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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: Amy Hawthorne, Frances G. Burwell, Danya Greenfield
  • Publication Date: 01-2015
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: A new Atlantic Council report warns against the tendency of Europe and the United States to sideline political and economic reform in the Middle East while they pursue urgent security priorities in this turbulent region. Instead, the transatlantic partners should forge a shared strategy to encourage political systems that can protect Arab citizens' basic rights, provide security, deliver broad prosperity, and mitigate violent extremism.
  • Political Geography: United States, Europe, Middle East
  • Author: Danya Greenfield, Faysal Itani
  • Publication Date: 02-2015
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: To cling to current short-sighted policies and to help sustain dysfunctional states in the Middle East for the sake of short-term security would condemn the region to poverty and further instability, which threaten to have negative consequences for US interests.
  • Political Geography: United States, Middle East
  • 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: Franklin D. Kramer, Melanie J. Teplinsky
  • Publication Date: 01-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: Cyber has become the new conflict arena. It ranks as one of the greatest national security challenges facing the United States for three reasons. First, as the revelations about the National Security Agency's (NSA's) activities suggest, cyber offense has far outpaced cyber defense. Second, cyber capabilities are prevalent worldwide and increasingly are being used to achieve the strategic goals of nations and actors adverse to the United States. Third, it is highly unlikely that cyber espionage and other cyber intrusions will soon cease. While the NSA disclosures focus on the United States and the United Kingdom, there is little doubt that China, Russia, Iran, North Korea and others are engaged in significant cyber activities. The fundamental question is whether the cyber realm can, consistent with the national interest, be made more stable and secure.
  • Topic: Defense Policy, Science and Technology, Military Strategy
  • Political Geography: Russia, United States, China, United Kingdom, Iran, North Korea
  • Author: Faysal Itani, Nathaniel Rosenblatt
  • Publication Date: 03-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: As the conflict in Syria enters its fourth year, US policy has consistently failed to achieve its stated object: a negotiated political transition based on the mutual consent of the regime and opposition. The United States and its Western allies have focused on summits and high-level diplomacy as the most effective means to that laudable end. This approach ignores an essential missing ingredient: an opposition able to coordinate different anti-regime forces, exercise agency on their behalf, and provide decent local governance, without which Syrians will continue to suffer and fight irrespective of whether the regime is overthrown.
  • Topic: Foreign Policy, Bilateral Relations
  • Political Geography: United States, Middle East, Syria, North America
  • Author: Bill Brownell, Scott Stone
  • Publication Date: 04-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: The release of the second installment of the Intergovernmental Panel on Climate Change's Fifth Assessment Report on March 31, 2014, provoked the usual calls for urgent and immediate action in response to climate change, including in particular at the international level in the form of a new climate treaty built upon domestic regulatory regimes. Irrespective of whether these calls for action are overly strident or carefully measured, the law plays a central role. In almost any discussion, the breadth and stringency of national and sub-national regulations and the extent to which a treaty can make them “legally binding” assumes paramount importance. But this emphasis on law is misplaced, because it runs headlong into the hard reality that would confront any international climate agreement in the US Senate. And given the soaring use of coal around the world, it also draws attention and resources away from far more achievable opportunities to develop and deploy advanced coal technologies that would allow the world's most abundant, accessible, and affordable energy resource to meet critical energy needs in balance with each country's environmental, economic, and security priorities.
  • Topic: Security, Climate Change, Economics, Energy Policy
  • Political Geography: United States, North America
  • Author: Franklin D. Kramer
  • Publication Date: 04-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: As the Ukraine crisis demonstrates, in an unpredictable world, military capabilities can be a critical factor. The longstanding goals of the United States and its NATO allies have been to create a Europe whole and free, and globally to support such goals through collective defense, crisis management, and cooperative security. Ukraine raises the issue of how best to accomplish those ends. As part of the Ukraine response, there have been and will continue to be diplomatic, economic, and energy efforts. However, one key element will be to create more effective integrated capabilities that will support NATO's military tasks, and thus the values and goals that NATO represents.
  • Topic: NATO, Diplomacy, Economics
  • Political Geography: United States, Europe, Ukraine, North America
  • Author: Pinar Dost-Niyego, Orhan Taner
  • Publication Date: 04-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: The recent events in Ukraine have revived the question of European dependence on Russian natural gas. The security of Europe's natural gas supply has been a consistently important issue in Russian-European Union (EU) relations. Russia provided 34 percent of EU gas in 2012, and Russian policies can have a direct impact on EU supplies. After the West-Russian confrontation over Ukraine, a lot has been said about the 'US shale gas revolution' and the possibilities of the United States becoming an energy exporter for future European energy needs. Although US energy independence seems to promise new perspectives for future European energy security, as well as for the balance of power in the Middle East, this is not for this decade. We cannot expect that the European Union would be able to cut off all of its energy relations with Russia, but we can foresee–or at least agree–that the European Union should diversify its natural gas supplies.
  • Topic: Security, Foreign Policy, Economics, Energy Policy
  • Political Geography: Russia, United States, Europe, Ukraine, Middle East, Asia
  • Author: Faysal Itani
  • Publication Date: 06-2014
  • Content Type: Policy Brief
  • Institution: Atlantic Council
  • Abstract: Jihadists are steadily capturing territory and resources and establishing a state in Syria and Iraq. The most capable jihadist group, the Islamic State of Iraq and Sham (ISIS), now controls swathes of territory, energy resources, and sophisticated military hardware in both countries. Although the extremists are currently occupied with fighting other nonregime armed groups and the Syrian and Iraqi regimes, these efforts are a means to an end: building a state from which to confront and target the United States, its allies, and its interests in the region. These jihadist groups also bring boundless suffering to the populations they control, and serve as a magnet for and inspiration to jihadists worldwide.
  • Topic: Security, Foreign Policy, Terrorism, Armed Struggle, Sectarianism, Sectarian violence
  • Political Geography: United States, Iraq, Middle East, Syria