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Lessons from COVID-19: A Catalyst for Improving Sanctions?

26 August 2020

Emanuela-Chiara Gillard

Associate Fellow, International Law Programme
As the COVID-19 pandemic continues, efforts by states and humanitarian actors to stop its spread and to treat the sick are being hindered by existing sanctions and counterterrorism measures.

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Syrians walk past a mural painted as part of an awareness campaign by UNICEF and WHO, bearing instructions on protection from COVID-19, in the Kurdish-majority city of Qamishli, Syria, on 16 August 2020. Photo by Delil Souleiman/AFP via Getty Images.

If sanctions imposed by the UN Security Council, the EU, or states unilaterally, are not sufficiently targeted, and do not include adequate safeguards for humanitarian action, they can adversely affect the very populations for whose well-being they were imposed in the first place.  This is not a new concern, but one brought starkly to the fore by their impact on responses to COVID-19.

The detrimental impact of sanctions, which can prevent the supply of medical or personal protective equipment (PPE), or the provision of technical support or training to local health authorities is evident. Sanctions can also affect remote learning if support cannot be provided to local education authorities, export licences cannot be obtained for the necessary equipment and software, or if the companies providing reliable internet coverage are designated under the sanctions.

A comparison of US and EU sanctions on Syria reveals key challenges, but also opportunities for improving current arrangements for the imposition and implementation of sanctions so as to minimize adverse consequences in Syria and more generally.

The US has imposed broad sanctions, such as restrictions on the provision of funds, goods or services – even charitable contributions – to the Syrian government, including the health and education ministries, now playing a central role in the COVID-19 response.

UN agencies are exempted from these restrictions. A general license authorizes NGOs to conduct activities to meet basic needs, but it excludes those involving the government. So NGOs wishing to provide medical devices, PPE, training or other support to ministry of health staff have to apply for a specific licence.

But procedures for applying for licences are complicated, and the approval process notoriously slow.  No accommodation has been made to facilitate the COVID-19 response: no interpretative guidance – that would be valuable for all NGOs – has been issued, and no procedures established for reviewing applications more quickly.  There is no statement of policy indicating the circumstances under which specific licences might be granted.

Transactions with designated entities other than the government, such as internet providers whose services are necessary for remote learning, remain prohibited, and regulations expressly preclude applying for specific licences.

US sanctions frequently have a broad scope, both in direct and indirect application.  NGOs registered in the US, and staff who are US nationals, are directly bound by them, and grant agreements between the US government and non-US NGOs require the latter to comply with US sanctions.

This leaves the non-US NGOs in a Catch-22 situation – as they are not ‘US persons’ they cannot apply for specific licenses, but if they operate without such licences they may be violating grant requirements. This lack of clarity contributes to banks’ unwillingness to provide services, and may lead NGOs to curtail their activities.  This situation is regrettable in Syria, where the US is the first donor to humanitarian action, and also arises in other contexts where the US has imposed similar sanctions.

The EU’s sanctions for Syria are far more targeted. Of relevance to the COVID-19 response, they do not include prohibitions on the provision of support to the government that could impede assistance in the medical field.  There are, however, restrictions on the provision of certain types of PPE or substances used for disinfection, and also on transactions with designated telecommunications providers that affect continuity of education during lockdowns.  Although not prohibited, these activities must be authorized by member states’ competent authorities. Similar concerns arise about the complexity and delays of the processes.

The EU sanctions framework is complex, so the recent European Commission Guidance Note on Syria providing official clarification of how it applies to humanitarian action is welcome.  Although the note only explains the existing rules rather than amending them to facilitate the COVID-19 response, it does include a number of important elements relevant not just to Syria, but to the interplay between sanctions and humanitarian action more broadly.

First, it notes that ‘in accordance with International Humanitarian Law where no other option is available, the provision of humanitarian aid should not be prevented by EU restrictive measures’.  This recognizes that humanitarian assistance takes priority over any inconsistent restrictions in sanctions, and it also applies both to UN sanctions and unilateral measures. It is a starting premise that is frequently overlooked in discussions of whether sanctions should include exceptions for humanitarian action.  Its reaffirmation is timely, and it must guide states in drawing up future sanctions.

Second, the note states that sanctions do not require the screening of final beneficiaries of humanitarian programmes.  This means that once someone has been identified as an individual in need on the basis of humanitarian principles, no further screening is required.  This is extremely important to COVID-19 responses as it reflects a foundational principle of IHL that, to the fullest extent practicable, everyone is entitled to the medical care required by their condition without distinction.

Third, while responsibility for the implementation of sanctions, including the granting of authorizations, lies with member states, the note nudges them to adopt a number of measures to expedite and streamline such processes.  These include the suggestion that states could issue a single authorization for the provision of humanitarian aid in response to the pandemic.

The European Commission is to be commended for this initiative, which should be replicated for other contexts where the COVID-19 response may be undermined by sanctions.  These include Gaza, where it would be important to highlight that the designation of Hamas under EU counterterrorism sanctions must not prevent the provision of assistance to relevant ministries.

Failing to draw a distinction between the designated political party and the structures of civil administration risks turning targeted financial sanctions into measures akin to comprehensive sanctions.

The pandemic should serve as a catalyst for improving the system for the adoption and implementation of sanctions by the UN, the EU and individual states, including the UK as it elaborates its sanctions policy post-Brexit. The principles are clear: without prejudicing the aims for which sanctions have been imposed, humanitarian needs must always be prioritized, and met.




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Rage Against the Algorithm: the Risks of Overestimating Military Artificial Intelligence

27 August 2020

Yasmin Afina

Research Assistant, International Security Programme
Increasing dependency on artificial intelligence (AI) for military technologies is inevitable and efforts to develop these technologies to use in the battlefield is proceeding apace, however, developers and end-users must ensure the reliability of these technologies, writes Yasmin Afina.

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F-16 SimuSphere HD flight simulator at Link Simulation in Arlington, Texas, US. Photo: Getty Images.

AI holds the potential to replace humans for tactical tasks in military operations beyond current applications such as navigation assistance. For example, in the US, the Defense Advanced Research Projects Agency (DARPA) recently held the final round of its AlphaDogfight Trials where an algorithm controlling a simulated F-16 fighter was pitted against an Air Force pilot in virtual aerial combat. The algorithm won by 5-0. So what does this mean for the future of military operations?

The agency’s deputy director remarked that these tools are now ‘ready for weapons systems designers to be in the toolbox’. At first glance, the dogfight shows that an AI-enabled air combat would provide tremendous military advantage including the lack of survival instincts inherent to humans, the ability to consistently operate with high acceleration stress beyond the limitations of the human body and high targeting precision.

The outcome of these trials, however, does not mean that this technology is ready for deployment in the battlefield. In fact, an array of considerations must be taken into account prior to their deployment and use – namely the ability to adapt in real-life combat situations, physical limitations and legal compliance.

Testing environment versus real-life applications

First, as with all technologies, the performance of an algorithm in its testing environment is bound to differ from real-life applications such as in the case of cluster munitions. For instance, Google Health developed an algorithm to help with diabetic retinopathy screening. While the algorithm’s accuracy rate in the lab was over 90 per cent, it did not perform well out of the lab because the algorithm was used to high-quality scans in its training, it rejected more than a fifth of the real-life scans which were deemed as being below the quality threshold required. As a result, the process ended up being as time-consuming and costly – if not more so – than traditional screening.

Similarly, virtual environments akin to the AlphaDogfight Trials do not reflect the extent of risks, hazards and unpredictability of real-life combat. In the dogfight exercise, for example, the algorithm had full situational awareness and was repeatedly trained to the rules, parameters and limitations of its operating environment. But, in a real-life dynamic and battlefield, the list of variables is long and will inevitably fluctuate: visibility may be poor, extreme weather could affect operations and the performance of aircraft and the behaviour and actions of adversaries will be unpredictable.

Every single eventuality would need to be programmed in line with the commander’s intent in an ever-changing situation or it would drastically affect the performance of algorithms including in target identification and firing precision.

Hardware limitations

Another consideration relates to the limitations of the hardware that AI systems depend on. Algorithms depend on hardware to operate equipment such as sensors and computer systems – each of which are constrained by physical limitations. These can be targeted by an adversary, for example, through electronic interference to disrupt the functioning of the computer systems which the algorithms are operating from.

Hardware may also be affected involuntarily. For instance, a ‘pilotless’ aircraft controlled by an algorithm can indeed undergo higher accelerations, and thus, higher g-force than the human body can endure. However, the aircraft in itself is also subject to physical limitations such as acceleration limits beyond which parts of the aircraft, such as its sensors, may be severely damaged which in turn affects the algorithm’s performance and, ultimately, mission success. It is critical that these physical limitations are factored into the equation when deploying these machines especially when they so heavily rely on sensors.

Legal compliance

Another major, and perhaps the greatest, consideration relates to the ability to rely on machines for legal compliance. The DARPA dogfight exclusively focused on the algorithm’s ability to successfully control the aircraft and counter the adversary, however, nothing indicates its ability to ensure that strikes remain within the boundaries of the law.

In an armed conflict, the deployment and use of such systems in the battlefield are not exempt from international humanitarian law (IHL) and most notably its customary principles of distinction, proportionality and precautions in attack. It would need to be able to differentiate between civilians, combatants and military objectives, calculate whether its attacks will be proportionate against the set military objective and live collateral damage estimates and take the necessary precautions to ensure the attacks remain within the boundaries of the law – including the ability to abort if necessary. This would also require the machine to have the ability to stay within the rules of engagement for that particular operation.

It is therefore critical to incorporate IHL considerations from the conception and throughout the development and testing phases of algorithms to ensure the machines are sufficiently reliable for legal compliance purposes.

It is also important that developers address the 'black box' issue whereby the algorithm’s calculations are so complex that it is impossible for humans to understand how it came to its results. It is not only necessary to address the algorithm’s opacity to improve the algorithm’s performance over time, it is also key for accountability and investigation purposes in cases of incidents and suspected violations of applicable laws.

Reliability, testing and experimentation

Algorithms are becoming increasingly powerful and there is no doubt that they will confer tremendous advantages to the military. Over-hype, however, must be avoided at the expense of the machine’s reliability on the technical front as well as for legal compliance purposes.

The testing and experimentation phases are key during which developers will have the ability to fine-tune the algorithms. Developers must, therefore, be held accountable for ensuring the reliability of machines by incorporating considerations pertaining to performance and accuracy, hardware limitations as well as legal compliance. This could help prevent incidents in real life that result from overestimating of the capabilities of AI in military operations. 




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Seven Ways the West Can Help Belarus

10 September 2020

Ryhor Astapenia

Robert Bosch Stiftung Academy Fellow, Russia and Eurasia Programme
Outlining the key steps that government, international institutions, and NGOs can take to bring an end to the suffering of the Belarus people.

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Opposition supporters hold white-red-white flags at a Minsk protest in support of Belarusian opposition activist Maria Kolesnikova. Photo by Natalia FedosenkoTASS via Getty Images.

1. Acknowledge the new reality

A huge number of Belarusians across all levels of society simply no longer recognize Lukashenka as their legitimate president. The unprecedented size and persistence of protests against his regime and the sheer scale of reports of repressive actions, torture, and even murder, mean Belarus will never be the same again.

However, current paralysis in EU policy and the absence of a comprehensive US policy are both serving as a de facto licence for Lukashenka to deepen the political crisis. The sooner policymakers realize this and act with more responsibility and confidence, the quicker the increasing repression can be reversed.

2. Do not recognize Lukashenka as president

If the international community stops recognizing Lukashenka as president, it makes him more toxic to others, including Russia and China, both of which will be reluctant to waste resources on someone who is seen as the main cause of Belarusian instability. Even if Russia still decides to save Lukashenka and financially support him, ignoring Lukashenka decreases the legitimacy of any agreements he signs with the Kremlin on collaboration or integration.

Demanding a re-run of the presidential election should also remain firmly on the agenda as functionaries within Lukashenka's system should know this international pressure is not going away until a truly transparent vote takes place.

3. Be present on the ground

In order to curb repression and establish ties with actors within Belarus, a monitoring group should be organized under the auspices of the UN, the OSCE or other international organizations to establish a presence on the ground, and to stay in the country as long as it is needed, and is possible. Governments and parliaments can send their own missions, while staff from international media and NGOs should be encouraged to report on what is actually happening inside the country.

The bigger the visible presence of the international community is in Belarus, the less brutal Lukashenka’s agencies can be in persecuting protestors, which in turn would then allow more substantial negotiations to take place between the democratic movement and Lukashenka.

4. Announce a package of economic support for a democratic Belarus

The Belarusian economy was already in bad shape before the election, but the situation is going to get much worse. The only way out is support from the international community with a ‘Marshall Plan for a democratic Belarus’. States and international financial institutions should declare they will provide significant financial assistance through grants or low-interest loans, but only if there is democratic change first.

It is essential to make this economic package conditional on democratic reform, but also that it will have no geopolitical strings attached. If a democratically-elected government decides it wants to improve relations with Russia, it should still be able to count on an assistance package.

This would send a strong signal to economic reformers who remain inside Lukashenka's system, giving them a genuine choice between a functioning Belarusian economy or sticking with Lukashenka, whose leadership is seen by many as to be responsible for ruining the country’s economy.

5. Introduce targeted political and economic sanctions

The Lukashenka regime deserves tough sanctions internationally, but so far only selective visa restrictions or account freezes have been imposed, which have little to no effect on what is actually happening on the ground. Visa sanction lists need to be expanded but, more importantly, there should be increased economic pressure on the regime. Companies which are the most important to Lukashenka's business interests should be identified and targeted with sanctions, all their trading activity halted, and all their accounts abroad frozen.

Governments should also persuade their own country’s large companies to reconsider working with Belarusian producers. It is shameful that international corporations continue to advertise in media controlled by Lukashenka and appear to be ignoring the reports of human rights violations at Belarusian companies they do business with.

Moreover, there should be a deadline set to halt all repression, or broader economic sanctions will be imposed. This would send a strong message to Lukashenka and also his entourage, many of whom would then become more convinced he has to go.

6. Support NGOs to investigate allegations of torture

There are few legal mechanisms to prosecute those thought to be involved in election fraud and acts of brutality. Nevertheless, all reports of torture and falsifications should be properly documented by human rights defenders, including identifying those alleged to have taken part. Gathering evidence now prepares the ground for investigations, targeted sanctions, and leverage on law enforcement officials in the future.

But, given that such an investigation is not possible in Belarus right now, international human rights activists should be enabled to start the process outside the country with support from Belarusian NGOs.

7. Support known victims of the regime

Even with an unprecedented campaign of solidarity among Belarusians, many people need support, especially those alleged to have suffered torture. Some media outlets claim to have lost a significant amount of revenue because advertisers were forced to pull out, and journalists arrested. Human rights defenders need funds to keep organizations running in the heat of this crackdown.

Supporting all these people and organizations will cost tens of millions of euros, but it would significantly ease the huge financial burden facing those who have opposed the regime.




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Novichok Poisons Germany's Relations with Russia

14 September 2020

John Lough

Associate Fellow, Russia and Eurasia Programme
The conclusion of a specialist German military laboratory that Alexey Navalny was poisoned with the nerve agent novichok has shocked Germany’s political class and is forcing the government to re-assess relations with Russia.

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A worker at the construction site of a section of the Nord Stream 2 natural gas pipeline near Kingisepp, Leningrad Region. Photo by Alexander DemianchukTASS via Getty Images.

When Chancellor Angela Merkel offered to provide medical care for Navalny in Germany after he fell ill from suspected poisoning in Russia, she could have hardly expected her humanitarian gesture would trigger a crisis in her country’s relations with Russia.

Merkel has used uncharacteristically blunt words to condemn the apparent attempt on Navalny’s life, saying the use of novichok raises serious questions that only the Russian government could answer. She described Navalny as being the ‘victim of a crime’ which was a violation of the ‘basic values and basic rights’ that Germany and its allies were committed to. Her tone and body language certainly showed how strongly she felt about the issue.

Germany’s Social Democrat foreign minister Heiko Maas then followed up by suggesting Russia’s response might force Germany to change its position on the construction of the Nord Stream 2 pipeline which aims to double Germany’s direct gas imports from Russia under the Baltic Sea.

This is a dramatic change of position since his party has been a staunch supporter of the controversial project. Two Christian Democrat candidates for the Chancellorship called for a stop to the pipeline together with representatives from the Greens, who could be part of a government coalition after the 2021 federal election.

Claims of hostile provocation

The Russian foreign ministry shot back with a statement condemning Berlin’s ‘unsubstantiated accusations and ultimatums’ and claiming Germany was using Navalny’s hospitalisation to discredit Russia internationally. It demanded Germany share data and test results with the Russian Prosecutor’s Office, saying any failure to comply would be ‘a crude hostile provocation against Russia’ that risked consequences for the bilateral relationship as well as ‘serious complications in the international situation’.

Such strong language from Moscow towards Germany has not been seen for over 30 years, and is all the more remarkable as Putin has personally invested heavily in the relationship with Germany in view of its economic and political importance, and its strong desire for constructive ties with Russia. Until 2014, Russian analysts viewed Germany as Russia’s ‘lobbyist’ in Europe.

Berlin is now trying to downplay the situation, claiming the Navalny poisoning is not actually a Germany-Russia matter and referring it to the Organisation for the Prohibition of Chemical Weapons. By consulting with its EU and NATO allies, Berlin is further internationalising the issue to reduce impact on the bilateral relationship.

Such a forceful reaction to the poisoning reflects Germany’s increasing frustration with the Kremlin. The murder in broad daylight in Berlin in August 2019 of a Chechen wanted by the Russian authorities has been traced to the FSB. And the publication of a report in May 2020 into the hacking of the German parliament in 2015, including Merkel’s parliamentary office, was a further reminder of how far Russia had deviated from the course of partnership that Berlin believed the two countries had established in the 1990s.

Merkel described the cyberattack as ‘monstrous’, saying it was part of a strategy of hybrid warfare that includes ‘disorientation’ and ‘manipulation of facts’. Further tension has been added since the recent Belarus election as Moscow is supporting Lukashenka’s presidency whereas the EU does not recognise him as the legitimate president.

This accumulation of events is forcing German policymakers to recognise the Russian leadership is a menace to its own citizens, its neighbours and to Germany itself. Although Berlin abandoned several of its illusions about partnership with Russia in 2014 when it led the EU response to Russia’s annexation of Ukraine and destabilization of south-eastern Ukraine, it still hoped that the Kremlin would see reason and adjust its policies.

It combined sectoral economic sanctions with continuing dialogue and a joint effort to help settle the conflict in Donbas despite the obvious fact that Russia was a party to the conflict. It still believed that Moscow had an interest in finding a compromise. Instead, experience so far suggests Russia has a greater interest in keeping the conflict ‘semi-frozen’ as a way of forcing Ukraine to compromise.

Controversially, Germany also saw the need to expand energy relations with Russia in a bid to stabilise ties and draw Russia closer to Europe. The Nord Stream 2 pipeline initiated in September 2015 by Gazprom and five European companies – two of them German – is a monument to this policy.

Even though this project lacked an overall economic rationale, the German government supported it – much to the consternation of the Baltic States, Poland and others who objected to what they saw as Berlin’s insistence on a ‘Russia-first’ policy that undercut the interests of Ukraine. This was because the pipeline’s purpose is to re-route gas flows away from Ukraine, depriving it of transit revenues and a lever of influence in its relations with Moscow.

It now appears the German government is finally waking up to the fact that its attempts to encourage better Russian behaviour have failed. Policy looks set to become tougher and a moratorium on Nord Stream 2 now appears a real possibility if Russia fails to investigate the Navalny poisoning and provide adequate answers.

However, sanctioning the new pipeline is likely to provoke counter-measures against German business interests in Russia. If Berlin is determined to pursue this tougher line, it could end up facing an uncomfortable dilemma and being forced to consider alternative ways to signal displeasure at Russia’s criminal actions.




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Kuwait: Brighter Future Beckons for Domestic Violence Sufferers

16 September 2020

Dr Alanoud Alsharekh

Associate Fellow, Middle East and North Africa Programme
The passing of a new family protection law is a major step forward for a country which has long suffered from high levels of hidden domestic abuse. But much work remains to be done in ensuring the principles it enshrines are translated to practical action and support for victims.

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Safa Al Hashem MP holds a red rose to mark Valentine's Day at the National Assembly in Kuwait City on February 14, 2017, the year a domestic violence bill was first introduced. Photo by YASSER AL-ZAYYAT/AFP via Getty Images.

Domestic violence has always been a complex issue in Kuwaiti culture, often tied to norms and beliefs relating to family structures and concepts of guardianship, honour and discipline. As with other forms of abuse within the family, it is also considered a private matter and therefore not addressed publicly.

Despite a lack of up to date figures, the problem is widespread, affecting 53.1% of women in Kuwait according to a 2018 study. But Kuwait’s last submission to the Committee on the Elimination of Discrimination against Women (CEDAW) showed only 447 domestic violence cases had been through the court system in 2016, and only 76 of those resulted in a conviction. Given the known difficulties of reporting abuse and getting a case to court, it is not a stretch to conclude the actual figures of abused women is much higher than this figure given by the Ministry of Justice.

In one recently reported case, a pregnant woman was shot in the head and killed by one of her brothers while she was recovering in the in the intensive care unit of Mubarak Hospital from being shot by her other brother the day before. The reason for such a horrific double attack was she had married without her sibling's consent, even though her father had accepted the match.

Worryingly, activists and experts claim domestic violence has been rising in Kuwait during COVID-19, in keeping with global trends during lockdowns, and aggravated by the lack of legal resources and shelters for survivors. Highlighting this unfortunate situation, along with worldwide interest in the issue of domestic violence within the current epidemic, did lead to renewed media interest in the issue in Kuwait, and brought the lack of resources available to abuse survivors into the public eye.

And it is this renewed attention – alongside the fact Kuwait is about to enter an election cycle in November – that may well have driven recent governmental and parliamentary moves on the long-awaited family protection law, which recently passed in Kuwait’s national assembly with 38 votes for, one MP abstaining, and another voting against.

But 17 MPs were conspicuously absent from the room, including the Women and Family Committee rapporteur Alhumaidi Alsubaei, known for his human rights activism. This signals how complex the social and political issues associated with domestic violence as, although the official version of the law is yet to be made public, the submitted bill contained 26 articles.

The articles call for the formation of a National Family Protection Committee to draw up plans countering the spread of domestic violence in Kuwait, as well as the review and amendment of existing national laws which may be perpetuating the violence. Other provisions cover mandatory training programs for all government sectors involved in family protection, awareness programmes on detection, reporting and survivor advocacy, and issuing an annual report about domestic violence statistics.

Article 5 specifically calls for activating a domestic violence shelter and offering rehabilitation and advisory services, while Article 13 tackles the punishment of those who try and coerce survivors not to report abuse. These two articles are especially important because, although the Fanar Advisory Service and Domestic Abuse Shelter was formally opened in 2017, it has never actually been functional due to the delay of legislation needed to make it operational. Described as a ’stillborn dream’, the unused building is surrounded by sewage water.

The new family protection law also gives important provision for cooperation with civil society organizations, such as Eithar, Abolish 153, and Soroptomists Kuwait working on this issue. Although Kuwait already has several official bodies meant to be dealing with ending violence against women, in reality it has been these groups effectively dealing with the plight of abuse survivors. With no functional shelters, dedicated hotlines or specialized resources to assist victims, Eithar and Soroptimists Kuwait provide resources and support, while Abolish 153 focuses on filling the hitherto legal vacuum.

The path to getting this law put to a vote has been a long and winding one. Back in 2017, Saleh Ashoor MP submitted the first version of the domestic violence bill when he was heading up the Women and Family Affairs Committee. At that time, the bill was signed by just four other MPs - Safa Al Hashem, Ahmad Al Fadhel, Khalil Al Saleh and Faisal Al Kanderi. But it was the starting point and, several iterations later, it is essentially a version of that proposal which has been voted into law.

Much of the delay over the past three years, both with the legislation and activation of the shelter, has been due to the fact there were many bodies involved, such as the Ministry of Interior, the Ministry of Social and Labor Affairs, and civil society representatives, all of whom at times had different agendas. But alongside the amendment to the press and publication law which also passed that same historic day in parliament, the family protection law is undoubtedly a major win for all those liberal civil society activists who have lobbied long and hard to change these dangerous and restrictive legislations in Kuwait.




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Saudi Leadership Must Focus on Innovation for the Future

16 September 2020

Dr Neil Quilliam

Associate Fellow, Middle East and North Africa Programme
A glorious year beckoned for Saudi Arabia, in leading the G20 and hosting the G20 Leaders' Summit in Riyadh in November. Instead, empowering its people and capitalizing on its youth should become the focus for an embattled leadership.

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Meeting of finance ministers and central bank governors of the G20 nations in the Saudi capital Riyadh on February 23, 2020. Photo by FAYEZ NURELDINE/AFP via Getty Images.

The G20 summit in November was to be a moment when the world focused its attention on Saudi Arabia. As the leaders of the world's 20 largest economies came together for the first time in an Arab capital and presided over the world’s greatest challenges and opportunities, King Salman would have taken centre stage with his son and crown prince Mohammed bin Salman not far behind in the spotlight.

However this will now be a virtual summit, and that is probably a blessing in disguise for the kingdom and its leadership which has not enjoyed a good year. It shares responsibility for crashing the price of oil, which, in conjunction with COVID-19, has brought the global economy to its knees. And it continues to be mired in the Yemen conflict, whereas its ally the United Arab Emirates (UAE) has, by and large, managed to extract itself while also seeking to rescue its reputation by signing a ‘peace deal’ with Israel.

More recently, it has been forced to push back plans to host the next instalment of ‘Davos in Desert’ until 2021 and the crown prince’s flagship charity Misk is currently under review. The Public Investment Fund (PIF) made a wholly unsuccessful bid to secure a major stake in Newcastle United Football Club which brought an unfavourable ruling at the World Trade Organization (WTO) and a heap of damaging media attention.

Squandered opportunity

Nothing washes away the stain of Jamal Khashoggi’s murder or the continuing imprisonment of women and men charged with being traitors. But in many ways, leading the G20 offered the Saudi leadership, especially Mohammed bin Salman, a chance to press reset and atone for some of the excesses of his more controversial policies, such as the war in Yemen and blockade of Qatar. But he appears to have squandered the opportunity so far and there are no signs that is about to change.

Hosting the summit in Riyadh would have given Mohammed bin Salman an opportunity to try and recapture the heady days of 2018, when many of the world's leaders and even the media still viewed him as a force for good. He would have had a captive audience and, instead of staying away from Western capitals which he has chosen to do recently, he could have been feted by world leaders on his home turf. Moreover, the presidency agenda — empowering people, safeguarding the planet, and shaping new frontiers — would have lent itself to meaningful engagement on key policy issues.

Although many analysts and commentators quite rightly argue that Riyadh’s focus on empowerment and safeguarding the planet is widely hypocritical given the kingdom has lurched further towards quashing any signs of opposition and remains highly dependent upon hydrocarbons, at least the ambitious goals of Vision 2030 ought to align with the G20 agenda. The goals of Vision 2030 remain aspirational and are far from ever being met, but there is synchronicity between the two agendas. In fact, the overview of Saudi Arabia’s G20 Presidency documentation states ‘the G20 agenda has a strong echo in the daily lives of the people in the Kingdom’.

Saudi Arabia really needs to empower its people and capitalize upon its youth dividend but that requires, as so many have argued persuasively, long-term investment in education, training, and skills acquisition, and will not be achieved overnight. It needs strategic thinking, capacity-building, commitment, scope for course correction, and patience. There are no quick wins, no shortcuts.

Safeguarding the planet is common to one and all but breaking a dependency upon hydrocarbons, diversifying its economy, and mitigating against the growing impact of climate change are all pressing issues Saudi Arabia needs to address. A failure to achieve these goals in a time-sensitive fashion poses a threat to the well-being of the kingdom and, in order to do so, it must empower its people and use technology wisely to advance the process. Saudi Arabia should be at the front of the pack, but is being surpassed by its neighbours and is in danger of being left way behind.

With its wealth and youthful population, the kingdom can be at the cutting edge of shaping new frontiers. It can deploy its substantive funds to support its own innovators and — to borrow the jargon — create an ecosystem that not only offers Saudis an environment fostering creativity, but also one that draws talent into the kingdom.

This does not mean investing in ‘white elephant’ projects that fail to spark the imagination of Saudis, or following the crowd to buy football clubs without rhyme or reason. It means gearing up to address everyday issues that preoccupy minds of Saudis, such as employment, housing, healthcare, and the well-being of family members. It is notable how the excitement of ‘bread and circus’ issues has abated and the focus moved once again towards family, faith and finance.

The Saudi presidency of the G20 is in danger of passing by with a whimper and the November summit may now be unremarkable. This does not mean the hard work of the continuously active engagement groups will go unnoticed or to waste, but it does mean the photo-opportunity will be passed up and the joint statement garner less interest than usual.

While it may feel like a lost opportunity for the kingdom and, in particular, Mohammed bin Salman, they should both breathe a sigh of relief. In many ways, they will be let off the hook by avoiding the direct scrutiny of the world’s media and human rights organizations. However, the crown prince could still seize the initiative given the spotlight will be on him, albeit from afar, and take bold steps towards resolving the thorny issues that have come to mar his pathway to power.




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First US Presidential Debate – Five Key Questions Answered

30 September 2020

Anar Bata

Coordinator, US and the Americas Programme

Dr Leslie Vinjamuri

Director, US and the Americas Programme; Dean, Queen Elizabeth II Academy for Leadership in International Affairs

Megan Greene

Dame DeAnne Julius Senior Academy Fellow in International Economics

Dr Christopher Sabatini

Senior Research Fellow for Latin America, US and the Americas Programme
On 29 September, US president Donald Trump went head-to-head with Joe Biden in the first presidential debate of the 2020 US election. Anar Bata spoke with experts across Chatham House to get their views on the key debate moments and the implications for the US election.

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People watch the first presidential debate between US President Donald Trump and Former US Vice President Joe Biden on 29 September 2020 in Hoboken, New Jersey. Photo: Getty Images.

What role do the presidential debates serve in encouraging voter turnout?

Leslie Vinjamuri: Going into the debates, 74% of Americans were set to tune in and watch according to a new Monmouth Poll. This is striking since more than 90% have already decided who their candidate will be, and many have already cast their ballots. 

During President Donald Trump’s time in office, Americans have been far more politically engaged than in previous periods. A record 49.3% of the voting eligible population turned out to vote in the 2018 midterm elections, according to the United States Election Project. This was the highest voter turnout since 1914, and it also reversed a downward trend. 

Debates don’t change voters’ minds and last night’s debate, the first between Donald Trump and Joe Biden is unlikely to be an exception. But debates can shape public sentiment and enthusiasm, not least for voting.

Polling confirms that Trump trails Biden by an average of around 7% nationally, but also that his base is highly enthusiastic. The same is not true for Biden: the older voters that support him are far more enthusiastic than younger voters that do the same.

How credible are Trump's claims that the US economy is experiencing a V-shaped recovery and Biden's claims that there is a K-shaped recovery? 

Megan Greene: Off the back of an unprecedented lockdown in the US and a resultant short and sharp contraction of the economy, the immediate recovery was swift and V-shaped. This is partly a reflection of significant support to Americans in the form of unemployment benefit enhancements and to businesses in the form of Paycheck Protection Program (PPP) loans. But as the economy reopened, growth was always going to rebound and a short-term V-shaped recovery was always going to materialize.  

Don’t be fooled by Donald Trump’s assertion that a V-shaped recovery will persist though. Most of the support for workers and small businesses expired in late July or early August and people and firms have stayed afloat by dipping into their savings. In the absence of another fiscal stimulus package—very unlikely before the end of the year—this is completely unsustainable.  

The K-shaped recovery that Joe Biden has suggested is far more likely going forward. The lockdown revealed extraordinary inequality in the US economy. The death toll of the virus on black and Asian Americans was higher than on white Americans. Huge disparities were laid bare in the labour market as well.

It was precisely those hourly service workers who saw few wage gains since the last recession who were first to lose their jobs in this crisis. The service workers who kept their jobs were real heroes—delivering our food, teaching our kids over Zoom, removing our trash—and yet have not been remunerated accordingly. Unemployment for high-income workers is nearly back to January 2020 levels, but is still down by over 15% for low-income workers.  

This trend will only get worse as small businesses go under and large, superstar companies step in to fill the void. This increase in market concentration reduces the number of potential employers from which workers can choose and reduces workers’ wage negotiating power.  

Rising inequality in the US is by no means a new trend, but as with many things it has been accelerated by the coronavirus crisis. Inequality will continue to drag on the economy if it is left unaddressed.

Did either candidate refer to America’s role in the world?

Leslie Vinjamuri: This debate could only have hurt America’s global image. This comes in the midst of a pandemic, when the gravest problems are at home, and when America’s global leadership depends on getting its house in order. Rather than restoring confidence, Donald Trump used the debates to undermine confidence in the elections and to stoke fear of violence in America’s cities.

By design, most of the debate was focused on domestic issues. But the candidates did discuss climate science, the one issue touched on that matters most beyond America’s borders. The difference between Trump's and Biden’s plans was stark and the debates made clear that America’s global leadership on climate change hinges on these elections.

Biden articulated a clear plan to reduce carbon emissions, create green jobs and invest in green infrastructure. When it comes to global leadership, this would bring the United States back into a debate that China has been leading. Last week, President Xi Jinping committed China to achieving carbon neutrality by 2060; Biden has committed the US to achieving this goal by 2050.

But Trump repeatedly deflected the moderator’s question about whether he accepted climate science. And when asked about the link between climate change and forest fires, he launched a series of attacks on forest managers.

In addition to Trump's comments on China and COVID-19, the only reference made to foreign policy was Biden's comments that he would be tougher on Russia. Did this debate reaffirm the notion that the majority of Americans prefer less engagement with the world? 

Chris Sabatini: According to the themes set by the moderator Chris Wallace and the debate committee, foreign policy was not scheduled to be among the topics covered in the 29 September debates. That will come up later. When it did appear in the first debates it was around largely domestic topics: COVID-19, allegations of corruption, concerns about trade and manufacturing and suspicions of Russian influence shaping the US elections and US foreign policy. 

That foreign policy surfaced in this debate and around those specific, partisan issues demonstrates not a lack of interest by US voters in the world but the ways in which extra-national influence is seen by some (and played by the candidates) as damaging US politics, society and the economy. The problem is that such fears don't make for coherent or constructive foreign policies, but rather reinforce a perception of the US as a victim. Let's hope the issue of foreign policy comes up and is discussed more thoughtfully and positively in future debates when it is on the docket.

How will this debate impact the rest of the race?

Leslie Vinjamuri: For voters at home, the most disturbing part of tonight’s debates should be Donald Trump’s repeated attacks on the integrity of the electoral process.  This comes on the heels of the president’s failure last week to confirm that he would respect the outcome of the elections.

Trump used the debates as a platform to launch a series of attacks on mail-in ballots, casting them as fraudulent and saying that people should just turn up and vote. The recent debates confirmed that when it comes to the pandemic, the economy, and especially the environment, the alternatives are stark and there is a lot at stake. Whether this drives voters to the polls, or to switch off the television remains to be seen.




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Inhibition of mitochondrial oxidative metabolism attenuates EMCV replication and protects {beta}-cells from virally mediated lysis [Immunology]

Viral infection is one environmental factor that may contribute to the initiation of pancreatic β-cell destruction during the development of autoimmune diabetes. Picornaviruses, such as encephalomyocarditis virus (EMCV), induce a pro-inflammatory response in islets leading to local production of cytokines, such as IL-1, by resident islet leukocytes. Furthermore, IL-1 is known to stimulate β-cell expression of iNOS and production of the free radical nitric oxide. The purpose of this study was to determine whether nitric oxide contributes to the β-cell response to viral infection. We show that nitric oxide protects β-cells against virally mediated lysis by limiting EMCV replication. This protection requires low micromolar, or iNOS-derived, levels of nitric oxide. At these concentrations nitric oxide inhibits the Krebs enzyme aconitase and complex IV of the electron transport chain. Like nitric oxide, pharmacological inhibition of mitochondrial oxidative metabolism attenuates EMCV-mediated β-cell lysis by inhibiting viral replication. These findings provide novel evidence that cytokine signaling in β-cells functions to limit viral replication and subsequent β-cell lysis by attenuating mitochondrial oxidative metabolism in a nitric oxide–dependent manner.




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Serum lipoprotein-derived fatty acids regulate hypoxia-inducible factor [Metabolism]

Oxygen regulates hypoxia-inducible factor (HIF) transcription factors to control cell metabolism, erythrogenesis, and angiogenesis. Whereas much has been elucidated about how oxygen regulates HIF, whether lipids affect HIF activity is un-known. Here, using cultured cells and two animal models, we demonstrate that lipoprotein-derived fatty acids are an independent regulator of HIF. Decreasing extracellular lipid supply inhibited HIF prolyl hydroxylation, leading to accumulation of the HIFα subunit of these heterodimeric transcription factors comparable with hypoxia with activation of downstream target genes. The addition of fatty acids to culture medium suppressed this signal, which required an intact mitochondrial respiratory chain. Mechanistically, fatty acids and oxygen are distinct signals integrated to control HIF activity. Finally, we observed lipid signaling to HIF and changes in target gene expression in developing zebrafish and adult mice, and this pathway operates in cancer cells from a range of tissues. This study identifies fatty acids as a physiological modulator of HIF, defining a mechanism for lipoprotein regulation that functions in parallel to oxygen.




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The bacterial cell division protein fragment EFtsN binds to and activates the major peptidoglycan synthase PBP1b [Metabolism]

Peptidoglycan (PG) is an essential constituent of the bacterial cell wall. During cell division, the machinery responsible for PG synthesis localizes mid-cell, at the septum, under the control of a multiprotein complex called the divisome. In Escherichia coli, septal PG synthesis and cell constriction rely on the accumulation of FtsN at the division site. Interestingly, a short sequence of FtsN (Leu75–Gln93, known as EFtsN) was shown to be essential and sufficient for its functioning in vivo, but what exactly this sequence is doing remained unknown. Here, we show that EFtsN binds specifically to the major PG synthase PBP1b and is sufficient to stimulate its biosynthetic glycosyltransferase (GTase) activity. We also report the crystal structure of PBP1b in complex with EFtsN, which demonstrates that EFtsN binds at the junction between the GTase and UB2H domains of PBP1b. Interestingly, mutations to two residues (R141A/R397A) within the EFtsN-binding pocket reduced the activation of PBP1b by FtsN but not by the lipoprotein LpoB. This mutant was unable to rescue the ΔponB-ponAts strain, which lacks PBP1b and has a thermosensitive PBP1a, at nonpermissive temperature and induced a mild cell-chaining phenotype and cell lysis. Altogether, the results show that EFtsN interacts with PBP1b and that this interaction plays a role in the activation of its GTase activity by FtsN, which may contribute to the overall septal PG synthesis and regulation during cell division.




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Inhibition of oxidative metabolism by nitric oxide restricts EMCV replication selectively in pancreatic beta-cells [Enzymology]

Environmental factors, such as viral infection, are proposed to play a role in the initiation of autoimmune diabetes. In response to encephalomyocarditis virus (EMCV) infection, resident islet macrophages release the pro-inflammatory cytokine IL-1β, to levels that are sufficient to stimulate inducible nitric oxide synthase (iNOS) expression and production of micromolar levels of the free radical nitric oxide in neighboring β-cells. We have recently shown that nitric oxide inhibits EMCV replication and EMCV-mediated β-cell lysis and that this protection is associated with an inhibition of mitochondrial oxidative metabolism. Here we show that the protective actions of nitric oxide against EMCV infection are selective for β-cells and associated with the metabolic coupling of glycolysis and mitochondrial oxidation that is necessary for insulin secretion. Inhibitors of mitochondrial respiration attenuate EMCV replication in β-cells, and this inhibition is associated with a decrease in ATP levels. In mouse embryonic fibroblasts (MEFs), inhibition of mitochondrial metabolism does not modify EMCV replication or decrease ATP levels. Like most cell types, MEFs have the capacity to uncouple the glycolytic utilization of glucose from mitochondrial respiration, allowing for the maintenance of ATP levels under conditions of impaired mitochondrial respiration. It is only when MEFs are forced to use mitochondrial oxidative metabolism for ATP generation that mitochondrial inhibitors attenuate viral replication. In a β-cell selective manner, these findings indicate that nitric oxide targets the same metabolic pathways necessary for glucose stimulated insulin secretion for protection from viral lysis.




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Coronavirus infection and PARP expression dysregulate the NAD metabolome: An actionable component of innate immunity [Molecular Bases of Disease]

Poly(ADP-ribose) polymerase (PARP) superfamily members covalently link either a single ADP-ribose (ADPR) or a chain of ADPR units to proteins using NAD as the source of ADPR. Although the well-known poly(ADP-ribosylating) (PARylating) PARPs primarily function in the DNA damage response, many noncanonical mono(ADP-ribosylating) (MARylating) PARPs are associated with cellular antiviral responses. We recently demonstrated robust up-regulation of several PARPs following infection with murine hepatitis virus (MHV), a model coronavirus. Here we show that SARS-CoV-2 infection strikingly up-regulates MARylating PARPs and induces the expression of genes encoding enzymes for salvage NAD synthesis from nicotinamide (NAM) and nicotinamide riboside (NR), while down-regulating other NAD biosynthetic pathways. We show that overexpression of PARP10 is sufficient to depress cellular NAD and that the activities of the transcriptionally induced enzymes PARP7, PARP10, PARP12 and PARP14 are limited by cellular NAD and can be enhanced by pharmacological activation of NAD synthesis. We further demonstrate that infection with MHV induces a severe attack on host cell NAD+ and NADP+. Finally, we show that NAMPT activation, NAM, and NR dramatically decrease the replication of an MHV that is sensitive to PARP activity. These data suggest that the antiviral activities of noncanonical PARP isozyme activities are limited by the availability of NAD and that nutritional and pharmacological interventions to enhance NAD levels may boost innate immunity to coronaviruses.




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COP27: Navigating a difficult road to Sharm El-Sheikh

COP27: Navigating a difficult road to Sharm El-Sheikh Expert comment NCapeling 6 July 2022

Against a backdrop of rising urgency, COP27 in Egypt will bring all aspects of climate action into the spotlight – but especially the role of the host country.

As COP26 drew to a close in Glasgow, Egyptian officials announced their priorities for COP27, emphasizing climate finance and climate adaptation – a new approach given previous COPs mainly focused on mitigation, reducing emissions to limit climate damage.

This was followed by the COP27 presidency outlining its vision at MENA Climate Week 2022 to achieve ‘substantive and equal progress’ on all aspects of the negotiations, and Egypt emphasizing its intention to focus on implementing existing carbon reduction targets rather than pushing for further carbon cuts.

Egypt argues it is hosting COP27 on behalf of African nations and that, while it is promoting the interests of the developing world, it will be an impartial arbiter. However it is also useful to consider its priorities from the Egyptian government’s perspective.

Agenda drivers

Egypt has long prioritized climate finance and adaptation because it remains in need of technical and financial support to adapt, especially in agriculture and tourism.

It plans to expand its access to climate funding and investment, an area in which Egypt has been relatively successful as it currently receives 27 per cent of all multilateral climate finance in the MENA region and has issued the region’s first sovereign green bonds.

With public debt currently 94 per cent of GDP, Egyptian officials have also called for debt relief for Egypt and other developing countries.

Egypt’s Climate Change Strategy reflects this approach, aiming to enhance Egypt’s rank on the Climate Change Performance Index in order to ‘attract more investments and acquire more climate funding’.

Not pushing for more emission reductions at this critical moment risks derailing global decarbonization momentum and undermining global climate action

Limiting the mitigation scope and the focus on finance also echoes Egypt’s own reluctance to make carbon reduction commitments. The Egyptian nationally determined contribution (NDC) – its 2030 pledge under the Paris Agreement – does not include any quantifiable emission reduction targets.

Egypt is one of only a few countries which failed to submit an updated NDC in 2021 and its upcoming update will not include an economy-wide carbon reduction target.

Egypt has also never published a long-term strategy and has no decarbonization plans despite independent estimates it should cut rising emissions by one-quarter by 2030, and by two-thirds by 2050 to be aligned with the Paris Agreement. This partly explains why observers rate Egypt’s climate action as highly insufficient.

Furthermore, Egypt’s championing of ‘moving from pledges to implementation’ without having quantifiable carbon reduction pledges of its own effectively exempts it from both pledging and implementation.

As a developing country, Egypt’s negotiating position is supported by UNFCCC provisions which recognize differentiated responsibilities and respective capabilities of nations.

Its proposal to focus COP27 on the implementation of climate action and finance pledges is important in consolidating progress. But not pushing for more emission reductions at this critical moment risks derailing global decarbonization momentum and undermining global climate action.

According to optimistic estimates, if current climate pledges were implemented the world would still remain on track for 2°C of warming by the end of the century, with far worse impacts than if warming was curbed at 1.5°C.

Under a 2°C scenario, 37 per cent of the global population could regularly be exposed to extreme heat waves compared to 14 per cent in a 1.5°C warmer world, with developing countries expected to be worst-affected.

A 2°C trajectory also runs the risk of tipping points such as the melting of ice sheets in Antarctica and Greenland, triggering runaway climate change. Time to change the warming trajectory is running out as the latest IPCC assessment warns the window of opportunity is now ‘brief and rapidly closing’, and the UN Secretary General recently called for faster carbon cuts by the end of 2022 to avoid a ‘climate catastrophe’.

A different energy transition

Egypt opted not to join any of the voluntary sectoral coalitions at COP26 on reducing methane, clean energy transition, transition to zero-emissions vehicles, or moving beyond oil and gas.

This position is explained by its growing role as an exporter and advocate for fossil gas in the energy transition. Egypt is the second-largest producer of natural gas in Africa and is emerging as a fossil gas hub for the eastern Mediterranean, which is shaping its domestic energy policy.

Egypt is open to dialogue – not just on refining the COP27 agenda but also on reviewing its own climate priorities and leveraging its energy sector for a more ambitious transition

Its 59GW electricity generation capacity is almost double the peak demand and is dominated by gas-powered electricity generation, which currently represents 42 per cent of all Africa’s gas generation.

Egypt’s climate policy is also shaped by fossil gas, and its national Climate Change Strategy encourages the expansion of gas use by promoting a transition to compressed natural gas for vehicles, the expansion of its domestic natural gas network – despite having universal access to electricity – and shifting to a gas-fuelled shipping sector.

Egypt also voiced support for other African countries to extract and deploy fossil gas and oil resources, making it one of the protagonists of the ‘great fossil gas pushback’. These advocates defend the right of developing countries to deploy fossil gas as a ‘transition fuel’ and champion its necessity to solve energy poverty.

But their position is not shared by all African and developing countries, and is rejected by some civil society groups, who argue it risks locking in greenhouse gases and local emissions for decades as well as delaying future development of low carbon energy systems.

Egypt’s huge spare generation capacity has contributed to a slowdown in renewable energy projects over the past two years. With renewables representing just 6GW, Egypt is expected to miss its renewable energy target for 2022, set at 20 per cent of generating capacity.

Engaging Egypt better

But these positions are more malleable than they seem, and Egypt is open to dialogue – not just on refining the COP27 agenda but also on reviewing its own climate priorities and leveraging its energy sector for a more ambitious transition.




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Now is the moment to launch an African vaccine industry

Now is the moment to launch an African vaccine industry The World Today mhiggins.drupal 31 July 2022

The continent plans to make 60 per cent of its vaccines by 2040. After the failure of the world to help in the pandemic, it’s high time, says Ngozi Erondu.

The lack of an African vaccine industry has been a glaring concern for decades. Before the pandemic, 99 per cent of Africa’s vaccines were manufactured outside the continent. As well as endangering the lives of millions, this situation has inhibited social and economic progress on the continent.

In response, the Africa Centres for Disease Control and Prevention (Africa CDC) has undertaken an ambitious plan, outlined in the Partnerships for African Vaccine Manufacturing (PAVM) Framework for Action, to develop the nascent African vaccine manufacturing sector into an end-to-end industry by 2040. The framework aims to raise the share of African-manufactured vaccines used across the continent to 60 per cent by 2040, or the equivalent to up to 1.7 billion doses annually.

Seven of every 10 vaccines used in Africa are currently donated through Gavi, the Vaccine Alliance. Most are administered within childhood immunization programmes and are largely manufactured either in India, or by  multinational vaccine manufacturers in North America or Japan.

Vaccine donations have inhibited the development in Africa of vaccines and other countermeasures against diseases.


Though the Ebola virus was discovered in Central Africa in 1976, vaccine development was not adequately funded until it emerged in Europe in 2014. Human monkeypox resurfaced in Nigeria in 2017, yet the global Coalition for Epidemic Preparedness Innovations only targeted it for vaccine development in July this year.

The pandemic highlighted Africa’s fatal dependency on imported vaccines. Only 20 per cent of Africans are fully vaccinated against Covid-19, due to the failure of countries in the Global North to ensure the equitable distribution of vaccines via the COVAX facility to 40 per cent of the world’s most vulnerable people. 

The pandemic also confirmed that Africa could not rely on fellow states of the Global South. At the height of the Delta variant outbreak in early 2021, India halted vaccine exports to Africa, where only 1.5 per cent of the population had at that time received any vaccine doses.

After decades of discussions, there are signs that Africa could soon succeed in creating its own vaccine industry. First, the 55-member African Union is in the process of establishing the African Medicines Agency, a regional regulatory body. 
 

‘The new public health order’

Additionally, the African Export-Import Bank and African Development Bank (AfDB) have established a foundation to provide financial and strategic support for the development of the pharmaceutical industry and the consolidation of regional vaccination programmes in Africa (the foundation would potentially negotiate intellectual property rights and licensing issues but that remains to be seen).

Second, studies show there is an emerging middle class in Africa. In a 2011 report by the AfDB, this was estimated at some 56 million households. Potentially, this means many people will be able to buy vaccines and medicines made in Africa.

About a third of African countries currently pay for their vaccine needs. According to PAVM forecasts, the value of the total African market could reach between $3 billion and $17 billion by 2040.

The recent entry into effect of the African Continental Free Trade Area should also prove conducive to African vaccine development. Through economic integration, free movement and harmonized regional standards, countries that invest in their biopharmaceutical and medical technology sectors may attract employees, regional and international businesses, and investment. Further, the pandemic has encouraged people to relocate to countries with, or planning for, universal healthcare.

Building an African pharmaceutical industry from the ground up could take much longer than two decades and cost tens of billions of dollars. Nevertheless, the moment seems ripe, and timely support has been forthcoming from influential regional actors, including Rwandan President Paul Kagame, South Africa’s Cyril Ramaphosa, and private sector business executives, including the Zimbabwean-born billionaire Strive Masiyiwa.

With a pandemic treaty embedding equity in prevention, preparedness and response some way off, and given the limitations surrounding the recent World Trade Organization compromise on the TRIPS waiver – which temporarily waives Covid-19 vaccine patent protections for poorer countries – it is doubly important for Africa to build up its own pharmaceutical industry and emergency systems. 

With a pandemic treaty some way off, it is important for Africa to build up its own pharmaceutical industry 


In 2021, John Nkengasong, then director of Africa CDC, wrote of the necessity of a post-pandemic ‘new public health order’ for Africa. Such a change may threaten the global health organizations, industries and institutes who derive payment from ‘saving Africa’ during emergencies. Additionally, through strengthening Africa CDC, other actors such as the World Health Organization may find that they have a diminished strategic role on the continent.
 
While Africa should not dismiss these valuable and long-standing partnerships, it must take the opportunity to advance its interests and to assume leadership in this important area.




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Review: Decolonization and its discontents

Review: Decolonization and its discontents The World Today mhiggins.drupal 1 August 2022

Jenna Marshall on a lively if flawed argument to find a way forward in a debate that has descended ‘into acrimony’.

Against Decolonization: Taking African Agency Seriously
Olufemi Taiwo, Hurst, £14.99

Decolonization was once heralded as a moment of potential and possibility for the formerly imperial world to chart a new way forward no longer tied to the apparatus of empire.

It marked a period of transition to nation states – and an expansion of a rights-based international community that would dispense with the morally bankrupt regime of racism, dispossession and subjugation that characterized colonialism.  
 

The descent of the decolonization debate

Half a century later, the debate surrounding decolonization has descended into acrimony. Some factions cast the issue of decolonization as a sustained attack on British and western culture writ large; other disparate voices coalesce around related social justice issues such as inequality, climate change and education. 

Decolonization has become ubiquitous in the public domain – and its ubiquity is the problem


Decolonization has become ubiquitous in the public domain – and its ubiquity is the problem. In Against Decolonization, Olufemi Taiwo renounces a concept he conceives as having been emptied of serious study and analytical purchase; one incapable of addressing the complexities of modern global politics and more importantly, Africa’s place in it. 

Although the book attacks the inexhaustible ways in which the ‘trope of decolonization’ has been deployed, Taiwo is less bothered by the purported failures of scholars he deems ‘decolonizers’ and focuses his attention instead on the political landscape of African countries, past and present. 

Central to the book’s argument are two distinct scholarly strands on decolonization. The first, legal focus, centres on the political and economic forces of state-building. The second essays an ‘ideology’ of decolonization that rests on ‘forcing an ex-colony to forswear on pain of being forever under the yoke of colonization any and every cultural, political, intellectual, social and linguistic artefact, idea, process, institution and practice that retains even the slightest whiff of the colonial past’. 

Whether one should characterize the latter as simply a field of study or a potential set of policy arrangements remains unclear – yet what is certain is that it is too nebulous, too elastic, too open-ended to offer any substantive model or mechanism to understand postcolonial Africa. 
 

Correcting Eurocentric narcissism

 The decolonization research agenda in Africa came to prominence during the Cold War period of national liberation struggles.

The intellectual project that followed centred on dismantling Eurocentrism as colonial subjugation through its promotion of the West as the crucible of legitimate and scientific knowledge. Since then, scholars have argued that decolonization itself has become compromised by its enduringly Eurocentric gaze at the expense of the agency of African thinkers, creatives and statesmen and women. 

Taiwo seeks to correct this narcissism – and the omissions left in its wake – by introducing lesser-known Africans and pan-African scholars and cultural figures. These voices, he hopes, will illuminate issues often ignored by ‘decolonizers’ and spark a ‘renewed interest in an appreciation of the many different ways in which African thinkers have responded to the colonial experience’.
 

The decolonization of language

Taiwo challenges the decolonization of language as an oversold promise.

Romanticizing an imagined, pristine African pre-colonial past, he says, ultimately leads to nativism and atavism. As a case in point, Taiwo highlights bureaucratic instances of ‘language policy planning’ to deploy African languages in places such as Niger, Mali, Cameroon, Senegal and Nigeria that were hindered by multilingualism, education and high rates of illiteracy.

The abstract language of decolonization allows western scholars to engage with the concept without considering their own complicity in upholding systems of exclusion

The author goes on to confront the abstract language of decolonization, which, he says, allows western scholars to unproblematically engage with the concept without any serious consideration of their own complicity in upholding systems of exclusion. It entrenches their own institutional power within the academy, amplifies their perspectives at the expense of others, and limits the possibilities for understanding the problems of world politics with deleterious effects on policy.

It is a serious claim, but there are issues to be addressed: Taiwo assumes there is coherence among scholars of decolonization, which is not the case. 

When Taiwo approaches how to foster political systems that cater to the needs of their citizens he dismantles the binary of ‘West as modern’ v ‘Africa as traditional’. Chieftaincies as traditional African governance, he points out, were the product of colonial anthropology, not Africans themselves. From the Fanti Confederation of 1871 to the Egba United Government in what is now Nigeria, Taiwo demonstrates that there has been a sustained tradition towards demands for democratic values. 

As he concedes an intellectual neglect of African philosophers that underlies the design and operations of Africa’s political institutions, Taiwo’s initial dismissal of the significance of cultural decolonization deserves another look. How should political and economic drives toward self-determination be advanced in the absence of knowledge shaped and mediated through African lived experiences?

In this respect, the tale of two decolonizations – the legal alongside the ideological – suggest an unhelpful, if not false, binary.
 

The problem of reconciling modernity and colonialism

What resonates throughout the book is the idea that Europe cannot profess to hold an exclusive intellectual claim to modernity. Its universal aspirations are open to all of humanity, allowing those who have historically been marginalized to be worldmakers. 

The idea that modernity and colonialism are irreconcilable is problematic. For instance, Taiwo argues that the curtailment of capitalism in Africa by restricting the growth of the middle classes while limiting competition between African capitalists and the metropole is the consequence of colonialism.

Capitalism not only requires inequality for it to function but that race – as a mechanism for producing ‘difference’ – enshrines it

Yet the celebrated cultural anthropologist Sidney Mintz established an understanding that the matter for debate is not whether non-westerners were part of the modern system, but how and to what degree they were included and able to actualise its ideals. 

The emerging capitalist world economy needed non-western lands and labour, and so they were conscripted to this end. Recent abolitionist and black radical scholarship has built on this argument to maintain that capitalism not only requires inequality for it to function but that race – as a mechanism for producing ‘difference’ – enshrines it.

Acknowledging the unacknowledged

In the end, Taiwo communicates a palpable frustration at the state of academic discourses on contemporary Africa under the guise of emancipatory and radical scholarship. He offers an alternative approach whereby African students might rid themselves of a faddism that is ‘at best unsatisfactory’ and at worst produces ‘confusion, obscurantism, if not outright distortion and falsification’.

Yet out of this irritation, Taiwo’s greatest contribution in Against Decolonization might be to urge an acknowledgement of how and to what degree decolonization has become subdued and its political possibilities curtailed. He ultimately urges us to reconsider the purpose of the decolonization academic movement as an ethics to abide by rather than a social theory of the postcolonial world. 

This requires those ‘decolonizers’ on whose careers the term is built to adopt greater intellectual humility – to resist the posture of the anarchist radical scholar armed for the ‘good fight’. Instead, they should apply a scholarly curiosity to genuinely engage with those already on the battlefield, so to speak; those ‘doing the work’ in practice, but who have been unacknowledged until now.




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Review: the rise of Africa’s superwomen

Review: the rise of Africa’s superwomen The World Today mhiggins.drupal 1 August 2022

From foster care in England to colonialism’s legacy in Zimbabwe, this set of essays on race, feminism and identity is searingly honest, says Masiyaleti Mbewe.

Black and Female
Tsitsi Dangarembga, Faber, £9.99

The 1988 novel Nervous Conditions by the Zimbabwean author Tsitsi Dangarembga is considered one of Africa’s finest literary exports. It won the Commonwealth Writers’ Prize and alongside The Book of Not (2006) and This Mournable Body (2018), shortlisted for the 2020 Booker Prize, forms a trilogy of semi-autobiographical novels that grapple with the gendered colonial oppression of young black girls and women from Southern Rhodesia through to Zimbabwe. 

In Black and Female, Dangarembga continues the interrogation of these intersections in an unflinchingly honest and personal, if occasionally dense, collection of essays. Along the way, she examines the sheer magnitude of colonialism’s effects on African people, and how they ripple through her early childhood in England and her formative years as a writer, filmmaker and feminist activist in post-independence Zimbabwe.

‘Writing While Black and Female’

In 1961 Dangarembga’s parents relocated from Southern Rhodesia to the UK. While they worked and studied in London, they put their two-year-old daughter, her older brother and, later, her younger sister into private foster care in Dover, Kent (as many Africans did – a fact that was new to me). The first essay, ‘Writing While Black and Female’, takes a painful look at the four years she spent with her foster parents, Mummy-Gran and Daddy Henry. 

Blackness, she learned in those years, was a consequence of her non-whiteness. So Dangarembga writes of the momentary elation she felt when a stranger addressed her as a ‘lovely little piccaninny’, giving her ‘a category I could wield against the void of no longer being’. To cope with this sort of racialization and her abandonment, the young Dangarembga turned to disassociation and self-harm. 

Blackness is a condition imposed on me, rather than being an experienced identity

Tsitsi Dangarembga

As she writes: ‘Blackness is a condition imposed on me, rather than being an experienced identity.’ Instead of ‘black’ people, therefore, Dangarembga prefers the term ‘highly melanated people’. It is a resonant phrase, highlighting the inherently ridiculous nature of racism.

Dangarembga’s ‘Africanness’ shifts into focus upon her return to Rhodesia in 1965. At first, other children refused to play with her and her siblings, calling them ‘varungu’ (white people). As she describes it: ‘The dance of my identities … became frenetic’. 

In ‘Black, Female and the Superwoman Black Feminist’, the second essay, Dangarembga is adamant about the urgent necessity of a black feminist practice that is centred on action to provide real, material change. Along the way, she makes a distinction – a slightly uneasy one to my mind – between the patriarchy that western colonization imposed, based on private ownership, and the patriarchy of pre-colonial African society with its foundations in kinship that devolved power to an extent.

Dangarembga’s discussion of a more accommodating, pre-colonial patriarchy is nuanced, but it jars a little


‘Hence women could and did become rulers and warriors, and royal spirit mediums called mhondoro,’ Dangarembga writes approvingly. She is making a nuanced point; but the idea of a more accommodating sort of patriarchy jars a little nonetheless.

While independence may have arrived for Zimbabwe more than 40 years ago, Dangarembga argues strongly that the subjugation of women and feminists at the hands of the ruling Zanu-PF government continues as an extension of colonial rule. Indeed, beyond Zimbabwe, black feminists remain ‘a small, often embattled group’ across Africa, believes Dangarembga. 

Pointedly, she criticizes global feminism’s greater focus on optics than on practical activism

 

As a young black feminist who is part of this ‘small, embattled group’, I should say we have been able to foster large communities digitally and otherwise to work around the hostility we are often faced with. Despite internet shutdowns and restrictions, we resist – an act Dangarembga encourages.  

Resistance, she says, starts with establishing community despite these difficulties. At the nucleus of Dangarembga’s argument is the ‘superwoman’ of the essay’s title, the African woman who doesn’t require external factors to be inspired to action but who continuously draws on what Dangarembga calls ‘internal agency’ that derives from ‘an unrelenting fight for survival and dignity’.

Pointedly, she criticizes global feminism’s greater focus on optics than activism in the practical sense. One only has to observe the performative allyship and ‘Instagram activism’ rampant on the internet today to see her point.
 

The complexities of decolonization

In the final essay, ‘Decolonization as Revolutionary Imagining’, Dangarembga turns her gaze upon the ‘highly stratified’ European societies that outsourced their violent inequality to their empires and ‘the work of decolonization’. However, decolonial discourse is complex, and it is here that the writing occasionally gets bogged down. Fewer recommendations with more elaboration perhaps would have helped.

She herself acknowledges the difficulties of decolonization. Centuries of the Enlightenment and its logic of ‘racism, slavery, genocide and colonization’ are hard to uproot ‘whatever one’s melanin concentration’, she writes.

Nevertheless, Dangarembga concludes with the radical determination to dismantle that is evident throughout this searing yet hopeful collection: ‘The trajectory of current and future generations depends on that uprooting.’




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Youth innovation can help shape the future of African cities

Youth innovation can help shape the future of African cities Expert comment LToremark 16 August 2022

To meet the challenges of rapid urbanization, African governments must harness the potential of young innovators to help shape the future of African cities.

It is projected that 1.3 billion people will be living in Africa’s cities by 2050, an increase of almost 1 billion from today, and largely driven by young people migrating to urban centres in search of work. As the continent’s urban population grows, cities will need to adapt by nurturing new economic ecosystems to create jobs, while managing the environmental, social and political pressures that urbanization brings.

The evolution of Africa’s cities is critical for meeting the demands of its youth population and must be co-created with them. Africa’s young innovators are already proving to be an asset in shaping the future of African cities and, if they are allowed to flourish, they could be at the forefront of finding much-needed solutions to the continent’s vast urban challenges.

Growing tech hubs

African countries are increasingly benefitting from growth in technology ecosystems, which are often clustered within cities. There are currently more than 600 tech hubs helping to incubate innovative solutions across cities in Africa. Between 2015 and 2020, the number of start-ups receiving funding grew six times faster than the global average. In 2021 alone, start-ups raised over $4billion in funding – twice as much as in 2020.

But significant challenges remain. While the number of new start-ups is an encouraging indication of the entrepreneurialism and creativity of Africa’s youth, job creation on the level required will demand that they grow and scale up to generate more and higher quality jobs. Research on scaling up in Africa is sparse but research by Endeavor suggests that in Nairobi – one of Africa’s top tech ecosystems – only 5 per cent of companies are able to sustain growth of 20 per cent or more each year, yet they created 72 per cent of new jobs in the previous three years. For Africa to fully harness the potential of digital innovation, making cities the best place for young people to launch ideas and grow them into thriving businesses must become a priority policy for African governments. 

Barriers to scale

On the most basic level, business growth needs access to the services that make cities more liveable and help both urban residents and firms become more productive, such as healthcare, transport, water and sanitation. African cities already struggle to provide their residents – in particular the poorest and most vulnerable – with equitable, reliable, affordable and quality access to these services, in a sustainable manner. And these challenges will only get more acute as urban populations rise rapidly, often without any kind of integrated planning.

For example, an estimated 70-80 per cent of municipal solid waste in Africa is recyclable, yet only about 4 per cent is currently recycled, with more than 90 per cent of waste ending up in uncontrolled dumpsites and landfills. As Africa’s urban population grows, these conditions are likely to worsen – unless there is urgent action. New technology has the potential to help by creating a positive feedback loop between innovation, service delivery and growth. For example, to bridge the waste management gap, innovators are exploring various tech-enabled circular economy models. These solutions are often ground-breaking and have the potential to leapfrog traditional waste management infrastructure. Crucially, they are also formalizing a largely informal sector and creating new jobs.

Across the continent, start-ups like Kaltani, Mr Green Africa and Freetown Waste Transformers build processing facilities to turn waste into energy or reusable products, such as construction materials. Others, like Scrapays, Regenize and Soso Care, are helping households and businesses sell off their recycled materials for cash and virtual currencies or exchange them for critical services, such as micro health insurance premiums. Such start-ups help empower informal waste pickers or agents with tech-enabled tools and target low-income urban communities that would not normally prioritize recycling.

Help or hindrance from the top?

But Africa’s young people cannot do this alone – government decision-makers must become catalysts for entrepreneurial leadership. This requires nurturing a mindset that sees young innovators as Africa’s biggest resource, not a threat. While the importance of young people to Africa’s development is acknowledged in various high-level regional treaties, patterns of inhibition and outright hostility from political ‘elites’ suggest that the disruptive nature of technology start-ups and their access to significant capital through venture capital funding models – unlike existing rent-seeking business models with government control – threatens the political establishment.

Africa’s young people cannot do this alone – government decision-makers must become catalysts for entrepreneurial leadership.

The growing use of tech solutions also leads to increased transparency and efficiency of service delivery, which in turn leads to increased demand for government accountability and pressure to adopt more liberal policies. Until there is a shift towards catalysing entrepreneurial leadership, there is a stronger incentive for political elites to leverage their powers to co-opt successful technology businesses, or otherwise try to control them for political gain, than let them flourish. This shift in mindset will be critical to unlocking the full potential of Africa’s young innovators.




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A new vision for African agency in sustainable development

A new vision for African agency in sustainable development Expert comment LJefferson 18 October 2022

Change is necessary not only in global economic structures and attitudes – but in African governance too.

The conventional notion that Africa is mostly a consumer of norms and practices designed by the Global North has been repeatedly challenged and is increasingly being debunked. Increased African agency in international affairs is today a well-established and documented reality. But Africa’s influence still does not match the scale of the challenges that it faces on its pathway to sustainable development. 

Pushing for African agency in sustainable development also warrants a critical assessment of how ‘sustainable development’ should be defined, and how it can be achieved in terms of actual poverty reduction and real improvement in the lives of local poor Africans. Sustainable development has been a political catchphrase for over 30 years – but a genuine transition towards sustainability has yet to begin.

African agency today

Historically, there have been structural limitations on the agency of African stakeholders to shape development pathways. Chief among them, donor-recipient power dynamics have persistently promoted dependency and sustained institutional corruption. Many African countries are also challenged by economic incentives and infrastructure that have favoured the market demands and supply chains of former colonial powers, which largely remain reliant on natural resource extraction, and are marked by limited investment in value-addition activities and technology development.

Donor-recipient power dynamics have persistently promoted dependency and sustained institutional corruption.

Today, however, African agency is being exerted in a more assertive fashion. The African Union (AU), individual African states, civil society, the private sector and eminent and ordinary persons are all displaying Africa’s agency in steering global sustainable development priorities, namely by proposing their own development agenda, The African Union Agenda 2063, adopted in 2013. This was followed by the UN Sustainable Development Goals (Agenda 2030), which in many ways mirror Agenda 2063 – a clear demonstration of the influence of Africa in the global arena. 

Agenda 2063 is a strategic roadmap for Africa ‘to build an integrated, prosperous and peaceful Africa, driven and managed by its own citizens and development goals representing a dynamic force in the international arena’. Prepared following a broad-based participatory consultation, it advocates for inclusion and empowerment and provides an excellent vision for African countries and African people. The SDGs address several of the key shortcomings of their predecessor – the MDGs – and incorporate a broader and more transformative agenda that more adequately reflects the complex challenges of the 21st century and the need for structural reforms in the global economy and governance norms.

In international forums on sustainable development, African countries are increasingly using their collective voice to change the discourse on how development can and should be done. For instance, by championing innovative solutions for carbon markets, African policy leaders are enabling access to climate finance for development while preserving Africa’s natural wealth.

In the post-COVID era, championing investments in and leadership of Africa’s global health architecture demonstrates a desire that in the next pandemic, Africa CDC, AMA and continental manufacturers will play leading roles in determining Africa’s public health strategy and implementation.

In trade, building on the groundwork led by the regional economic commissions, the AfCFTA will catalyse and scale regional integration, trade and cooperation, leading to promising new modes of supply chain and self-sufficiency.

Encouraging signs, but persistent shortcomings

Encouraging signs that African agency is gaining momentum cannot disguise the fact that Africa has yet to move from rhetoric to implementation in the realm of sustainable development. Continental visions often fail to go beyond declarations of intent, and have only limited influence on governance systems or national structural transformation, and African states remain vulnerable to economic shocks emanating from the global system.

African agency should not be only seen as emanating from government, but also as being exerted by independent civil society organizations and committed ordinary individuals.

Change will require governance systems that are coordinated, transparent, efficient, and inclusive, as well as tools, processes, and means (material, technical, and human) for successful implementation. There is an urgent need for a new governance paradigm in Africa and internationally, dealing with long-term social change.

Notably, African agency should not be only seen as emanating from government, but also as being exerted by independent civil society organizations and committed ordinary individuals. Effective agency needs to be multi-faceted and multi-actor, and depends on the inclusiveness of African governments and their willingness to work with civil society in their strategic engagements with external partners.

Both Agenda 2063 and the SDGs hold the potential for transformation, but implementation will depend on continued advocacy to hold authorities to account and change the dominant discourse, logic and rules of engagement at global, regional, national, and local levels. There is a need for a dynamic new model of African ‘development’.

Time for a new vision

Africa’s economic landscape is changing rapidly, with new regional and local value chains, and integrated regional economic corridors to link countries, minimize the burden of high-cost production and logistics, and boost real incomes and international competitiveness. But Africa continues to face structural challenges, including the need for large investment projects – at a time when Africa remains a net exporter of capital.

Donors and development partners must reflect upon their prior modes of engagement and commit to genuine and equitable relationships with African states. Such partnerships must reflect mutual respect of ideas and accountability, and commit to making space in international forums and multi-lateral arrangements for African people and countries to realize their own visions for progress.

More resources should be channelled to actors engaging closest to communities and people, who can better understand and communicate local needs.

But African leaders and actors must also recognize that with the advent of resources and agency comes responsibility for results and outcomes, notably the need to improve governance. Gaps in accountability, widespread corruption, and lack of successful implementation and sustainability of projects must be addressed.




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Africa’s maritime agency cannot be overlooked

Africa’s maritime agency cannot be overlooked Expert comment LJefferson 3 November 2022

Increasing maritime awareness has already delivered impact, but consistency and continental leadership are needed to realize the sector’s full potential.

Africa’s 48,000 kilometres of coastline, shared among 38 coastal states, are resource rich and hold some of the world’s most strategic sea lanes, including the approaches to the Suez Canal, which carries 12 per cent of worldwide trade, and the Gulf of Guinea, a critical route for global energy. But despite the vast potential this represents, piracy and maritime insecurity have dominated the narrative of Africa’s coasts, and further propagated the image of African states as beholden to external intervention.

Yet African agency is established and evolving in the sector, with African littoral states enhancing their capacity to face collective security threats and exercising increasing autonomy in responding to the recent rush of external actors looking for port facilities and military bases. Enhanced continental coordination, consistency and leadership can help Africa’s maritime endowment become a resource that can bring sustainable benefit across the continent.  

Agency beyond piracy: the Gulf of Aden and Western Indian Ocean

Piracy became the dominant frame of reference for the East African maritime space as a result of the crisis off the coast of Somalia, which peaked between 2008 and 2012. In 2008, the UN Security Council (UNSC) took the unprecedented step of authorizing international naval operations in Somali territorial waters, contributing to a gradual reduction in attacks. There have been no successful hijackings reported since 2017.

As the immediate threat of piracy has quietened, broader geopolitical dynamics have come to the fore, notably in a surge by external actors to establish strategic ports and military bases.

But progress has not just been down to international assistance. Somalia is prioritizing increased domestic enforcement capacity – as demonstrated in the establishment of  a new specialized maritime unit and the wider region enhanced collaboration and information sharing through the Djibouti Code of Conduct of 2009, amended in 2017.

South Africa’s recent admission as a new signatory demonstrates its continued relevance. In March 2022, the UNSC authorization lapsed, following pressure from the Somali government. Although it is not yet clear whether Somali efforts will be sufficient to repress piracy in the long term, this reverse was a clear statement of Somalia’s agency at a level unthinkable during the outset of the crisis.

As the immediate threat of piracy has quietened, broader geopolitical dynamics have come to the fore, notably in a surge by external actors to establish strategic ports and military bases. Here too, African states have demonstrated enhanced agency, for better or worse. Consider Djibouti’s unilateral seizure of a container terminal from an Emirati firm, Sudan’s review of Russian and Turkish deals for maritime facilities, Tanzania’s rejection of a Chinese-led port investment, or the Seychelles withdrawing agreement for an Indian naval base.

Such examples point to a growing awareness of the value of maritime resources within African states, alongside a willingness and ability to push back against external imposition – and indeed to innovate in finding solutions beyond infrastructure and ‘hard’ security. In 2018, the Seychelles launched the world’s first sovereign blue bond to fund sustainable marine projects. That other countries are seeking to replicate this model points to the potentially global impact of African leadership on maritime issues.

Regional cooperation or competition in the Gulf of Guinea?

The Gulf of Guinea is likewise resource rich and geographically strategic, and has faced diverse maritime security threats including piracy, smuggling, illegal fishing, oil theft and pollution. Gulf of Guinea states put in place several initiatives to promote security, including the Yaoundé Code of Conduct (YCoC), signed by 25 states in 2013, that led to information-sharing and cooperation on interdiction, investigation and prosecution. But crime in the Gulf of Guinea nonetheless reached an all-time high in 2020, suffering 130 of the 135 maritime kidnappings recorded worldwide, due to the non-binding nature of the YCoC and gaps in capacity and finance.

Despite the clear impact of growing African agency in the maritime space, a long road remains towards the realization of its full potential.

Though external actors have become increasingly engaged, including the EU, US, France, Denmark, and the G7++ Group of Friends of the Gulf of Guinea (FOGG), states within the region, especially those most affected by piracy and armed robbery, have nonetheless demonstrated leadership. Nigeria, Ghana, and Cote D’Ivoire have all developed maritime security strategies; Nigeria launched its Deep Blue Project to secure Nigerian waters; Ghana has strengthened its navy; and Togo has changed its laws and judicial system to allow the arrest and prosecution of ships and persons. Maritime security incidents have consequently reduced in 2022.




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Africa-Japan relations and evolving multilateralism

Africa-Japan relations and evolving multilateralism 23 November 2022 — 9:00AM TO 10:30AM Anonymous (not verified) 17 November 2022 Online

This panel discussion reflects on the outcomes of TICAD 8 in 2022 and looks forward to TICAD 9 in 2025.

The eighth edition of the Tokyo International Conference on African Development (TICAD), held in Tunisia from 27–28 August 2022, marked the second time that Japan’s now-triennial summit was hosted in an African country, after TICAD 6 was held in Kenya in 2016.

The summit was attended by 48 representatives of African countries and at least 20 heads of state and government and included a pledge by the Japanese government to commit $30 billion in public and private finance to Africa over the next three years.

In reaffirming the three pillars of TICAD 8 – revolving around the economy, societal resilience, and peace and stability – the newly adopted Tunis Declaration (28 August 2022) also outlined some of the key projects underpinning Japan’s pledge, including a $4 billion fund for a Green Growth Initiative with Africa (GGA).

2023 will mark 30 years since the inception of TICAD in 1993 and ten years since the African Union (AU)’s adoption of its flagship Agenda 2063, on which the Tunis Declaration placed distinct emphasis.

This panel discussion reflects on the outcomes of TICAD 8 in 2022 and looks forward to TICAD 9 in 2025, exploring wider developments in summitry, Africa-Asia relations, and modes of multilateralism.

Questions explored include:

  • How has international summitry evolved over the past three decades since the inception of TICAD in 1993, which represented the first periodic high-level summit engagement with Africa by a ‘non-traditional’ partner?
  • Looking ahead to TICAD 9 in 2025, what are the priorities for enforcing the stated tenets of TICAD – ‘African ownership, international partnership, inclusivity and openness’ – in cooperation efforts?
  • What lessons can be drawn from TICAD’s co-partnership approach (with the African Union Commission and others) – particularly given increasing calls for AU membership of the G20 and Prime Minister Kishida’s pledge at TICAD 8 to support a permanent African UNSC seat during its non-permanent membership in 2023–24? Beyond membership, what are the priorities for furthering agency?
  • How are Africa-Asia relations evolving and diverging? How are Japan and other Asian countries perceived by different African countries?

This event is the third in the Chatham House – Japan House London webinar series (2022-2023). The series is held in partnership with Japan House London. You can watch previous webinars from the series here.




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Africa in 2023: Continuing political and economic volatility

Africa in 2023: Continuing political and economic volatility Expert comment NCapeling 6 January 2023

Despite few African trade and financial links with Russia and Ukraine, the war in Ukraine will cause civil strife in Africa due to food and energy inflation.

Africa’s economy was recovering from the COVID-19 pandemic in 2022 when a range of internal and external shocks struck such as adverse weather conditions, a devastating locust invasion, and the Russian invasion of Ukraine – all of which worsened already rapidly-rising rates of inflation and borrowing costs.

Although the direct trade and financial linkages of Africa with Russia and Ukraine are small, the war has damaged the continent’s economies through higher commodity prices, higher food, fuel, and headline inflation.

The main impact is on the increasing likelihood of civil strife because of food and energy-fuelled inflation amid an environment of heightened political instability.

Key African economies such as South Africa and Nigeria were already stuck with low growth and many African governments have seen their debt burdens increase – some such as Ethiopia and Ghana now have dollar debt trading at distressed levels – and more countries will follow in 2023.

On average the public sector debt-to-GDP ratio of African countries stood at above 60 per cent in 2022. The era of Chinese state-backed big loans and mega-projects which started 20 years ago in Angola after the end of its civil war may be coming to an end but Chinese private sector investments on the continent will continue through its Belt and Road Initiative and dual circulation model of development.

Great and middle powers building influence

Geopolitical competition in Africa has intensified in 2022, particularly among great powers such as China, Russia, the US, and the EU but also by middle powers such as Turkey, Japan, and the Gulf states.

The sixth AU-EU summit held in Brussels in February 2022 agreed on the principles for a new partnership, although the Russian invasion of Ukraine which followed disrupted these ambitions. Japan’s pledge of $30 billion in aid for Africa at TICAD 8 in August 2022 was clearly made due to the $40 billion pledged at the China–Africa summit in November 2021.

The geopolitical and geoeconomic ramifications of the war in Ukraine has directly impacted the African continent by contributing to food and cooking oil inflation and humanitarian aid delivery

The US also launched a new strategy to strengthen its partnership and held a second US-Africa Leaders’ summit in Washington in December, the first since 2014. Russia’s ambition has been curtailed by its invasion of Ukraine, postponing its second summit with African states to 2023.

The imposition of international sanctions complicated its trade and investments, and military support such as that provided by Russian paramilitary group Wagner focused on Mali, Libya and the Central African Republic (CAR) has been curtailed.

The strategic importance of Africa has resulted in all the UN P5 members calling on the G20 to make the African Union (AU) its 21st member in 2023 under India’s presidency.

International competition to secure Africa’s critical and strategic minerals and energy products intensified in 2022 and, in the energy sector, European countries are seeking to diversify away from Russian oil and gas with alternative supplies, such as those from Africa.

Western mining companies and commodity traders are also increasingly seeking alternative supplies from Africa. Decarbonization is becoming a driver of resource nationalism and geopolitical competition in certain African mining markets, home to large deposits of critical ‘transition minerals’ such as copper, cobalt, graphite, lithium, or nickel.

COP27 was hosted in Egypt in November and gave African leaders an opportunity to shape climate discussions by pushing priority areas such as loss and damage, stranded assets, access to climate finance, adaptation, and desertification. Climate adaptation in Africa is a key condition to preserving economic growth and maintaining social cohesion.

The Horn of Africa, particularly Somalia, is suffering from one of the worst droughts in memory. The geopolitical and geoeconomic ramifications of the war in Ukraine has directly impacted the African continent by contributing to food and cooking oil inflation and humanitarian aid delivery.

Thoughout 2022 the AU was undergoing intensive reform and it struggled to respond to the growing number of security crises across the continent. Hotspots in 2023 will be in the western Sahel and Lake Chad Basin, eastern DRC, and northern Mozambique, all of them crossing state borders.

In Mozambique, a 2019 peace deal assisted by the United Nations (UN) will see the last ex-guerrillas from Renamo demobilized in 2023 to reintegrate into civilian life – some having been recruited in 1978.

Jihadist activity may spread further into coastal states which has resulted in international partners such as France and the UK redesigning their security assistance strategies for the region

In eastern Congo, M23 – one of around 120 armed groups – resumed its conflict against the central government. After lying dormant for several years, it took up arms again in 2021 and has been leading an offensive in eastern DRC against the Congolese army.

According to the UN, Rwanda has been supporting M23, and Kenya’s parliament approved in November the deployment of about 900 soldiers to the DRC as part of a joint military force from the East African Community (EAC) bloc – DRC joined the EAC in March.

In the Horn of Africa, Ethiopia saw an uneasy ceasefire agreed between the federal government and the Tigray People’s Liberation Front (TPLF).

Islamist militant groups in Africa further expanded their territorial reach in 2022, particularly in the western Sahel where al-Qaeda and Islamic State affiliates are competing for influence and continued to make inroads.

The drawdown and exit of western forces from Mali, both the French Operation Barkane and international contributions for the UN’s MINUSMA mission there, adds new dimensions to regional security challenges.

Mali’s decision in May to withdraw from the G5 Sahel has also eroded the regional security architecture. Jihadist activity may spread further into coastal states which has resulted in international partners such as France and the UK redesigning their security assistance strategies for the region.

Coups on the increase again

Since 2020, there have been successful military coups in Burkina Faso (twice), Chad, Guinea, Mali (twice), and Sudan, and failed ones in the CAR, Djibouti, Guinea-Bissau, Madagascar, Niger, and possibly Gambia and São Tomé and Príncipe.

Three national elections illustrate the state of African democracy in 2022. In Angola’s August elections, the ruling MPLA lost its absolute majority with the opposition UNITA winning the majority in Luanda for the first time.




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Fighting over ‘white gold’: Sesame in Ethiopia and Sudan

Fighting over ‘white gold’: Sesame in Ethiopia and Sudan Expert comment LJefferson 3 April 2023

The supply chain of a seemingly innocuous cash crop – sesame – has intersected with transnational conflict dynamics, exacerbating tensions between Ethiopia and Sudan.

Late 2020 saw the beginning of the devastating war in Tigray and the occupation of a disputed region on the Ethiopia–Sudan border – Al Fashaga – by the Sudanese army. These shocks disrupted settled patterns of land ownership and control in both Ethiopia’s volatile north and Sudan’s borderlands, historically the heart of the sesame and oilseed production that is economically vital to both countries.

These seemingly harmless cash crops are now embedded in local, subnational and national political contestations in both countries. Sesame value chains are being reshaped, with power and profits being used to entrench the grip of political and armed actors who are reinforcing new patterns of land control and driving informal and illicit trade – impacting the coping mechanisms of local communities and threatening to fuel further conflict.

Regional rivalries drive contestation over the Ethiopia supply chain

Internal borders between most of Ethiopia’s regions are marked by boundary disputes, which often degenerate into violent conflict. The most important is between the Tigray and Amhara regions. Since the war began in 2020, the Amhara region has annexed vast areas of western and southern Tigray, which the Amhara region claims were taken from them by Tigray 30 years ago, after the Tigray People’s Liberation Front (TPLF) dominated ethnic coalition came to power.

Conflict has exacerbated a steady decline in formal revenues from sesame exports, dropping over $115 million from 2016 to 2021.

Ethiopia’s exports of spices, oilseeds and pulses brought in over half a billion dollars in 2021, roughly a quarter of the country’s total export revenues and second only to coffee. The sector has been rocked by the war in the north, which accounted for much of Ethiopia’s sesame production, with an estimated 500,000 hectares of sesame fields taken out of cultivation during the 2021 growing season. Conflict has exacerbated a steady decline in formal revenues from sesame exports, dropping over $115 million from 2016 to 2021.

Alongside falling production, the previously integrated value chain has been disrupted and decentralized by political fragmentation and land competition between Amharas and Tigrayans. Before the war, the agricultural sector in Western Tigray/Welkait was dominated by Tigrayan business interests, through the TPLF’s regional endowment fund EFFORT, a business conglomerate including subsidiaries such as Guna Trading House, and Hiwot Agricultural Mechanization.

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Two-minute video explainer: Supply chains, land contestation and conflict in the Horn of Africa

The taking of the area by Amhara forces in late 2020 saw the control over agricultural supply chains shift to actors from the Amhara region, amid contestation between regional officials, businessmen and security actors, backed by political elites. Thousands of displaced ethnic Tigrayan inhabitants of the area have been replaced by ethnic Amharas, enticed to settle there by the Amhara regional government’s offer of grants and leases for land which promise better livelihoods. The sesame they farm is now largely exported through informal and illicit channels, with profits used to reinforce de facto regional control.    

But there is also contestation within the Amhara region over the land and sesame supply chain between sub-regional elites from Gojjam, Gondar and indigenous Welkaites. Welkaites, who were marginalized under TPLF rule, believed that by aligning themselves with powerful Amharas they would reclaim land and influence. But this has not been fully realized, with the local administration reliant on Amhara region subsidies, rather than the federal budget. With little support from the federal government, local Welkait officials are strengthening their ties with Eritrea.

The Ethiopian government’s pursuit of peace with Tigray may lead it to turn away from the Amhara region, which could result in a renewed showdown between Amhara and Tigrayan forces.

At the national level, regional contestation over the control over Western Tigray/Welkait feeds into shifting political alliances between the Amhara, Tigrayans and Oromo which threaten the sustainability of the peace agreement struck between the federal government and TPLF in November 2022 – despite efforts by the government to defer the thorny issue.

While the constitutional return of the land to Tigray remains unlikely anytime soon, there is a feeling that Amhara control over Western Tigray/Welkait is no longer certain. The Ethiopian government’s pursuit of peace with Tigray may lead it to turn away from the Amhara region, despite their alliance during and before the war, which could result in a renewed showdown between Amhara and Tigrayan forces.

The prospect of losing territory could also heighten Amhara nationalist claims on Al Fashaga – the loss of which was partly offset by gaining Western Tigray/Welkait – leading to renewed conflagration with Sudan, outside of federal direction. Eritrea’s presence and alliance with Amhara militias remains a concern, given Asmara’s demonstrable ability to inflame tensions.  

Sudan’s securocrats battle over resources to entrench political power

The war in northern Ethiopia was also used opportunistically by the Sudanese Armed Forces (SAF) to take control of the fertile Al Fashaga borderland. This roughly 250 sq km area had been awarded to Sudan when the boundary was initially demarcated by the British in 1903, a ruling that remained contested by Ethiopia. An uneasy truce had seen Ethiopian farmers cultivate the land under nominal Sudanese administration; a settlement that collapsed in 2020 when thousands of predominantly Amhara farmers were evicted.

Local Sudanese farmers have also lost out – with some not compensated for the loss of lands to their own military, with land given to people from other parts of the country, and through lost relationships with Ethiopian farmers, labourers and investors.

The Sudanese military now allegedly controls more than 90 per cent of the disputed areas and security-linked companies and investors have moved into the lucrative sesame sector, re-routing the supply chain, which used to flow largely through Ethiopian markets. These companies are connected to Sudan’s Military Industrial Corporation, a vast conglomerate of business subsidiaries controlled by SAF – which is headed by General Abdel Fattah al-Burhan.

Competition between Sudanese security actors fuels volatile political rivalries, and further entrenches military control of economic resources.

The commander of the paramilitary Rapid Support Forces, General Mohamed Hamdan Dagolo (or Hemedti), also has interests in agriculture, through his family business Al-Junaid. Both sit at the top of Sudan’s Sovereign Council. Hemedti’s competition with Burhan has seen him develop relations with Ethiopia’s prime minister – counter-balanced by recent rapprochement between Abiy and Burhan – as well as senior Amhara leaders, including over business activities.

Moreover, competition between Sudanese security actors fuels volatile political rivalries, and further entrenches military control of economic resources, undermining civilians at a time when pro-democracy forces are seeking to restore a reform-minded government. One of the key challenges for a new civilian government will be to quickly build up a domestic revenue base to compete with the economic heft of the country’s prominent security institutions, which will demand taking on military-controlled holdings in civic sectors such as agriculture, including sesame.

Informal and illicit trade reinforces conflict dynamics

This context has driven the informalization of trade, with cash crops such as sesame increasingly exported outside of formal channels and connected to other illicit cross-border activities between Ethiopia and Sudan. Indications are that sesame production in Western Tigray/Welkait has recovered significantly during the current 2022/23 harvest season. However, rather than contributing much needed currency to soften Ethiopia’s forex crisis, the Amhara elite-controlled supply chain is primarily being used to secure a variety of regional interests.




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Guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An Information Statement from ASNC and SNMMI




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The added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in patients with castration-resistant prostate cancer

Purpose: The 68Ga-PSMA PET/CT is a commonly used imaging modality in prostate cancers. However, few studies have compared the diagnostic efficiency between 68Ga-PSMA and 18F-FDG PET/CT and evaluated whether a heterogeneous metabolic phenotype (especially PSMA-FDG+ lesions) exists in patients with castration-resistant prostate cancer (CRPC). We determined the added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in CRPC patients and identified CRPC patients who may benefit from additional 18F-FDG PET/CT. Methods: Data of 56 patients with CRPC who underwent both 68Ga-PSMA and 18F-FDG PET/CT from May 2018 to February 2021 were retrospectively analysed. Patients were classified into two groups with or without PSMA-FDG+ lesions. The differences in patient characteristics between the two groups and predictors of patients who having at least one PSMA-FDG+ lesion were analysed. Results: Although both the detection rate (75.0% vs. 51.8%, P = 0.004) and positive lesion number (135 vs. 95) of 68Ga-PSMA PET/CT were higher than 18F-FDG PET/CT, there were still 13/56 (23.2%) patients with at least one PSMA-FDG+ lesion. The prostate-specific antigen (PSA) and Gleason score were both higher in the patients with PSMA-FDG+ lesions than in those without PSMA-FDG+ lesions (P = 0.04 and P<0.001, respectively). Multivariate regression analysis showed that the Gleason score (≥8) and PSA (≥7.9 ng/mL) were associated with the detection rate of patients who had PSMA-FDG+ lesions (P = 0.01 and P = 0.04, respectively). The incidences of having PSMA-FDG+ lesions in low-probability (Gleason score<8 and PSA<7.9 ng/mL), medium-probability (Gleason score≥8 and PSA<7.9 ng/mL or Gleason score<8 and PSA≥7.9 ng/mL), and high-probability (Gleason score≥8 and PSA≥7.9 ng/mL) groups were 0%, 21.7%, and 61.5%, respectively (P<0.001). Conclusion: Gleason score and PSA are significant predictors for PSMA-FDG+ lesions, and CRPC patients with high Gleason score and PSA may benefit from additional 18F-FDG PET/CT.




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Theranostics for Meningioma on the Rise: New EANM/EANO/RANO/SNMMI Guidelines Pave the Way to Improved Patient Outcomes Using Radiolabeled Somatostatin Receptor Ligands




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Impact of 18F-FDG PET/MRI on Therapeutic Management of Women with Newly Diagnosed Breast Cancer: Results from a Prospective Double-Center Trial

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Diagnostic Radiopharmaceuticals: A Sustainable Path to the Improvement of Patient Care




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Reply: One Bite from the Apple, One Bite from the Orange in the PRECISE-MDT Study and Limitations of Retrospective Study Design and Potential Bias in the PRECISE-MDT Study




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SNMMI Procedure Standard/EANM Practice Guideline for Brain [18F]FDG PET Imaging, Version 2.0

PREAMBLE

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine.

The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.

Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized.

These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, both the SNMMI and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines.

The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment.

Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.




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Limitations of Retrospective Study Design and Potential Bias in the PRECISE-MDT Study




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Improved Localization of Insulinomas Using 68Ga-NODAGA-Exendin-4 PET/CT

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MIRD Pamphlet No. 31: MIRDcell V4--Artificial Intelligence Tools to Formulate Optimized Radiopharmaceutical Cocktails for Therapy

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Head-to-Head Comparison of [68Ga]Ga-NOTA-RM26 and [18F]FDG PET/CT in Patients with Gastrointestinal Stromal Tumors: A Prospective Study

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[18F]F-AraG Uptake in Vertebral Bone Marrow May Predict Survival in Patients with Non-Small Cell Lung Cancer Treated with Anti-PD-(L)1 Immunotherapy

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Intraarterial Administration of Peptide Receptor Radionuclide Therapy in Patients with Advanced Meningioma: Initial Safety and Efficacy

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Outcomes for Patients with Metastatic Castration-Resistant Prostate Cancer and Liver Metastasis Receiving [177Lu]Lu-PSMA-617

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Clinical, Pathologic, and Imaging Variables Associated with Prostate Cancer Detection by PSMA PET/CT and Multiparametric MRI

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Oncologist, Business Leader, and Investor Arie S. Belldegrun Discusses a Career in Innovative Medical Entrepreneurship: A Conversation with Ken Herrmann and Johannes Czernin




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Feasibility, Tolerability, and Preliminary Clinical Response of Fractionated Radiopharmaceutical Therapy with 213Bi-FAPI-46: Pilot Experience in Patients with End-Stage, Progressive Metastatic Tumors

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Performance Characteristics of a New Generation 148-cm Axial Field-of-View uMI Panorama GS PET/CT System with Extended NEMA NU 2-2018 and EARL Standards

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SPECT/CT in Early Response Assessment of Patients with Metastatic Castration-Resistant Prostate Cancer Receiving 177Lu-PSMA-617

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International Metabolic Prognostic Index Is Superior to Other Metabolic Tumor Volume-Based Prognostication Methods in a Real-Life Cohort of Diffuse Large B-Cell Lymphoma

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From the frontlines: Our CISO’s view of Pacific Rim

On beyond “Detect and Respond” and “Secure by Design”






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VEEAM exploit seen used again with a new ransomware: “Frag”

Last month, Sophos X-Ops reported several MDR cases where threat actors exploited a vulnerability in Veeam backup servers. We continue to track the activities of this threat cluster, which recently included deployment of a new ransomware. The vulnerability, CVE-2024-40711, was used as part of a threat activity cluster we named STAC 5881. Attacks leveraged compromised […]




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Re: Voluntary assisted death: how to ensure access and safety




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Overdose crisis: more common sense and less ideology




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Addressing Climate Catastrophe Concerns in Asthma Medication Delivery: Rethinking Inhaler Use for Environmental and Clinical Efficacy




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Re: Scandal of “newborn gang” that put profits ahead of babies’ lives rocks Turkey’s health system