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Perseverance and collaboration: How a new clinical trial aims to determine whether sex matters when matching blood products to patients

Perseverance and collaboration: How a new clinical trial aims to determine whether sex matters when matching blood products to patients


Thursday, October 31, 2024 Abby Wolfe

As the Principal Investigator for the SexMatters trial described in this blog, Dr. Mickey Zeller is an Associate Professor in the Department of Medicine at McMaster University. She is also a Medical Officer at Canadian Blood Services. 

Around 2018, Dr. Mickey Zeller's grandmother asked her a question that she couldn’t fully answer at the time. It’s a question that Dr. Zeller continues to keep top-of-mind in her roles as an Associate Professor at McMaster University and a Medical Officer at Canadian Blood Services. Having sustained a pelvic fracture at the age of 94, she asked her granddaughter, “If I need a blood transfusion, could it come from a man... and if it does, would that be safe?”. As Dr. Zeller describes, “I looked at her and, in that moment, I said, ‘Grandma, no one knows! But it’s on my list to find out!’.” 

In fact, questions about whether selecting products based on the sex of donor and recipient could improve outcomes following blood transfusions have been around for years. However, there is not yet been enough evidence to definitively answer whether this strategy would help optimize hospital and blood operator practices.

After much perseverance, collaboration with researchers across Canadian Blood Services’ extended research network, and a successful bid for CIHR funding, a research team led by Dr. Zeller is embarking on a new research journey they hope will finally provide the evidence to answer questions about whether sex matters in red blood cell transfusion.

What will the study focus on and why is it needed?

When a patient requires a transfusion of red blood cells (RBCs), the matching of product to patient is based on compatibility testing that looks at whether the blood is group A, B, AB or O, whether it is Rh positive or negative, and what other antibodies are present. Canadian Blood Services’ Rare Blood Program also helps ensure patients with specific combinations of antigens – proteins that appear on the surface of red blood cells – can be matched with appropriate blood components. Laboratory studies on donor factors such as age and sex have looked at their impact on characteristics of RBCs in terms of hematocrit, cell volume, hemoglobin content, and deformability – that is, the flexibility or “squeeze-ability” of the cells. However, currently available evidence has not demonstrated a need for red blood cells for transfusion to be matched based on the sex of either donor or recipient. 

The principal research question being posed by this study is: In adults admitted to the ICU who require RBC transfusions, do donor-recipient sex-matched RBC transfusions result in improved 30-day mortality compared with sex-mismatched RBC transfusions? Answering this question has a large potential for impact because of the substantial number of blood transfusions that occur throughout Canada every year.  

“If there was a risk identified [from the sex of the donor and recipient], even moving the needle a little bit to improve the matching of blood product to recipient could add another layer of safety to current practices,” Dr. Zeller explains.  

What had to happen to make this study possible?

While it seems like a basic question to remain unanswered, Dr. Zeller acknowledges the investments of energy, expertise, and funding to get the study to this point.  

“Sometimes these basic questions remain for a long time because it is challenging to get the funding and infrastructure in place to be able to answer them in a scientifically rigorous way; even if they’re basic-level questions, it’s only by investing that you are able to gather the evidence to answer the question.” Dr. Zeller says.

That’s part of the reason why Canadian Blood Services’ investments in networks like CTTG are important. The Canadian Transfusion Trials Group (CTTG) is funded by Canadian Blood Services with the aim of supporting and accelerating clinical trials that can inform best practices in transfusion medicine in Canada. CTTG reviewed and endorsed this SexMatters study and provided support through its development, making it the second RCT since CTTG’s inception to earn CIHR funding following participation in their review process.

"I had the opportunity to present to CTTG twice and receive feedback that improved this study design and my application to CIHR for its funding. Having it reviewed by people like Dr. Donald Arnold, Dr. Jeannie Callum, Dr. Nadine Shehata – people with world-recognized expertise in this area – really led to the success of this application,” Dr. Zeller says. “We were able to have really rich discussions on tough questions about study design and impact, including details like how we would account for patients that are pre-transfused entering the study.”

Dr. Mickey Zeller, Principal Investigator for the SexMatters clinical trial, and Dr. Donald Arnold, Co-Director of the CTTG network, discuss aspects of the newly funded clinical trial. 

Says Dr. Zeller, “Each time the application went through reviews, I could present to these colleagues to essentially say, 'Here are the criticisms it has received and here’s how I’ve handled them.' And they would provide me advice and encouragement to resubmit. It is really valuable having people across the country who are cheering for you, and who are hand-in-hand with you to celebrate your success!”

“It’s an absolute privilege to do high quality research because you have to be surrounded by an incredible group of humans. Academic curiosity and commitment by those that have mentored me have enabled me to do this work. It’s out of a generosity of spirit that people have shared their expertise with me for this work, and it takes a lot of time and effort.”

Dr. Mickey Zeller, Principal Investigator for the SexMatters trial

What other research has informed this study? 

Before this study received CIHR support, the research team undertook an exploratory analysis, a systematic review and meta-analysis, and a pilot trial which took place in 2022 across five Ontario-based hospitals to establish feasibility of the randomized controlled trial. Findings of retrospective observational studies indicated potential association between sex-mismatched transfusions and mortality, but some aspects remained unclear due to low certainty of evidence, inconsistencies or contradictory subgroup analyses in the available literature.  

Much previous research involving Canadian Blood Services researchers has also supported the need for this randomized controlled trial. This includes: 

Read the Research Unit summarizing some of MCTR’s research on blood.ca (2019)Sex-mismatched red blood cell transfusions and mortality | Canadian Blood Services

Earlier publications involving these and other researchers have also investigated the impact that blood donor age and sex have on outcomes for transfusion recipients, summarized evidence related to sex-matched versus mismatched transfusions and mortality, and the biological mechanisms implicated in adverse outcomes of sex-mismatched transfusions. There is still room for more investigation to build on this previously completed research, and that aligns with Canadian Blood Services' emphasis on the importance of research that spans the continuum from bench-to-bedside to continuously improve our processes, products and services. As Dr. Zeller describes: “There are biological studies and retrospective data, but we only have one existing RCT. There’s a real importance to pursue a prospective, RCT so we can look forward as opposed to looking back.”

“As every blood donor is unique, the challenge we have is to understand which donor-specific factors can be better matched to improve patient outcomes.  Differences in the biology of blood cells from male and female blood donors are well defined, but what we do not understand is if these differences affect health outcomes in transfused patients.  This is very important question that the SexMatters clinical trial is proposing to address.”

Dr. Jason Acker, Co-Investigator in the SexMatters trial

How will the study work and why the focus on transfusions in the ICU?  

Focusing on transfusions in the ICU is a significant distinguishing feature of this study. The iTADS trial was completed as a multicentre, double-blind trial, but it looked at mortality rates across the whole hospital. This new trial will look at transfusions received by patients in the intensive care unit (ICU) specifically. 

“In the hospital, we know that mortality rate is much higher in a transfused ICU patient compared to a patient in another part of the hospital,” Dr. Zeller says. “We’ve chosen to focus this study on the sickest population of patients – those in the ICU – with the idea that any impact will be seen most prominently in this group. The analysis will include consideration to dosage so we can adjust for the specific number of units transfused to each patient.” 

The study is also designed so that participants will not know whether a blood transfusion is matched or mismatched based on the sex of donor or recipient – a method used to prevent potential bias in the trial. 

“At the hospital, you always get a list with each shipment of blood product that says what units you have received from the blood operator”, Dr. Zeller explains. “As part of this study’s protocol, participating hospitals will see an additional colour-coding noted on this inventory, and this is what will be used when it comes time for us to do our analysis.”  

Who could benefit from this knowledge and what are the next steps?  

Dr. Zeller is glad to have Canadian Blood Services involved in this research, acknowledging that changing policy related to matching of blood products would be a significant change for hospitals and blood suppliers, requiring strong evidence from RCTs like this one.  

“This study will help to inform health-care professionals who prescribe and administer blood products, along with patients, donors, and the blood operator, too. One of the important questions if it does turn out to have a significant difference is ‘Then what?’ We already divide our inventory by group (ABO) and by Rh status (+/-). Would the need to be matching by sex further impact inventory? We don’t know yet, but that’s why it’s important to have the blood supplier involved,” Dr. Zeller says. 

The study will require a total sample size of approximately 11,000 patients across an expected nine hospital sites in Ontario.  

“We’ve designed this study to be very efficient; it’s got components of what would be considered a pragmatic study design,” Dr. Zeller says. “In terms of the products, Canadian Blood Services does not have to provide anything different than they already do for this study (other than the colour-coded markers) and we will use electronic capture to pull data, so we don’t need to collect study information at bedside. These were processes leveraged from the earlier iTADS study as the iTADS research team was very supportive of us learning from what they did.”  

“Whether transfusions should be matched for donor sex is a question that has been percolating in people’s minds for many years. Dr. Zeller has had the courage and perseverance to tackle this important question, which could have important policy implications.  I’m excited for Dr. Zeller to embark on this journey and advance knowledge on best transfusion practices.”  

Dr. Donald Arnold, Co-Director of CTTG and Co-Investigator in the SexMatters trial 


Canadian Blood Services – Driving world-class innovation 

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact.   

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.  

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When doctors select compatible red blood cell units for transfusion into a patient, they don’t consider the sex of the patient and whether the donor is the same (sex-matched) or opposite sex (sex-mismatched). But a study led by Dr. Michelle Zeller, Canadian Blood Services medical officer and assistant professor in the department of medicine at McMaster University, suggests that the role of donor sex in red blood cell compatibility may be worth a closer look.


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Why the UN matters for Britain Interview LJefferson 6 September 2022

In the fourth of a series of interviews with Queen Elizabeth II Academy faculty, Jeremy Greenstock argues that the UN is still important in a polarized world.

For many people looking at the United Nations (UN) today, the institution (and the world) appears to be at an inflection point and the UN seems ill-equipped to meet these challenges. From your vantage point, how does this period look in relative terms? 

I think for an institution like the UN founded on principles and compromises laid down in 1945, the passage of time is bound to be difficult because society changes quicker than an institution can reform. We can talk about reform later, but the UN has challenges. Where do these challenges come from? I see them coming from a crisis in governance, in governments around the world.

The UN is a forum of member states, and the member states carry their national labels at the UN and follow their national interests at the UN. And almost all governments are suffering huge challenges, not just from the circumstances of geopolitics, but from the expectations of their own people, which they find difficult to meet.

The UN still retains a tremendous value as a forum. It is a natural forum for governments to talk before they shoot, which was not there in previous eras, and that has had a significant effect since 1945 in reducing the incidence of war between states.

The UN is a servant in that sense, of governments, and so what happens at the UN reflects what is happening in and between governments. We need to keep that in perspective. The UN still retains a tremendous value as a forum. It is a natural forum for governments to talk before they shoot, which was not there in previous eras, and that has had a significant effect since 1945 in reducing the incidence of war between states, particularly between the largest states.

It has obviously been more difficult to deal with local and regional conflicts, but the kind of confrontation that threatens to escalate into a global war has been severely restricted by the UN. The habit of talking at the UN General Assembly (UNGA), artificial as it may seem, is an extremely important part of the avoidance of conflict in the modern age.  

There is a deep scepticism about the UN. Many people think there is a lot of talking but that the real action takes place elsewhere. What is the value of the UN?  

Well, there are two aspects to this. One is the fact that leaders must give their reasons for their policymaking to an international public. This has a force in today’s digital world where most people have access to a megaphone of some kind. The legitimacy of what governments do is exposed at the UNGA.

Secondly, alongside the open meetings and the publicized speeches, there are countless side meetings that go on, and it is an opportunity for leaders to test each other out, and to have private words that may differ from the public words they have to produce for their own followers in their own capitals.

It is an opportunity for personal diplomacy which is highly valuable, and which might not otherwise happen, particularly between leaders who have very serious differences. And I think that the testing of the legitimacy of policy in both the public and the private spheres is an important aspect of international diplomacy that the UNGA provides an opportunity for.  

At the UNGA, states are called to account before the UN, and this can expose hypocrisies. But sometimes there are fundamental clashes over interests and also over values. How would you characterize the UN’s handling of Russia’s invasion of Ukraine?

It is a different audience at the UN from the audience that they have back in their capitals or in their own groups of like-minded people. They must justify themselves in different ways, and there are a whole host of inconsistencies in foreign policy that get exposed at the UN when people must explain themselves in public.

A lot of member states around the world have not condemned the Russian invasion of Ukraine; yet underneath their non-condemnation is a general regret because Russia has broken a huge taboo of the UN Charter, which is the sacrosanctity of independent sovereign territories in Article 2.7.

And that article is valuable to member states who feel threatened by more powerful member states. Russia, as a permanent member, has ridden roughshod over sovereign independence. China and India will have equivocal feelings about that, but they can’t say so in public because they want some of the West’s hypocrisies and inconsistencies exposed, and because they find the approach of sanctions very unpalatable.

Sanctions are unpopular, and the use of sanctions has become a major weapon of non-war by the United States in particular. So, the Russian invasion is unpopular, but the approach of the West is also unpopular for not better looking after the interests of emerging economies and lower-income states, particularly on climate change, but also on economic development.

So, a whole host of different considerations come into play over Ukraine at the UNGA.

How do you think the UN could be best repurposed or reformed?  

It is terribly difficult, because if you open the UN Charter for one reason, you are opening it up to a host of demands from member states for other reforms. And remember that no reform of the Charter can happen without a 2/3 majority at the General Assembly, and that is an effective blocker, because you will always find more people opposing a particular reform that supporting it.

Just improving the competence of the UN and its agencies will ensure the relevance of the UN to people’s material interests.

So, I think formal reform remains a bit of a dream in the circumstances of a polarized world. I want to divert discussions about UN reform into areas where the Secretary General has a competence without needing a vote from member states.

I am talking about improvement in methodologies, in the meritocracy of appointments, in the day-to-day workings of the UN. It looks unambitious on a large-scale basis, but just improving the competence of the UN and its agencies will ensure the relevance of the UN to people’s material interests in terms of human rights, refugees, food distribution, and children, and all the other things that the agencies look after.

So, I would prefer to concentrate reform energy into competence reforms, management reforms, rather than reforms of the Charter. 

This takes us to the question of the permanent members of the Security Council, and especially the US and the UK. You have experienced first-hand America’s ambivalence towards the UN. How much has this undercut the UN’s relevance?

I was frequently disappointed by the approach of the US to issues of policy at the UN. The US finds it very difficult as a nation to move beyond the primacy of its own domestic public opinion.

I think it is more than untenable, it is against the US’s long-term interests to demand such national exceptionalism.

That perspective – that we have democracy at home, but we will not, as Americans, allow international democracy – is regarded around the world as an untenable position for the superpower. And I think it is more than untenable, it is against the US’s long-term interests to demand such national exceptionalism.

That exceptionalism is extremely unpopular, and the US’s extraterritorial reach is very unpopular. That loss of legitimacy around the world is affecting American interests, in the Middle East, over Afghanistan, over the reaction to the Russian invasion of Ukraine; America losing the argument with international public opinion has a material effect on American power, influence and interests.

Has America paid the price for asserting its exceptionalism? From your perspective, representing the UK, arguably the closest ally of the US and one with a permanent seat on the Security Council, how did you manage this?

Well, I had a long experience of that in my job in Baghdad. Yes, the UK normally supports the US in international forums because our interests coincide. In foreign policy, interests are more important than values, and sometimes you have to make compromises and shade your values in order to get results and to avoid conflict.

I found myself taking up the US’ arguments and trying to deliver them as the UK, because the US was more unpopular than the UK and we could act more subtly. The US was more unpopular than the UK because the UK – and a lot of the time France – tried a lot harder than other permanent members to work for the common interest of UN members.

There were times I argued publicly against the US at the Security Council because their logic was incompatible with a multilateral approach, over the International Criminal Court for instance, or over some approaches to the Middle East. I would take a different view, not just because I didn’t want to seem like a constant puppet of the US, but because I thought the logic that they were following was constraining for them, and the counter-productiveness washed off on us.

Here, I want to make an important point. You won’t get governments coming together to form a multilateral approach with all the compromises that this entails unless they are confident of their position at home. They can’t otherwise explain those compromises to their domestic public opinion. If governments are insecure at home, they won’t pursue a multilateral approach because of that insecurity.

The UK is seeking to define a new global role for itself. It has been one of the most influential states at the UN. Do you see this changing?

I don’t think the change of leader makes a terrific difference for the UK in the UN because there is cross-party parliamentary agreement that the UN is important.

I was disappointed that the UK did not take the UN more seriously at a political level except when it badly needed it at a particular moment. At an official level, there was plenty of support from London, but I don’t think that politicians ever gave much priority to the health of the UN.




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Why America’s midterm elections matter for the world

Why America’s midterm elections matter for the world The World Today mhiggins.drupal 28 September 2022

The outcome could threaten the fight against climate change and the future of democracy itself, warns Leslie Vinjamuri.

As the November 8 midterm elections in the United States approach, the sense of urgency among the Democrats and Republicans is escalating. Early voter turnout is on track to surpass the 2018 midterms, when a record 122 million Americans voted ahead of election day. The midterms – when congressional, state and local seats are determined – used to pass almost unnoticed, especially outside the US.

The midterms will be the first real litmus test for the continued relevance of Donald Trump and Trumpism
 

Since 2018, though, they have become a matter of global concern. The 2022 midterm elections will be the first major elections in the US since the January 6 insurrection at the US Capitol. As such, they will be the first real litmus test for the continued relevance of Donald Trump and Trumpism.

For both parties, winning is more important than ever and it is not only a matter of policy. Today, a majority of members of both parties – 72 per cent of Republicans and 63 per cent of Democrats – see those belonging to the opposing party as immoral, according to a Pew Research Center poll in September, representing a significant rise since 2016.

In many states, the midterms will have a direct impact on the 2024 presidential elections, influencing who decides how voting takes place, how votes are counted and, especially, who controls the certification of election results.

Given this context, the stakes in elections are especially high. The winners will have the upper hand not only in defining many procedural rules but also the values that constitute the nation, such as on abortion rights, education and healthcare.

Republicans and Democrats align on most key foreign policy

Though foreign policy will bear a strong resemblance to its former self even if Republicans gain a majority in the House of Representatives, as many anticipate, the outcome of the elections on US global influence could impact efforts to combat climate change and to support the defence of Ukraine.

The Republican Party has become known for its embrace of climate deniers and the radicalized anti-immigrant rhetoric of many of its party’s most established figures. The failure to address rampant gun violence – and, instead, to defend a historically suspect interpretation of the right to bear arms – and the push for a national abortion ban mean that the party is imposing a version of America onto itself that is out-of-step with virtually all other rich democratic countries.

The choices voters make in November are likely to shape the values that come to the fore in the US, and with this the affinity that America’s closest partners feel for it.

Domestic policy is likely to be more heavily affected by the elections. A Republican majority in the House would stall progress on President Joe Biden’s domestic agenda and undercut his ability to raise the taxes he needs to pay for his spending plans. The drive to hold the former President Trump accountable will also be affected by the choices voters make in November.

A Republican majority in the House would spell an end to congressional investigations of Donald Trump

A Republican majority in the House would spell an end to congressional investigations of Donald Trump. Instead, Republicans would use their electoral gains to launch their investigations into the Democrats.

One anti-Trump Republican on the January 6 committee investigating the storming of the Capitol building last year warned of a vengeful and obstructive turn against Biden from his Republican colleagues if they took the House. ‘They’re going to demand an impeachment vote on President Biden every week,’ said congressman Adam Kinzinger. It is under this shadow that the January 6 Committee is pressing ahead to finish its proceedings and publish its report.

On foreign policy, the parties are more aligned than divided on most of the key issues. Their differences are a matter of diplomacy, which matters, and degree. Support for Ukraine has had bipartisan backing, but in recent weeks the issue has become politicized. Some congressional Republicans are more hawkish than their Democratic counterparts in their ambition to support Ukraine. Yet, the congressman set to be Speaker of the House if Republicans gain a majority, Kevin McCarthy, is leading an effort to exercise far stronger oversight of any additional funds for Ukraine.

Ultimately, though, the president and his advisers maintain considerable control over foreign policy.  

Bipartisan support for a tougher stance on China was consolidated under Trump. He mobilized US voters by blaming China for the loss of manufacturing jobs. Later he held China responsible for the outbreak of Covid and for covering it up. China’s crackdown on democracy in Hong Kong, its assertiveness in the South China Seas, tensions over Taiwan and reports of human rights abuse against the Uighur in Xinjiang have cemented a bipartisan consensus on America’s China policy. But a more empowered Republican base looks likely to lead to a more ideologically driven anti-China rhetoric. 

The ground has also shifted over Russia. During President Trump’s tenure, Republican attitudes towards Vladimir Putin softened. But the Russian president’s aggressive invasion of Ukraine has entrenched American opposition to him and bolstered support for NATO.

Democrats and Republicans are also more aligned on policy towards Iran today than they were before Trump abandoned the Iran Deal negotiating the Middle Eastern country’s nuclear programme. On some contentious issues, such as immigration reform, progress is already stalled and that is unlikely to change.

US climate change policy may depend on the results

The upshot of all this is that the president is unlikely to make radical changes to US foreign policy regardless of the results of the midterms. The most important exception to this is climate change, which continues to be the unwanted stepchild of the Republican Party. Domestic infighting in the US would inevitably detract even further from the bold policy that is needed.

Republicans are unlikely to get the two-thirds majority needed to pass legislation that would undermine President Biden’s climate bill. Republican control of House committees, however, would add more politically driven oversight of any climate spending, including what has already been authorized by the Inflation Reduction Act. 

Policy convergence and clear executive authority cannot mitigate the sheer disruption that would be unleashed if the Republicans were to gain majorities in both the Senate and the House, however. For the rest of the world, and especially within Europe, this would send warning signs about the future trajectory of US foreign policy commitments and set off alarm bells that an ‘America First’ president might return to the White House after 2024.

Especially within Europe, Republican victories would send warning signs about future US foreign policy


A Republican majority in the House with a Democratic majority in the Senate would be disruptive, if less so, but would probably spell the end of business as usual, unsettling people, states and markets. All of this is unfolding at a time when many of the world’s rich democracies face internal divisions, rising inequality and populist challenges at home and so are ill-equipped to lead.

Democracies face a trust deficit. This is especially apparent in the US where only 43 per cent of Americans have trust in US institutions, according to the 2022 Edelman Trust Barometer.

Internal threats to democracy also unsettle the promise of US global leadership at a time when concerted and determined leadership is needed to maintain a strong and united response to Russia, and to tackle global food insecurity and the energy, climate and debt crises. In addition, the failure to lead a global response that can help developing countries is feeding a trust deficit between rich and poor countries.

The midterms will reveal a greater truth about the future of the Republican Party. Even more so, it will reveal the values held by the American electorate. In the run-up to the 2020 US presidential elections, Europeans frequently said that they would not give Americans a pass if they voted for Donald Trump twice – and indeed only 17 per cent of those in European Union countries would have cast a vote for Trump if they could.

A Republican midterm victory in both the Senate and the House of Representatives would have ripple effects across the Atlantic at a time when the threat from Russia has intensified.

The US is judged around the world for what it does, but also for who it is. The perception that democracy is failing in America creates a permissive environment for aspiring autocrats. At a time when democracy has been in decline around the world for more than 15 years, it is essential that the US fix its own democracy and that it demonstrates to the rest of the world that democracy can deliver.

The midterms will signal to the world what Americans value, sending a message about what it can expect from the US.

This article was updated on October 31, 2022 to reflect developments such as early voting turnout, and the impact of the midterms on the 2024 presidential election, support for Ukraine and climate change spending.

 




matter

A seat at the table – why inclusivity matters in global governance

A seat at the table – why inclusivity matters in global governance 10 May 2021 — 1:30PM TO 3:00PM Anonymous (not verified) 22 April 2021 Online

Exploring the changing dynamics of global cooperation and the role inclusivity can play in building collaborative action.

Please click on the below link to confirm your participation and receive your individual joining details from Zoom for this event. You will receive a confirmation email from Zoom, which contains the option to add the event to your calendar if you so wish.

The scale of today’s global challenges demand collaborative and coordinated action. But deepening geopolitical competition is threatening multilateralism while growing inequality and social tensions continue to undermine public confidence in the ability of international institutions to deliver.

Into this challenging environment, add the complexity and sheer pace of many global challenges such as the climate crisis and the proliferation of new technologies – issues that cannot be addressed effectively by governments alone.

  • How do global institutions and mechanisms need to adapt to address the demands for a fairer distribution of power between states and to engage the diverse set of actors essential today for effective solutions?
  • What can be learnt from existing initiatives that bring together governments, civil society, private sector, cities, next generation leaders and other stakeholders?
  • And what are the political obstacles to greater inclusivity?

This event supports the launch of a synthesis paper from Chatham House’s Inclusive Governance Initiative.




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Why the Mali Coup Should Matter to the UK

20 August 2020

Dr Alex Vines OBE

Managing Director, Ethics, Risk & Resilience; Director, Africa Programme
This coup was not unexpected as it followed months of mass protests against alleged corruption, a worsening economy and disputed elections.

2020-08-20-Mali-Coup-Military

Press conference in Kati after the military arrested Malian president Ibrahim Boubacar Keita and he officially resigned. Photo by ANNIE RISEMBERG / AFP via Getty Images.

The coup in Mali is not a putsch by disgruntled soldiers in a distant land. It is an extended European neighbourhood and matters to Britain. The UK already has three Chinook helicopters deployed in country and 250 British troops are scheduled to take up UN peacekeeping duties in December in what could be the ministry of defence’s most dangerous deployment since Afghanistan.

This coup was not unexpected as it followed months of mass protests against alleged corruption, a worsening economy, disputed legislative election results and deteriorating security in this West African country. Mali’s military is struggling to stop the insurgents, some of them now also affiliated with the ISIL (ISIS) armed group, despite UN, EU, French and regional military support.

The departure of Mali's President Ibrahim Boubacar Keita was met with jubilation by anti-government demonstrators in Bamako and the leaders of the military coup say they would enact a political transition and stage elections within a 'reasonable time'.

Coups, followed by transitional arrangements and then new elections, are not rare in this region and have happened before in Mali when Keita’s predecessor Amadou Toumani Toure was overthrown by the military in 2012. The current cycle of insecurity followed despite a significant military intervention by France to restore elected government and stop the spread of Islamic extremist insurgency.

This is a reminder of how fragile the Sahel regon is and the importance of seeking stability and state building in a region of spreading Islamic extremist insurgency and rapidly-eroding state legitimacy.

The regional bloc ECOWAS (Economic Community of West African States) has denounced the coup and ordered the closing of regional borders with Mali as well as the suspension of all financial flows between Mali and its 15 members states. What follows now will be negotiations over the transitional arrangements and the timetable for new elections.

This will not be straightforward. Although the opposition was united in their demand for Keita's resignation there is little consensus on what to do next, while the UN Security Council and ECOWAS are divided on how to respond beyond initial condemnation.

It is urgent that three UK cabinet ministers, led by the first secretary of state Dominic Raab, who are currently reviewing the UK’s Sahel strategy complete this and decide upon its future direction.

The UK government needs crystal clarity on its Mali objectives as the clock ticks down to the deployment of British troops there. Increasingly this UN duty looks to become more peacemaking than peacekeeping.

This article was originally published in The Telegraph.




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