Tackling the Neglected: Attention for Tropical Diseases

Author: Jared Sawyer

        If we are willing to spend $10 on Nyquil for a night’s reprieve from a stuffy nose, then why not spend less than $1 a year to prevent lymphatic filariasis or soil-transmitted helminthiasis? Or, what about schistosomiasis, onchocerciasis, or maybe trachoma? Then again, why waste a dollar on these long-named diseases you have never heard of?

        This is the problem that plagues these neglected tropical diseases. These unfamiliar diseases remain unheard of to us Americans, but are overbearingly common in tropical countries where over a billion people[1] are disabled and disfigured annually due to these neglected diseases.

        Lymphatic filariasis (better known, but still not known well as, elephantiasis) is a parasitic disease that is rarely fatal. Nevertheless, those who develop symptoms are faced with painful and disfiguring swellings in the arms, legs, or genitals.[2] Following the pain and permanent disability comes horrid social stigma tied to the visible physical disfigurations created. A quick, although disturbing, Google image search will demonstrate why these disfigurations are so ostracizing. Yet, while billions get spent on social stigmatizing issues such as acne, little is spent on the debilitating effects of lymphatic filariasis.   

        Soil-transmitted helminthiasis includes roundworms, whipworms, and most famously, hookworms. Around 1.5 billion people or roughly 20% of the world’s population are currently impacted by these worms. However, these infections are not equally distributed around the world, but rather, most of the infections reside in the developing tropical and subtropical world.[3]

        These parasitic worm diseases are also rarely fatal. The more common symptoms include anemia, lack of energy, and stunted growth and cognitive development.[4] These symptoms are specifically devastating for the 267 million preschool-age children and the 568 million school-age children at risk of infection from these worms.[5]

        The scariest part of neglected diseases like lymphatic filariasis or soil-transmitted helminthiasis is how easy they can be solved and even eradicated. Simple strategies such as educating about the importance of peeling and cooking of vegetables, avoiding walking barefoot, and not using night soil (otherwise known as excrement used for fertilizer), can prevent infection.[6] Nonetheless, in the areas where these neglected tropical diseases are prevalent, education may not be useful; these recommendations may be impossible to realistically implement. There are populations without access to water to wash their vegetables, without shoes to wear, or without access to proper fertilizer.

        The good news is that there is an even easier solution available: mass drug administration. Not only does the preventative cure already exist, it costs no more than $0.64 annually per person to treat both lymphatic filariasis and soil-transmitted helminthiasis. [7] For under a dollar, or the cost of about one tenth of a bottle of Nyquil, a successful preventative and curative measure can be taken against these neglected tropical diseases. Even better, the cure, a mixture of albendazole and diethylcarbamazine, comes in pill form, making them easy to mass distribute and administer.

       Hope is not lost.There has been past success in eradicating neglected tropical diseases. For example, Dracunculiasis was a parasitic worm disease that affected around 3.5 million people in the mid-1980s.[8] Due to an effective prevention campaign, only 25 human cases were reported last year.[9] Turns out that when the World Health Organization (WHO) and the United States Centers for Diseases Control and Prevention (CDC) formulate and implement a strategy together, neglected tropical diseases can get eradicated.

        So, what are we waiting for? If we can solve these terrible diseases so easily, why haven’t we? The problem is that most of the people who are impacted are those without voices. The poor from the most destitute areas are the ones who get knocked down and further impoverished by these neglected diseases. In opposition, those with voices push for resources and money to funnel toward the more profitable diseases we regularly hear about. Why spend money abroad when we cannot solve our issues back home?

        Beyond the screaming from my moral and ethical compasses, factually, these neglected tropical diseases are simply not confined to the tropics Approximately 12 million Americans are affected. Over 2.5 million African-Americans are infected with toxocariasis, and around 300,000, mostly Hispanic-Americans, are affected by American Trypanosomiasis.[10]  These primarily low income voiceless communities are being devastated by these diseases without help and without attention. To make matters worse, due to the pervasive lack of attention, the current absence of viable diagnostic tests and sufficient education commonly leads health care providers to either misidentify or fail to recognize the disease.

Neglecting these tropical diseases is no longer a viable strategy due to any notion that it does not affect us. Neglecting them is now synonymous with neglecting the disenfranchised.

Nevertheless, diseases like cancer take the whole stage while diseases both easier and cheaper to solve are ignored. This is not the fault of private industry. What money is there for making cheap cures for those without the money to buy them? Rather, this is a problem of attention. It is increasingly hard to gain momentum for solutions to problems that are unheard of. The first step here is to generate a new wave of easily accessible and persuasive information about these neglected diseases. Only when these neglected tropical diseases reach the limelight can impetus be achieved for solutions. It is time to tackle the neglected.

[1] http://www.who.int/neglected_diseases/diseases/en/

[2] http://www.who.int/mediacentre/factsheets/fs102/en/

[3] http://www.who.int/mediacentre/factsheets/fs366/en/

[4] WHO, ibid.

[5] WHO, ibid.

[6] https://www.cdc.gov/parasites/hookworm/prevent.html

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205627/

[8] http://www.who.int/mediacentre/factsheets/fs359/en/

[9] WHO, ibid.

[10] http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003012

A Saad Departure: Hariri’s Resignation and What it Could Signal for the Middle East

Author: Jackson McGlinchey

On November 4, Saad Hariri, the Prime Minister of Lebanon, announced his resignation live on TV. This announcement was not made from Beirut, however, but from Riyadh, where Crown Prince Mohammed Bin Salman has been making bold moves to consolidate power and guide Saudi Arabia toward his grand vision of reform. Prime Minister Hariri’s resignation was surprising, but not exactly unexpected. The Prime Minister, a Sunni, was presiding over a government controlled by Hezbollah, an Iranian-backed Shia militia group and rival to Mr. Hariri. Additionally, Lebanese Prime Ministers have certainly resigned in the past as a political move–—including Mr. Hariri’s late father, Rafiq Hariri, who was assassinated months later. However, the peculiarity of his resignation announcement from Saudi Arabia, in addition to recent events in Lebanon’s neighborhood, hints at something more.

Mohammed Bin Salman has been making increasingly bold moves both within Saudi Arabia and in its neighboring countries. The diplomatic crisis with Qatar this past summer was largely a push by the Crown Prince against warming relations between Qatar and Iran. The ongoing civil war in Yemen is a proxy war between Saudi Arabia and Iran, and has recently become more heated as a missile fired from Yemen was intercepted close to Riyadh on November 4. Following which, Saudi Arabia launched its worst barrage of airstrikes in over a year. Three days later, Abd-Rabbu Mansour Hadi, the Saudi-backed President of Yemen, was placed under a sort of house arrest, reportedly for his antagonism toward the UAE, a strong member of the Saudi-led coalition in Yemen. Meanwhile, Bin Salman made his strongest move yet toward consolidating power internally, purging several senior ministers and princes and arresting many wealthy power-holders. All these moves hint at a much more hawkish and hardline approach toward the increasingly hostile Cold War with Iran.

Saad Hariri’s resignation appears to be, at least in part, yet another play orchestrated by Saudi Arabia to counter Iran’s growing influence in the region. With Hezbollah in a strong position in Lebanon and Syria, and other Iranian allies gaining in Yemen and Iraq, Saudi Arabia is likely gearing up for a push against Iranian influence in Lebanon. It is notable that Hariri’s resignation speech contained a heaping helping of anti-Hezbollah and anti-Iran vitriol, to the surprise of the Prime Minister’s aides and even apparently Mr. Hariri himself.

So what could the resignation of the Saudi-backed Prime Minister do for Saudi Arabia? Hezbollah clearly has military superiority in Lebanon, and Iran is quickly developing a corridor of influence stretching across Iraq, through Syria, to Lebanon. So, Hezbollah–—and Iran–—has a clear military advantage. This move is seemingly a political one. With the resignation of Hariri, the Hezbollah-dominated government loses some of its legitimacy, opening it up to stronger attacks from America and Israel. Furthermore, Mr. Hariri’s resignation could be part of a move to run as an opposition candidate in the 2018 parliamentary elections, giving the Saudi alliance a chance to challenge Hezbollah politically.

Whatever the plan, it is clear that Mohammed Bin Salman is adopting an ever more hostile approach to the Cold War with Iran. As Iran continues to gain influence and Saudi Arabia digs in and fights back, the Middle East is in an increasingly precarious condition. We have seen what a proxy wars between the two powers have wrought in Syria and Yemen. We should hope that the same fate is not in store for Lebanon now.

Now Accepting Submissions for the 2018 Edition!

Hemispheres, The Tufts Undergraduate Journal of International Affairs, one of the oldest undergraduate journals in the field, is now accepting submissions relating to this year’s theme of Dynamic Identities. Submissions should be research articles, approx. 5000-8000 words, written by undergraduates in a broad range of fields relevant to international affairs. To view paper requirements and guidelines, please visit our submissions page. To submit a paper, or if you have any questions or concerns, please contact hemispheres@tufts.edu.

Submission Deadline: December 31st, 2017.

We welcome and encourage a broad interpretation of the theme. Potential research topics may include, but are not limited to:

Hemis Solicitations Poster (2)

Editorial: Austria’s New Leader Came to Power on Anti-Refugee Sentiment    

The 31 one-year old campaigned on closing Austria’s Borders and implementing other Far Right policies.

Author: Ashrita Rau

On Sunday October 15^th, Austria elected 31 year old Sebastian Kurz to be its next chancellor. Kurz, who was appointed Foreign Minister of the country at age 27 (becoming the youngest person to ever hold the position) ran his campaign on a platform that advocated for the closing of Austria’s Borders. Kurz and his followers believe that the 90,000 refugees that arrived in Austria during the past two years have stolen social benefits that should have been given to Austrians, and his anti-refugee sentiment continues to gather increasing support.

The refugee crisis has caused problems in Austrian politics. In May of 2016, Chancellor Werner Faymann resigned suddenly due to tensions created by his refugee policies. At first a supporter of opening borders to refugees, Faymann changed positions after receiving criticisms from the right. However, his establishment of border fences and promise to crack down on refugees failed to do enough to please right-wing politicians and caused Faymann’s own party to view him as a turncoat, consequently prompting his resignation.

Kurz takes an even more hardline stance on refugees. During his term as Foreign Minister, he advocated for closing the Balkan route for refugees, pushed for a ban on burqas, and supported the idea that “immigrants should receive less state support for their children than native-born Austrians.” His campaign is infused with anti-Islamic sentiment, and many of its’ views echo that of the far-right Freedom Party, which was founded by ex-Nazis in the 1950s.

The campaign that Kurz ran has been compared to that of Emmanuel Macron, who managed to win the presidency in France with the new political party En Marche! In contrast to Macron, however, Kurz did not create his own political party—he revamped an already existing party (The People’s Party) and branded it around himself just as much as around anti-migrant ideas. The new name of his political party is “The Sebastian Kurz list—the New People’s Party.”

Apparently a charismatic personality, Kurz found success by centering the political party around himself. 42% of the people who voted for the New People’s Party did so because of Kurz, as compared to only 7% of Freedom Party voters who voted for the party because of its’ leader (Stache) and 20% of Social Democrats who voted for their party because of Chancellor Christian Kern.

Kurz is a sign that the apparent rejections of far-right thinking demonstrated by the election of Macron over National Front leader Marine LePen and the failure of Geert Wilders to win the presidential election in the Netherlands may have been abnormalities. By using the refugee-crisis, far-right politicians are continuing to gain traction in Europe. The question now is whether or not Kurz will align with the Freedom Party or reject ideas of the Extreme Right and stick to a more centralist political agenda.

Sources:

https://www.nytimes.com/2017/10/16/opinion/austria-election-sebastian-kurz.html

http://www.politico.eu/article/werner-faymann-how-not-to-handle-anti-immigration-backlash-refugee-crisis-austria-far-right/

https://www.theatlantic.com/international/archive/2017/10/austria-immigration-sebastian-kurz/542964/

https://www.theguardian.com/world/2017/oct/15/sebastian-kurz-on-track-to-become-austrias-next-leader-projections-show

https://www.vox.com/world/2017/10/16/16482416/sebastian-kurz-austria-far-right-right-migrants

Editorial: You Can’t Buy Peace: The US’s Flawed Foreign Aid Strategy in Afghanistan         

(Editor’s Note: This article kicks off our 2017-2018 online editorial submissions! Feel free to submit by emailing tuftshemispheres@gmail.com)

Author: Doug Berger

Despite more than 100 billion dollars in international aid, mostly from the US, and the sacrifice of thousands of NATO soldiers, Afghanistan remains on the brink. The Taliban controls the largest share of the country since the US-led coalition toppled its regime in 2001—the Afghan Government controls less than two-thirds. Afghanistan’s GDP is increasing slower than its population and it ranked seventh to last in Transparency International’s 2016 Corruption Perception Index. How can this be?

Much of the blame lies with the United States’ flawed aid strategy. Rather than supporting development, we have attempted to buy peace. Aid is disproportionately distributed to the regions with the most conflict, leaving Bamiyan and Daikundi, the most secure provinces since 2001, the poorest and least developed. The instinct to try to “win hearts and minds” in areas with a strong Taliban presence is understandable, but it has had disastrous consequences.

More than 80% of aid has gone towards short-term projects designed to improve the local security situation, such as walls around schools, or repairs to local irrigation infrastructure. While these projects have certainly done some good, long-term economic development and institution building have been neglected. The result: When NATO troops began to pull out in 2011, economic growth plummeted from well over 10% to just 2% and the poverty rate increased from 36% to 39%.

Moreover, there is evidence to suggest that this aid has failed in its primary objective: demonstrating the benefits of supporting the Kabul government. An internal report produced by the US Agency for International Development (USAID) found that its “stabilization” program had the opposite of the desired effect. In Taliban controlled villages receiving aid, opinion of the Taliban, rather than the US or the Afghan Government, improved—villagers generally believed that the projects must have been approved by the local Taliban militia.

USAID had been justifiably reluctant to provide aid through the Afghan government, which suffers from widespread corruption. However, Afghanistan has consequently lacked the resources to combat that corruption and build local institutions. Until 2014, 90% of all aid was spent outside Kabul’s budget. Significant US aid was (and continues to be) funneled through international corporations and multiple layers of subcontractors. This has lead to inefficiency and higher overhead costs—in 2012 just 30 cents of every dollar USAID spent actually went to aid—half the norm for other aid groups like the World Bank. In 2014, the US pledged to provide 50% of aid directly to the Afghan government, but with the security situation deteriorating, the window to build a stronger Afghan state may have passed.

In a situation as complex and difficult as Afghanistan, no solution can work perfectly, and any improvements will be gradual. However, there are a number of ways the US can improve its aid strategy to encourage better outcomes. Rather than attempting to buy peace, aid should concentrate on long-term growth and institution building. This necessitates a shift in focus to more secure provinces—long-term investments won’t pay off under constant threat of violence. For humanitarian reasons, aid to war-torn areas certainly shouldn’t be cut off, but the emphasis must change.

Sustained economic development would help the Afghan government collect revenue and decrease its dependence on foreign aid. Surely the chief goal of aid must be to reduce its necessity in the future. To this end, the US should focus on improving Kabul’s revenue collection capability, which remains relatively low at 10.7% of GDP.

Finally, when providing aid outside the government, USAID should strive to democratize the process—avoiding the use of international corporations. Rather than imposing projects based on what we believe the population’s needs are, programs should leave decisions on what to build where up to the local population. When possible, locals should be given the resources to complete projects themselves. This buy-in would empower the local population and help improve perceptions of the US and Afghan government.

2017 Journal

We’re proud to present our 2017 Journal: The Global Commons! Please head over to the current issue section of our website to view it.

Democracy in Tunisia

Another excellent paper we received, “Islamists for Democracy: Explaining Ennahda’s Democratizing Role in Tunisia’s Jasmine Revolution”  is from Shawn Patterson, a student at Tufts University studying International Relations.

This paper analyzes the success of Tunisia’s Jasmine Revolution, especially in light of the failures of various other Arab Spring Revolutions to bring about democratic states, and can be accessed by clicking on the hyperlink below.

islamistsfordemocracytunisia