Coronavirus Outbreak

One of the fastest moving global news stories of early 2020 has been the spread of the coronavirus. Sourced back to Wuhan, China, the virus has reach over 7,000 confirmed cases worldwide according to the latest data from the World Health Organization. The World Health Organization is deciding again whether to declare a Public Health Emergency of International Concern (PHEIC), a major move that would intensify the the global response.  

The World Health Organization’s (WHO) Role

What is the World Health Organization’s role in a situation like this? Ambassador John E. Lange, previously a U.S. Special Representative for avian flu and pandemic flu preparedness and currently a senior fellow for global health diplomacy at the United Nations Foundation comments on the current coronavirus outbreak in a podcast interview of Global Dispatches. “When SARS first came about [in 2003] it really sent shockwaves around the world because there was so much fear and confusion.” He goes on to say that SARS spurred changes in International Health Regulations. Each state that signed onto the agreement, now over 194 countries, would be legally bound to follow the updated international health requirement “to build their own capacities to detect, prevent, and respond to emerging health threats.” It established norms and guidelines to share information and respond quickly to growing health threats with the World Health Organization. The World Health Organization coordinates the reporting and responsiveness of global health threats on an international level.

Public Health Emergency of International Concern (PHEIC)

Dr. Tedros, the director General of the World Health Organization, met with Xi Jinping, the president of China in Beijing to discuss the coronavirus outbreak. Dr. Tedros himself said afterward, “stopping the spread of this virus both in China and globally is WHO’s highest priority”. Ambassador John Lange continues to say, “so it’s very clear that they’re fully geared up on this and working with the government of China and other countries that are affected to try to provide the information that they need. How to diagnose the virus, how to manage cases, how to connect surveillance efforts from different countries, etc., all with the goal of reducing transmission and eventually stamping out what seems to be a growing epidemic and maybe a pandemic.”

Invoking a Public Health Emergency of International Concern (PHEIC) is essentially the most dramatic step that the World Health Organization (WHO) can take.   According to Lange, to declare a PHEIC, three criteria must be met. It must be an extraordinary event with a risk that constitutes public health risk to other countries and requires a coordinated international response.

For More In-Depth Information on the Coronavirus and WHO’s Response

Listen to Global Dispatches episode titled How the World Health Organization is Responding to the Coronavirus Outbreak in the field below, on Spotify, Apple Podcasts, or wherever you listen to podcasts.

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Mark Goldberg: (00:32)
At the time of recording the coronavirus outbreak that originated in China has infected over 4,500 people though that number is sure to dramatically increase in the coming days. The vast majority of the people affected by this outbreak are in China. Though infections have been confirmed in at least 14 other countries. And again, the number of countries impacted will certainly increase in the coming days. There is still a lot we do not know about this virus and the outbreak, but we do know that this coronavirus outbreak is poised to become a major global health crisis. So for this episode, I wanted to give you a sense of the kind of global health infrastructure that exists for exactly moments like this on the line with me to discuss. The international response to this outbreak so far, including actions taken by the world health organization is ambassador John E. Lange He is a retired ambassador from the United States who currently serves as a senior fellow for Global Health Diplomacy with the United Nations Foundation.

Mark Goldberg: (01:47)
Ambassador Lange also served from 2006 to 2009 as the U.S. special representative for avian flu and pandemic flu preparedness. This gives him some unique insight into how both the U.S. Government and entities like the World Health Organization respond to these kinds of fast-moving outbreaks. We kick off discussing the WHO’s role in managing the global response, including the relevance of something called the 2005 International Health Regulations. We also discussed potential scenarios for this outbreak to turn into a pandemic that could deeply impact poor countries with weak health systems. Now at the time that I spoke with ambassador Lange, the World Health Organization had not yet declared that this outbreak constituted a Public Health Emergency of International Concern. However, by the time that you are listening to this, they almost certainly will have done so. And we do discuss in this episode at length what a public health emergency international concern means and why it’s so significant.

Mark Goldberg: (03:03)
So this episode, obviously, is dealing with a fast moving global news story. And whenever I approach those kinds of stories on the podcast, my intention is always to give you context. You need to understand events as they unfold. So that was my intention with this episode. I think you will appreciate it. Also, I think one thing this episode does hammer home is the need for more global health professionals. And if you’re thinking about pursuing a career in global development or global health, I do strongly encourage you to check out Northwestern University’s online master’s program in global health. You can learn how to make a meaningful difference in places where it is needed. The most go to sps.northwestern.edu/global or click on the add on globaldispatchespodcast.com to learn more. And if you have any questions about that graduate program, please reach out to me directly. And I’m happy to put you in touch with the good folks at Northwestern. All right. And now here is my conversation with ambassador John E. Lange of the United Nations Foundation.

John E. Lange: (04:18)
today January 28th, Dr. Tedros met with the Chinese president, um, as Xi Jinping in Beijing and with him or of the WHO Regional Director for that region plus the head of the who emergencies program, Dr. Mike Ryan. So you, you’re dealing with the highest-level people in WHO, who will focus on this particular issue. And Tedros himself said afterward, stopping the spread of this virus both in China and globally is WHO’s highest priority. So it’s very clear that they’re fully geared up on this and working with the government of China and other countries that are affected to try to provide the information that they need.  how to diagnose the virus, how to manage cases how to connect surveillance efforts from different countries, et cetera, all with the goal of reducing transmission and eventually stamping out what seems to be a growing epidemic and maybe a pandemic.

Mark Goldberg: (05:24)
So what is the world health organization’s role in a situation like this? Like what can the WHO do and what can the WHO not do in these kinds of situations?

John E. Lange: (05:35)
The specific role for WHO in this case stems from the international health regulations. That’s something it may not sound very exciting when you say it stems from regulations, but it’s really one of the few areas of international law dealing with global health that the regulations themselves STEM from efforts way back in 1851 when there was the international sanitary conference and the efforts then to revise the International Health Regulations over the years occurred to the point where they had to be expanded from their original focus, which was just cholera plague and yellow fever. And in the early two thousand the severe acute respiratory syndrome, SARS came about and that really spurred the effort to finalize the new regulations that were finally adopted by the World Health Assembly. That’s all the member states of WHO, now 194 countries. In the year 2005.

Mark Goldberg: (06:43)
So you’re seeing, it was really like the, um, the problematic global response to the SARS outbreak, which also was a coronavirus that originated in China, um, in 2003 that led to a revamping of these new International Health Regulations in 2005. What went wrong in 2003? And how does that 2005 International Health Regulations sort of offer a remedy to what went wrong?

John E. Lange: (07:12)
Yes. When SARS first came about in February 2003 and ended up killing a 774 people and infecting 8,098 people it really sent shockwaves around the world because there was so much fear and confusion. What was the cause of this what was the source? The modes of spread the appropriate interventions, et cetera. And SARS had a 9.6% case fatality rate, which is about triple to what the current novel Coronavirus has. And there was a question of what seemed to be a lack of transparency on the part of the government of China.  so the, this, while there had been contemplation of updating these International Health Regulations prior to SARS, SARS really spurred this and they were quickly produced by 2005 and so that it would bring about a, a fundamental requirement on the part of every government that signed up for this.

John E. Lange: (08:18)
And every member of who did sign up for it that they would  accept the legally binding requirement to build their own capacities to detect, prevent and respond to emerging health threats. And it establishes important norms and guidelines to share information and, and report quickly possible health emergencies of international concern to the world health organization.  so that this can be coordinated at the global level by who. So who is really the repository of the secretary at for the International Health Regulations? And it really has set the norm for how countries should respond and be transparent in their response. And it really has made a major difference in global health.

Mark Goldberg: (09:11)
So how, how are you seeing the International Health Regulations being applied today in response to this coronavirus, for example?

John E. Lange: (09:21)
Well, for one thing there’s a the importance of transparency. Now.  Dr. Tedros has said that he appreciates the seriousness with which China is taking the outbreak and its commitment from the top leadership and the transparency. It’s demonstrated including sharing data and genetic sequence of the virus. There have been some who’ve complained that China should be more transparent than it has been in terms of sharing not just the information, but also the data. But on the whole, I think this is a, and I’m not the expert on this, but I think its much better emphasis on the transparency than, than was witnessed back in 2003. So that’s a clear example of how the IHR have made a big impact. But I think the biggest area in this is the public that whether or not who will declare a Public Health Emergency of International Concern.

Mark Goldberg: (10:30)
What’s your preferred nomenclature?

John E. Lange: (10:32)
I like PHEIC.

Mark Goldberg: (10:34)
Well, we’ll go with PHEIC, but if that’s based off stands for the Public Health Emergency of International Concern. And this is essentially the most dramatic step that the World Health Organization can take by to invoke this emergency, which I suppose probably triggers other aspects of the international health regulation. Can you just sort of describe the process that leads to that declaration? Because as we’re speaking now, that declaration has not been evoked. There was one meeting of outside experts that are advising the executive director, the director of general of the World Health Organization on this. But in that meeting they declined as of yet to declare that emergency. Um, could you describe the process behind the PHEIC and then if the PHEIC is declared what that means in terms of those international health regulations, what additional obligations are required by a member states, the world health organization upon that declaration?

John E. Lange: (11:36)
Yes. The, um, the, the way the PHEIC is defined, it’s, there are basically three essential criteria.  it needs to be an extraordinary event with a risk that the constitutes of public health risk to other countries through international and potentially requires a coordinated international response. Now the director general does not just make this decision on his own or on her own. His, Dr. Tredos, his predecessor was Dr. Margaret Chan.  instead, there is an emergency review committee that meets, and these are true experts in public health.  and they meet that they did last week to discuss whether or not they will recommend to the director general to declare a PHEIC.  and that then it is up to the director general to make the decision. When the committee met last week, it was split down the middle and in terms of whether or not to recommend to the director general to declare one, and he decided not to declare it at that time.

John E. Lange: (12:49)
I myself was surprised by that. I thought it met the definition of a Public Health Emergency of International Concern. But I have to say, I’ve since heard from some people who believe otherwise, that there just wasn’t enough data. They weren’t sure whether it was any worse than seasonal influenza. The severity at that time wasn’t yet clear. And there was also concern about the economic and trade implications because once a peak is declared, then that can trigger actions in terms of tests for people entering countries to determine whether or not they’re ill.  and other things that can have economic and trade implications. So the decision, and I, I would put, from what I can gather, it was a close one was that it was not this international emergency of international concern.

John E. Lange: (13:50)
But I have to say, if you just look back and look at how this has progressed on January 20th eight days ago from today, there were over 200 infections reported.  today we now have a total of over 4,500 infections reported.  and while there were three deaths back that were known on January 20th, it’s now up to 106. So this has really become much bigger just in days.  and it includes 73 cases outside of China. So it has, the international spread has become clearer. I was just on a conference call earlier today with, um WHO staff saying that once the director general returns from China to Geneva, they expect that he soon thereafter we’ll reconvene that emergency review committee to determine whether or not now is the time to declare this PHEIC.

Mark Goldberg: (14:48)
And so assuming a PHEIC is declared, um, what happens then? Like what, what is incumbent upon both the WHO and also WHO member states? Like, I guess my understanding is that in part it’s a bureaucratic designation that for one allows, for example, the expedited, you know, visa approval of WHO experts and other international health officials to visit affected sites. Um, are, are there like other aspects of the International Health Regulations that are relevant? Um, to this situation if, if that emergency declaration is, is declared.

John E. Lange: (15:24)
What happens is it, first of all, it’s, it clearly puts all countries in the world on notice that this is a global concern and that’s then likely to trigger actions. And those actions are, are clearly needed. And already being anticipated.  the Bill and Melinda Gates Foundation, for example, yesterday announced that they were giving $10 million, $5 million to entities in China and also $5 million to the African centers for disease control and prevention so that they can help improve the preparedness on the part of African governments. And that’s along the lines of what one can expect globally once a PHEIC is declared, because it does trigger those international actions now WHO normally doesn’t recommend travel restrictions, but those, um but, but it has developed guidance for travelers and for airports and other points of entry. And that’s the kind of thing that will kick in once a PHEIC is declared and so it basically, it puts the entire world on a higher state of vigilance.

Mark Goldberg: (16:40)
So from 2006 to 2009, you served in the State Department as the Special Representative on Avian and Pandemic Influenza. Presumably you, um, game planned and went through various scenarios for situations like this. Can you just sort of discuss what, how that experience is informing how you’re understanding this developing situation and what sort of preparations the U S government for example, would be making in a situation like this?

John E. Lange: (17:12)
Yes. While I’m no longer in the State Department that whole experience is informing me, but I have to say there are people who were very much involved in the planning for a possible pandemic influenza stemming from the H5N1 virus back in that period, 2006 to 2009 when I was working on this, who are still in the U.S. Government including at CDC at very high levels. And all of that kind of preparedness that was done in the past helps to develop, the responses to the current situation. And even though this novel coronavirus is not influenza, many of the things that one does and needs to do are similar. For example, there were a lot of, studies and modeling done during the presidency of George W. Bush on the idea of whether the U.S. Government should close its borders to keep out the pandemic.

John E. Lang: (18:20)
and all the conclusions were that it would give only maybe a week’s worth of gain if you tried to close the border because there’s just no way to completely seal off the United States. And you can’t just do that kind of thing without having major disruptions to not just people crossing borders, but the trade could really cause much more harm to the U.S economy than any good by gaining a strong short amount of time, by closing the border. So that’s something that I would assume will apply now also, and particularly since we already have some cases in the United States and people being checked, right as we speak on as to whether or not they have the novel coronavirus.  it’s just the kind of thing where it sounds easier, it sounds so obvious. Well, let’s just close the border and we’ll keep it out. And all the studies and modeling indicate that that won’t work. So that’s one of one example of some of the studies that were done to prepare for pandemic influenza that would apply now

Mark Goldberg: (19:35)
In the coming weeks and even days. Are there any indicators that you’re going to be looking to that will suggest to you one way or another, how this situation is, is unfolding?

John E. Lange: (19:49)
Yeah, we’re talking about days and maybe a few weeks be is to see how this unfolds.  one of the keys is human to human transmission.  if that is self-sustaining that is a major concern.  and that was the concern back when we were worried about H5N1 which was known as bird flu.  you had just a few cases within families of human to human transmission, but mostly it came from very close contact with poultry that were infected by H5N1 in the case that we’re dealing with now with the novel coronavirus initially it seemed that the only people who got it were at these wet markets in Wan in China and those live markets with the animals. And some speculate that this came from bats.

John E. Lange: (20:43)
They were the ones who were getting it since then there been human to human transmission and it’s already present in most if not all major cities in China.  so that’s probably the single most important factor in my mind as to what the future of this holds. Another factor is what an expert would call the ‘are not’ factor. It’s the reproductive level. And, and if it reproduces at a level of less than one, in other words, every individual insect less or fewer than one other person, then you then eventually this dies out. If it’s more than one, then it will spread. And right now the estimates are it’s about 1.5 to 3.5, so that and while it’s very early to get some of these estimates, if that were to continue, that would mean this will spread and not be quickly eliminated. And once it is spread, then one of the key things is to limit the population mobility and what they call ‘social distancing’. And what they’ve already been doing in China, especially at the time of the Lunar New Year Celebration there is to cancel mass gatherings and closed schools and you can urge people to work from home, um, and other things so that by limiting that population mobility, you can try to keep many people from being coming infected.

Mark Goldberg: (22:13)
Um, okay. Well this, is there anything else you think is worth emphasizing or discussing or pointing out about the global response or, you know, just in general the situation?

John E. Lange: (22:25)
Yeah, I think one of the important things that’s come about in the years since SARS is not only the international health regulations, but certain norms for sharing of data. For example, the Global Initiative on Sharing Avian Influenza Data, called GISAID, is a platform for open and timely sharing of influenza data and for building trust.  and the theory is that transparency brings about confidence, which, which brings about rapid sharing of critical data. And China has released genome sequencing and China, Japan, Thailand, Taiwan in the U S have been sharing genetic sequence and metadata in this situation. And that’s so it’s, it’s not just a matter of  one entity out there who, and it’s International Health Regulations that are dealing with this globally, but others also  that, that are working to help scientists analyze the pharmaceutical industry will be working on vaccines once the viruses themselves are available for that.

John E. Lange: (23:45)
And that will  possibly then become a longer term solution even though it takes many months to put it together. Um, and there’s one other thing I think is very important to, to mention that that has occurred since in this period since SARS. And that is the Global Health Security agenda. It was launched in February 2014.  it has about 60 or 70 governments that are involved in it and many other institutions, including the United Nations Foundation where I work.  and that has been an effort to try to promote and help countries to build the capacities that they need under the international health regulations. Because even if you say that these International Health Regulations are out there and accepted by all countries, that doesn’t mean all countries in especially low and middle income countries have had the capability to build up their capacities, laboratories, train staff, et cetera, that you need to monitor infectious disease outbreaks such as this one and the GHSA has been a major effort to build up those capacities as well as other capacities to improve health security.

Mark Goldberg: (25:04)
Well, it’s just interesting you’ve cited a number of, well, it’s just interesting that you’ve cited a number of sort of innovations and like global governance and multilateral cooperation that have occurred over the last decade that seemed to have like this, you know, kind of seemed to be custom built for this very situation. And it seems in a way, this is both a demonstration, one of the value of things like the International Health Regulations and the global health security initiative that you just described, but also sort of a test of them as well.

John E. Lange: (25:37)
Yes, but I think it is a test, but I my concern is that despite all the efforts that have been done over the last several years to focus on these needs to build capacity  on under the international health regulations, especially in lower middle income countries, so much more needs to be done. It’s a matter of providing the financing and the part of donor governments and other institutions to help countries so they can make it a priority to build up those capacities. And to tell you the truth, one of my concerns in a global context is in Africa, I already mentioned how the Gates Foundation has given $5 million to the African CDC, but you also have a lot of Chinese who are working in Africa based there who presumably many of them went to China for the Lunar New Year when they come back to their homes in Africa.  you may find that this starts spreading there and spent much of my career in Africa at different embassies.  I must say it’s very worrisome, just w when, when these kinds of things an infectious disease outbreak such as this one hits a very poor country it could be very bad.

Mark Goldberg: (27:03)
At least like China has like some capacity to respond, but the capacity is far limited, say in places, you know, like where you’re in a master like Tanzania.

John E. Lange: (27:13)
Yeah. Or, or Botswana or Togo. They’re the three countries where I was based in, and so I have to say it’s a, we have all these efforts out here, but there an anybody who’s been dealing with the IHR or the Global Health Security Agenda or these other efforts, who would say, who would say that they’re well-funded?

Mark Goldberg: (27:35)
Can I ask one final question?  you brought up Taiwan. Um, how has the sort of relationship between Taiwan and China complicated the global response to this new coronavirus right now? Or has it?

John E. Lang: (27:52)
I’m not aware of a complication that has occurred, but it does get to be a little tricky within the context of a U.N. agency when you have Taiwan and China and how they relate to each other.  and who is no exception in that regard. But it’s a moment I, I’m not aware of any concerns or complications that have arisen during this current outbreak.

Mark Goldberg: (28:21)
Um, all right.  well, thank you so much for your time, ambassador. This was very helpful.

John E. Lange: (28:27)
Okay. All right. Very good to talk to you, Mark.

Speaker 4: (28:32)
All right. Thank you all for listening. Thank you to ambassador Lange. That was very helpful, and as I said at the outset, you know, I do think it does provide some helpful context for understanding events as they unfold. So let me know. Let me know what you think about this episode. Let me know what’s on your mind. You can always reach out to me using the contact button on globaldispatchespodcast.com. All right sees you next time. Bye.

What is the Global Fragility Act?

The Global Fragility Act is intended to address one of the major issues the U.S. government faces as it approaches conflict prevention and post-conflict peacebuilding in what are known as ‘fragile states’. Dr. Dafna Rand, the Vice President of Policy and Research at Mercy Corps stated, “The Global Fragility Act, in just one sentence, is a new way for the U.S. government, particularly the State Department, USAID, the Department of Defense, and the White House, can think more strategically and more proactively about preventing conflict by picking a few specific countries and saying, “look, we need to align our diplomatic efforts and some of our program money.”” These efforts, as Dr. Rand states later on in the podcast episode, need to be carried out as long-term initiatives, focusing on 10-year plans rather than the short term 2 to 3-year cycles that characterize the typical lifespan of initiatives in the U.S Government. 

Two Exciting Aspects of the Global Fragility Act

Long-Term Strategy for Strategy and Stabilization

In practice, the Global Fragility Act will begin by picking a few pilot countries to focus on and write a strategy to determine how to prevent violence and reduce conflict for their specific situation. The legislation itself actually directs the government to come up with a 10-year strategy. Each of the 5-6 countries picked for the initiative will be divided into different categories – prevention and stabilization.

Funding and Bi-Partisan Support

Dr. Rand, commenting on the possibilities of the new law, added that the second exciting part of the bill was that it came with money. Rand continued, “there are often congressional bills and pieces of legislation just telling the government or the State Department to do stuff, but coming with resources really was an eye opener. So, the State Department and USAID are watching because there’s nothing like resources to focus the mind.” The Global Fragility Act seems to have opened up a new landscape of opportunity as both sides of the aisle, Republicans and Democrats alike, came together to pass the bill into law.

Fragile States and Why They Need Support

When asked about the reason these ‘fragile states’ need U.S. support, Dr. Rand responded, “since 9/11, the U.S. government amazingly has spent $5.9 trillion fighting terrorism, right? There has been a war on terrorism since 9/11/2001, but that is still a lot of money. And yet, the terrorism continues to be a problem.” Rand continues to say that one aspect of the ‘fragile states’ that really worries foreign policy and national security thinkers is that terrorism tends to come from states in fragile contexts about 90% of the time. For groups such as ISIS, Al Qaeda, and Boko Haram – both the individuals perpetrating the acts and the havens in which they thrive tend to be found in fragile contexts. Neglecting these fragile contexts will only continue to produce a negative impact on the international stage.

For a more in-depth look at the Global Fragility Act, listen to Global Dispatches podcast episode titled Can the Global Fragility Act Help Prevent Conflicts Before They Start? | Dr. Dafna Rand wherever you listen to podcasts. You can access the episode using the links below:

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Mark Goldberg: (00:03)
Welcome to Global Dispatches, a podcast about foreign policy and world affairs. I’m your host Mark Leon Goldberg, editor of UN Dispatch, and in this show we discuss topical global issues, have conversations with foreign affairs, thought leaders, and Newsmakers and give you the context you need to understand the world today. Go to globaldispatchespodcast.com to learn more and now on with the show.

Mark Goldberg: (00:31)
In the midst of impeachment drama unfolding in Washington D.C. A rare thing happened. Republicans and Democrats came together and in an overwhelmingly bipartisan move supported a bill known as the Global Fragility Act. The act became law when it was inserted into a spending bill that passed Congress and was signed by the president at the end of the year. In brief, the Global Fragility Act is intended to address a key gap in how the U.S. government approaches conflict prevention and post-conflict peacebuilding in what are known as fragile countries.

Mark Goldberg: (01:11)
The bill was broadly supported and in part conceived by advocates in the global humanitarian and relief community. And on the line with me to discuss this new Global Fragility Act is Dr. Dafna Rand vice president of policy and research at Mercy Corps. She’s also a former Deputy Assistant Secretary of State for democracy, human rights, and labor in the Obama administration. We kick off discussing the act itself before having a longer conversation about how U.S. approaches to conflict prevention in post-conflict reconstruction have sometimes fallen short and how this act may usher in a new whole of government strategy around conflict prevention and peace building. The Global Fragility Act is one of those under the radar policy stories that has big potential to change how the U.S. government  and the U.S. Foreign Policy bureaucracy approaches parts of the world that beset by instability so I’m glad to bring this story to you.

Mark Goldberg: (02:15)
And a quick note to premium subscribers and those who want to become premium subscribers. I still have a couple of slots left, in my January and February office hours. It’s been really interesting to me to hear what you are working on to hear what’s on your mind. If you want to schedule one of those time slots. If you are a premium subscriber, just check the message I sent you via the Patrion page. And if you want to become a premium subscriber, go to patrion.com/globaldispatches or you can follow the links on globaldispatchespodcast.com.

Mark Goldberg: (02:49)
And today’s episode is brought to you by Northwestern University’s Online Master’s Program in Global Health. You can learn how to make a meaningful difference in places where it is needed, the most go-to globaldispatchespodcast.com and click on the ad to learn more or go to sps.northwestern.edu/global and now here is my conversation with Dr. Dafna Rand of Mercy Corps.

Dafna Rand: (03:20)
The Global Fragility Act, just in one sentence is a new way for the U.S. government, particularly the State Department, USAID, um, even DOD, the Department of Defense and the White House. To think more strategically and more proactively about preventing conflict, um, by having greater strategy and picking a few countries and saying, look, we need to align our diplomatic efforts and some of our program money. Um, so that, that’s it in a short statement and it, you know, so that’s, that’s what it’s going to do.

Mark Goldberg: (03:50)
Well how will it do that though?

Dafna Rand: (03:52)
So there are two really exciting parts of this piece of legislation and the first part is kind of maybe boring and inside the beltway but really matters to people working in these buildings, which is just picking a few countries, these pilot countries up to six and saying look, we’re going to pick these countries whether it’s Yemen or the Central African Republic or Kenya and we’re going to write a strategy on how we prevent violence there and how we reduce conflict. You know, stepping back a little bit from the day to day humdrum of what we’re doing now and we’re going to present it to Congress and we’re going to report on our efforts toward achieving it. Um, so the legislation actually directs the government to come up with a 10-year strategy on each of these five or six countries and very smartly divides the different types of countries into prevention cases. And then stabilization.

Mark Goldberg: (04:41)
That’s what I was going to say, cause you mentioned Kenya and Yemen in the same breath. Uh, you know, Yemen is, you know, where there is a hot civil war ongoing. Kenya is a country that you know, in the last 15 years, 10-15 years has experienced some violence. But you know, it’s not a place where there is a conflict ongoing.

Dafna Rand: (04:59)
Right. So, the idea here is written pretty broadly, which to foreign policy wonks like me can be a little bit mind numbing. But the idea was to get at the fact that there’s different types of problem sets here. When you talk about the rise of global conflict and violence. So, you have situations like Kenya where every couple of years, usually around an election cycle, but sometimes not. There might be a spike in inter-ethnic communal violence, usually civil conflict, rarely of the international sort. And then you have very different case studies like Bolivia or Syria where you know, in this point, in both of those wars there’s major international powers intervening. So, it’s a layered conflict with an international level, a state level, civil level, and even sub state. Right. And local level violence. So, we want to make sure that we don’t, you know, drive the same broad-brush strokes and we recognize that a strategy will have to look very differently in those two types of cases.

Mark Goldberg: (05:49)
So the act requires the government is, presumably the to draw up strategies around a certain number of specific countries that are fragile?

Dafna Rand: (06:01)
Right. So, it doesn’t specify the countries. It says that the State Department and USAID and a high-level person appointed by U.S. State Department probably will get to pick these countries, which is really key because if you let Congress pick, you know, every Congressman would have their own country of choice. Um, so has to draw up and report to Congress on a 10-year plan for addressing violence and fragility. We left it broadly – fragility has kind of a, you know, a jargony word. I’ll be honest. Um, I think the development folks really like the word fragility because it encompasses development interventions, economic assistance and, but in some cases, you know, there’s a programmatic element. There’s going to be a foreign assistance project and some cases there’ll be more diplomacy that’s necessary. So, you know, the idea is to have to not pre-prescribe for the State Department or people writing the strategies what combination of tools in their toolbox they are going to need to use.

Dafna Rand: (06:53)
Um, but for the State Department and for the government to have ownership over this strategy and have to continuously report back against it, which is sort of novel because if you think about the way the government works, it’s often in one, two, three year cycles cause that’s the rotation of the personnel to do. But to say over 10 years we want to reduce violence or conflict by this amount and we’re going to report on our measurement. We’re going to measure our effectiveness as the new and novel way of looking at foreign policy.

Mark Goldberg: (07:19)
When you say fragile, like a fragile country, what do you mean? I mean, I know for example, there are organizations that put out like fragile state indexes. What is meant by the term fragile in the, in the context of, you know, international development or international relations or just, you know, what does that mean?

Dafna Rand: (07:38)
Yeah, the international development community has indices that add after sort of a fragility index, but broadly speaking, it’s a combination of socioeconomic factors, inequality factors, weak state, institutional factors and repressive regime factors and just basic conflict at every level that would describe any share and would also describe a Yemen, right? So, there’s many different types of countries that would fall into sort of the fragility index. Um, you know, people will criticize this because let’s be honest, no state wants to be called fragile. It seems sort of pejorative and kind of weak. Um, so one word that we’re using more and more at Mercy Corps, we talk about fragile contacts. We talked less about fragile States and more about these parts of the world. They’re often kind of regions or provinces within states where, you know, you don’t really see government anywhere. There are often militias running around the delivery of services could be like ISIS is a delivering service one day and some other jihadist group another day.

Dafna Rand: (08:35)
Right. So, a lot of the places where Mercy Corps works or in these contacts where the state is not really relevant as an organizing principle. So, these are the types of places in the world that we’re talking about. Northeast Syria, Northwest Syria, most of Syria is fragile, so and then a lot of African countries. Um, and, and, and even in non-fragile States there could be these pockets. So even in Nigeria, which is the biggest country in Africa, we look at Northeastern Nigeria, sort of a fragile context because they are, Boko Haram is in a bitter battle with the Nigerian armed forces to control, you know, who governs, who deliver services, who even controls the roads. And daily there’s a shift. And who’s at the checkpoints up there?

Mark Goldberg: (09:17)
Well, so why is it that fragile States are a fragile context, as you say, are a problem for the United States? Or why is it something that the U.S. Foreign policy should be in engaged in, in sort of helping to resolve or increase the relevance of a state institutions in those places?

Dafna Rand: (09:36)
Sure. So, since 9/11, the U.S. government amazingly has spent $5.9 trillion fighting terrorism, right? Like we know this, we know there’s been a war on terrorism since 9/11, but that is a lot of money. And yet the terrorism, you know, continues to be a problem. And so one aspect of the fragile context that really worries a foreign policy and national security thinkers is that the continents and the overlap between where terrorism come from, the tends to come sort of usually in probably over 90% from these fragile contexts, both the individuals perpetrating the acts, but also the ways in which there’s havens for groups like ISIS, Al Qaeda, Boko Haram, they tend to thrive in some of these more fragile contacts. And again, you know, some state might have authority and control over institutions and all, but you know, a tiny part of their, their country. And that’s where, of course the terrorists will thrive. So, this has become, you know, uh, after almost 20 years of fighting terrorism and recognition that it’s the nature of these incubating environments that’s really part of the problem. And that the terrorist will take advantage of these places where there’s no real, uh, government authority, no real official monopoly over the use of force and where people are, you know, willing to accept whoever will just turn on the lights, you know, give them minimal roads, deliver some sort of basic services,.

Mark Goldberg: (10:54)
So it’s like a national security argument that um, you find most persuasive here?

Dafna Rand: (11:00)
No, I mean, as a Mercy Corps executive, I’m committed to helping these contacts because that is what we do. You know, I mean the development community, um, is not bound only by the national security argument. We’re committed to improving and developing and, um, delivering humanitarian aid and these places, Mercy Corps has, you know, increasingly are distinctive as an organization, as we are that humanitarian organization that is just willing to go regardless of the security risks, regardless if there’s kind of no government in sight. And so, we’ve become as an organization and expert in these parts of the world. Um, and the bulk of our work is in these parts of the world. So, Mercy Corps. And then the reason we’re super aware, I began working on this bill so many years ago, we started working on it three years ago, is that even as a humanitarian authorization, we were shocked by how much the world was paying on the back end of these conflicts.

Dafna Rand: (11:44)
So, you know, more support. We get all these grants, but to be honest, we’d rather not be a booming industry. Right? Humanitarian aid has soared because there’s just, you know, millions and millions of people all around the world in the past 15 years who are caught up in some of these conflicts. So just last year, Mark Lowcock, who’s the head of the U.S. humanitarian agency estimates that a hundred-

Mark Goldberg: (12:05)
He’s been a previous guest on this podcast on this very podcast.

Mark Goldberg: (12:07)
Oh he is? Okay, great. So, he’s predicting that in the coming year, 168 million people around the world are going to be in need if that sort of highest level of UN humanitarian assistance. Okay. So, most of the world will take that money and we’ll deliver the services. But honestly that’s giving a food that’s a Band-Aid that’s giving out water. That’s, that’s epost, that’s after the problem. So, as an organization, we started looking for what’s the solution? What are the root causes of this?

Dafna Rand: (12:29)
Why are these Wars going on and on? Why is civil conflict not ending? Why are international actors exploiting local conflicts? Um, to real, the real detriment of the civilians. And so around three years ago, we sat down with members of Congress. There were also looking at this from a national security angle and from frustration, honestly, by how much the U.S. was investing in the war on terrorism without much return and with burgeoning new terrorist organizations. And we had a real meeting of the minds where we were kind of a credible voice that said, we’re happy to be a booming industry. And the, you know, humanity interesting, very square has grown exponentially, but we’d prefer that there not be all these people caught up in the crossfire of war and conflict. So, let’s try to do something about it and let’s try to turn us foreign policy toward this lens of stopping violence and conflict.

Mark Goldberg: (13:14)
So if you are back at the State Department and you are the officials sort of in charge of managing the um, you know, global fragility strategy, could you maybe just kind of dial in on some examples of what that strategy in practice would look like? Like what would be elements of this strategy in place in a fragile country or fragile context?

Dafna Rand: (13:41)
Great. Yes. So first I add at the second really key part of this bill. And the part that really wowed a lot of people in the country was that it’s come with money. And so, there’s often, you know, congressional bills and pieces of legislation just telling the government the State Department to do stuff. But coming with resources will really was an eye opener. It was kind of a wakeup call. So, the State Department and USAID are watching because there’s nothing like resources to focus the mind. If I were back at state, I would immediately start thinking about what kind of countries fit into these two categories, preventing conflict and then stabilization. So, after conflict or during conflict, how do you stabilize different communities? And then I would start thinking, you know, where there are countries that I want to nominate to be one of these new pilot priority countries for this Global Fragility Act where I can work on a strategy with my colleagues at USAA, with my colleagues at DOD.

Dafna Rand: (14:29)
I look at countries like Niger, like Nigeria, like Kenya where there’s different types of violence in age, you know, and in Niger the issue is really a jihadist terrorist groups. Um, and in Nigeria there’s all kinds of conflict including Boko Haram conflict and ethnic tension conflict and also conflict between pastoralists and herder community. So anyway, I would look at, I would think about the different countries I wanted to nominate and then try to bring together the folks in DOD who were hand training security services, the folks at state who are looking at human rights, the folks who were looking at economic development and see if we can synthesize all of the different parts of the U.S. intervention in that country. Um, and, and really it would be exciting because these parts of the government talk to each other, but we’re usually just working on the day to day.

Dafna Rand: (15:18)
Right. And the government just working on kind of their urgent. Now you know, what’s the next big fire burning in that country. But to come together with a goal of over 5-10 years trying to reduce conflict or trying to reduce violence would be a new way of working. And then I would start thinking through, you know, what more evidence do we need? And that’s a big part of this bill. What evidence do we need? What research do we need about what works? Not all of these programs are reducing violence or preventing conflict. Um, so I would solicit some great researchers, you know, maybe even mercy Corps researchers to conduct some studies, um, empirically with quantitative methods over which parts of the foreign assistance packages have worked over time. There’s too little of that kind of after-action accountability in the U.S. foreign assistance apparatus. And it needs to be driven by state department, USAID asking like, we’re not just going to give out money. We’re going to ask which of your programs that you have implemented have worked the best and have been the most sustainable. So that’s what’s, that would be exciting to me if I were back at the state department.

Mark Goldberg: (16:13)
I’m like a firm believer that people in general discount the role of bureaucratic politics and crafting foreign policy. Um, what are ways, for example now in like Niger, um, in which bureaucratic politics are undermining overall goals around fragility? And how would this act, you know, shift the, um, bureaucratic motivations to try to, as you do like work together, create this kind of whole of government approach that you, that you describe? Like what’s, what’s, um, the problem now in terms of bureaucratic politics?

Dafna Rand: (16:47)
Okay. So, let me give a Niger example. That’s a good one. So you have a situation where it’s very clear to the department of defense and those who look at threats, that there’s a lot of really bad, scary actors who are endangering the security of Nigerians first and foremost, and making their lives miserable, but also endangering regional and international security coming out of Niger. So they’ve invested a tremendous amount of money in the hundreds of millions in new security assistance programs that will train the Nigerian officials working with others, working with Europeans, with French and other European partners to train Nigerian security officials to fight some of these terrorist groups. Right? And that there’s nothing wrong with that. But if you don’t do that, and at the same time look diplomatically, which ministries is in, the ministry could actually improve the education system could actually deliver, take out the trash, turn on the lights, pave the roads, um, work on health issues and those same environments that are, where some of this radicalization is spreading.

Dafna Rand: (17:42)
You’re losing an opportunity. You know, you are first of all, creating incredible imbalance between the in the military and Niger and the poor beleaguered civilians. And at the end of the day, we know that the grievances that drive some of these types of conflicts like in Niger the first place are really civilian grievances. They have to do with really basic things like who was going to help me pay for school and why isn’t the government delivering me school for my kids? Um, and why is there so much inequality and why is there so much corruption? Those are the things that are driving the grievances and we know that and that’s what the research has shown. So bureaucratically this bill will help those at the state department, USAID call up Africom and say, look guys, we got to sit down at the table because for every unit that you’re training, we need to make sure that when you send those New Jersey and security forces up into the regions where ISIS and other bad guys are hiding out and really taking some of these civilians hostage, we create a complimentary development plan and an even a diplomatic plan to help the civilians who are living under these, um, these threats.

Dafna Rand: (18:44)
So that’s what’s exciting about this. It will give new resources and new kind of congressional, uh, uh, egging on, um, for lack of better term. And often Congress will give more resources and more, you know, and more championing of the DOD levers in the, in the tools and the, in the toolbox and less on the diplomatic and then development.

Mark Goldberg: (19:03)
And to what extent does the act, um, enable or encourage the U.S. government ‘s work in partnership with other governments or the United Nations or civil society actors?

Dafna Rand: (19:17)
Yeah, there’s actually a language in the bill and this part of the bell was championed directly by Senator Graham himself, who was one of the originally co-sponsors. So one of the key Republicans who helped bring this bill to passage. And in it, it has, it authorizes a new multi-donor fund. And the idea here is that the U.S. could use its, uh, its leverage and its leadership to get other donors. So other countries that have money to give to foreign assistance, um, to, to, you know, to write in some money and to work together. And this seems like a really exciting opportunity. We don’t know if this State Department under secretary Pompeo or this USA ID under Mark Green will seize on this authority. Um, we haven’t talked much with them yet about whether they’re excited about it, but Congress is saying, you haven’t this new authority for this new fund. Um, and imagine if like the MCC was more of a global fund. That’s what this could be.

Mark Goldberg: (20:05)
So the MCC is the millennium challenge corporation. The idea here is to create a, uh, a fund that the U.S. would contribute to, but also because the U.S. is contributing it to it, other countries, other donors may contribute to it as well. And that might be used for prevention and, and other, you know, antifragility operations more broadly. Is that right?

Dafna Rand: (20:29)
That’s right. So the idea is to kind of use-

Dafna Rand: (20:32)
Like a global fund kind of model.

Dafna Rand: (20:33)
A global fund kind of model and to kind of all work together on the same countries, the same ambitions, to coordinate resources to make sure that we’re not overlapping and let’s say all investing in education in Niger, you know, to make sure that some countries are investing in Education, some in health, some in housing, some in infrastructure, right. But it is again, complimentary, organized, efficient, um, and you know, and just there’s chains of communication.

Mark Goldberg: (20:58)
So the bill was just passed at the end of 2019. Um, what, what comes next? What are some inflection points for the Global Fragility Act in the coming weeks and months that you’ll be looking towards to see how it will evolve. And you know, in the near future.

Dafna Rand: (21:16)
Right? So we, mercy Corps and some of our partners, we amassed a coalition of 70 civil society groups, you know, from right from left, religious affiliated groups or um, and all kinds of groups. And so we’re going to continue our coalition work cause we’re going to keep on pressing the executive branch now to make sure that they are taking Congress’s intent and they implement it. So the first thing we’re looking for is high level leadership, probably at the State Department at the under-secretary or so level. Again, back to bureaucratic politics being everything we really need, you know, a supervisor at the State Department to make sure that this works out well. We can’t have these bureaus fighting over the money. So that’s the first point that we’re going to be pushing for. I said, you know, to appoint and to ask, uh, to make sure that there’s someone designated by the secretary of state who’s at the under-secretary level, um, who can really coordinate this and own this and report back to Congress on that.

Dafna Rand: (22:05)
So that’s step one. Um, and then second thing we’ll be looking for is to make sure that all the different parts of State Department and DOD and NSC are all involved in this. Um, it would be a real waste to go back to business as usual if it got kind of sent down and delegated to a couple people, you know, here and there and the bureaucracy. So we want to make sure that, you know, everyone’s working on this together. And as an outside civil society coalition, we have our ways of pressuring even the executive branch. Um, so that’d be the second. And then, you know, we’re hands off on the, on the country selection. That’s up to the U.S. government to decide there are many different countries that would benefit from this kind of spotlight and this attention and these resources. So we’ll be looking to see how they sell back to the countries in the conflict prevention category and those countries in the stabilization.

Mark Goldberg: (22:49)
When would that selection happen?

Dafna Rand: (22:52)
We’ll be looking for them for the, uh, State Department to report back to Congress in a timely manner. And they are split and they, it requires the executive branch develop its strategy by September 15th, 2020. So they have around nine months.

Dafna Rand: (23:05)
Hmm. Okay. So that’s a, that’s when we’ll know what the first iterations of the strategy might look like.

Dafna Rand: (23:12)
Yes. And I should say that one of the other, um, indicators that this is a succeeding is it’s very, very clear in the bill that the Global Fragility Act is not just about foreign assistance, but it’s not just about these programs and the money, but it’s about diplomacy. And this is the trickier part of oversight Congress always wrestles with how do you do oversight over what diplomacy is going on at the State Department with them? Private messages are, they’re being whispered around the world, right? By us diplomats. And so Congress and the civil society groups like Mercy Corps expect or an accounting, what kind of messages did you pass to those ministers in Niger? Or what did you tell the government of Kenya about election prevention? Right. And so this is novel, and this is the hardest part I think will be for to demand accountability by Congress over the diplomatic efforts that we’re involved in the strategy.

Mark Goldberg: (23:58)
Uh, well definitely. Thank you so much for your time. This is interesting. Helpful.

Dafna Rand: (24:01)
Sure. Pleasure talking to you.

Mark Goldberg: (24:05)
All right, thank you all for listening. Thank you to Dr. Dafna Rand, that was very helpful and also a really good, I think explanation of how and why bureaucratic politics plays such an important role in foreign policy making. There’s actually a really good book. It’s probably one of my favorite and most useful foreign policy books or us foreign policy books. It has a terribly boring name. It’s called Bureaucratic Politics and Foreign Policy, but trust me, it explains how Washington works. It’s by Morton Halprin and Priscilla Clapp. It was published a few times over the years with updates, but I’ll post a link to it on the homepage. It’s a great book and kind of explains the sausage making process of foreign policy. It’s very interesting and again a do feel free to book an office hour time slot with me. Happy to chat with you about whatever is on your mind, uh, to access that. Just go to patrion.com/globaldispatches and become a premium subscriber. Thank you.

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The conflict in Syria is entering a new phase. Over the last several years Syrian government forces, backed by outside powers like Russia and Iran, have steadily regained control of territory held by rebel factions.  As they lay siege to opposition fighters, they forced groups, including massive numbers of civilians to retreat to a part of Syria called Idlib. This is in the Northwest of the country near the border of Turkey. Today, this is the largest rebel-held bastion. The number of fighters is relatively small compared to the some 4 million civilians trapped there.

Russian fighter jets and Syrian artillery have continued to target this area, though there has not been an all out ground invasion. Meanwhile, millions of civilians trapped here and also other rebel held parts of the country in the Northeast are dependent on humanitarian relief to stay alive.

For the last six years, the main lifeline for civilians in rebel held territory in these parts of Syria has been aid delivered across the border. What is significant about the cross border aid delivery is that it is done without the consent of the Syrian government; this is unusual because for both legal and practical reasons the United Nations and aid agencies it works with requires the host country’s permission to operate. But in 2014, with humanitarian disaster mounting across the border from Turkey, and with the Syrian regime not permitting aid deliveries to rebel held parts of the country, the UN Security Council used its authority to authorize the cross border delivery of aid —  even if the Syrian government would not consent.

This was a big deal at the time, and allowed a massive aid operation to reach vulnerable populations in Northern Syria.

The Security Council resolution enabling the cross border delivery of aid requires re-authorization every year. And every year, even with Russian acceptance, it was re-authorized.

That was until this year. On January 10th Russia forced the Security Council to severely limit these aid operations. Now, says Vanessa Jackson of the humanitarian organization CARE International, cross border aid operations will be extremely limited and perhaps even cease all together in the near future.

Vanessa Jackson is the United Nations representative for CARE International. She has been following both the debate on Syria at the Security Council closely we discuss the impact of this restriction on the delivery of humanitarian aid as well as how this move fits into the broader trajectory of the conflict in Syria.

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