I write this as I learn of the beating death of an Azerbaijani journalist Rasim Aliyev. His “crime” was to post a Facebook item about football. What follows seems insignificant compared to his murder.

Two articles have appeared in prominent Western outlets in the past month addressing developments in the South Caucasus and the need for adjustments in U.S. (and Western) policy toward the region. The first was an excellent, in-depth Brookings report titled "Retracing the Caucasian Circle—Considerations and Constraints for U.S., EU, and Turkish Engagement in the South Caucasus"; the second was a shorter essay that Bill Courtney, Denis Corboy, and I penned for Newsweek on the need to reboot policy toward Armenia, Azerbaijan, and Georgia. Both reflected the difficulty of writing about the “South Caucasus” as if the three countries had common interests and objectives. Increasingly these interests and objectives are diverging, except for a growing unhappiness with the United States and the West for not paying attention to—or doing enough to support—the region. In the case of Azerbaijan, the frustration stems from U.S. leaders paying too much attention to the appalling human rights situation in the country.

What’s making the Azerbaijanis so upset with the West?

The authors of the Brookings report point to elite cynicism over Western disinterest and policy failures in the region as sources of Azerbaijani leaders’ unhappiness. This, in their view, is causing Armenia, Georgia, and Azerbaijan—for different reasons and in different ways—to tack toward Russia.

We have a different take in our Newsweek piece. We argue that the unhappiness results from governing elites recognizing that U.S. and Western policy regarding human rights, democracy building, corruption, and conflict resolution (especially the Nagorno-Karabakh conflict) threaten regime stability. Therefore, the tacking toward Russia is a conscious choice to avoid pressure and the transparency that closer association with the United States and Europe would involve.

The new orientation of these countries requires serious adjustment in Western policies. There are four new drivers prompting change (beyond the role of Russia): the regional consequences of the Iran nuclear agreement; the growing economic crisis, which is affecting the South Caucasian states in different ways; the threat of renewed military conflict between Armenia and Azerbaijan; and the internal security implications of suppression of human rights. While each country responds to these drivers in different ways, they are the source of a new dynamic in the South Caucasus that requires a fresh Western policy approach.

Three wild cards will shape these drivers and the Western approach to them: First, how hard will Russian President Vladimir Putin push his objective of rolling back the degree of Western influence achieved since the fall of the Soviet Union? Second, how well will Iran play the nuclear agreement card, especially regarding its reentry into global energy markets? Third, how distracting will Turkey’s military response to the Islamic State and the Kurdistan Workers’ Party (PKK) be for Turkey’s interests in the South Caucasus and its objective of becoming a regional energy hub?

The shortcomings of soft regionalism

What is to be done? Faced with such a challenging situation, the default policy response is to provide more assistance (economic and military), dispatch senior officials from Western capitals to visit the region, and indulge (rather than criticize) democracy and human rights abuses, all in the name of developing a strategic partnership. In other words: Show more love.

That business-as-usual approach is inappropriate for these challenging times. In the case of Azerbaijan, it is an inappropriate response to the continued violations by the Baku regime of basic human rights and freedom of expression.

The Brookings paper suggests a multilateral approach (involving the United States, EU, and Turkey) based on soft regionalism. I do not believe that soft regionalism will work. The best we can hope for is parallel bilateral engagement on the basis of common interests (e.g. conflict prevention) and shared values (e.g. democratic evolution, observance of human rights). We need to treat the energy issue in the region as a commercial rather than geopolitical one. Changes in the global energy market have undermined the geopolitical significance of Caspian energy resources compared to two decades ago. With low energy prices likely the norm for the near future, energy no longer plays a strategic role for the region. Among other weaknesses, the soft regionalism prescription implies coordinated interests with Turkey—this will be difficult absent an opening in Turkish-Armenian relations.

Who needs who more?

The burden of choice in this relationship with the West must shift from the outside parties to the South Caucasian states themselves. The outsiders should stop talking about “strategic” partnerships, trans-Caspian pipelines and Silk Roads because this perpetuates a “you-need-us-more-than-we-need-you” starting point. Rather, the time has come for Armenia, Azerbaijan, and Georgia to decide on their own where their interests coincide with those of the West. That’s where we and they can begin to develop meaningful relationships, rather than trying to invent a veneer to cover differences—as in the case of Azerbaijan’s record on human rights.

Another recent article in Newsweek, by Theodore Gerber and Jane Zavisca, raised questions about promoting democracy and human rights where populations and elites are skeptical of U.S. motivations in promoting these issues. Fairly, the article questions the effectiveness of the traditional instruments of promoting opposition political parties and local NGOs as a way of winning “hearts and minds” in the former Soviet Union. Unfortunately, these traditional instruments tend to emphasize the attractiveness of the “American way of life” through student and scientific exchanges. This offers a variant on the soft regionalism theme advanced in the Brookings paper. Both require a receptivity to change that both elites and populations increasingly find threatening. Developing a values-based relationship is difficult when values diverge.

To the extent our interests do not coincide, then the Western policy focus must be transactional and rest exclusively on conflict prevention and/or amelioration. It also should not shy away from pressing all three South Caucasian states on their obligations to observe international standards regarding human rights, democracy, and freedom of expression.

       

       

       

This paper lays out the fundamentals of a downtown turnaround plan and the unique "private/public" partnership required to succeed. Beginning with visioning and strategic planning to the reemergence of an office market at the end stages, these 12 steps form a template for returning "walkable urbanism" downtown.

Though every downtown is different there are still common revitalization lessons that can be applied anywhere. While any approach must be customized based on unique physical conditions, institutional assets, consumer demand, history, and civic intent, this paper lays out the fundamentals of a downtown turnaround plan and the unique "private/public" partnership required to succeed. Beginning with visioning and strategic planning to the reemergence of an office market at the end stages, these 12 steps form a template for returning "walkable urbanism" downtown.

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Over the past few years, more than 600 Accountable Care Organizations (ACOs) have formed across the country, charged with the dual goals of improving health while also reducing health care costs. Increasingly, evidence on how public and private ACOs are progressing toward these goals is beginning to emerge. Based on these results, major regulatory changes are anticipated in the months ahead that will impact accountable care programs in Medicare, as well as future uptake within the private sector.

On October 20, the Engelberg Center for Health Care Reform hosted a half day forum to assess the latest evidence on accountable care, discuss strategies to overcome unique ACO challenges, and provide an overview of accountable care reforms. Sean Cavanaugh of the Centers for Medicare and Medicaid Services (CMS) provided keynote remarks on the latest Medicare ACO results and potential changes to the Medicare Shared Savings Program (MSSP). Panel sessions featured leading experts in ACO research, implementation and health care policy.

 Join the conversation on Twitter using #ACOFuture or follow @BrookingsMed

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• The Medicare Shared Savings Program (MSSP): Looking Ahead
• Big Issues for ACOs Going Forward
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• The State of Accountable Care: Evidence to Date and Next Steps

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• 102014_Accountable Care_Transcript

       

       

Introduction

During 2006, the United States saw a considerable upswing in the number of new mortgage defaults and foreclosure filings. By 2007, that upswing had become a tidal wave. Today, national homeownership rates are falling, while more than a million American families have already lost their homes to foreclosure. Across the country, boarded houses are appearing on once stable blocks. Some of the hardest hit communities are in older industrial cities, particularly Midwestern cities such as Cleveland, Detroit, and Indianapolis.

Although most media attention has focused on the role of the federal government in stemming this crisis, states have the legal powers, financial resources, and political will to mitigate its impact. Some state governments have taken action, negotiating compacts with mortgage lenders, enacting state laws regulating mortgage lending, and creating so-called “rescue funds.” Governors such as Schwarzenegger in California, Strickland in Ohio, and Patrick in Massachusetts have taken the lead on this issue. State action so far, however, has just begun to address a still unfolding, multidimensional crisis. If the issue is to be addressed successfully and at least some of its damage mitigated, better designed, comprehensive strategies are needed.

This paper describes how state government can tackle both the immediate problems caused by the wave of mortgage foreclosures and prevent the same thing from happening again. After a short overview of the crisis and its effect on America’s towns and cities, the paper outlines options available to state government, and offers ten specific action steps, representing the most appropriate and potentially effective strategies available for coping with the varying dimensions of the problem.

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Introduction

Ohio has already taken important steps to address the state’s ongoing foreclosure crisis, yet the crisis continues, causing distress for thousands of families and individuals, and destabilizing cities, towns and neighborhoods across the state. Therefore, the state, its local governments and private stakeholders need to do still more to deal more effectively with the crisis and its impacts on the state’s housing stock, cities and neighborhoods.

What is often termed the “foreclosure crisis” is actually a multi-dimensional crisis, in which the collapse of the housing bubble, the devastation caused by the lax and often irresponsible credit practices that accompanied and perpetuated that bubble, the resulting freeze on commercial and consumer credit, and the worldwide recession are interwoven, and can only with great difficulty be untangled. In Ohio, those forces are further exacerbated by profound changes to the state’s historical economic underpinnings. Ohio cannot solve the crisis by itself, but it can significantly mitigate its impact on people, neighborhoods, and towns and cities. These mitigating efforts will also help preserve the value of homes and neighborhoods in the state, and place Ohio in a stronger position to benefit from the future economic recovery.

The paper begins with a short summary of current conditions and the actions the state has already taken to address the wave of foreclosures, followed by a discussion of areas for future action. This discussion will address mitigating both the individual and community impacts of foreclosure, but will give particular emphasis to the critical issue of softening the blow of foreclosure on communities, which up to now has been less of a focus for state action.

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In an era of fluid geopolitics and geoeconomics, challenges to the global order abound: from ever-changing terrorism, to massive refugee flows, a stubbornly sluggish world economy, and the specter of global pandemics. Against this backdrop, the question of whether leader summitry—either the G-7 or G-20 incarnations—can supply needed international governance is all the more relevant. This question is particularly significant for East Asia this year as Japan and China, two economic giants that are sometimes perceived as political rivals, respectively host the G-7 and G-20 summits. 

On April 18, the Center for East Asia Policy Studies and the Project on International Order and Strategy co-hosted a discussion on the continued relevancy and efficacy of the leader summit framework, Japan’s and China’s priorities as summit hosts, and whether these East Asian neighbors will hold parallel but completely separate summits or utilize these summits as an opportunity to cooperate on issues of mutual, and global, interest.

Join the conversation on Twitter using #G7G20Asia

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The final months of Obama’s historic terms of office as America’s first black president are taking place against the backdrop of an ugly Republican nominating race, and to the sound of ugly language on race from Donald Trump. Progress towards racial equality is indeed proceeding in faltering steps, as the president himself made clear in a commencement speech, one of his last as president, to the graduating class of Howard University.

“America is a better place today than it was when I graduated from college,” the president said. But on the question of progress on closing the race gap, he provided some mixed messages. Much done; more to do. The president picked out some specific areas on both sides of the ledger, many of which we have looked at on these pages.

Three reasons to be cheerful

1."Americans with college degrees, that rate is up.”

The share of Americans who have completed a bachelor’s degree or higher is now at 34 percent, up from 23 percent in 1990. That’s good news in itself. But it is particularly good news for social mobility, since people born at the bottom of the income distribution who get at BA experience much more upward mobility than those who do not:

2. "We've cut teen pregnancy in half."

The teen birthrate recently hit an all-time low, with a reduction in births by 35 percent for whites, 44 percent for blacks, and 51 percent for Hispanics:

This is a real cause for celebration, as the cost of unplanned births is extremely high. Increased awareness of highly effective methods of contraception, like Long Acting Reversible Contraception (LARCs), has certainly helped with this decline. More use of LARCs will help still further.

3. "In 1983, I was part of fewer than 10 percent of African Americans who graduated with a bachelor's degree. Today, you're part of the more than 20 percent who will."

Yes, black Americans are more likely to be graduating college. And contrary to some rhetoric, black students who get into selective colleges do very well, according to work from Jonathan Rothwell:

Three worries on race gaps

But of course it’s far from all good news, as the president also made clear. 

1. "We've still got an achievement gap when black boys and girls graduate high school and college at lower rates than white boys and white girls."

The white-black gap in school readiness, measured by both reading and math scores, has not closed at the same rate as white-Hispanic gaps. And while there has been an increase in black college-going, most of this rise has been in lower-quality institutions, at least in terms of alumni earnings (one likely reason for race gaps in college debt):

2. "There are folks of all races who are still hurting—who still can’t find work that pays enough to keep the lights on, who still can’t save for retirement."

Almost a third of the population has no retirement savings. Many more have saved much less than they will need, especially lower-income households. Wealth gaps by race are extremely large, too. The median wealth of white households is now 13 times greater than for black households:

3. "Black men are about six times likelier to be in prison right now than white men."

About one-third of all black male Americans will spend part of their life in prison. Although whites and blacks use and/or sell drugs at similar rates, blacks are 3 to 4 times more likely to be arrested for doing so, and 9 times more likely to be admitted to state prisons for a drug offense. The failed war on drugs and the trend towards incarceration have been bad news for black Americans in particular:

Especially right now, it is inspiring to see a black president giving the commencement address at a historically black college. But as President Obama knows all too well, there is a very long way to go.

      

As every good teacher knows, education is not just about academics. It is about broadening horizons and discovering passions. (The root of education is the Latin e ducere, meaning “to draw out.”) From this perspective, extra-curricular activities count for a great deal. But as Robert Putnam highlights in his book Our Kids, there are growing class gaps in the availability of music, sports, and other non-classroom activities.

Fewer field trips?

Schools under pressure may also cut back on field trips outside the school walls to parks, zoos, theaters, or museums. In the 2008-09 school year, 9 percent of school administrators reported eliminating field trips, according to the annual surveys by the American Association of School Administrators (AASA). That figure rose through the recession:

Just 12 percent of the administrators surveyed about 2015-16 said they had brought back their field trips to pre-recession levels. Museums around the country report hosting fewer students, from Los Angeles and Sarasota, to Minneapolis, and Columbia, Missouri. None of this is definitive proof of a decline in field trips, since we are relying on a single survey question. But it suggests a downward trend in recent years.

Museums help with science tests

If some children are missing out on field trips, does it matter? They may be nice treats, but do they have any real impact, especially when they take time away from traditional learning? There is some evidence that they do.

Middle school children with the chance to go on a field trip score higher on science tests, according to a 2015 study by Emilyn Ruble Whitesell.

She studied New York City middle schools with teachers in Urban Advantage, a program that gives science teachers additional training and resources—as well as vouchers for visiting museums. In some schools, the Urban Advantage teachers used the field trip vouchers more than others. Whitesell exploits this difference in her study, and finds that attending a school with at least 0.25 trips per student increased 8^th grade scores by 0.026 standard deviations (SD). The odds of a student passing the exam improved by 1.2 percentage points. There were bigger effects for poor students, who saw a 0.043 SD improvement in test scores, and 1.9 percentage point increase in exam pass rates.

Art broadens young minds

Students visiting an art museum show statistically significant increases in critical thinking ability and more open-minded attitudes, according to a randomized evaluation of student visits to the Crystal Bridges Museum in northwest Arkansas. One example: those who visited the museum more often agreed with statements like: “I appreciate hearing views different from my own” and “I think people can have different opinions about the same thing.” The effects are modest. But the intervention (a single day at the museum) is, too. Again, there were larger effects for poor students:

All this needs to be put in perspective. In comparison with the challenge of closing academic gaps and quality teaching, field trips are small beer. But schools create citizens as well as undergraduates and employees. It matters, then, if we have allowed field trips to become a casualty of the great recession.

      

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In an era of fluid geopolitics and geoeconomics, challenges to the global order abound: from ever-changing terrorism, to massive refugee flows, a stubbornly sluggish world economy, and the specter of global pandemics. Against this backdrop, the question of whether leader summitry—either the G-7 or G-20 incarnations—can supply needed international governance is all the more relevant. This question is particularly significant for East Asia this year as Japan and China, two economic giants that are sometimes perceived as political rivals, respectively host the G-7 and G-20 summits. 

On April 18, the Center for East Asia Policy Studies and the Project on International Order and Strategy co-hosted a discussion on the continued relevancy and efficacy of the leader summit framework, Japan’s and China’s priorities as summit hosts, and whether these East Asian neighbors will hold parallel but completely separate summits or utilize these summits as an opportunity to cooperate on issues of mutual, and global, interest.

Join the conversation on Twitter using #G7G20Asia

Audio

• Japan’s G-7 and China’s G-20 chairmanships: Bridges or stovepipes in leader summitry?

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20160418_g7g20_transcript

       

David Caprara, a Brookings nonresident fellow and expert on volunteering, says that John F. Kennedy’s call to service a half-century ago led to the founding of dozens of international aid organizations, and leaves a legacy of programs aimed at improving health, nutrition, education, living standards and peaceful cooperation around the globe.

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• @ Brookings Podcast: International Volunteers and the 50th Anniversary of the Peace Corps

      

This week, our nation reflects on the 50-year legacy of the Peace Corps, which President John F. Kennedy signed into law on September 22, 1961. The passing earlier this year of Sargent Shriver, the indefatigable founding director of the Peace Corps, furthered national and international recognition of America’s longstanding traditions of service to the world. The time is right to expand the national policy discussion to include a broadened array of global service actors inspired by the example of Peace Corps volunteers to address critical human needs.

The largest independent representative survey of Peace Corps volunteers to date is being released this week as part of the 50th anniversary assessments by Civic Enterprises and the National Peace Corps Association with Peter D. Hart Research Associates. The survey documents responses from 11,138 Peace Corps volunteers who served from 1961 to 2011.

Among the survey findings of the returned Peace Corps volunteers:

• 82 percent view Peace Corps service “effective in promoting a better understanding of Americans in the communities they served,” and 74 percent indicated they view it “helps the U.S. adapt to globalization.”

• 59 percent view their service as, “effective in meeting the needs for trained workers.”

• 98 percent would recommend Peace Corps service to their family members.

Enhanced international awareness among volunteers was underscored in prior research assessing international NGO service released at a Brookings-Washington University joint forum. The Center for Social Development (CSD) report found that cross-cultural service also contributes significantly to international social capital, by developing a group of volunteers abroad who can leverage additional resources and connections to coordinate humanitarian aid projects.
 
Impacts of the broadened field of global and local volunteers are being demonstrated in critical issue areas such as basic hygiene and malaria reduction by Peace Corps and Malaria No More in Senegal, and a promising demonstration project led by Omnimed and Makarere University in Kampala, Uganda. The Omnimed model has utilized an innovative combination of international medical volunteers, supported by Volunteers for Prosperity at USAID and Peace Corps, to train and equip local village volunteers in Community Health Teams in sustaining malaria prevention. By expanding this network of public and private partners, and empowering local social entrepreneurs and village volunteers, potential exists to spread effective, results-based malaria health service corps across Sub-Saharan Africa and worldwide.

A steadily growing recognition of the importance of the wider landscape of volunteers— including NGOs, faith-based institutions, corporations and universities—is furthering goals for multi-sector inclusion in international service that Peace Corps’ founding director Sargent Shriver articulated to President Kennedy in his original 1961 report.

The Call to Peace and accompanying Service World recommendations represent a fresh call to action which should be taken up by foundations and both national parties to develop innovative and results-oriented solutions to today’s challenges of development and peace.

      

       

Editor's note: Tamara Cofman Wittes testifies before the Senate Committee on Foreign Relations for a session on aggravating factors and ways to stem the violence in the Syrian conflict. Read her full written testimony below or watch the live coverage.

Thank you, Mr. Chairman and Senator Cardin, for the invitation to appear before you today. I’d like to request that my full statement be entered into the record, and I’ll give you the highlight reel. And let me begin by emphasizing, as always, that I represent only myself before you today – the Brookings Institution does not take institutional positions on policy issues.

Opportunities Lost

When I last testified before this committee regarding Syria, in April 2012, I expressed my concern that American reticence to act to shape the emergent civil war and the involvement of regional powers in it risked enabling an unbridled escalation of the conflict. I suggested then that uncontrolled escalation could entrench sectarian violence, empower radicals, destabilize the neighborhood, and generate wide human suffering. While the Obama Administration has taken incremental steps over the last four years to try and shape both the battlefield and the context for diplomacy, those steps have proved too little and too late to alter the conflict’s fundamental dynamics.

President Obama’s initial read of the Syrian conflict as holding only narrow implications for American interests was a signal failure to learn the lessons of the post-Cold War period, and the civil wars of the 1990s, by recognizing the risk that Syria’s civil war could spill over in ways that directly implicated U.S. interests. The experience of the 1990s clearly suggested how a neglected civil war offered easy opportunities for a violent jihadist movement—just as the Afghanistan war did for the Taliban in the mid-1990s—and how large-scale refugee flows would destabilize Syria’s neighbors, including key U.S. security partners like Jordan and Turkey. And as we now know, ISIS used the security and governance vacuums created by the Syrian civil war to consolidate a territorial and financial base that the United States has been seeking since late 2014, with limited success, to undermine.

Unfortunately, the realistic policy options available to the United States have narrowed considerably since 2012, the violence is entrenched, the spillover is creating serious challenges for the neighborhood and for Europe, and the number of actors engaged directly in the Syrian conflict has proliferated. All of this means that the continuation of the Syrian civil war has direct and dire consequences today, not just for regional order, but for international security. This reality, combined with the tremendous human suffering this war generates every day, drives two clear imperatives for U.S. policy: to intensify efforts to contain the spillover and misery, and to seek an end to the conflict as soon as possible.

Ending the War

We must be realistic, however, about what steps will, and will not, end the Syrian conflict. Recently, some policy experts have suggested that, in the name of advancing great-power concord to end the war, the United States should relax its view that Bashar al-Assad’s departure from power is a requisite for any political settlement. This view rests on the assumption that Russia will not bend in its insistence on Assad’s remaining in place, and on the assumption that a U.S.-Russian agreement on leaving Assad in place would override the preferences of those fighting on the ground to remove him. Both of these premises, in my view, are incorrect.

We must therefore understand clearly the interests and imperatives driving the major players in this conflict, and we must understand, too, that the battlefield dynamics will heavily condition the prospects of any political settlement. Ending the bloody war in Bosnia in the 1990s involved getting the major external powers with stakes in the outcome – the United States, the Europeans, and Russia – to agree on basic outlines of a settlement and impose it on the parties. But imposing it on the parties required a shift in the balance of power on the battlefield, brought about by Croat military victories and ultimately a NATO bombing campaign. Bosnia also required a large-scale, long-term United Nations presence to separate the factions and to enforce and implement the agreement.

So I believe that, absent a change on the ground, diplomacy alone is unlikely to end the Syrian war – but I certainly agree with diplomatic efforts to advance a country-wide cessation of hostilities and advance a vision for a political settlement. A full-scale cease-fire could create more space for political bargaining, and in the meantime reduce human suffering and mitigate the spillover effects of the ongoing violence. Right now, however, the Assad government and its patrons in Tehran and Moscow have no interest in a sustained cease-fire, because the battleground dynamics continue to shift in their favor. They used the partial cease-fires of the past weeks to consolidate territorial gains from opposition forces and to further weaken those forces through continued air attacks. Without agreement amongst the various governments around the table as to which fighting groups constitute terrorist organizations, a ceasefire will inevitably disadvantage opposition factions as the Assad regime targets them in the name of counterterrorism. That will likewise advantage the most extreme among the rebel factions as well as jihadi groups like ISIS and Al Qaeda’s affiliate, Jabhat al-Nusra, who will all continue to use force to acquire and hold territory and to force their political opponents and inconvenient civilians off the field.

Likewise, some suggest that the sectarian nature of the conflict, and the deep investment of regional powers in backing their preferred sides, mean that it is not possible to hasten an end to the war at all, and that it must be allowed to “burn itself out.” This policy option is infeasible for the United States, from moral, political, and security standpoints. The scale of death and destruction already, over nearly five years of war, should shame the conscience of the world. Those seeking to escape this misery deserve our succor, and those seeking to end the carnage deserve our support. And it is beyond question that Bashar al-Assad and his allies are the ones responsible for the vast majority of this death, destruction, and displacement.

In political and security terms, the war’s spillover into neighboring countries and now into Europe can still get worse. Key states like Lebanon and Jordan are at risk of destabilization and/or extremist terrorism the longer the conflict goes on and the more of its consequences they must absorb. Turkey, as we know, has already suffered attacks by extremist groups. And the war has continued to be a powerful source of recruitment for extremists, drawing fighters and fellow travelers from around the world. ISIS and Al Qaeda feed on the civil conflict and the chaos on the ground is what gives them room to operate. It is indeed imperative that the United States remain engaged, and intensify its engagement as needed, to secure an end to the conflict as soon as possible.

Understanding the Geopolitical Context

In the ongoing diplomacy over how the conflict ends and what political settlement results, there are two issues on which the parties involved in the Vienna talks demonstrate sharp disagreement, and about which the United States needs to advance clear views. The first is a disagreement over the primacy of preserving the central Syrian government, currently headed by Assad. Russia, along with some regional actors (even some opponents of Assad), believe that the most important determinant structuring a political settlement must be the preservation of the Syrian central government, even if that means preserving Bashar al Assad in office. If Assad is ousted without an agreed-upon successor in place, they argue, then Syria will become a failed state like Libya, in which ISIS will have even more space to consolidate and operate, with dire consequences for regional and international security. It is this concern over state collapse and the desire for strong central authority that keeps Russia united with Iran behind Assad.

It’s understandable to desire the preservation of Syrian government institutions as a bulwark against anarchy, and to want a central government in Syria with which to work on counterterrorism and postwar reconstruction. The problem with elevating this concern to a primary objective in negotiations is its embedded assumption that any Syrian government based in Damascus will be able to exercise meaningful control over most or all of Syria’s territory after rebels and government forces stop fighting one another. That’s a faulty assumption, for several reasons.

First, it is extremely unlikely that we’ll see swift or effective demobilization and disarmament of sub-state fighting factions in favor of a unified Syrian military force. If the central government remains largely in the form and structure of Assad’s government, and even more so if Assad himself remains in power, it is hard to imagine rebel groups agreeing to put down their weapons and rely on security provided by the central government. Thus, local militias will remain important providers of local order and also important players in either defeating or enabling extremist groups like ISIS and Al Qaeda.

Second, effective governance from Damascus is extremely difficult to imagine, much less implement. The degree of displacement, the extent of physical destruction, and the hardening of sectarian and ethnic divisions due to five years of brutal conflict (and decades of coercive rule before that) all present steep challenges to centralized rule. Those with resources and capacity within local communities will end up being the primary providers of order at the local level – and it is local order, more than a central government, that will enable communities to resist ISIS infiltration. Thus, countries concerned with having effective governance in Syria as a bulwark against extremists need to recognize the value and importance of local governance in any post-war scenario.

Finally, there is the unalterable fact that Bashar al-Assad and his allies have slaughtered perhaps as many as 400,000 of Syria’s citizens; have used chemical weapons against civilians; have imprisoned and tortured thousands and displaced millions; and, through Assad’s own horrific decisions, have broken Syria’s government, the Syrian state, and the Syrian nation to bits. Those who demand his ouster as a prerequisite for ending the war are justified in their view that Assad does not have and will not have legitimacy to govern from a majority of Syrians, that his continued rule would be divisive and destructive of Syrian unity and security, and that he should instead face justice for war crimes and crimes against humanity. As a practical matter, and because of all this, many Syrian fighting factions on the ground and their supporters, are committed to Assad’s ouster. US-Russian concurrence on setting that goal aside will not induce them to end their fight. The only way that might occur is if Turkey, Qatar, and Saudi Arabia – who are committed to Assad’s ouster – relent on their demands and agree to curtail support to rebel factions who continue to fight. This is hard to imagine in the current circumstances.

In other words, while preserving the Syrian state is a laudable goal, it will not alone achieve the objectives set by those who hold it out as the primary imperative in the political negotiations over the future of Syria. I would suggest that, while the fate of Bashar al Assad is not perhaps of primary concern from the perspective of U.S. interests, the United States should be pressing Russia and others involved in the talks to relax their fixation on Syria’s central government (and who runs it) as a counterterrorism goal, and to recognize that a significant degree of decentralization and international engagement with local actors inside Syria will be necessary to preserve the peace, to carry out reconstruction, and to defeat ISIS. Likewise, the Syrian opposition and those states demanding Assad’s ouster as a precondition for peace must recognize that they have even more to gain from insisting on decentralization and local autonomy than they do from Assad’s departure from power. They might even be able to trade their current demand for Assad’s immediate departure against robust assurances for empowerment of local authority, release of detainees and internationally guaranteed transitional justice.

The second major issue under contention regarding a negotiated end to the Syrian war is the role that Iran will play in post-conflict Syria. Iran’s efforts to expand its infuence – in Syria and in the region as a whole – present a concern that unites all of the United States’s partners in the region, and should be a major concern for Washington as well. The gains made by the Assad regime (with Russian and Iranian help) over the past eight months enhance the disturbing prospect of a Syrian government remaining in power in Damascus that is dependent on Iranian funding, Iranian military support, and the importation of Iranian-backed militias. While the Russians are perhaps concerned more about the Syrian state as a bulwark against extremism, Iran is deeply committed to the survival of its Alawi client and the maintenance of Syria as a channel for Iranian support to Hizballah. And while some Sunni Arab states embrace the goal of preserving Syrian territorial integrity and the central government, all are troubled at the prospect that this government would be under the thumb of Tehran. Any political settlement that institutionalizes Iran’s overwhelming role in Syria will likewise increase Iran’s ability to impact to threaten Israel’s northern border, to destabilize Lebanese and perhaps also Jordanian politics, and to interfere with ongoing efforts to assuage the anxieties of Iraqi Sunnis and bring them back into alignment with the government in Baghdad.

The rising likelihood of an Iranian-dominated Syria emerging from the war has induced a change in attitude toward the Syrian conflict by America’s closest regional partner, Israel. Israeli officials took a fairly ambivalent stance toward the civil war for several years, although they were always wary of the Syrian-Iranian alliance. But today, they judge Assad’s survival as possible only through effective Iranian suzerainty, putting their most powerful enemy right on their border. Iranian domination of post-conflict Syria would also likely spell an escalation in Iranian weapons transfers to Hizballah – and Israel cannot expect to have 100% success in preventing the provision of increasingly sophisticated rocket and missile technology to Hizballah. These and other types of support from Iran through Damascus could increase Hizballah’s capacity to wage asymmetric war against Israel, at great cost to Israel’s civilian population. Israeli observers are increasingly alarmed at this scenario, and Israeli officials now state clearly that, if faced with a choice, they’d prefer to confront ISIS than Iran across the Israeli-Syrian frontier.

American diplomacy in Vienna must take greater account of the destabilizing implications of an Iranian-dominated Syrian government, even a rump government that does not control all of Syrian territory. A U.S. focus on constructing a political settlement that limits Iran’s influence in postwar Syria could induce greater coherence among American partners in Vienna currently divided over the fate of Assad; and it could prevent a situation in which the United States trades the threat of ISIS in Syria for the threat of Iranian-sponsored terrorism and subversion emanating from Syria.

Al Qaeda and the Syrian conflict

Al Qaeda’s affiliate Jabhat al-Nusra has particularly benefited from the war’s continuation, from the weakness and partiality of the ceasefires negotiated earlier this year, and from the inability of the U.S.-Russian diplomatic process to generate any progress toward a political transition. Shrewdly, Nusra has focused on building its reputation as the most consistent, and most effective, military opponent of the Assad regime, and on its readiness to cooperate with anti-Assad factions with whom it has other, ideological and political, disagreements. The failures of diplomacy feed Nusra’s strength and win it allies amongst more nationalist rebel factions. And while it’s tempting for American efforts to focus on rallying forces to defeat ISIS, our diplomats and decision makers must beware that leaning too far back on the issue of political transition for the sake of building an anti-ISIS coalition might just end up pushing more hardline opposition elements into the arms of a different extremist movement, one with demonstrated intent and capability to attack the United States.

To summarize, it’s imperative that American diplomacy to produce a political settlement of the Syrian war be firmly focused achieving two goals crucial to the interests of the United States and its regional partners: first, enabling and institutionalizing local governance as a bulwark against ISIS (more than central government institutions), and second, establishing hard limits on Iran’s role in a post-conflict Syria and on its ability to use Syria as a conduit for support to Hizballah.

Managing Spillover and Restoring Stability

A second major priority for US policy, in addition to this refocused diplomacy, must be stepped-up efforts to mitigate the destabilizing consequences of the Syrian war, no matter how long it goes on. And, while the United States continues to work through diplomacy and pressure to produce an end to the war, work must also begin now to prepare for the long-term and wide-scale effort needed for post-conflict stabilization and reconstruction.

The scope of death, displacement and destruction threatens to rob Syria of the basic ingredients for social stability, regardless of what lines might be drawn at a negotiating table in Vienna. Without concerted effort to ameliorate the effects of this conflict for people on the ground, to rebuild social trust, and to nurture resilience within these battered communities against conflict and division, any peace settlement could quickly unravel the face of local security dilemmas and intercommunal tensions, as well as in light of the unaddressed scars and grievances of Assad’s brutality against the Syrian people.

Meeting this challenge requires at least four lines of effort:

• doing more to engage Syrians in building local governance and community resilience, especially skills and platforms for conflict resolution;
• doing more to stabilize and secure frontline states, including support for integrating refugees into the economy and society;
• helping more refugees create new lives far from the conflict zone, including much more resettlement in the United States; and
• working diligently with regional partners to tamp down the sectarianism that both drives and is driven by the war, and that feeds extremist recruitment and violence.

As we have seen, ISIS markets itself partly on the order it provides to local communities – a brutal order to be sure, but still a contrast with the chaos and insecurity of civil war. To counter ISIS effectively, we must help local communities with governance and service delivery. More can be done even now to put into place the ingredients for successful and sustainable conflict resolution for Syrians. These steps include enabling and encouraging Syrians displaced by the fighting, whether in neighboring countries or in areas of Syria not under ISIS or regime control, to engage in dialogue over, and planning for, their own communal future. Neighboring states accepting refugees have understandably sought to tamp down political discussion and debate within refugee camps, for example. But these refugee populations need to engage in dialogue to build the basis, in social trust, that will enable them to manage daily governance and resolve differences peacefully if and when they are no longer living under refugee agencies and host-government security services. These processes can also connect, over time, to negotiating efforts on a political transition in which the Syrian opposition is represented, yielding greater legitimacy and efficacy to that more formal political process.

Too often, in discussing Syria, we posit a choice between working with the central government and working with unsavory non-state actors. There is an obvious additional option, already in play, that deserves greater emphasis: empowering and engaging local municipalities, local business sectors, local civil society, and other actors who exist in territory not under extremist or regime control and who have an obvious stake in the success of their own communities and their defense against coercion either from ISIS or from the Assad government. It is these local actors who will make or break the implementation of any political settlement, because they are the ones who will give it life and legitimacy. They are the ones who will help manage differences within their own communities and with their neighbors to avoid outbreaks of violence, and they are the ones who will lead the establishment of a new social compact to enable long-term stability in Syria. USAID and its implementing partners have been creative in developing programs to engage local communities and local governing institutions, and this work deserves robust, sustained support from Congress.

The United States continues to lead in international support for refugee relief – but it lags woefully in refugee resettlement. Only about 1300 of the 10,000 Syrian refugees the Obama Administration promised to admit into the United States have been resettled here so far; and the United States can and should accept more.

In addition, American policy efforts to address the refugee crisis must go beyond humanitarian relief and expanded resettlement. Working with European partners, the United States government can work to save lives along the transit routes for refugees fleeing the region, can support successful integration of refugees into European cities (again, working at the municipal level), and can do more to support social stabilization, livelihoods, and development for the large refugee communities in Lebanon, Jordan, and Turkey and for the societies hosting them.

On June 14 and 15^th, the Brookings Institution will convene a high-level gathering of regional, European, and American leaders to develop new responses and more robust forms of cooperation to meet this global humanitarian crisis. I look forward to reporting back to you on our results.

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Employers continued to boost payrolls in 2015, capping six straight years of job gains. It was the third year in a row in which employment gains topped 210,000 a month. In the 12 months ending in November, public and private payrolls increased 220,000 a month, or about 1.9 percent over the year. Virtually all the growth in payrolls was in the private sector, which added 212,000 jobs a month. The public sector added modestly to its payrolls last year, but the number of government employees remains more than one million (4.4 percent) below the peak level attained in 2010. 

Nearly all major industries except mining contributed to job gains in the past 12 months, though gains in manufacturing were weaker than in any year since the expansion began in 2010.  Payrolls in the mining industry tumbled more than 10 percent, hurt by a steep fall in oil and gas prices and the decline in exploration for new energy reserves. The construction industry continued to add to payrolls last year at about the same pace as in the previous two years, although the level of employment is still about 1.2 million (15 percent) below the peak level achieved in 2006.

Based on the age composition of the U.S. population, between 65,000-80,000 new jobs are needed every month to keep the unemployment rate from rising. Since late 2010, monthly payroll gains have comfortably exceeded this threshold. As a result, the jobless rate has declined steadily. In the 12 months through November 2015, the unemployment rate dropped another 0.8 percentage point, falling to 5.0 percent. The jobless rate is now within a half percentage point of its level immediately before the Great Recession. Since reaching a peak in the autumn of 2009, the unemployment rate has been cut in half.

We’ve also seen improvement in other indicators of job market distress in the past year. The number of Americans who want full-time jobs but have been forced to take part-time positions fell more than 11 percent in the 12 months through November 2015. About 9 million workers who wanted a full-time job were employed part-time in the middle of 2010. That number has fallen to about 6 million in recent months.  Similarly, the number of Americans in long spells of unemployment continues to shrink. Workers reporting they were unemployed 6 months or longer fell to 2.05 million in November, representing a considerable improvement since 2010. In that year, more than 6 million jobless workers reported they had been looking for work for at least a half a year.

The most welcome news for Americans who hold jobs is that inflation-adjusted wage levels improved last year.  Real average hourly earnings increased 1.8 percent between November 2014 and November 2015, and real weekly earnings climbed 1.6 percent.  These gains represent a considerable improvement compared with earlier years in the recovery, when real wage gains were negligible.  Nonetheless, nominal wage gains in 2015 were only slightly faster than they were in earlier years of the recovery. The reason for the startling turnaround in real wage growth is that consumer prices increased very little over the past year.  In the 12 months ending in November, the CPI edged up just 0.5 percent, almost a full percentage point more slowly than the average rate of consumer inflation in the previous three years.  The slowdown was driven by lower prices for energy and other key commodities.  (The “core” consumer inflation rate, which strips out the effects of price changes in energy and food, was 2.0 percent last year, a bit higher than the rate in the previous year.) 

Back when politicians and voters cared more about inflation than they currently do, Brookings economist Arthur Okun proposed an economic indicator called the “misery index” to summarize the dual hardships of inflation and unemployment. To measure economic misery Okun suggested adding the current unemployment rate and a measure of consumer price inflation.  In Chart 1 below I have added the civilian unemployment rate and the trailing 12-month percentage change in the CPI.  In the 11 months of 2012 through November, the misery index averaged just 5.4, its lowest level since the 1950s and well below its average levels in the 1990s (8.8) and in the period from 2000 to 2007 (7.8). When inflation is benign and has remained subdued for a long time, Americans may forget the pain they feel when price increases are frequent and large. Okun’s misery index fell to an exceptionally low level in 2015, even if a small majority of Americans continues to believe the economy is getting worse.

The good news in 2015 is that unemployment continued to fall and real wages began to rise.  The less welcome news is that key measures of labor force participation failed to improve.  For example, the labor force participation rate of Americans between 25 and 54 was the same in November 2015 as it was in November 2014. More worryingly, it was 2.1 percentage points below its level in November 2007, just before the Great Recession.  So far we have seen no rebound in participation among people in prime working ages, despite abundant signs that it’s easier to land a job. 

Low participation is the main explanation for depressed employment rates among prime-age Americans.  Participation rates are not only low in comparison to levels seen before the Great Recession, they are also now below those in other rich countries.  Charts 2 and 3 compare employment-to-population rates among 25-54 year-olds in seven OECD member countries (Canada, France, Germany, Japan, Sweden, the United Kingdom, and the United States).  The charts show employment rates separately for men and women in two different years, 2000 and 2014.  The countries are ranked, from left to right, by their employment rates in 2014. In 2000 the U.S. had the second highest male employment rate (Chart 2) and the second highest female employment rate (Chart 3) of the seven countries listed.  By 2014, the U.S. had the lowest male and female employment rates among the countries compared.  Although several nations saw declines in their prime-age male employment rate, only the U.S. also experienced a decline in its prime-age female employment rate.  The other six countries all saw increases in female employment.

The main reason for the drop in prime-age U.S. employment was the decline in prime-age participation. An enduring puzzle of the current recovery is the failure of participation rates to rebound, even in the face of steady improvement in the job market.

      

      

       

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As Turkey prepares for highly-contested elections on November 1, concerns are growing about the country’s politics, economy, security, and foreign policy. Just a few years ago Turkey was recognized as a model of democracy and beacon of stability and economic growth in a challenging region. However, more recently, Turkey’s economy has lost its dynamism, its leaders’ commitment to democratic principles seems to be eroding, and doubts are emerging about the country’s interests and engagement in the region. Even more disturbing, as the conflicts in Syria and Iraq continue unabated and massive refugee flows spill over into Europe, violent Islamic extremism has now surfaced in Turkey. With the government and opposition trading accusations, the horrific, recent bombing attack in Ankara has further polarized an already deeply-divided and anxious country.

On November 2, the Center on the United States and Europe at Brookings will host a discussion on the Turkish elections. Panelists will discuss how recent events might influence voters what the election results might portend for Turkey’s strategic orientation. Panelists will include Ömer Taşpınar of the National War College and Brookings; Gönül Tol of the Middle East Institute; Kadir Üstün of the SETA Foundation; and Robert Wexler of S. Daniel Abraham Center for Middle East Peace. Brookings Turkey Project Director and TÜSİAD Senior Fellow Kemal Kirişci will moderate the discussion.

After the program, panelists will take questions from the audience.

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After his first place finish in Iowa, which was supposed to propel him to a New Hampshire victory, “change” is probably a word Barack Obama does not like as much anymore. But, his support did not really change much between these two elections. He won 38 percent of Iowa’s delegates and 36 percent of New Hampshire’s vote. It was Hillary Clinton and John McCain who were the big change candidates.

What happens when a presidential candidate that does well in a primary or caucus state, does not do so well in the next? The dynamic of the presidential election can swiftly and stunningly change, as it did in New Hampshire on Tuesday.

How Barack Obama wishes John Edwards showed up in New Hampshire.

Edwards was awarded 30 percent of Iowa’s delegates, barely denying Clinton a second place finish. He finished a distant third in New Hampshire, receiving only 17 percent of the vote. There are strong indications that a shift among his supporters helped propel Hillary Clinton to her New Hampshire victory.

According to the exit polls, Edwards did 8 percentage points worse in New Hampshire among women, while Clinton did 16 percent better. Obama’s support was virtually identical, dropping a statistically insignificant 1 percentage point.

Obama’s support among young people remained strong, if slightly increasing among 18-24 and 30-39 year olds. Clinton’s support remained strong and slightly increased among those 65 and older. Edwards won Iowa’s middle-aged voters, age 40-64, but it was Clinton who decisively won this coveted age demographic in New Hampshire. And where these people were 38 percent Iowa caucus attendees, they were 54 percent of New Hampshire voters. (To understand why their turnout increased, see my analysis of Iowa’s turnout .)

Moving forward, the generational war is still a strong dynamic in the Democratic race, as evident in the candidates’ speech styles following the election results. In Iowa, Clinton was flanked by the ghosts of the Clinton administration. In New Hampshire, she shared the stage with a sea of young voters. In Iowa, Obama spoke of change, a message that resonates with younger people who are not part of the establishment. In New Hampshire his slogan was a message that echoes the can-do spirit of the greatest generation, “Yes, we can!”

In the days between Iowa and New Hampshire, Edwards spoke about how he wanted the election to become a two-way race. One should be careful with what one wishes for. Edwards and Clinton are vying for the same support base, that when united can defeat Obama, at least in New Hampshire. In the short-term, Obama most needs Edwards to do better so that support can continue to be divided.

Among Republicans, John McCain recreated his magic of eight years ago and bounced back strong from a poor Iowa showing to win New Hampshire.

The Iowa and New Hampshire electorates are so different it is difficult to compare them. In Iowa, Evangelical Christians were 60 percent of the electorate, while in New Hampshire, they were only 23 percent. Mike Huckabee’s move from first in Iowa to third in New Hampshire can be clearly attributed to the shrinking of his base. His collapse paved the way for a new winner to emerge.

It is thus tempting to attribute McCain’s victory solely to the different electorates, but he still had to defeat Mitt Romney to win New Hampshire.

According to the exit polls, the battle between McCain and Romney is a referendum on the Bush administration. Surprisingly, McCain, who has tried to rebuild bridges with the Bush establishment since his defeat in the 2000 presidential election, is still seen as the outsider and agent of change by voters participating in the Republican nomination process.

In both Iowa and New Hampshire, McCain drew his support from those who said they are angry or dissatisfied with the Bush administration. Romney drew his support from those who said they are enthusiastic or satisfied. Not surprisingly, McCain is also drawing more support from self-described Independents and Romney from Republicans.

The candidates seem to understand this dynamic, too, as they gave their speeches following the election results. In a contrived bit of acting, Romney showed up on stage without a podium and shoved a prepared speech back into his pocket (if he had needed a podium, his advance team would have provided it). He appeared relaxed, delivering his speech in a personable style reminiscent of Huckabee, who is competing with Romney for those who support Bush. But he also seemed to be reaching out to Independents with a message of change. In stark contrast, McCain delivered a carefully written, almost sedate speech designed to reassure Republicans of his conservative credentials.

This three-way dynamic between Huckabee, McCain, and Romney should prove fascinating as the Republican nomination process moves forward. Where Evangelicals are strong, Huckabee should do well. Where they are not, the rules governing if Independents can or cannot participate will dictate how McCain and Romney do. And we have yet to see regional candidates like Fred Thompson have their day in the sun. And then there is Rudy Giuliani, who is lying in wait in the larger states where his name recognition should give him a significant boost over the other candidates. All of this points to an extended campaign among Republicans.

Michael P. McDonald is an Associate Professor at George Mason University and a Non-Resident Senior Fellow at the Brookings Institution. He studies voter turnout and is a consultant to the national exit poll organization.

      

       

An academic-industrial partnership published last January in the prestigious journal Nature the results of the development of antibiotic teixobactin. The reported work is still at an early preclinical stage but it is nevertheless good news. Over the last decades the introduction of new antibiotics has slowed down nearly to a halt and over the same period we have seen a dangerous increase in antibiotic resistant bacteria.

Such is the magnitude of the problem that it has attracted the attention of the U.S. government. Accepting several recommendations presented by the President’s Council of Advisors on Science and Technology (PCAST) in their comprehensive report, the Obama Administration issued last September an Executive Order establishing an interagency Task Force for combating antibiotic resistant bacteria and directing the Secretary of Human and Health Services (HHS) to establish an Advisory Council on this matter. More recently the White House issued a strategic plan to tackle this problem.

Etiology of antibiotic resistance

Infectious diseases have been a major cause of morbidity and mortality from time immemorial. The early discovery of sulfa drugs in the 1930s and then antibiotics in the 1940s significantly aided the fight against these scourges. Following World War II society experienced extraordinary gains in life expectancy and overall quality of life. During that period, marked by optimism, many people presumed victory over infectious diseases. However, overuse of antibiotics and a slowdown of innovation, allowed bacteria to develop resistance at such a pace that some experts now speak of a post-antibiotic era.

The problem is manifold: overuse of antibiotics, slow innovation, and bacterial evolution.

The overuse of antibiotics in both humans and livestock also facilitated the emergence of antibiotic resistant bacteria. Responsibility falls to health care providers who prescribed antibiotics liberally and patients who did not complete their prescribed dosages. Acknowledging this problem, the medical community has been training physicians to avoid pressures to prescribe antibiotics for children (and their parents) with infections that are likely to be viral in origin. Educational efforts are also underway to encourage patients to complete their full course of every prescribed antibiotic and not to halt treatment when symptoms ease. The excessive use of antibiotics in food-producing animals is perhaps less manageable because it affects the bottom line of farm operations. For instance, the FDA reported that even though famers were aware of the risks, antibiotics use in feedstock increased by 16 percent from 2009 to 2012.

The development of antibiotics—perhaps a more adequate term would be anti-bacterial agents—indirectly contributed to the problem by being incremental and by nearly stalling two decades ago. Many revolutionary innovations in antibiotics were introduced in a first period of development that started in the 1940s and lasted about two decades. Building upon scaffolds and mechanisms discovered theretofore, a second period of incremental development followed over three decades, through to 1990s, with roughly three new antibiotics introduced every year. High competition and little differentiations rendered antibiotics less and less profitable and over a third period covering the last 20 years pharmaceutical companies have cut development of new antibiotics down to a trickle.

The misguided overuse and misuse of antibiotics together with the economics of antibiotic innovation compounded the problem taking place in nature: bacteria evolves and adapts rapidly.

Current policy initiatives

The PCAST report recommended federal leadership and investment to combat antibiotic-resistant bacteria in three areas: improving surveillance, increasing the longevity of current antibiotics through moderated usage, and picking up the pace of development of new antibiotics and other effective interventions.

To implement this strategy PCAST suggested an oversight structure that includes a Director for National Antibiotic Resistance Policy, an interagency Task Force for Combating Antibiotic Resistance Bacteria, and an Advisory Council to be established by the HHS Secretary. PCAST also recommended increasing federal support from $450 million to $900 million for core activities such as surveillance infrastructure and development of transformative diagnostics and treatments. In addition, it proposed $800 million in funding for the Biomedical Advanced Research and Development Authority to support public-private partnerships for antibiotics development.

The Obama administration took up many of these recommendations and directed their implementation with the aforementioned Executive Order. More recently, it announced a National Strategy for Combating Antibiotic Resistant Bacteria to implement the recommendations of the PCAST report. The national strategy has five pillars: First, slow the emergence and spread of resistant bacteria by decreasing the abusive usage of antibiotics in health care as well as in farm animals; second, establish national surveillance efforts that build surveillance capability across human and animal environments; third, advance development and usage of rapid and innovative diagnostics to provide more accurate care delivery and data collection; forth, seek to accelerate the invention process for new antibiotics, other therapeutics and vaccines across all stages, including basic and applied research and development; finally, emphasize the importance of international collaboration and endorse the World Health Organization Action Plan to address antimicrobial resistance.

University-Industry partnerships

Therefore, an important cause of our antibiotic woes seems to be driven by economic logic. On one hand, pharmaceutical companies have by and large abandoned investment in antibiotic development; competition and high substitutability have led to low prices and in their financial calculation, pharmaceutical companies cannot justify new developmental efforts. On the other hand, farmers have found the use of antibiotics highly profitable and thus have no financial incentives to halt their use.

There is nevertheless a mirror explanation of a political character.

The federal government allocates about $30 billion for research in medicine and health through the National Institutes of Health. The government does not seek to crowd out private research investment; rather, the goal is to fund research the private sector would not conduct because the financial return of that research is too uncertain. Economic theory prescribes government intervention to address this kind of market failure. However, it is also government policy to privatize patents to discoveries made with public monies in order to facilitate their transfer from public to private organizations. An unanticipated risk of this policy is the rebalancing of the public research portfolio to accommodate the growing demand for the kind of research that feeds into attractive market niches. The risk is that the more aligned public research and private demand become, the less research attention will be directed to medical needs without great market prospects. The development of new antibiotics seems to be just that kind of neglected medical public need. If antibiotics are unattractive to pharmaceutical companies, antibiotic development should be a research priority for the NIH. We know that it is unlikely that Congress will increase public spending for antibiotic R&D in the proportion suggested by PCAST, but the NIH could step in and rebalance its own portfolio to increase antibiotic research. Either increasing NIH funding for antibiotics or NIH rebalancing its own portfolio, are political decisions that are sure to meet organized resistance even stronger than antibiotic resistance.

The second mirror explanation is that farmers have a well-organized lobby. It is no surprise that the Executive Order gingerly walks over recommendations for the farming sector and avoid any hint at an outright ban of antibiotics use, lest the administration is perceived as heavy-handed. Considering the huge magnitude of the problem, a political solution is warranted. Farmers’ cooperation in addressing this national problem will have to be traded for subsidies and other extra-market incentives that compensate for loss revenues or higher costs. The administration will do well to work out the politics with farmer associations first before they organize in strong opposition to any measure to curb antibiotic use in feedstock.

Addressing this challenge adequately will thus require working out solutions to the economic and political dimensions of this problem. Public-private partnerships, including university-industry collaboration, could prove to be a useful mechanism to balance the two dimensions of the equation. The development of teixobactin mentioned above is a good example of this prescription as it resulted from collaboration between the university of Bonn Germany, Northeastern University, and Novobiotic Pharmaceutical, a start-up in Cambridge Mass.

If the NIH cannot secure an increase in research funding for antibiotics development and cannot rebalance substantially its portfolio, it can at least encourage Cooperative Research and Development Agreements as well as university start-ups devoted to develop new antibiotics. In order to promote public-private and university-industry partnerships, policy coordination is advised. The nascent enterprises will be assisted greatly if the government can help them raise capital connecting them to venture funding networks or implementing a loan guarantees programs specific to antibiotics.  It can also allow for an expedited FDA approval which would lessen the regulatory burden. Likewise, farmers may be convinced to discontinue the risky practice if innovation in animal husbandry can effectively replace antibiotic use. Public-private partnerships, particularly through university extension programs, could provide an adequate framework to test alternative methods, scale them up, and subsidize the transition to new sustainable practices that are not financially painful to farmers.

Yikun Chi contributed to this post

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Israel apologized to Turkey today for the May 2010 incident on board the Mavi Marmara naval vessel, part of a flotilla to Gaza, in which nine Turks were killed from Israel Defense Forces fire. The apology came during a 30-minute telephone conversation between Israeli Prime Minister Benjamin Netanyahu and Turkish Prime Minister Recep Tayyip Erdogan, orchestrated by President Barack Obama, who was ending his 3 day visit to Israel and the Palestinian Authority. Erdogan accepted the Israeli apology, and the leaders agreed to begin a normalization process between Israel and Turkey, following the past three years, when relations were practically at a standstill. (Last December, I wrote about the beginnings of a Turkey-Israeli rapprochement, and discussed more of the policy implications here.)

This development allows the two countries to begin a new phase in their relationship, which has known crisis and tension, but also cooperation and a strong strategic partnership.

The U.S. administration played a key role behind the scenes in creating the conditions that paved the way for an Israeli apology and Turkish acceptance. Undoubtedly, a close relationship between Turkey and Israel-- two of America’s greatest allies in the region-- serves United States’ strategic interests globally and regionally. At a time when the Middle East political landscape is changing rapidly, it was imperative to end the long impasse between Ankara and Jerusalem.

Over the past year, Turkey and Israel have also come to realize that repairing their relationship and re-establishing a dialogue is at their best interest, as they face great challenges in their immediate vicinity (first and foremost, the Syrian civil war).

United States officials emphasized that this is the first step in a long process. Nevertheless, the parties will have to make a great effort to overcome years of distrust and suspicion if they want the relationship to work. No one is under the allusion that relations will go back to what they were in the “honeymoon” period of the 1990s but modest improvement can be made. It will not be an easy task, and for that to happen it is essential that the parties not only talk to each other, but also listen to one another and begin to respect each other’s sensitivities. In order for this rapprochement to be successful, United States will have to continue to oversee discussions between Turkey and Israel, and remain heavily engaged in this process.