policy framework has steadily evolved over the past few decades that identifies health as a national security issue and calls for a broad-based, inclusive national response to addressing the issue of health security. Now is the time to more fully integrate DOD’s unique expertise and capabilities in a more cohesive and efficient manner. This paper provides a broad overview of DOD health security activities and capabilities and also offers select concrete recommendations for strengthening the coherence and integration of DOD activities, with a special emphasis on leadership, novel diseases and new dangerous forms of resistance, surveillance, building host country capacities, and expanded exercises.
Topic:
Security, Defense Policy, Health, and Civil-Military Relations
Political Geography:
North America and United States of America

5. Engaging India: Guide to Developing Health Care Partnerships with States

Author:
Nicole Davis, Christa Twyford Gibson, and Jonathan Gonzalez-Smith
Publication Date:
08-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Indian states control most facets of healthcare delivery. Every state has a different set of healthcare delivery gaps and priorities. Understanding these gaps can help foreign institutions target cooperation more effectively- going to the right place with the right type of cooperation. But having a base for cooperation must be paired with an effective strategy to engage India's states. Issues such as states' political timelines, shifts in key bureaucrats, and other issues can have a major impact on potential projects. In this report, Innovations in Healthcare and CSIS lay out strategies employed by a range of international institutions with current subnational partnerships in India.
Topic:
Health, Governance, Health Care Policy, and Innovation
Political Geography:
India and Asia

6. Federal Funding for Biosafety Research Is Critically Needed

Author:
Rocco Casagrande
Publication Date:
08-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The advent of powerful new tools in biotechnology promises to open a new era in the battle against infectious disease. This research will undoubtedly lead to better capability to predict and prevent global outbreaks, and will support the development of new vaccines and treatments to reduce the burden of outbreaks we cannot prevent. The benefits afforded by these powerful tools are not without attendant risks. The threat of biological laboratory accidents is not commonly understood to be a serious health security concern similar in significance to the threats of emerging infectious diseases and biological attacks. However, scientists are just now creating viruses that exceed the transmissibility or pathogenicity of naturally occurring strains. Also contributing to the rising risk of accidents is the entry into the life sciences of scientists from other fields and hobbyists, who may be accustomed to weaker accountability measures, enjoy less training and weaker knowledge of safety and consequences of accidents, and yet are drawn to the tools of biology because of the expansive power they afford. Unlike accidents in transportation, chemical production, or even nuclear power, biosafety accidents can result in the unforeseen and uncontrolled infection of lab personnel or their local communities, the release of a pathogen into the environment, or even the initiation of a global pandemic that could reach millions. There is abundant concern among health security experts and U.S. policymakers over the threat of pathogens being deliberately released into communities by malevolent actors and terrorist attacks. While these concerns are valid, we are not paying enough attention to the costly and real risks of biological laboratory accidents that threaten similarly dangerous outcomes. The United States is underinvesting in the science of biosafety. The resulting lack of data and active research in the field leaves the biosafety community with little understanding of how accidents are likely to occur and impedes the identification of cost- effective measures to prevent accidents. This gap in knowledge could be addressed with a modest budget of $10 million per year given to the National Institute of Occupational Safety and Health to fund a dedicated U.S. biosafety research program. The funding is modest because the first step is to develop a research community that focuses on these issues; currently, the lack of funding has prevented focused attention on research in biosafety. With adequate funding, this research will lead to the development of cost-effective training programs to reduce human error in the laboratory, the redesign of risky experiments to prevent outbreaks before they occur, and the identification of cost-effective investments in laboratory safety equipment, which could make the conduct of life sciences research more efficient.
Topic:
Health, Science and Technology, Biosecurity, and Medicine
Political Geography:
North America and United States of America

7. Putin and Global Health: Friend or Foe?

Author:
J. Stephen Morrison and Judyth L. Twigg
Publication Date:
09-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Over the course of this decade, Russia has consciously enlarged its engagement and commitments, at home and in the wider world, in battling both tuberculosis (TB) and non-communicable diseases (NCDs). Despite these positive steps, Russia remains a serious global health security threat. There is a live risk of uncontrolled HIV/AIDS and drug-resistant tuberculosis (DR-TB) epidemics within Russia itself, as well as ongoing risk of export to neighbors in Eastern Europe and Central Asia, whose deep interdependence with Russia, including extensive migrant traffic, creates acute vulnerabilities. Beyond Eurasia, Russia stands out as one of several flashpoints in the world that could contribute to a resurgent HIV/AIDS and DR-TB epidemic that reverses the global gains of the past 15 years. Russia’s social media practices deliberately spread confusion and distrust surrounding a wide range of preventive health measures, ranging from vaccines to harm reduction. This analysis weighs Russia’s positive contributions against its multiple destructive actions in global health, examines what the overall pattern of Russian behavior means for U.S. policy, and concludes with a proposal for an expanded U.S. health security alliance with Eastern Europe and Central Asia. It argues that the United States should welcome Russian contributions and collaborate with serious Russian partners in the service of broader shared health goals. At the end of the day, however, Russia will only earn a legitimate global health leadership seat through progressive, evidence-based policies and actions, which can never be wholly segregated from the noise created by its geopolitically destabilizing actions.
Topic:
Health, International Cooperation, Public Health, and Pandemic
Political Geography:
Russia, Europe, North America, and United States of America

8. More Is Possible Now to Address North Korea’s Health and Humanitarian Needs

Author:
J. Stephen Morrison
Publication Date:
02-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
As President Trump and Kim Jong-un meet for their second summit in Hanoi, will there be serious consideration given to what concrete actions can be taken to protect and advance a health and humanitarian agenda that can directly benefit North Korea’s impoverished majority and reduce the threat of a runaway tuberculosis (TB) outbreak? Perhaps. Certainly, let’s hope so. There is much that can be done.
Topic:
Foreign Policy, Health, Poverty, and Humanitarian Crisis
Political Geography:
Asia, North Korea, North America, and United States of America

9. Indian State Priorities for Health Innovation Partnerships

Author:
Nicole Davis, Christa Twyford Gibson, and Jonathan Gonzalez-Smith
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Many international institutions—universities, foundations, companies, NGOs, and governments—would like to engage more deeply with the government of India to improve health outcomes. However, a lack of transparency, changing state-level priorities, and the absence of a single venue to learn about engagement opportunities holds back many potential partnerships. The Center for Strategic and International Studies (CSIS) Wadhwani Chair in U.S.-India Policy Studies and Duke University’s Innovations in Healthcare have launched the “Indian States Health Innovation Partnership” to address this information gap and encourage subnational health care cooperation between Indian government entities and external partners. The primary goal of this project is to strengthen health outcomes in India by methodically identifying which Indian states are ripe for innovative partnerships with international institutions and broadcasting these opportunities publicly to spur future partnerships. In the first phase of this project, the team developed a clearer picture of India’s state-level health care reform priorities and identified specific areas for potential partnership across four categories: capacity building, organizational delivery, financing, and specific health conditions.
Topic:
Health, Governance, Health Care Policy, Innovation, and Public Health
Political Geography:
India and Asia

10. Harnessing Multilateral Financing for Health Security Preparedness

Author:
Center for Strategic and International Studies
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The economic consequences of large-scale disease outbreaks can be enormous: pandemics could cause $570 billion per year in average economic losses over the coming decades. Health security threats have an especially destructive impact on development investments and GDP in low-income and lower-middle-income countries (LICs and LMICs): the 2014-2015 Ebola outbreak in West Africa wiped out nearly five years of existing investments in the region, gravely setting back the region’s future development prospects. By contrast, upgrading countries’ preparedness is relatively inexpensive and affordable; recent data demonstrates most countries would need to spend approximately $0.50-$1.50 per person per year to get an acceptable level of epidemic preparedness. The financing gap for preparedness is one of the starkest problems in health security, especially among LICs and LMICs. That gap is estimated at $4.5 billion per year. Investments in preparedness are cost-effective and affordable, but low-income and lower-middle-income country governments continue to underinvest at dangerously low levels. These governments bear lead responsibility for addressing financing gaps, but external funding can be catalytic. At present, there is no financing mechanism and no adequate incentive structure to motivate governments in high-risk countries to invest in preparedness, particularly when those investments compete with more visible priorities such as education, housing, transport infrastructure, and other pressing health needs. As a consequence, countries remain ill-prepared and vulnerable to the persistent threat of pandemics and large-scale disease outbreaks. The World Bank Group’s International Development Association (IDA) replenishment takes place every three years and presents a choice opportunity to make adjustments that reflect important emerging priorities. In the current IDA19 replenishment, stakeholders can take a major step towards closing the preparedness financing gap by incentivizing $1 billion or more per year in preparedness investments in LICs and LMICs.
Topic:
Security, Health, Multilateralism, and Public Health
Political Geography:
North America and United States of America

11. Venezuela’s Crisis Is Now a Regional Humanitarian Disaster

Author:
Moises Rendon and Mark L Schneider
Publication Date:
03-2018
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The Issue Venezuela has been subjected to an unprecedented man-made humanitarian crisis, including extreme food and medicine shortages, thousands of children dying of malnutrition, and malnourished people contracting formerly eradicated diseases. While Venezuela’s dictatorial regime has repeatedly rejected humanitarian aid from the outside, the country’s humanitarian, economic, social, and institutional collapse, along with fierce political repression, have caused 1.2 million Venezuelans to flee the country over the past two years, with hundreds of thousands more and possibly millions expected to flee in the future. Our Recommendations Encourage the United States and other like-minded countries to provide leadership on the diplomatic and assistance fronts to help respond to this crisis. Work to build consensus within the international community on the urgency of the Venezuelan humanitarian crisis and to agree on steps to address the crisis, including convening a high-level task force. Develop a comprehensive policy response that includes immediate relief efforts on Venezuela’s border with Colombia and within Venezuela using innovative mechanisms due to the current limited humanitarian access. Provide immediate technical assistance to help estimate the level of need and identify available resources. Support and engage civil society and local actors, including nongovernmental organizations (NGOs), the private sector, and entrepreneurs, as well as the Venezuelan diaspora community, to help limit the suffering of the Venezuelan people. Encourage host countries to grant temporary protected status to Venezuelans and create a broader burden-sharing arrangement in the region for processing those seeking refuge, following the recent guidelines by the UN High Commissioner for Refugees (UNHCR). Support the use of innovative technology tools, such as blockchain and digital currencies, to facilitate distribution of aid within and beyond Venezuela.
Topic:
Health, Poverty, United Nations, Food, and Humanitarian Crisis
Political Geography:
United States, South America, and Venezuela

12. U.S. Actions Can Help Keep Global Polio Eradication Strategy on Track

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, and Health Care Policy

13. Counting the Cost of South Africa's Health Burden

Author:
Richard Downie and 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 and Health Care Policy
Political Geography:
South Africa

14. Global Action toward Universal Health Coverage

Author:
Nellie Bristol
Publication Date:
01-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
As national incomes have risen across diverse countries—along with the burden of noncommunicable diseases—demand has intensified for quality, affordable health services. Many countries today are actively seeking to bring about universal health coverage—ensuring quality health services for all at a price that does not create undue financial pressure for individuals seeking care. The effort has stirred expanded interest and guidance from international organizations such as the World Health Organization and the World Bank, and led to new platforms for developing countries to learn from each other. While universal health coverage will provide new funding and opportunities, including for the private sector, there is a need for dynamic, transparent negotiations among all health constituents, to forge enduring, feasible arrangements that ensure quality services reach all populations and make the best use of scarce health resources. Universal health coverage will remain a work in progress for many countries for many years. It will require grappling with considerable uncertainties and risks. It also has the potential to attract greater attention to health spending, health systems, and improved equity, advances that will benefit human development more broadly.
Topic:
Development, Economics, Health, and International Organization
Political Geography:
Brazil

15. U.S.-Russia Health Engagement

Author:
Judyth L. Twigg
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Over the last few years, Russia's relationship with the United States has traveled a swift and seemingly deliberate arc from partner to pariah. The current turmoil in Ukraine and near-certain resulting isolation of Russia culminate several years' worth of deteriorating ties. The Edward Snowden mess, disagreements over Syria and Iran, dismay over the eroding human rights environment in Russia, and now Russian annexation of Crimea have led the previously heralded "reset" to an unceremonious end. What are the implications of these and related developments for U.S.-Russia collaboration in medicine and public health? Should avenues of partnership remain open, even in such a frosty political context? Should the international community support Russia's health sector when ample resources exist within Russia itself? Is it even possible anymore?
Topic:
Development, Diplomacy, Economics, Health, Human Rights, Human Welfare, and Bilateral Relations
Political Geography:
Russia, United States, and North America

16. The Global Youth Wellbeing Index

Author:
Nicole Goldin
Publication Date:
04-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Youth comprise a quarter of the world's population, but remain an underutilized source of innovation, energy, and enthusiasm in global efforts to achieve and promote the increased wellbeing of all. As children grow and mature into adults, they make choices that affect not only their own wellbeing, but that of their families, communities, and countries. Youth-inclusive societies are more likely to grow and prosper, while the risks of exclusion include stinted growth, crime, and unrest. Therefore, it is imperative that education and health systems, labor markets, and governments serve their interests and provide the policies, investments, tools, technology, and avenues for participation they need to thrive and succeed. Yet, at a time when policy and investment decisions are increasingly data driven, data on youth development and wellbeing is often fragmented, inconsistent, or nonexistent. Thus, our understanding of how young people are doing in their own right and vis-à-vis their peers elsewhere is limited. As a result, the needs of young people often remain unexposed and marginalized by their complexity.
Topic:
Security, Development, Economics, Education, Health, Human Rights, and Youth Culture

17. Family Planning and Linkages with U.S. Health and Development Goals

Author:
Janet Fleischman and Alisha Kramer
Publication Date:
04-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
For decades, the United States has been the global leader in supporting voluntary family planning services around the world. The benefits of family planning are numerous, not only for women's health, but also for increasing child survival, nutrition, education, and economic development, as well as preventing mother-to-child transmission of HIV. For these reasons, family planning is a core component of sustainable development.
Topic:
Health, Foreign Aid, and Health Care Policy
Political Geography:
Africa and United States

18. Replenishing GAVI in 2014: Options for U.S. Engagement

Author:
Katherine E. Bliss
Publication Date:
04-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Toward the end of 2014, the Global Alliance for Vaccines and Immunisation (GAVI) will host a pledging conference to generate funds for activities to be carried out during 2016–2020.
Topic:
Diplomacy, Health, and Foreign Aid
Political Geography:
United States

19. Repurposing Global Polio Eradication's Tool Kit

Author:
Nellie Bristol
Publication Date:
09-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The Global Polio Eradication Initiative (GPEI), a 26 year, $11 billion drive to eradicate poliovirus worldwide, is one of the largest public health initiatives ever. It is led by national governments together with the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the U.S. Centers for Disease Control and Prevention (CDC), Rotary International, and the Bill Melinda Gates Foundation. Involving a variety of partners from NGOs to universities and foundations and engaging millions of health workers and volunteers, the GPEI has provided billions of polio vaccine doses around the world. While it recently has faced new outbreaks and international spread of poliovirus, the GPEI has reduced the annual number of polio cases globally by more than 99 percent.
Topic:
Health, World Health Organization, and Health Care Policy
Political Geography:
India and United Nations

20. Improving Maternal, Neonatal, and Child Health in Ghana

Author:
Katherine E. Bliss and Cathryn Streifel
Publication Date:
11-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
In June 2014, a small team from the CSIS Global Health Policy Center traveled to Ghana to examine U.S. bilateral support for maternal, neonatal, and child health (MNCH). The purpose of the trip was to plan a return visit with a delegation of U.S. congressional staff in August 2014. Ghana's mixed progress toward meeting Millennium Development Goals (MDG) 4 and 5 related to maternal and child health; its strong relationship on immunizations with Gavi, the Vaccine Alliance; and its longstanding partnership on health with the United States were all reasons we decided to examine the country's MNCH situation. By late July, the acceleration of the Ebola outbreak in West Africa led us to postpone the trip until emergency preparations are not a major focus of the Ghanaian government, the United States, and other partners. Considering the fruitful meetings we had in June, we have captured here some of our initial impressions, observations, and recommendations.
Topic:
Health, Infectious Diseases, and Foreign Aid
Political Geography:
Africa, United States, and Ghana